Why Expedite a Disability Case?

Using our new Olivia© software as the centerpiece, our Business Guide training helps you set up a successful business efficiently processing disability claims.  In this final lesson you’ll learn some little-known secrets that speed up the process for the benefit of SSA, your clients and you.  Why is this important?

·        For the SSA employee, expediting a disability claim is beneficial because the DDS Examiner must move cases through the system to maintain his/her rank and pay.  Anything you do to speed things up is invaluable.  

·        Of course, fast processing is good for your client because the quicker the decision the sooner he/she can start collecting benefits.  Also, a rapid decision from SSA can help speed up access to other services.  Many state welfare and adult or child protection agencies will not provide assistance to a claimant until SSA has made a disability decision.  For someone in this situation, expediting the process can be critical. 

·        Successfully expediting cases helps you build your business image and reputation – and, of course, you get paid sooner! 

Expediting in the First Client Contact

Here are a few tips for eliminating time wasters during first contact:

• Briefly explain your service and tell the potential client what you want to accomplish in the initial interview.
• Ask questions that help you determine the claim’s potential viability. 
• Allow the potential client to tell his/her story, but do not let it become an epic.  Directly ask for information you need to properly assess the case.
• Note any red flags that flash in the interview or Case Assessment alerting you to possible problems.  Examples of red flag issues are: 

ü       Very old onset dates

ü       No medical sources

ü       History of incarceration

ü       Already has a representative

ü       Still working full-time

ü       No mailing address

ü       No personal phone number

• Interview the potential client thoroughly before committing to a time-consuming Case Assessment
• Prepare for a possible case acceptance ahead of time by having everything you need at hand (the Information Package, Guidance Package, a brochure, Acceptance Letter, Business Card, etc.).  When you’re prepared, signing up a new client is just a matter of sending out the appropriate materials.

 
Expediting on the Initial Level

If you enter a case on the Initial Level, working closely with your client speeds up the process.  Use him/her as the main source for documentation.  You can instruct him/her to get copies of all the records for you, or you can get them directly from the sources with his/her written permission.

Even if you reject the case at this level, encourage the claimant to collect copies of his/her records for possible use later.  Remember, Case Development is the major bottleneck in the disability process, accounting for at least half of the case time.  If the claimant has the records ready, development time is greatly reduced.

Expediting on an Appeal Level

As the client’s designated Advocate, you have the option of choosing how to process the case. You can jump in and make things happen or you can sit back and let the process bump along at its own pace.  Many attorneys and others not trained by Disability Advocates use the passive approach to Case Development, so the case moves through the system like cold molasses.  You can succeed using this passive approach, but you’ll have less satisfied customers.  Expediting cases through the appeals process gives you a major marketing edge.

Expediting at the Reconsideration Appeal Level

When beginning a Reconsideration Appeal, find out from your client if there have been any additional medical visits, new medical sources or new allegations since the decision.  Use signed releases to get copies of all the evidence directly and have the client and SSA make the same request.  If the client is scheduled for a medical appointment for his/her impairment, have him/her request a copy of the doctor’s report at the visit.  This will help move the case forward.

SSA assigns a new DDS Examiner to the case on the Reconsideration Level.   How do you find out which Examiner is handling the case now?  First, make sure you send SSA a signed Form 1696.  Once you’re official, you can simply call and find out who has the case.  At the Reconsideration Level, SSA uses Form 3441 to list any additional medical sources since the last decision.  If the claimant lists any such sources, the DDS Examiner will attempt to recover this information before rendering a decision.  It usually takes him/her much longer to get the records, so if you or the applicant has copies, send them directly to the Examiner.  If you really want the case to fly, send them with a certified letter! 

Avoid Irrelevant Evidence:  Having SSA seek out new evidence that isn’t relevant to the case can seriously slow down the Reconsideration Appeal process without adding any substance to the case.  If your client has seen a medical source since the last denial decision, decide if this evidence is relevant.  If the visit was a quick checkup or medication renewal, ignore it unless some important discovery was made.  Additional evidence at the Reconsideration Level is only useful if it helps your client appear more disabled.  If the new or additional evidence adds nothing to the case, don’t waste your time.   

A Reconsideration Appeal case without additional evidence usually takes only six to ten weeks to process, unless the system is overloaded. Generally during any given year at least five to ten states are in case overload.  When this occurs, it’s not unusual for Reconsideration Level cases to take three to four months to process.  Still, the faster that SSA receives all pertinent evidence, the less time spent in Case Development and the faster the decision will come.

Be Sure to Submit Relevant New Evidence Quickly:  Do not become careless and ignore new evidence that might reverse a denial decision just because you want to speed up the case.  If your client has been hospitalized or seen by a doctor after a disability decision has been rendered and the information is relevant to the case, get copies immediately.  If possible, have your client get the report copies, as he/she can get them faster than anybody else.  Then forward copies to the DDS Examiner.  Experience has shown us over and over again that the claimant or representative can get information to SSA much faster than they can get it themselves.

One of the most important skills to learn in this business is how to get stuff from SSA when you need it.  Some tips:

·        Limit your request to anything you can’t get faster from another source

·        If possible, go to the DO and make your own copies

·        Always bring ID and a signed Form 1696 when visiting an SSA office

Expediting at the Administrative Law Judge Level

Speeding up the case process on the ALJ Level is similar to expediting a Reconsideration Appeal.  When you receive a negative Reconsideration decision, use the sixty-day appeal window to modify the case and draft your Formal Argument.  Then request the appeal.  SSA requires that your Formal Argument be submitted within ten days of the appeal request.  This is SSA’s way of expediting the process, but its effect on you is to give you little or no time to prepare the Formal Argument.   If you develop the case before requesting the appeal, your preparation window becomes 70 days   Make sure your client has signed all the appropriate forms before you begin work.

By directly involving the claimant in acquiring records, you can formally stay out of the case until the materials are available to you.  Once they are available, you create your strategy and then apply.  This gives you plenty of time to prepare the case prior to requesting the appeal.   But make sure that you formally request an appeal before the sixty-day limit expires!  SSA does not consider Case Development alone to be good cause for extending the appeal deadline.

If you represented the case on the Reconsideration Level, you will already have most of the materials you need to create your new Formal Argument.  In this situation, modify the argument to specifically address the reasons given for the Reconsideration Level denial. 

In Business Guide Lesson Five we pointed out that requesting an on-the-record review speeds things up by eliminating the wait for a hearing.   There are some cases in which it is to your client’s advantage to have a face-to-face ALJ hearing:

• Your client’s case is strong and he/she is willing to attend a hearing 
• Your client is visibly disabled, which can cause the ALJ to go beyond the evidence in deciding for an allowance 

Whether you opt for a hearing or not, be sure to make it as easy as possible for the ALJ to review case evidence by listing all sources and events in chronological order.   Place your Formal Argument at the top as a quick case summary.

Keep in mind that an ALJ can make a favorable decision in a disability case based on factors beyond SSA policy. He/she is empowered to make gut-level decisions, making the ALJ Level the best place to win borderline cases.  Only at this level can subjective factors such as claimant physical appearance, witness testimony, emotional and/or financial pleas, come into play.

All other methods for expediting ALJ Appeals depend on the individual case characteristics.  For example, cases with only one allegation that is fully documented typically take less time than complex cases involving multiple impairments or medically undocumented allegations. 

While you want to be as efficient as possible, be patient and follow whatever course is in your client’s best interest.  Remember, the ALJ Level is your best chance for winning the case!

Speeding up Consultative Medical Examinations

SSA can request that the claimant attend a consultative medical examination at any case level.   You can potentially speed up this process in three ways:

1.      Eliminate the procedure altogether!  Find out SSA’s concern to determine if it can be addressed with existing evidence. 

Example: Your client, Amos, has asthma and SSA requests a pulmonary function test because they haven’t been able to get a copy of the one his attending physician performed.  To avoid this delay, you send Amos to his doctor’s office to personally collect a copy of the test results.  As soon as he gets it, you send it directly to the DDS Examiner, who is grateful for the help and cancels the consultative examination request. 

2.      If you can’t avoid the procedure or if you believe it will help your case, try to get the examination or tests done by your client’s attending physician or a specialist who is independent of SSA, as they can usually schedule them more quickly and the results are more likely to be impartial.   In most cases, SSA will still pay for the examination.  If SSA orders a consultative examination without consulting you, try to get it rescheduled with a physician who agrees with your perspective of your client's condition. 

3.       Make sure your client attends the examination as scheduled - even if you have to make arrangements to get him/her there yourself!  The sooner SSA gets the exam results, the sooner the case will be adjudicated.  Also:  A missed examination without justification is grounds for a denial on the basis of a “failure to attend” or “failure to cooperate.”  

The Imminent Death Case

Some time ago, SSA’s disability program experienced a huge case processing problem.  Cases were moving through the system so slowly that people were dying before receiving benefits.  SSA’s solution was to create a case category that at the time was dubbed the "Teri" category. 

A Teri case is defined as one where the claimant’s impairment is expected to result in death.  Any case that SSA designates as an imminent death or Teri case gets immediate attention.  In our experience as SSA employees, we were completing imminent death cases within weeks of application.

To qualify as a Teri case, the claimant's condition must be so severe that death is expected to occur within one year or less.  If your client has a condition that fits this definition, request that the case be designated and expedited as an imminent death case.  Do this by sending a single-page letter to the appropriate DO or DDS briefly explaining why it is warranted. 

SSA doesn’t always reply to imminent death request letters, so it’s a good idea to call a few days after sending one.  Once connected, ask the case status.  If it appears that nothing is being done with the request, ask to speak to the person handling the case. This will expedite the case by bringing the imminent death issue to the attention of the appropriate SSA staff person.  It will also reinforce your serious involvement in the case and allow you to ask if anything else is required for an allowance decision.

Client Updates are Good Customer Service!

Your clients love it when you keep them updated.  With Olivia©, each time you take action you can easily send your client an update notice by email.  It will also appear in his/her Olivia© control panel.  This utility makes it easier to expedite cases through rapid communication with your client.

What’s Next?  (We’re Not Done Yet!)

You’ve completed the basic portion of your Advocate training and are well on your way to being ready to start your new career.  Now it is time to experience a case.  When you receive your Certificate of Completion, you’ll also receive instructions for setting up your first case de-briefing.  A Disability Associates staff member will schedule a time to do this by phone.  It will take up to an hour for the de-briefing, depending your level of interaction with the trainer. 

In the first case de-briefing, your trainer will walk you through a typical SSDI case from start to finish.  All you need to do is to sit back with a pen and paper and allow your mind to follow the process.  You may ask questions at any time. 

Your course schedule provides additional information on completing all phases of your training.