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» LymeNet Flash » Questions and Discussion » General Support » Complicated SSDI question

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Author Topic: Complicated SSDI question
Julie SO Cal Lyme
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Complicated


I have question that I'm hoping someone migh be able to help with. I applied for SSDI in Oct. 2004 but of course got denied. I hired a SSDI lawyer that says I need to prove disability in 1996 or before. I was diagnosed with lyme in 1995. After a few years I found a different LLMD. The problem is that the one who originally diagnosed me is no longer in practice. The lawyer says the only thing holding us back would be the records from that Dr. I've kept copies of all of my positive tests but I guess that's not good enough. Does anyone know if it's possible to get a hold of records from a Dr. that is no longer around? His office isn't even there any longer. Any help or info would be very much appreciated!

Thank you-Julie



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tabbytamer
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Do any of your present doctors happen to have any copies of these records?

How about any doctors that you used to see back in 1995? Would any of them have been sent copies of records for reference from your Lyme doc?

If so, are any of those other doctors around?

------------------
Tabby


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bg
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Julie, go here & check ... complete rules/regs for SSDI....
http://www.ssa.gov/OP_Home/cfr20/404/404-0000.htm

out of time today; back this weekend...

bettyg


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Julie SO Cal Lyme
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Thank you for the info!

Julie


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seibertneurolyme
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In my opinion, your lawyer is incorrect. You can only claim benefits for 8 months retroactive prior to the time you filed and only as long as you have appealed and kept the original file open.

I am pretty sure about this.

If that is indeed the case it doesn't matter what happened in 1995. All that is relevant is the time frame that you are claiming benefits for.

If your lawyer is not Lyme literate or at least experienced with chronic illness cases you might want to look for another lawyer.

It is very difficult to win a case with a Lyme diagnosis -- they are usually filed as arthritis, chronic fatigue, epilepsy etc or something else which is actually on the Social Security list of disabilities.

Do not be tricked into filing with depression or anxiety or another psych diagnosis as that limits your disability to 2 years.

Bea Seibert

Copies of lab tests or office notes that you kept should be ok to use. You can also submit relevant medical literature with your file. Everything does not have to come directly from the doctor.

If you really need test results I would suggest you contact your insurance company and get a claims history for the relevant time frame and then you could contact the labs directly to get anything you really need.


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minoucat
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Julie, I don't know the answer, but you might find some helpful resources through this link: http://flash.lymenet.org/ubb/Forum1/HTML/030280.html

Scroll down to the "Disability/Insurance Claims" heading.

The dsinissues board is spectacularly informative, and since the moderator used to be in the biz, she may know the answer explicitly.

You're in the middle of a very tiring and frustrating process. All I can say is, 1)persevere and 2) remember that the success of the claim ultimately depends on documented evidence of your disability and your inability to work -- not the dx itself.

Best of luck.


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docdave
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bea is partially correct the figure is 1 year prior to claim filing. before that everything is useless.
your lawyer does not know this then you need another good lawyer that deals with chronic illness. they all charge the same it is determined by ssdis.
you must be able to prove that you can not do any job because of your illness ANY JOB.
you must write a diary of your daily life and how the illness has changed your way of life, emotiionally, physically, family, friends, work ,play.
they don't care what illness it is just that you can't do any job ie cfs must sleep 2 hours a day , fibro can'yt lift because of joint pain etc.
this is how you must treat the ssdid case.
documentation of the decline of these things in your life is vital.
write a list and how it effects working and have your present llmd sign and verify it.

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bg
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"Do not be tricked into filing with depression or anxiety or another psych diagnosis as that limits your disability to 2 years.

Bea Seibert"

Bea, please explain this to me since depression/anxiety were what the ALJudge fully approved my 5 yr. SSDI case on! Please help me to understand your statement.

bettyg


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Julie SO Cal Lyme
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My lawyer said that nobody is disputting the fact that I am disabled (can't walk, wheelchair bound, can't drive, etc...). My problem is having written documentation of any illness before the year 1996. I have copies of my many positive tests in 1995 and 1996 but according to SSDI that does not prove disability. And like I said before, the LLMD who diagnosed me is nowhere to be found. He would be such a big help because of all of written documentation of how my illness was affecting me and my limitations because of it. The lawyer said that I should have applied when I first got diagnosed, but honestly I didn't need the money like I so desparately do now. I was married then and didn't think that my husband would desert me like he did.

Julie


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bg
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Julie, here a few more ideas; don't know but worth a try!

1. Contact your local senator's office, both republican & democare, to see if they can assist you. You'll need to sign a release of info.

2. Contact your state governments OMBUDSMAN to see what they can find out about the LLMD who used to be there & isn't, but more importantly WHERE the files might be so you could get a coopy of them.

Again, just guessing on my part. Good luck.

bettyg, Iowa


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ConnieMc
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When did you last work? Your atty may mean that you do not have enough work credits to file for SSD unless you document disability prior to 1996. Call the SSA toll-free number and ask them what your "last date insured" is. If it is 1996, then that is why you have to prove disability back that far.

If you are applying for SSI, that is a different story. That is a needs-based program, and you are only eligible if you have a disability AND no money or assets.

The last date insured is generally set 5 years after you last worked as long as you had met the 20 quarters requirement.

A person is only eligible for SSD if they have worked 5 out of the previous 10 years. You need 20 of the last 40 quarters of work credit. For example, if you worked from 1985 to 1990, you qualified for SSD as long as you became disabled before the 5 years of eligibility ran out, which would be 1995. That may be why your date is way back in 1996.

That is an easy example to give. But is a person worked on and off for years, it complicates the situation a bit. Even if you did work after 1996, you might not meet the work credits requirement if you didn't meet the requirements for credit for the quarters. The only way to sort it out is to have an atty do it.

If you have an atty, ask them why they cannot try to get previous cases reopened if it is within your eligibility period. If you filed a new application right now, and could document disability prior to 1996, and was approved on that basis, then you still can only get benefits back to one year prior to application. That's why I suggest you try to get your atty to get previous cases reopened. If you have a new case approved because you did show disability prior to 1996, then you could probably get older cases reopened and get credit and back pay for that too.

If your "last date insured" is way back in 1996, it will be difficult to prove disability. You will need much more than a positive test result. You will need medical records which show severe difficulties you were having. And testimony from witnesses which will document what was happening way back then. Remember, it is all about documenting your "function" from that time period. A positive test means nothing if you do not have evidence to show the extent of your functional limitations.


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Julie SO Cal Lyme
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Connie-The last time I worked was in 1992, that is why I have to prove disability in 1996 or before. SSI showed that I worked from 1986 through 1992.

Thanks-Julie


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ConnieMc
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quote:
Originally posted by seibertneurolyme:

Do not be tricked into filing with depression or anxiety or another psych diagnosis as that limits your disability to 2 years.


I assume that is true is you just happen to have a private disability policy you are receiving beneifts under at the same time. Private disability policies have limits for psych illness. Usually they limit benefits for psych claims for 2 years. But this is not true for benefits received under SSA claims.

It is a common tactic for LTD companies to try to get your disability pegholed into a psych diagnosis so they can cut you off after 2 years.

Actually you generally are approved under another diagnosis for Lyme. CFS, depression, arthritis, etc. They will review you periodically just like anyone else with any diagnosis once you are approved, but there is no 2 year limit for psych benefits.


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seibertneurolyme
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Bettyg and ConnieMc,

Sorry for the confusion. Hubby told me I was wrong in what I posted.

He had filed for and won a settlement on his private long-term disability policy and it was that lawyer who told us about the 2 year psych limit on PRIVATE disability policies only.

My only excuse is that I have been short of sleep lately.

Bea Seibert


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bg
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Bea, no problem at all ... thanks for clarifying. I'm that way daily ... with or without sleep. LOL.

bettyg


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