“Questions You Can Ask Your Social Security Disability Examiner When You Periodically Check the Status of Your Disability Claim”

Excerpt--This is Step 3 -- a sample chapter from the Ebook Entitled Getting Social Security Disability: Your 9 Step Guide

2)  Checking the status of your disability claim 45 days after application.

      Depending on what was needed after your first 30-day check, this will determine what questions you will ask during your second or 45-day follow-up. When you call, you can ask:

                                      i.   “Have all the MER (medical records) now been received?”  If so, “When can I expect a decision?” The DE will generally explain what remains to be done in the process. If s/he does not, you can ask directly, “What remains to be done in the processing of my claim?”

                                      ii.   “Have all the questionnaires now been received?”

                                      iii.  “Have you reviewed the record to determine if other MER will be needed?”  The answer to this question is critical. At day 45, it is crucial that a review of your case by the examiner be initiated if you want to ensure you get a decision within 90 days, which is the average time (nationwide) that most claimants receive a decision.

a)    So if at this point you as the claimant report that you have been back to the doctor, know that the DE is obligated to request those new records, which will begin the MER timelines all over again and will make it very difficult to get a decision on your claim in a reasonable amount of time. So if you have been to the doctor for a routine visit where no new tests were done and no new diagnoses were made that changed your ability to function, you might want to K.I.T.Y. the information at that point (Keep It To Yourself)—Hey did I just coin a new term? :) - Keep reading to see when is the most opportune time to report any new medical records you may have.

b)      So, if all the MER is in, you can ask the worker whether they will be setting up a consultative examination, (CE) based on the MER in file. Of course, you don’t really care how the DE responds to this question because your goal in the 45 day follow-up is to keep the ball rolling so that your claim comes out of the back log stack and moves into the “this claimant will be calling so I better take some action” stack.

c)    The goal of asking about a Consultative Exam appointment is to get the examiner to take a look at or at least do a cursory review of your claim to determine if a CE is needed. If it is needed, and depending on which state you are in, you can add another 30 to 75 days to your processing time. That is because the scheduling department will have to arrange for the appointment with a participating medical doctor or psychologist or other physician specialist, and this appointment is then mailed to you and to the doctor. Your consultative examination appointments may be scheduled two weeks later or two months later, depending on the availability of doctors, and whether or not a specialist was needed.

Your 45-day status check has as its primary purpose to:

1) Force the claims DE to do a brief or in-depth review of your claim for the purpose of deciding what further development is needed, and

 2) Force the claims DE to begin the process of setting up a doctor’s appointment (CE) if not enough MER to “allow” the claim (i.e. issue a favorable decision) has been received, either because your doctor has not sent in your records or because you simply have not had the necessary testing done which can prove your claim, such as x-rays or mental health counseling records, etc.)

3)   After the 45-day status check, you should check on the status of your claim at day 60, and every 15 days thereafter.

The exception would be if you have been given a CE doctor’s appointment. If a CE has been scheduled and you have attended the examination, there is nothing the worker will be doing on your claim except waiting to receive the results of the examination. So in that case, plan to check the status 15 to 30 days after the date of your CE doctor’s visit. (In NC, you might check after 15 days; in GA, wait at least 30 days). Different states allow the medical doctors doing your consultative exams different time periods in which to get the results back in to the DDS office.

    Because you will have to wait for the CE appointment and the results of the exam, this would be an excellent time to inform your claims DE of any other medical records out there that you did not report on your initial application for disability benefits. If you have been back to the doctor, this is the time to let your worker know. That way, they can request them and all the records can be available for review after the CE exam results have been received.

4)   If it has been 30 days after your CE exam, you can be justified in requesting an update on your claim status on a weekly basis, unless your DE tells you otherwise.  For instance, after the doctor that Social Security sent you to for the examination sends the report to your claims examiner, most will summarize the case and write it up for review by the staff medical consultant as quickly as possible. The only exception would be if the DE is managing a huge caseload and is behind in their work. So,

a.   Your weekly call after you have waited 30 days post a CE visit will help get your case in the top of the review piles. This is a case where the squeaky wheel gets the oil because no adjudicator/examiner wants weekly calls on a case that has the results of a consultative examination in file and is ready for a decision. And

b.   When you should not call weekly? Because the DE knows the workflow of its medical consultants who have to review cases after they have summarized them, ask the examiner the anticipated wait time. The examiner may know that their psych MC has a three week back log of cases and won’t get to yours prior to that three weeks, or they may know that the MC doctor has only a three day lag in case reviews. In this case, if the DE says it will take the psych MC three weeks to get to your case, then you should not call prior to that time as you will be spinning your wheels as well as wasting the DEs time.

While you can help the claims DE write up your case faster through your status check calls, you cannot get him/her to force a psychologist or medical doctor to review or skip over other cases ahead of yours without a really good reason. 

The list of really good reasons include: if your doctor tells you that you only have six months to live (i.e. your condition is terminal) or if you have been placed in an assisted living home or you can no longer walk without a medically prescribed cane or walker or you are now on kidney dialysis due to chronic renal failure. All these cases generally result in your claim being allowed, and cases that are allowances are written up before cases that are going to be denials).

The bright side of this is that, generally, after the examiner writes up a medical summary of the claim, if s/he strongly feels that your case will result in an approval, s/he can issue something called a presumptive disability (PD) decision at that time which will allow you to receive benefits while you await the final decision. But this is only true if you have an SSI claim or if you have a combination claim that includes eligibility for Supplemental Security Income.

Action Step : If you have applied for disability, find a calendar and use it to jot down the dates that you will be calling your examiner for status updates. The dates can fluctuate from the schedule I have outlined here, but it is important that you call periodically if you want a quicker decision on your claim.

Excerpt--This is Step 3 -- a sample chapter from the Ebook Entitled Getting Social Security Disability: Your 9 Step Guide

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