Many Claimants do not meet the 60 day deadline for Filing an Appeal when they have received Notice of the Determination. There must be an overwhelming reason for the delay or your case must start again from th beginning: new appliction, new disability report AND A MOTION TO REOPEN THE PRIOR CLAIM. A new Claim Filed within a year of the prior Claim Denial, can be considered a Motion to Reopen but at some point in the new Claim you need to actually request that the prior Claim be reopened and that is with a Motion to Reopen with case citations and applicable Regulations, Statutes, SSR, or AR.
Some good reasons for missing the date could be:
you were hospitalized for the majority of the 60 day period
your Appointed Representative was hospitalized for the majority of the 60 day period
neither you nor your Represenative received the Notice of Determination
on the date you had an appointment at the SSA local office you became ill and had to go to the Emergency Room
on the date you had an appointment at the SSA local office, weather closed their office.
You can see, there must be a verifiable and serious reason to miss your date.
When a Claimant is mentally retarded or has significant psychiatric disease, and they were unable to adeqautely understand the Notice giving them only 60 days to Appeal, a Representative may be able to have those cases Reopened.
Showing posts with label documentation. Show all posts
Showing posts with label documentation. Show all posts
Thursday, August 25, 2011
Tuesday, August 23, 2011
How important are medical records to a Disability case before SSA?
Social Security requires that you provide medical documentation of your disabling condition(s). If you were getting regular medical care and then lost your insurance and had no means of obtaining medical care, SSA Regulations require that DDS obtain a Consultative Examination(s) of your conditions. During the most recent years, these have increasingly been performed at "mills" by medical care providers who do not see you in their practice, many do not have a practice and only perform DDS and Workers Compensation evaluations. It is my opinion that Claimants are not served well by these evaluations when done by these groups. I have numerous clients who say that they were not even touched by the examining clinician. There is no way that I am aware of that a clinician can comment accurately about muscle spasms if they do not touch the patient! With this in mind, it is essential that you have consistent medical records.
FIND a free clinic or a sliding fee scale clinic; APPLY for Medicaid so those medical care providers who do provide treatment and evaluations during this determination period, will be able to bill Medicaid/Medicare for your services when you win. Major medical centers and medical school clinics provide exceptional documentation of disability cases.
The Social Security Administration Regulations require that your medical records meet certain standards. These are not my standards; these are the Rules: generally very little evidentiary weight is given to the records of an LCSW who is not having their records and case work supervised by a PhD in psychology, a LPC (Licenced Professional Counselor), or a MD with a psychiatric specialty; SSA usually will give little weight to the medical opinions of a Nurse Practitioner unless counter signed by a physician. A General Practitioner or Family Practice physician's opinions of mental disease or some other highly specialized disease process, such as anxiety and depression, cancer, diabetes, neuropathy, stroke, cardiac conditions,etc, are given little weight if the symptoms do not require the referral to a specialist You must recognize these limitations when you are seeking medical documentation of your condition(s). I cannot tell you the number of Claimants who have to accept a much later onset date than when they first became disabled by a condition because the Claimant continued to be seen by a physican/medical care provider that SSA does not consider to be adequate to provide treatment and/or diagnosis. Many times, once referred ot the specialist, the Family Practiiotner "supervises" the care prescribed by the specialist, and SSA will accept those records.
FIND a free clinic or a sliding fee scale clinic; APPLY for Medicaid so those medical care providers who do provide treatment and evaluations during this determination period, will be able to bill Medicaid/Medicare for your services when you win. Major medical centers and medical school clinics provide exceptional documentation of disability cases.
The Social Security Administration Regulations require that your medical records meet certain standards. These are not my standards; these are the Rules: generally very little evidentiary weight is given to the records of an LCSW who is not having their records and case work supervised by a PhD in psychology, a LPC (Licenced Professional Counselor), or a MD with a psychiatric specialty; SSA usually will give little weight to the medical opinions of a Nurse Practitioner unless counter signed by a physician. A General Practitioner or Family Practice physician's opinions of mental disease or some other highly specialized disease process, such as anxiety and depression, cancer, diabetes, neuropathy, stroke, cardiac conditions,etc, are given little weight if the symptoms do not require the referral to a specialist You must recognize these limitations when you are seeking medical documentation of your condition(s). I cannot tell you the number of Claimants who have to accept a much later onset date than when they first became disabled by a condition because the Claimant continued to be seen by a physican/medical care provider that SSA does not consider to be adequate to provide treatment and/or diagnosis. Many times, once referred ot the specialist, the Family Practiiotner "supervises" the care prescribed by the specialist, and SSA will accept those records.
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