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.