In appeal, should I pay $600 for RFC ?
 

Hi
 

Paying for a letter takes 1/2 day? Costs $600???? Someone is making money on you. My lawyer,(representative) who saw me though my hearing etc. didn't collect until my case was settled. The main thing that helped me was a" private", written letter by my primary care Physician. He said in just a few paragraphs what was needed to tell those hearing the case just what was wrong. He dictated it to his nurse and never charged one thin dime. The letter was brought up in court, and the judge granted my SSD on the spot. Perhaps your PCP would do this for you. In this day and age with PC's and fast printing, I can't see what the $600 is for. I think they may know how important these letters are and are taking full advantage. This is just my opinion, and what happened to me. I hope things work out for you. ginnie:hug:

I cannot believe your doctor's office charges $600 to complete a form. It sounds to me like they're confusing it with a FCE (functional capacity evaluation) that does usually take a minimum of four hours to evaluate you doing different things, like lifting, pushing, pulling, they evaluate your endurance. My dr told me that insurance usually doesn't cover it and it costs around $800 - $900 (my insurance covered it and I paid only a $25 co-pay).

Good luck!!
Nanc

They test me for 1/2 a day to complete the form
 

I would wait
 

Hi Debi,

I would wait until you get a response to your reconsideration. If denied, after reconsideration, then I would consider spending the money to get a functional report from the PT department. It would be beneficial at the ALJ hearing level especially under your circumstances with no assistance from the physicians that see you.

If you are denied at the reconsideration level, you will have plenty of time to decide and get a functional report while you await your hearing.

I think the fee is high and I would also investigate other PT sources and ask what they would charge. I would also make some calls to some disability attorneys and get some FREE phone advice. Many are willing to do a brief phone consult and could steer you in the proper direction. They may know of PT sources and their respective fees that may be less expensive.

You do not need to sign up with the attorney just to pick his/her brain for a few minutes over the phone. I spoke with several different firms on the phone long before I chose one to be my representative.

Just my opinion. You have been in the reconsideration stage for a little while so I think you may be too late to have any effect on that stage. I could be wrong but I think you may hear from them shortly with their decision.

Would hate to see you pay out the money if you are in the pipe for an approval already. I would wait until denied and they appeal requesting an ALJ hearing. Then I would get as much info as possible in front of them.

Best to you.

Hopeless

Thanks to all who replied above :)
 

She didn't say that she was paying $600 for a letter. She said she was considering paying that for the EXAM and the documentation of the findings of that exam.

It sounds like they plan on doing an FCE exam for Debi.

Debi, to make sure that you understand the difference (although some of our other posters might be able to explain it better)......

The FCE (functional capacity evaluation) is usually done by a PT and does take hours to complete. It measures your ability to do certain tasks on the day of the test. Many of those "tasks" or questions are also listed on an RFC form (residual functional capacity). Completing an RFC form doesn't require that a doctor watch one stand for 8 hours to determine whether or not a patient can or cannot stand for that long. The RFC asks for the doctor's JUDGEMENT on how long the patient can stand, sit, walk, etc in an 8 hour period. If your doctor completes an RFC form and he understands that you USUALLY are limited in a certain way, ie, if you have to lay down due to severe pain or fatigue every few hours on MOST days, your doctor can document that you are unable to RELIABLY stand, walk, or sit or any 8 hour period. If you happen to have a good day, or take extra meds to get through the FCE exam with a PT, when they check off what you could do THAT day, it implies that you could do at least that every day.

SSDI doesn't require an FCE EXAM. In the practical sense, SSDI approval seems to require the INFO that can be found on an RFC or FCE FORM. Because so much of the info on either form can be interchangeable, people can mistakenly use the terms interchangeably.

If all of your docs are adamant about not spending the time completing the documentation that you need and this is the only way you can get some of this info into your SSDI application, I would feel like I had no choice but to fork over the $$$. I would clarify first that your treating orthopedic doc will also be signing the form. In the land of the SSA, it seems an MD opinion counts more than a PT opinion, so make your money count.

Debi,

You should look into your state laws on unemployment. In many areas there is a conflict between collecting unemployment and applying for disability.

FCE....RFC.....ABC :) lol
 

Hey Finz and thanks for the reply and info. I think my dr is 'afraid' to fill out anything right now. They were taken over by Emory out of Atlanta and everything has changed drastically. I've been using this clinic for over 30 years and I've have been seeing Amy for over 5 years. We are close and I've become one of her favorite patients. My mom and daughter see her too. It's frustrating for me that she will not fill this out or write a letter (well she did write a letter but all it said was that I had been her patient for over 5 years and listed all the issues that I have). Before all this it was sinus infections, her referring me to have my gallbladder out, colds and such. I am one of those that waits until I'm sick sick before going and she would always want to write me out of work for a day or 2 and I always told her no that I was going straight back to work. The visit notes from her that I have sent to ss disability have been very detailed. She has mentioned more than once that I am disabled in her opinion but I have no idea how much that helps. My onocolgist also wrote in his notes that this is a result of diabetes and the chemo he gave me (taxol/carbo combo) and that I could no longer work, shop or drive.

I know this is long but I just had to get it out ! The biopsy report I send with my reconsideration was also very descriptive. Things like "intra-epidermal nerve fiber density severely decreased, epidermis essentially devoid of fibers...one biopsy was 0.0 fibers/mm and the other 0.06 fibers/mm"......."the utter absence of fibers is indicative of advanced small fiber neuropathy" and finally "severe loss of intra-epidermal fibers" along with all the other mumbo jumbo.

I also included in the package to ss letters from my husband, son, daughter, daughter in law who is an RN that talked about my condition and what I could and could not do and what they now have to do for me. Also letters from prior co workers and 2 prior bosses that said how much I enjoyed working and they thought if there was anyway I could work I would be doing so.

There it is.....in all it's glory....think I have a chance without the FCE/RFC ?

Thanks.........Debi

Finz....just saw your last post.......I did check with the dept of labor.......IF I get approved I will have to pay back the unemployment I've received if I'm back dated to May 1 and receive back pay. I was thankful they let me keep drawing. That's how GA does it anyway.

I would absolutely pay for it. ALJ's aren't stupid, they're well aware some doc's will make claims that they can't substantiate and having this type of testing will give you evidence that neither you or anyone on your behalf is exaggerating your limitations. This is especially the case with an invisible disability.

Can you make your claim without it? Perhaps, but IMO it's not worth the gamble, unless the cost is such a burden you'll be having a problem covering your necessities.

On doctors letters
 

Doctors don't want to compromise themselves to false notes on a patient. They have a hard enough time. Any of the good docs. have the tests, medical records to back up what they write about you. ginnie

No attorney yet :)
 

Debi--Here's an excellent link for you:

http://www.socialsecuritydisabilityr...acity_RFC.html

Thanks
 

Hi Lit Love,

Thanks for the link you gave Debi. Interesting info.

in my opinion your best bet for an attorney is someone who used to work for social security as an attorney. they know the system and have contacts. check your local yellow pages.

At my last hearing I presented three RFC's, one from my orthopedist, neurologist, and my internal medicine guy. All three were longtime treating physicians, the RFC's detailed documents, fully supportive of my claim...

I lost, with the ALJ choosing to virtually completely ignore them, instead lending all weight to the SSA hack who had never so much as seen my face, let alone examined me.

But attorneys seem to like having the RFC's....

Here's what my advocate says on SSDI peeps
 

Outcome
 

Dear Direwolf,

Did you persue your case any further after being denied at the hearing level? What explanation did they give for your denial? They are suppose to give MORE weight to your "treating" physicians than any physician that has not seen you, the SSA doc that reviewed your file. Where do you stand now?

Remember you would be paying for Functional Capacity Testing and an RFC, which is harder to dismiss, at least that was the reaction by SS, IMO.

I've been pursuing my claim's since 2003, which includes 7 consecutive denials until prevailing against SSA in federal court this past winter, with notification from the federal judge coming my way in July!

The federal judge didn't even mention the ALJ giving more weight to the SSA hack in his ruling, in fact he turned him over on a ridiculous technicality pertaining to some silly job description thing. If not for that, it appears he'd have upheld the ALJ's original decision, which was just a black outrage.

My three RFC's were highly detailed, and completely supportive of my claim, I recall them being at least seven pages each. The neurologist charged me $500.00 for his contribution, the other two were simply done with no charge beyond the office visit required to deliver them into the doctors hands.

My attorney at that time did an awful job, he failed to obtain my full medical files, even after three face to face meetings in which it was explained to him that he did not have all of my files, and he assured me that he would obtain them. He also failed to brief me on the importance of the RFC's, I only found out about them 60 days out from the hearing(the neurologist books appointments 6-months out), I literally handed two of them over to the attorney in the hearing room, the day of the hearing! This did not sit well with the ALJ(Gaffney out of MLPS MN)who very obviously had made up his mind about my case well before I had entered his hearing room.

So RFC's are complicated, the attorneys love them, but they are absolutely no assurance of victory, and in my case they were completely ignored, which obviously was devastating. Despite overwhelming evidence supporting my claim, the ALJ chose to ignore them, he even went as far as stating in his decision that my doctors were lying! An absolute black outrage....

My advice is to obtain the RFC, but more importantly check out your ALJ's record, and don't allow your attorney to destroy your case through incompetence, you really have to watch them closely, they will lie to you over and over and over again, you just have to be intensively involved, YOU must physically verify that they have all of your records, they will deceive you on this count. You have to look at it from the attorneys perspective, they only can earn a max of about $6,000, and most of them will only prepare for your case a week or two out from the hearing, if that! My first attorney gave the strong impression of having not prepared at all, showing up at the hearing office with a a few notes scribbled on the cover of a palm sized notepad, she didn't even know my first name...

Hi Direwolf,

Thanks for the scoop. I really do wish you well.

My hearing is next week. I have "control issues" so I left nothing to my attorney. I got my files, I got the Medical Source Statements, and I made a list of important points to make or clarify.

You are correct that the amount of $ is not a strong incentive but getting ZERO is worth nothing. I would hope that the max of $6K vs Zero should be some incentive.

The way these attorneys work is to bulk up on clients, 20 client cases translates to however many approvals, its strictly a numbers game. They don't want to lose, but for that kind of dough they are only prepared to do so much. If your case is complicated, as mine is, they can hurt you badly by not knowing the file....

Good luck....

Size of firm?
 

Hi Direwolf,

I just lost my entire response.

Will try again.

You won your appeal on a procedural error--a positive thing, and easier to prove than the ALJ made the wrong decision based upon the medical evidence. SSDI/SSI rulings are based upon medical/legal evaluations. Those technicalities often mean the difference between a Fully Favorable Decision and a Denial.

The DOT (Dictionary of Occupational Titles) was written in 1986 and the job descriptions as written can seem insanely outdated, but that doesn't change the reality that is what a Vocational Expert uses to determine if you are capable of working.

A I mentioned previously in the thread, some ALJ's don't trust the credibility of a RFC without a Functional Capacity Evaluation...

The VE's are really a joke, unfortunately not a good one! I do hope its a positive thing, I've been waging this fight for ten years, I am at the end, one way or another this is going to be it.

I'll tell you what I'm afraid of, I share the opinion of a few SSDI experts who believe that the SSA sees a cancer diagnosis and they purposely target them, knowing that the odds are quite good that they can outlast them through the process.

I do believe that....

That is a travestry. I do not doubt the possibility but if true, that is just an utter travestry. I am beginning to think that the more deserving are the least receiving, based on your statement and stories I have heard from others.

I hope you get a fully favorable decision and soon. It is time (long past time) for you to win the battle AND the war. Wishing you not just approval but also better health and brighter days.

about benefits
 

Yes, unfortunately, they make a sick person wait. SS hopes they give up or die. It should not be a war to get medical help in this day and age. It is all about the money these days, and maybe not so much those deserving of help. I am horrified at the number of deserving people, sick in bed and unable to get their disability. It takes a lawyer, or a representative to keep the process going. We must remember those in office don't live by the same standards as we do. If they had to abide by the same conditions, perhaps there could be a change.
The war to get health benefits must end. We must protect those least able to care for themselves. Write to those in office, and be proactive. I wish the best for all of us. ginnie:grouphug: