Initiating a disability claim, unable to afford expensive doctor; can this be done remotely?

[velcrowings]

I'm considering filing for disability however I don't have health insurance and am unsure how I would afford paying for numerous appointments with doctors that cost $400+/hour.

Does a doctor have to be seen locally to initiate a claim? My energy levels are really limited and going on a long drive to see a doctor wouldn't be good for me.

How have others in this situation gotten by?

 

[wabi-sabi]

Do you mean SSDI?

 

[Faith2007]

Are you in the USA? If so, you don't have to see a doctor to initiate the claim. You just need to be diagnosed with something that will qualify you as disabled under social security guidelines that can be proven.

Social security will send you to local doctors that will evaluate you in whatever way they think necessary, without cost to you. For me this was both for separate physical and psychological evaluations.

I'm waiting on a verdict for my SSDI case after I've recently been to court online with an administrative law judge and my representative. We are going for a straight up CFS claim, where I have met 5 requirements necessary for this, my representative has said. We also discussed Long Covid with the judge, and secondarily are going for a significant mental health diagnosis on top of it, if necessary.

Both my CFS specialist and Social Security Disability Advisors that I've hired (payment only upon winning my case) are in a different state from me. So I do that kind of stuff via phone and email. You don't have to go to a social security office, either, to deal with their paperwork.

Good news for all of you reading this. My representative has been telling me he has been winning social security cases based on a Long Covid diagnosis alone!

Best wishes to you, velcrowings, and don't hesitate to ask more questions.

 

[velcrowings]

@Faith2007

Yes, I mean SSDI. I haven't done a lot of research about this yet so am quite ignorant of procedure and everything else.

Social security will send you to local doctors that will evaluate you in whatever way they think necessary, without cost to you.

What is the first step to initiate this process?

Can I ask where you found your Social Security Disability Advisors? What kind of payment do they require upon winning your case?

Thank you for your help!

 

[Faith2007]

What is the first step to initiate this process?

Can I ask where you found your Social Security Disability Advisors? What kind of payment do they require upon winning your case?

This thread is a good place to start https://forums.phoenixrising.me/thr...sability-ssdi-resources-of-interest-us.81449/ thanks to @nyanko_the_sane which contains many links, including a link to lawyer recommendations by @Pyrrhus

But some of these social security rules change from year to year, like work credits. So it's best to go directly to the ssa.gov website, instead of taking somebody else's word for it. There you can find out what type of benefits you are eligible for, how to apply, etc. You can also call social security directly for help on this. But you initiate the process when you actually apply for whatever form of social security benefits you may be eligible for.

I have talked to somebody else with ME/CFS who won their SSDI case on their own, without representation. So it can be done. She had to prove before a vocational expert she was unable to do any level of work. You may also be able to find an advocate willing to help you with your paperwork and your case.

For me, this process was too much for me to try to do alone. And after my first denial when I tried to do it alone, I hired Social Security Disability Advisors (SSDA). I found them online, with many positive reviews. Then by talking to the case manager there I found out they knew about CFS. They then helped me with my appeal, and the denial of that appeal, which led me to court with the administrative law judge. If we lose that, they will help me with an appeal for that. This process has taken me almost 2 years and 5 months so far. But it's not like that for everyone.

So the rules governing the maximum amount your representative may charge you are here https://www.ssa.gov/OP_Home/ssact/title02/0206.htm and in November 2022 this amount for me was $7200 according to my contract. But my understanding is this amount is actually based on when SSA approves your representative's fee, which can make that amount higher, according to my contract. For example if the fee was approved in 2023 it could be higher based on that amount allowed. Also, past-due benefits can be different based on how far back you are eligible for benefits, if I understand correctly, which the maximum amount you can be charged by your representative is based on. Which means the amount you have to pay a representative could be different from mine.

I hope this helps.

 

[velcrowings]

@Faith2007 Thank you!

Can I ask why your claim has taken so long, and do you have any idea how long it normally takes?

 

[Faith2007]

Can I ask why your claim has taken so long, and do you have any idea how long it normally takes?

I believe it matters that I first applied in November 2021, when Covid-19 may still have been slowing things down a bit, though I'm not fully certain of that. When my representative talked to me, I believe he mentioned that it took a year for SSA to make the first ruling, and the first rejection, which he seemed to indicate was quite a while.

One thing that can slow things down is when your doctors' offices don't promptly respond to requests from SSA for your medical records. I was asked by SSA for help getting records from two of my private doctors' offices, since they weren't getting back to them in a timely manner. That also happened again with the same doctor's office when it came time for my case to go to court. I had to request the records twice after my representative had asked for them, which took a total of three week's time from the original request date.

Another thing I suspect is that my case sat around for a lot longer than necessary because a different person started handling my case at our local or state SSA office without my knowledge. I'm even wondering if the first person at SSA who was handling it had left SSA. I hadn't heard from SSA since August of 2022 after I helped them with the records request from my doctors' offices, until I finally called them myself at the end of December or beginning of January in 2023. And that's when I found out I had to deal with somebody completely different there. At that point, enough time had passed that they had to request medical records from my doctors' offices again, another delay. But after I had called and spoke with the new person handling my case, I think it only took a month for me to be rejected. I found out later that they hadn't received records from one of my slow doctor's offices that second time before the first ruling, which irked me. So let's say that first ruling was made at the end of January or start of February 2023.

Because of this, I recommend you call over to SSA yourself every so often to see where your case is at, especially if you don't have somebody else representing you. You can ask whoever is assigned to you at SSA how often checking in with them will be acceptable. It's possible it cost me months of time due to not checking in, especially with SSA's change of personnel.

After that first rejection, I hired Social Security Disability Advisors. I think I only had two months to appeal after that first rejection. So I wasn't calling SSA directly, but going through the advisors I hired. And my advisors could see always where SSA was at with getting my medical records. My advisors had requested to also get records of everything SSA mailed to me from SSA. You can check on how many of your medical records that SSA has received yourself somehow, without calling, but I'm not sure how to do it. In the end it was my hired advisor checking with me and making sure she had gotten all of my medical records for court in enought time for preparation before the court date. And asking me for help if necessary.

You can also check online at anytime to see what step you are at in the application and ruling process if you make an online account with SSA, which I hadn't figured out at first.

I wouldn't be able to guess on average how long it takes for a SSA case to succeed or be completely rejected. I may still need to appeal if I lose my court case. So I can't even be sure of a timeline for myself. The other thing I'm wondering is if SSA caseloads vary from state to state. My guess is there are many factors that can affect how long a ruling takes.