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Your Benefits and You

Working with Disability Analysts

June 2000

If you recently submitted an application for Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI) or Medi-Cal, your application has been forwarded to one of the state's Disability and Adult Program (DAP) offices.

When your application arrived at DAP, it was assigned to someone called a disability analyst. The disability analyst's job is to obtain and review information about your medical condition, and decide if you are disabled and entitled to benefits.

Case Reviews

Social Security also sometimes performs continuing disability reviews to determine if individuals who are already collecting SSI or SSDI continue to be disabled and eligible for benefits. When a case goes through a full disability review, it will also be sent to DAP for a disability determination.

After your case arrives at DAP, many of you will be sent a letter with instructions to appear at a "consultative medical exam." A consultative exam is typically a physical or psychiatric exam performed by a doctor with whom DAP contracts to help decide if you are disabled.

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The idea of being examined by a "Social Security/Medi-Cal doctor" can be distressing. Questions that commonly arise are: "Why do I need to be examined by their doctor?" "How will a doctor who only sees me once be able to decide I'm disabled?" "What if their doctor is not familiar with HIV/AIDS?"

By taking an active role during this critical portion of the disability determination process, you can increase your chances of being approved for benefits.

Once a Last Resort

Originally, the consultative exam was established to be used as a "last resort" alternative for the disability analyst.

Social Security regulations clearly state that information from your doctor(s) is to be considered the preferred source of evidence used to decide if you are disabled. All efforts to obtain information from your physician are to be exhausted before you are sent for a consultative exam.

The regulations go on to explain that the consultative exam is meant to be used only when your doctor or hospital is not able or willing to provide the disability analyst with necessary medical information, or when the medical record shows conflicting or inconsistent information that cannot be clarified by the medical provider.

Automatic Referrals

Although Social Security/Medi-Cal rules are very clear about use of the consultative exam, there appears to be a growing trend of disability analysts automatically referring HIV/AIDS claimants for consultative exams without first utilizing the medical provider's records/information as the primary source of evidence.

If you receive a letter instructing you to appear at a consultative exam, you have the right to contact your disability analyst and request that your own physician provide any additional information that is needed. Having your own HIV/AIDS physician provide the information usually works to your advantage because your own doctor is usually able to provide more detailed, complete information than an unfamiliar consultative exam doctor with whom you will only meet with for 10 to 20 minutes.

Unfortunately, few claimants are informed of the possible option of having your own doctor provide additional information or perform the consultative exam. In some cases the analyst may have a strong reason why the consultative exam is needed. Even in these cases, it is important to contact the analyst to find out why.

Don't miss out on what could be your one opportunity to provide medical information that could lead to a favorable disability determination, and ultimately, SSDI, SSI or Medi-Cal.

Julie Cross is a public benefits coordinator in AIDS Project Los Angeles' Benefits Department. She can be reached by calling (323) 993-1475 or by e-mail at jcross@APLA.org.


This article has been reprinted at The Body with the permission of AIDS Project Los Angeles (APLA).


  
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This article was provided by AIDS Project Los Angeles. It is a part of the publication Positive Living.
 
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