Sunday, September 23, 2007



Applied for disability - what comes next

If you've applied for disability (either social security disability or SSI), you can, in most cases, expect to receive a disability claim decision within three to four months, just as most social security field offices would ordinarily advise.

There are cases in which decisons may take six months to a year, even at the disability application level. However, by and large, most disability cases get decided in the average amount of time quoted by SSA.

Many applicants, of course, wonder what comes next after an application for disability has been filed. Here's a short discussion of what usually happens after the filing of a disability claim and also what may happen after a claimant has filed.

After a claim has been taken, it will, after a short time, be transferred to a disability examiner. Disability examiners do not work at social security offices but, instead, work at state agencies that make decisions on disability claims.

What does an examiner do? An examiner gathers a claimant's medical records and then does a "write-up" of a case. The writeup is essentially a preliminary decision on a claim. The decision reached by the examiner, however, is not final until the disability examiner consults with either a medical doctor or a psychological consultant (or both) who is assigned to the examiner's working unit. This consultation is actually where the decision on a social security disability or SSI disability case really gets made, because the majority of all claims will need to have the signature of an M.D. or a PH.D. (depending on whether a claimant's impairments are physical or mental in nature).

So, a disability application gets filed with a local social security office, and then gets passed to a state disability agency where a disability examiner and a medical and/or psychological consultant work together to stamp the case as an approval or denial.

Sounds fairly simple in concept, right? In most respects, it is. However, a number of things may happen while a disability examiner has a case, prior to a decision being made.

1. The disability examiner may contact you to discuss your medical treatment sources. This typically happens when a claimant does not provide full information regarding their medical treatment sources when applying, such as addresses and phone numbers. Why does this matter? Because although the database used by the state disability agency is extensive, not every doctor and clinic is listed in it. And if an examiner does not have the address of a medical treatment source, this will delay the request for medical records which will delay the case itself. Supplying phone numbers is important, of course, because, at some point, the disability examiner will probably have to make followup calls to doctors, clinics, and hospitals regarding the records they've requested. Can't they just get the number from information, you may wonder? Unfortunately, obtaining a number through directory assistance is not always quick or efficient, and certainly not as efficient as the claimant supplying the number when they submit the disability application. It is worth stating that every delay imposed on the disability examiner is a delay imposed on a claimant's social security disability case or SSI disability case.

2. The disability examiner may contact you to discuss your work history. This is done for a specific reason. Unless a disability claimant's case actually satisfies the medical requirements of a listing (certain conditions have disability approval criteria contained in an impairment listing manual, known as the "blue book"), the decision on the claim will based on A. whether or not the claimant can return to their past work and B. whether or not the claimant can perform some type of other work. To answer both questions, of course, the disability examiner will need to know what types of work you've actually done. Therefore, if you did not provide a work history at the time of your application or the information you provided was "sketchy", the examiner will probably need to contact you for clarification. What needs to be clarified? Information such as job titles, the duties performed for each job, and the dates particular jobs were worked.

3. The disability examiner may need to contact you (and possibly also a friend, neighbor, or relative) regarding your ADLs. What are ADLs? ADLs are activities of daily living and they include activities such as dressing, meal preparation, household tasks, shopping, etc. Basically, these are the activities you do on a normal basis. Why does the examiner need to ask you (or someone else) about your daily activities? In a basic sense, to get an idea of how your condition affects and limits you, as in "what you are still capable of doing". Consequently, some of the questions asked during an ADL call will include "Are you able to use a vacuum cleaner?", "Are you able to dress without assistance?", "Can you reach into overhead cupboards?", "When you pick things up off the floor, do you crouch or bend at the waste?", etc, etc.

How does an ADL call affect your disability case? That's a good question. Typically, the information given by a claimant during an ADL call will be of little value in moving a case toward an approval. However, very often the information given by a claimant will be used to justify a denial decison. For this reason, a claimant who is represented by a disability lawyer may wish NOT to verbally supply information to a disability examiner, but instead, have it supplied in writing by the attorney's office.

These are just some of the things that will normally follow after a person has applied for disability. However, I should mention one last thing. A significant percentage of claimants are scheduled for social security disability and SSI medical examinations. These are known as consultative exams, CE for short.

Why are some people scheduled for such exams and others are not? It usually depends on whether or not the disability examiner either A. needs more medical evidence, B. needs more recent medical evidence, or C. the claimant in question has never been treated for an impairment that was listed on the disability application suchs as depression (it happens fairly often that claimants will list depression but will never have been treated for depression--if this happens, a claimant may or may not be sent to a psychological or psychiatric evaluation).

The most important thing to remember about disability medical exams, however, is this: if you get scheduled for one, go to it because a failure to do so can potentially form the basis for a denial of a disability claim.




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