Changing Times at Social Security Patients Must Navigate a New System for Screening Claims

The Social Security Administration has launched a new system for screening disability claims filed by people in Massachusetts and the five other New England states.

The new system relies on computer software to scan a patient’s medical file, then decide if the patient’s medical records fit into a “predictive model.”

Social Security has not explained what words and phrases the predictive software will be looking for. However, a complete treatment record submitted with the disability claim will help the patient get the case referred to the Disability Determination Service in Worcester for a quick disability determination. The ‘quick’ determination must be made there within 20 days.

People in the Social Security District Office will also be looking to see if the claim has high potential for a quick determination. Whether written in a medical file being read by a person or contained in a scanned electronic file being read by a computer, medical chart entries that are brief and incomplete will not help the patient get a prompt decision from Social Security. So, if a physician recognizes that a patient might someday become a candidate for Social Security Disability, more detailed chart entries will help Social Security decide a case.

Some Examples

A good real-life example is the neurology notes that gave important details of the declining capability of a multiple sclerosis patient. The neurologist took a few moments during the office visits to document the patient’s increasing symptoms of fatigue, muscle weakness, and lassitude that interfered with attention and concentration.

Then, when the application for Social Security disability was filed, it was clear that symptoms of MS, combined with side effects of medication (severe headaches) and the emotional effects of the disease, had prevented the patient from engaging in competitive work for many months. Details of how a progressively worsening disease is affecting a patient’s daily life can help establish the ‘onset date’ of the disability.

Medicare eligibility begins two years plus five full months after the patient is considered disabled under the Social Security rules. If details in the treatment records show it has been impossible for the patient to work for that long, the patient is instantly eligible for Medicare. That’s very important if the patient has no access to private health insurance.

One example is a client who had tried for many months to work with osteoarthritis, depression, and other problems. The orthopedic treatment records confirmed that the many months of unsuccessful work attempts should not be counted against the patient in the calculation of his waiting period for Medicare.

In another actual case, ancient microfiche records retrieved from the basement of a closed hospital helped a patient who was denied benefits because of what Social Security called his ‘date last insured.’

The patient had tried to continue working for several years as a self-employed tradesman. When the patient finally applied for disability benefits, Social Security said he was no longer insured, because of sparse earnings during the final years he had tried to work. But the microfiche records of hardware implanted and then removed from his knees and legs as a child, added to evidence of recent treatment for other impairments that had overtaken him in adult life, proved that the onset date of disability was well within the insured period.

Don’t Wait

A patient should never procrastinate in filing an application for Social Security disability insurance benefits. The patient should be encouraged to make sure that someone follows up if the application is initially denied. Even if a patient has become overwhelmed and given up on an application for disability benefits months or years ago, the previously unsuccessful applications can sometimes be revived to get benefits payments and Medicare coverage sooner.

An initial denial from Social Security means either that the patient really isn’t disabled under the rules, or the person reviewing the case for Social Security does not see how the medical evidence fits into Social Security’s rules and listings of impairments.

Sorting through all the rules is overwhelming for the patient who is trying to manage the pain and uncertainty of disabling impairments. A disability attorney who takes responsibility for putting the puzzle together can help the patient obtain a prompt Social Security disability decision, as well as a definite date for Medicare eligibility.

Nationwide, the state disability determination services processed claims from more than 2.6 million people seeking Social Security disability benefits last year. Approximately 500,000 had to appeal their cases to Social Security hearing offices. But the hearing offices do not always require claimants to wait for a hearing. Administrative law judges in Springfield have been able to issue ‘on-the-record’ decisions when the medical record has enough details, or when the physician is able to answer a short written questionnaire based on the specific Social Security medical regulations that apply to the patient.

If the new screening system works in Massachusetts, more of these ‘on-the-record’ disability decisions will occur earlier in the process, and make Medicare available more promptly for more of the disabled patients who have no private health insurance.

Attorney John L. Roberts of Longmeadow helps disabled patients obtain Social Security disability insurance benefits, with no attorney fee until benefits are awarded by Social Security. He has handled Social Security disability claims and appeals since 1989, and is a sustaining member of the National Organization of Social Security Claimants Representatives. His Web site iswww.disabilitydesign.com.