No medical exam, incomplete records
 

I filed for SSDI October 30th. I got my denial letter at the beginning of February. According to the letter it says the decision was based on information from ( list of my doctors), but there were ones that are currently treating me for some of my issues that it appears they didn't ask for records from.

Also they did not request a medical exam.

Is this normal?

I dont know if it is normal but I can tell you my SSDI experience. I was denied when I first filed and I never went for a medical exam. My lawyer appealed, went for medical exam, and was denied again. Lawyer appealed again, about 1 1/2 years later went before a judge. Judge asked me couple questions,wished me good luck and she said she would evaluate my case and I would be getting a letter in 4-8 weeks. 2 weeks later there was bunch of money deposited in my account from SSDI and next day I received the letter. I was awarded SSDI. It was about a 12 page letter stating how the judge came to her decision and how my injuries, my age, my education and my work history all met Social Security admins criteria. The judge wrote that she totally ignored the reports of the 2 people who denied me earlier. She said they did not have all the facts. She also ignored a doctor who worked for State of New Jersey who said I could return to work. She said out of the 10 doctors reports, 9 have me from 65% to 100% and the 10 report was ludicrous. Think thats the word she used. Anyway, thats my experience with SSDI.

It's not uncommon not be sent for a medical exam or exams at the point you are in the process.

Follow through and file for reconsideration. Also go into SS and give them the names of all your docs to request current medical records. Then follow up with those doc offices and SS, to make sure it happens. Also go through the sticky "Don't start your claim unprepared" since there are additional things you can do to help yourself, and it's very important to understand how the system works. Read through any threads that apply to you here as well.

Lastly, you might want to consider hiring an attorney or a non attorney SSDI claim rep (usually former SS employees). I still recommend learning as much as possible about the process yourself, even if you do. It is a much more difficult and lengthy process than most people assume. It's a complex medical/legal evaluation.

I have legal assistance already. My long term disability insurance company provides it at no charge.

They assisted me in filing the claim and the daily activity form that followed. The hearing department I supposed to call me next week.

On my original application all my doctors were included. That is why I don't understand why they didn't get records from all of them.

Tombyr thanks for sharing your experience as well.

I think I am overly annoyed about them not getting all the records as I have been trying to get Medicaid(state insurance) for 6 months and they keep failing to correctly do things. I had a hearing and the ALJ reamed the representative out for not getting records and exams done and I just got another denial in the mail and they still didn't do what the ALJ told them to do. I can't afford my $820 COBRA, but for 1 more month. Between this and my SS stuff I feel like I am beating my head on a wall!

SSA will make at most two requests for your existing medical evidence. If the source does not comply, SSA does not work harder at it. Are you sure that you provided the correct address for the medical treating sources? Are you sure that the records are held in your current name? There are a lot of things than can go wrong when records are provided. I suggest you contact the medical treating sources and see if their records show an SSA request and the response. You may decide to pay for the records yourself and submit them.

In theory, your counsel should be handling this stuff, in reality, you have to make sure they are. If they're not doing an adequate job, complain to the insurance company and have them replaced.

Sending notifications to the doc offices out via certified mail return receipt requested might not be a bad idea even.

Did the ALJ make an error in the denial?

You can submit a new application, btw. It might cost your insurance company the lost backpay, but that doesn't seem to be your fault...

great judge
 

sounds like you hit the jackpot with that judge since so many others enjoy denying disibility claims...

They never requested them. I did receive a letter for records they requested and hadn't received prior to the denial. I made sure the ones listed sent the information.


They are saying the wait for a SSDI hearing is 10-18 months. Guess we have plenty of time to get the remaining records from the couple of treating physician's they didn't get!


The ALJ was for my Medicaid application, not for my SSDI. I haven't received his decision on my Medicaid yet. DHS (department of human services) is supposed to request medical records for Medicaid. During that hearing I told him I had some records I had obtained from my LTD insurance company, but not my complete records and that I could not afford to get copies of them all. The DHS representative was on her phone reading Facebook through the whole trial (the ALJ was on a phone) so I'm assuming she didn't even hear that she needed to get the remaining records....which she was initially supposed to do 6 months ago!

I did'nt get a medical exam until the appeals council remanded my case back. It most case's it will only hurt you, so I would be thankful they have'nt ask for one. I personaly would go out and get a Lawery, it won't cost anything up front, and their fees are not that bad. They only get paid when you do so they tend to work alot harder for you. Just a thought.

I already have it. My LTD insurance company provides legal assistance free to me.

I finally got some good news. Yesterday I received the ruling from the ALJ in my Medicaid (state insurance) hearing. He deemed me disabled and overturned the decision of the department of human services. I will now be able to get Medicaid and possibly other assistance.

I'm going to contact the people handling my SSDI claim and let them know. I'm wondering if this will help speed things along for that. They use the SS classification to determine disabilities. So if an ALJ has deemed me disabled for the Medicaid maybe that will be enough and I won't have to have another hearing?? Opinions...

it certainly cant hurt. i would besides calling them, mail them the decision certified mail return receipt. good luck.

That's some good news in the battle, fbodgrl !

I sent all the info to the people representing me ( provided by my LTD insurance company). I haven't heard back, which is frustrating! I've been having additional health issues and been dealing with some other stuff so I back burnered it. I'm going to follow up this week.

On another note ....I got more information on my state Medicaid that the ALJ decision sided with me. They now say I am disabled (since the ALJ said I am), but now they say because my LTD payments I only am eligible for a deductible based program. My deductible us $1572 a MONTH! I am getting SO angry! This basically does not help me at all. According to the DHS representative it is based on my income alone and it doesn't matter that I need to eat, pay a mortgage, utilities, etc. I just can't believe how ridiculous this is! Also they aren't reimbursing me ( which the ALJ back dated to July 2012 when I applied)

I'm sorry, fbodgrl, that's a really tough spot to be in. Once you get approved for SSDI and have the 24 months in to get MC, at least you'd have that option for healthcare, but I can't imagine how much harder that makes the wait. I hope that you can find some way to hang on. :hug:

Thanks! I just can't believe how ridiculous the "system" is. I know people here get it. I have to say before I became disabled I never knew how much you had to fight to get help. It seems like it is a constant battle.

Lost
 

I hand delivered my medical records the next day after applying online for disability. I was denied stating they did not have sufficient medical records. They did not list the medical records I had submitted. Even when you make sure that you have all your ducks in a row, SS will lose your info.

They Lost My Records
 

I too, got a denial letter that did not list some of my doctors. I had hand delivered the medical records for ALL my doctors yet some were not listed on the denial. They lost ALL the records I delivered and only used the ones they requested. I have hired an attorney to represent me at the hearing. I continue to see my doctors as needed and will have MORE medical records to add to my claim. The major debilitating health issue was also not listed on the denial. They only listed the 8 other issues that alone do not make me disabled but combined with the ONE that does disable me. How do they overlook the most important and most severe issue? They did have the medical records from that specialist, the neurosurgeon.

That stinks !

I needed my lawyer to follow up on all that kind of stuff, to make sure my record was complete and that te documentation fully described me disability.

Ignored by SSA
 

After being denied, and seeing that the main condition for which I applied and some medical records, (which I had submitted) were not listed in the denial letter, I contacted SS in writing asking for a copy of my complete file. NO response. Again, I requested in writing, via Certified Mail, NO response. Again, wrote requesting copy of my complete file. Finally, a response. A letter saying they were enclosing a copy of my denial letter, and they included the medical records THEY had acquired, none of the ones I submitted. NOTHING else. I thought I was entitled to my "COMPLETE" file which they consistently refuse to give me. How am I to prepare for my hearing before the ALJ without it? I have since obtained an SS atty. I have no heard from him since our initial meeting authorizing him to represent me. I will be contacting him this week for any updates.

I believe the problem is one of procedure. You are supposed to call your local office (or write a request) to view your file. SS locates it, and then sends it to either your local office or if it's already at the ALJ offices, you must go there. You can take copies of the file for free. If you're unable to manage the copying yourself, you can bring someone to help you.

I don't believe they have a legal requirement to do the copying for you and mail it. Whether or not, the copies you gave them are in the file? Someone perhaps made a judgement call not to spend their time copying something they figure you already have. Or maybe, it truly was lost?

Have you researched the grid rules? The standards for approval over age 55 are significantly lowered.

Hopeless,

It's also easier if you start a new thread rather than adding bits onto other people's threads if you still actively need help, and that way it also doesn't derail the OP's thread. :)

Ugh...now maybe 1 1/2 months after the ALJ deaming me disabled and getting approved for Medicaid I get a denial for not meeting my deductible for at least 1 of the last 3 months. I haven't even had the paperwork for 3 months! I tried to call my case worker. Called 3 times and no return phone call...just makes me furious. Now the only way to get answers is to request another hearing AGAIN!

The company handling my SSDI claim is preparing a pretrial brief. I guess they use all the medical records and information they got from me. Write a brief and present it. The hope is that it will then get approved before/without a hearing. Has anyone had experience with this?

Confused
 

I read in the NOLO book that one's complete file is put into electronic media and you can obtain a copy in CD format. When I "called" my local SSA office, they told me that a CD was a recording of the ALJ hearing. When I first consulted a disability attorney, they told me that I could obtain my complete file from SS on a CD. After the initial meeting with that particular law firm, I sought advice and have signed with a different atty. (First firm and I did not see eye to eye and I did not feel that I could work with them.) That is a long story.

What am I entitled to in order to prepare for my ALJ hearing? The date has not been set yet and is months away due to backlog but I do not want to be unprepared due to lack of time.

New to Forums and Threads
 

I am not very internet savvy. This is my first time using a forum. Not familiar with them at all nor the terminology. Just beginning to figure out what a "thread" is and I did post a new thread that has NO responses.

Hopefully, I will get the hang of this soon. Thanks for your advice. My apologies if I am not doing things correctly. Not only is my body getting OLD, my computer is old also, a desktop model, and NO wireless anything. Not only am I a bit antiquated, my technology is also.

Thanks for your patience with me. (And your help.)