(Remastered) 9.11.2011 (Taking documents to hearing, reimburse for medical expenses, and more)

0:13 All right, everyone, this is Tony Reeves, Attorney at law, and welcome to another edition of Q and A Social Security Disability Today. Of course, today it's September eleventh, So for those of you who have loved ones, have family, friends, or just want to pay your proper respects, please take some time during today to acknowledge the day that our nation stood up against tyranny. I know that you're probably getting bombarded with a variety of different rememberance ceremonies or homages or things of that nature. Allow me to also extend one on behalf of the whole diiff of the Q and A SOB Security Disability Today family, to also say to you we remember. All right, go ahead and get shaken with our questions for today. I've got a

0:54 few here, so I want to kind of move kind of quick through these my apologies as always. You know, if I don't get through them in their entirety, you want me to have a special one on the topic, just let me know. All right, I'm wondering if the gap in medical records will affect my benefits, first for an initial application and for continuing disability benefits. All right, here's what happens let's attack the continuing disability one. First, Let's say you were found disabled back on January one, two thousand and six, so you got approved. Rolling along, here we are January one, twenty eleven, and their Social Security is telling you you're having what they call a Social Security Disability reviewer we call a continuing disability review

1:34 to determine if you're still disabled now. Between six and eleven and twenty eleven, you found out or you realize if you haven't been able to go to the treatment that you normally would have been able to go to. So now you're freaking out because you got gaps in your treatment. How's it going to affect your case? First and foremost, let me go ahead and make one point clear.

1:53 Is it going to affect your case? I'm going to give you the typical lawyer answer. It depends. It depends one on what kind of condition you have, because you know, some conditions support even if you're not on the treatment for those periods of time, you're going to still have those conditions regardless. The idea is Social Security is not going to have an idea whether your condition improves if you're not getting any treatment. The second thing you need to worry about is that it depends on how long you've been without treatment. For instance, let's say that you were getting treatment from two thousand and six to two thousand and eight, then all of a sudden you just stopped because you didn't have any insurance for eight to

2:29 no nine, and then you start to back up again. Well, if the problems in two thousand and six to two thousand and eight and in two thousand and nine to the president are still the same, social Security might not hit you that hard because there's a gap in treatment. Keep in mind, people we don't have universal health care, so a lot of people don't have insurance. You should either have Medicare or Medicaid under Social Security Disability Insurance Benefits or SSID, either one, so you should have the insurance coverage. So they may us look at what is going on during that lapse to explain why you aren't getting treatment. So for purposes of the continuing disability review, they are going to look at that gap to evaluate

3:08 how that gap came about and making a determination of how are they going to evaluate whether or not that's going to be penalized against you. For instance, let's use that same example Let's say that the gap is because the doctor that you have no longer takes Medicare or no longer takes Medicaid, and it took you a year and a half to two years to find another doctor.

3:28 So they'll take all those things in mind. So keep in mind for purposes of your continuing disability review. If there's a gap in treatment, it depends again on what the conditions you have and what the reasons are for the gap and how long the gap is. Now, let's say you're applying for disability benefits for the first time and you've got gaps and treatment, same rationale applies. It's because Social Security. Typically this is where people fail to realize you have the burden of proving your disabled, but they do take in consideration that there may be circumstances that prevents you from being able to get treatment. Keep this in the back of your mind, people, and I tell this people all the time. Under continuing disability to review,

4:09 it's a little different because you have insurance for Social Security when you're applying, you usually or probably won't. But the scrutiny is even greater if you're in an area that provides premedical treatment or a reduced medical treatment or the county provides it. What do I mean by that? That means if you got something in your town or your city or your neighborhood you just don't want to go there, then you got a problem. But if it's there and you haven't used it at all, or you've chosen not to use it at all, or you've chosen not to even look, then we've got a problem. Because if the resources are there and you have chosen not to use them, then that might affect your ability when you're applying for the first time. So just keep those

4:52 things in the vack your mind. All right, Let's go to the second question. Have a hearing coming soon and wonder am I entitled to be reimbursed for all the medical expenses if awarded benefits? Keep in mind there's two prongs to this. First, of all the benefits that you get, that's money. That's your money that's coming to you. They're not going to pay you extra money because you paid stuff out of pocket. That's the first thing. However, second num point number two, if you're getting SSID, you'll be entitled to medicaid. If you're getting VIB you're entitled to Medicare.

5:26 Keep that in mind because if by some chance you pay for out of pockets that Medicaid or Medicare should have covered, then they may go back and you might be able to get reimbursed there. Now here's what I tell you. There's a company called Worldcare that's funded by I believe, the federal government. They are a great resource.

5:42 And also for contact the local Social Security office that you're dealing with for the SSI for the medical portion. You need to find that out in advance, if whether or not, because usually if you've got bills that you haven't paid, if you give them the Social Security and you have Sure's coverage and the insurance the Medicare of the Medicaid you have covers it, they should take care of that. That's why I say it's a little tricky when you pay out of your pocket. Multiple I deal with are not really paying out of pocket or they don't have the ability to ask those questions in advance.

6:13 So this way you're not getting mad because you paid out all this money. Also, be advised there may be a possibility that the Medicare or the Medicaid may not cover what you pay money out for, so don't think it's because you get awarded disability benefits, you will get all that money back. It may not go down like that.

6:33 Make sure you go and you talk to them about it so that you know ahead of time. Do I take documents to my Social Security disability hearing? Outstanding questions? Okay, if you're doing a case by yourself, most people don't realize that Social Security is electronic. Please don't come walking up in there with a bunch of records because they don't like that. Because most of your cases are not paper.

6:54 That means somebody has to scam those documents in. Here's what you should do first to answer your question. Should you take them with you? Well, if you got them the day before the hearing, absolutely, because you can't do anything about that. But let's say, for instance, that you're one of those people that you go to your doctors and you ask for your records all the time, and you kept all those records, but you never took the time to give them to the judge. You're going to make that judge really pissed, all right, because you could have given them to them ahead of time. This is what you should do. Contact the Social Security Office, tell them that you have records that from going to your doctors,

7:30 and you ask it is your file electronic or paper? If they tell you it's electronic, ask how do you get it into your file? They're probably going to tell you to do one a couple of things. One, they may send you a fax cover sheep in the mail, which should have come with your hearing notices anyway, if you're at the local office level, now I mean it's give me at the hearing level. They're going to send you a cover sheet that you put on the cover and you facts and that will facts directly into your system.

7:54 Or they'll give you an address if I believe the Disability Determination Service at Center which is the OKATED in London, Kentucky. I believe, And what you do is you mail your records there. They'll take those records and they'll scan them into the system. Here's another thing you need to be aware. Make sure you pay attention to what records that you have that you sent to them. And then when you go to Social Security for your hearing, they're going to give you a CD. Look on that CD and see if it's there. If you know you fax them and you know you mail them, make sure you pay attention and let the court know when you fax them when you mail. So this way they won't be like, oh you bringing it to this now, Well I mailed on

8:32 this day. Here's a copy of it, my certified returna receipt, and make sure somebody signed for it. Here is the fax cover sheet and the barcode plus the facts confirmation I faxed in. I don't know why it's not here. So this way you can make sure the core is aware that you tried to get the records in and they didn't. Under that scenario, if you got the records with you, I would tell you to bring them with you at that point, just to make sure. But if you're one of those people who stop poles records and you want to roll in today in the hearing, don't do that because that's not going to make you a favorite person in now the jedge. I'm just putting it out there, all right. What if I have a doctor I want to see and sometimes he has that physician's

9:09 assistant see me instead, then the position assistant takes over my treatment. Does this count as seeing the doctor? Now? This comes up a lot of time because typically Social Security gives them a lot more weight to a doctor, positions assistants, nurse practitioners, mental health counselors, they're given weight, but just not as much weight as a treating doctor. Now, when asking the question, should you ask to specifically be see by a doctor before you start thugging out and saying I don't want no PA around a thing, I want be a doctor, ask whether or not, and I would speak to doctor first and just say listen, I'm applying for those security and it's my understanding that those security gives a little bit more weight to treating doctors

9:54 than they do to nurse practitioners and positions assistance. Do you review all the docum that the VA that the PA actually does more than likely doctor is going to tell you yes, And in that particular scenario you should be fine because what it means is the physician assistant and they are awesome, and trust me when I tell you they are really good. Usually what happens is that the doctors will go back, take a quick cursory review, make sure and monitor under those scenarios. I wouldn't say is there's not a huge need to actually have them switch throver to a doctor. What I would tell you is this is that if you go into hearing, you make it very clear that you spoke to your doctor, and the doctor says your doctor informed you, that he

10:35 reviews or she reviews all the records of the PA. Because for purposes of Social Security, a treating doctor's opinion is given substantial weight if it's supported by the evidence. A PA was what we call a position assistant an ARMP, which is a registered nurse practitioner. Providers like that are given weight, not as much weight, but they are given weight.

10:58 So treated like this, let's say that the positions assistant gives you a diagnosis and a lot of their things that they say is similar to other doctors as well, then it's going to be given more weight because the evidence supports what they say. So I hope that answer your question. Now, which is more important a doctor an MD or a doctor of osteopathy with regards to treating.

11:21 In terms of the treating doctors, people mddo same thing. As far as social Security is concerned, They're still considered a doctor, so you don't have to worry about that. One someone asked me about their forty two year old mail HIV positive diabetes, high blood pressure, asthma, depression plus severe migraines. Do you have a case all these conditions that have more than fifteen years? Awesome question, because there's two things you need to look at. When Social Security is looking at your case, they're looking at two things.

11:48 After they've determined whether you're working or not, they're going to go to the second part is do you have a severe impairment that's lasted twelve months or more? Now most times and I've had people throw this at me, Oh, I've got this gond shot. I had a fifteen twenty years. Can I look at them and I say, is it long?

12:04 Have you had a condition lasting longer than twelve months? And they're like, well, obviously it's been fifteen years. I said, yeah, that's the first part. The second part is does it impact you to the level of severity that prevents you from working people. I don't mean to be rude. I didn't wearing glasses since I was twelve thirty plus years.

12:22 That doesn't necessarily mean that I'm disabled because of my vision. That high blood pressure since I wasn't home in college doesn't mean that I'm disabled because of it. So don't get wrapped up in the length of time If it's more than twelve months, it's awesome. But what you want to ask the question is that has it been more than twelve months? And it was those medical conditions the reason why you were no longer able to work. That's the important inquiry is how severe is your condition? So the fact that you have fifteen thousand different conditions or you've got a lot of conditions itself, don't pull yourself into believing that the number of conditions and the length of time alone is enough to say, oh, I got

12:58 a case. No, it's whether or not these conditions keep you from working. Because if you've got all these conditions HIV, diabetes, high blood pressure, asthma, depression, ans, severe migraines, but you're working forty hours a week, my answer to you is no, you don't applicates. But if these conditions have kept you from working for more than twelve months or more, then I would then I would say, you know what, roll the dice with an application. Speak to a representative if you haven't, because you might have something there. Final question, if SOID security requires me to have a representative pay, is there anything I can do to prove that I can handle my own money? In most cases, I tell people the hand the biggest thing they look at is

13:37 if you have a doctor that they can clear you. I hate to be the bearer of bad news. If you've handled your money on your own, or you've got people who've helped you out, or you haven't had a problem, it's usually not a big deal. Social Security wants a doc and to be honest, you would probably need to speak to Social Security and ask them do they have somebody?

13:55 If what else you can do to show that you are no longer that you don't need a representative pay they can help you out there. All right, everyone, I hope today was helpful to you. Had a lot of great information, a lot of great questions. Keep them coming. I am attorney Anthony Reids, and this is your Q and a Social Security disability today.