Helping Your Social Security Claim through the System
Jacques Chambers, CLU, Benefits Consultant

The majority of people who file for Social Security Disability benefits, either SSDI or SSI, complete the requested paperwork, submit it—then they wait. Sometimes for months without hearing a word. Not following up on the claim and tracking it through the system may be one reason over half of the disability applications are denied the first time around.

After you have submitted your initial paperwork, there is a lot you can do that will improve the chances of an approval. In addition to making sure your claim doesn’t get lost or sidetracked, tracking your claim allows you to make sure that they receive every piece of information they need to approve your claim.

First, understand that the Social Security Administration is not “out to deny your claim.” The people that decide whether or not you qualify for benefits would just as soon approve your claim as deny it. It’s not their money; they’re happy for you to get it. The problem they have is the small amount of time they can spend on each claim.

The people reviewing disability claims work in a huge bureaucracy. That bureaucracy, in its attempt to decide claims in the same manner in all offices, requires that specific information and documents must be in the file before a claim can be approved. A Claims Service Representative or a Claims Analyst’s performance is measured by how quickly and thoroughly they can complete and close their claim files.

Their workload is such that they can’t follow up and track down everything they need or have requested. If they don’t have enough information to approve your claim and if they do not receive the medical records they need after a few requests, they will simply deny the claim. You can prevent that by staying in touch with the people handling your claim. They will appreciate any help you can give them.

Your first step is to take all the necessary information and documents needed to the initial interview. You can obtain a list of what you will need at www.ssa.gov, at other websites, from Social Security literature, or from the telephone clerk who schedules your initial appointment.

The person you meet with at the initial interview is not the person who will be reviewing your medical records. Once a disability file is opened at Social Security, they will send your file to the local state office that examines all disability claims is your state and determines if you meet Social Security’s definition of disability. A Claims Analyst in that office will be assigned to your claim and will order the medical records from your doctors, send you and your doctors questionnaires to complete, decide whether you need to see a Social Security doctor, and finally decide whether or not you are eligible for benefits. You can provide invaluable help to the Analyst through the process.

When you have your initial interview, ask the Claims Representative how long it will take to assign a Claims Analyst. This will vary by office and can be anywhere from two or three days to two or three weeks. Ask for the phone number you can call to find the name of the Claims Analyst once your file is assigned.  Following the timeline recommended by the Social Security Representative, call the number and get the name and phone number of Analyst assigned to your claim.

Call the Analyst. Introduce yourself. Usually she will need your name and Social Security number to locate your file. Ask her for the Case or File Number. This is an internal number that the Disability Evaluations Department assigns to each application. Using that number during future calls will help the Analyst find your file faster.

Let her know (the Analyst may be a “he” but most are women) that you are calling simply to offer your help in obtaining all the information needed to make a determination.

When talking to the Analyst (or the Social Security Representative), stay helpful and empathetic to her workload. While you want to make each contact as pleasant as possible, don’t expect her to have the time to “visit” with you. Keep your contact brief and to the point.

A good way to avoid calling too often and becoming a “pest” is, at the end of each conversation, tell the Analyst, “I don’t want to bother you but I want to stay on top of my claim. When would be a good time to check back with you? In a week?” That lets the Analyst stay “in control” of your contacts. She won’t feel so intruded upon if you call back after an interval that she has already agreed to. 

Also remember that your contacts are to help the Analyst perform her job. Trying to persuade her to approve your claim is no help. Focus on getting her what she needs to decide your claim. And arguing with her is downright harmful. In fact, if you end up in a conflict with the Analyst, I encourage you to hire an attorney or advocate to deal with her directly. That will get things off to a fresh start.

During the first phone call, ask her if she has had a chance to look at your file to see what medical records she will need to obtain. It is entirely possible that she has not. Ask her to let you know when she sends out requests (if she hasn’t already) for medical records. Ask her to send you copies of the requests so you can follow up with each doctor to make sure the records are sent promptly.

Once you know which doctors she is sending requests to, you should contact each doctor’s office, advise the office staff that the request is coming, and ask them to send the information as quickly as possible. If the staff is busy, you or your spouse may even want to offer to come in and do the photocopying of the medical record for them.

Once you have the date that the records were sent to the Analyst, allow for mail time, then call the Analyst to make sure she got them. You may have to go back and forth between the various doctors and the Analyst several times. Do not be impatient, and don’t blame either the Analyst or the office staff. Be patient and persistent. Just keep calling and asking and checking. In other words, do everything possible to see that the requested records get to the Analyst. If necessary, go to the doctor’s office, photocopy the records yourself and send them registered to the Analyst.

If the Analyst sends you a questionnaire to complete, it is usually due back within ten days. However, if you call the Analyst, she will always allow you extra time to complete and submit it.

If the Analyst wants you to see a Social Security doctor, call her and ask if your own doctor can perform the examination. They will approve that most of the time provided your doctor agrees and is willing to accept Social Security’s fee.

There are some things that an Analyst will not do, however, so it is better not to ask. They will not help you fill out the questionnaires they send. Those are for you and your advocate to do. Also, they are not allowed to tell you whether your claim has been approved or denied. As long as the Analyst wants more information, you know that there is not yet enough information in your file to approve your claim, but she is willing to approve it if she can obtain the documentation she needs.

As long as you are willing to continue to provide information, whether it is medical records, physician statements, additional diagnostic examinations, or statements from third party friends or family, most Analysts will keep your file open as long as they know you are working to provide additional evidence.

Once the Analyst states that all the necessary information is in, there is nothing more she can tell you. You need to direct further questions back to your local Social Security office. However, you may get a clue to the decision by what happens next. The Analyst sends out the denial letters, but acceptances must be sent from the Social Security Administration. So once all the information is in, if you don’t receive a denial fairly quickly, that’s a good sign.

Occasionally, a claim is sent to the Regional Headquarters for a “quality review,” before being returned to the SSA office. The good news there is most claims sent for qualify review are approved claims.

One final note, some Analysts never answer their phones and rely on voicemail for client contact or only take calls at certain times. Don’t let that deter you. Conduct your business by voicemail, just as if you are talking to her. Offer to help; ask for the doctors she is contacting; offer to follow up. It is the rare Analyst that won’t take advantage of your offer. Your assistance makes it easier for her to do her job.   

[Jacques Chambers, CLU, and his company, Chambers Benefits Consulting, have over 35 years of experience in health, life and disability insurance and Social Security disability benefits. For the past twelve years, he has been assisting people with their rights, problems, and other issues concerning benefits and disability. He can be reached at jacques@helpwithbenefits.com or through his website at: http://www.helpwithbenefits.com.]
Copyright July 2003 – Hepatitis C Support Project - All Rights Reserved. Permission to reprint is granted and encouraged with credit to the Hepatitis C Support Project.