|
||||||||||||||||||||||
|
Business Guide
Lesson
Three Introduction: In this lesson, we'll concentrate on the steps involved in the initial acceptance of a client's disability case. We'll begin this lesson with certain assumptions. First, let's assume that you have already structured your company and you're receiving inquiries from potential clients. You are utilizing an answering machine, voice mail or an answering service to capture your customer calls because you still have a full-time job.
You have just received a call from an individual responding to your company's ad offering disability advocacy services. The caller indicates an interest in applying for Social Security disability benefits. However, the customer also wants to know what his chances would be if he applies for benefits.
You would start by explaining your service to the customer. Put the customer's mind at ease by letting him know that you are not after a sale. Tell the customer a little about your company and how the disability process works. Maintain the flow of the communication by asking his permission to probe more deeply into his case. If he refuses, explain the need for honesty and frankness, then end the conversation without performing a case assessment. If the customer is cooperative, then move the conversation forward by asking these important interview questions:
The list of interview questions above are the most important questions you can ask in the early stages of disability case. These questions enable you to determine if the client has an impairment that is serious enough to meet Social Security's definition of a total disability. These interview questions also allow you to determine the most likely onset of the claimant impairment and whether the claimant is being treated for this condition on a regular basis. An impairment that is not medically documented is of no use to you or the claimant. It is also important to know if and how the claimant's impairment limits him physically and/or mentally. If the customer's impairment is having no limiting affect on the claimant, then the impairment is by definition not disabling. Next, you can refine your knowledge of the claimant's impairment by asking the claimant how the impairment prevents work. If the impairment does not prevent work, it is by definition, not disabling. If the claimant has a serious impairment that does cause limitations, but he continues to work, then you must determine if he is working under special conditions.
If a person is employed in a special working environment that if not present would prevent him from working, that person is said to be working under special circumstances. Social Security cannot deny a person back to a past job that was performed under special circumstances making it easier to rule out this past work. The interview questions listed above also enable you to make a guess as to what kind of case this might be. If the claimant has never worked or has not worked for many years, the case will probably be of the SSI case type. If there were sporadic or inconsistent periods of work, the case could probably be both an SSI and SSDI (concurrent). If the claimant has a strong and consistent work history, the case will probably be an SSDI claim. SSDI claims are preferred because they generate the highest fees for advocates. Case type approximation can be further refined by asking the claimant questions about his current assets. For example, if the claimant has no current assets and has not worked in years, you're probably dealing with an SSI claim. If the claimant has assets and has a descent work history, you’re probably dealing with an SSDI claim. Approximating a case type enables the disability advocate to determine the potential worth of a case. Keep in mind that only Social Security can determine the exact case type. However, approximating a case type at the outset of a case gives you an excuse to continue pursuing the case until you know for sure. The pain questions asked in the interview list above are also important. Pain is one of the most useful tools in an advocate’s arsenal of strategic weapons. If properly argued, pain can be used to significantly reduce a claimant's perceived Residual Functional Capacity (RFC). The lower the perceived RFC, the more likely you will win the case. The incarceration and
crime questions are also important because clients with criminal histories
can be trouble. Not only are you dealing with a person of questionable
morality, criminal applicants are not paid for impairment time that
pasted while he/she was in prison. Generally, if a person has been
incarcerated during their impairment period, disregard the case. The Case Assessment Process: Disability Associates developed the case assessment process over an eleven year period. We have found the assessment process to be useful in further determining the quality of a Social Security disability case. The assessment process is deceptively simple. On the surface, it appears that all you're doing is asking a series of questions. In reality, each assessment question is carefully weighed to determine its possible influence on the outcome of the case. Recently, we noticed one of our competitors attempting to offer what he calls case probability software. The probability that this software will be useful to an advocate is zero. Our Navigator software contains custom algorithms that are required to accurately predict a specific case outcome. Unless this company directly copied our software, the likelihood of him creating an equally effective assessment tool is extremely low. It takes many years to develop the skills required to accurately assess a disability case. It takes many more years to translate that experience into an effective software tool.
You perform a case assessment to determine the approximate percent chance of winning the case. Since a disability advocate is only paid for the cases he wins, it makes good sense to use every tool at your disposal to increase your odds for success. If you do not have our Case Assessment Navigator software, you can use the sample case assessment form below to perform a manual assessment:
The Manual Assessment: If a manual assessment is performed, expect to spend several hours making this acceptance determination. If you perform a manual assessment, be sure to review at least one piece of the claimant's medical evidence. This action will help to verify the strength and validity of the claimant's primary allegations, helping you to make a better decision to accept or reject the case. Until you are experienced in this field, your manual assessment will be considerably less accurate than those performed using the Navigator software. However, the more manual assessments you perform, the better at it you will become.
If you have purchased our Case Assessment Navigator software, you will not need the assessment form provided above. The Navigator allows you perform a full case assessment within minutes without the need to request medical evidence. Keep in mind that the claimant could be lying to you during an assessment. If you accept a case and determine later that the claimant was untruthful, you can use the claimant's dishonesty as the reason for a unilateral termination of the representational contract.
Begin your assessment by explaining to the customer the reason for asking the case assessment questions. Request that the claimant be candid in his answers. Make sure he understands the consequences of being dishonest with you or the Social Security Administration. Next, allow the claimant a brief period to discuss his answers if he seems to need to do so. During the claimant's narrative, there will be ample opportunity for you to inject questions covered in the case assessment process. There is also a marketing aspect to the case assessment process. Once the claimant discovers that you are rating him instead of him rating you, you’ll note a change in the claimant’s attitude. When this perceptive switch occurs, the claimant may unknowingly try and meet your standards for acceptance. This will psychologically bond the customer to your service. People will do almost anything to avoid rejection. The case assessment process if used properly can actually motivate the client into signing up with your firm because you see the value and righteousness in his case.
Clients who contact you for assistance will fall into one of three case categories. These categories are: a. Have never applied for disability benefits before. b. Have applied and either received no decision or a denial. c. Have applied and is now on appeal. a) Client has never applied for benefits: When a client who has never applied contacts an advocate disability help, this places the advocate in an uncomfortable position. Even if the case sounds strong, you’re still in a position of trying to determine the quality of a case without access to the client’s records. You also know that by accepting a case on a person who has never applied before, you’re in for a lot of case development work which may not result in an allowance determination. At the initial application level, you can expect a denial rate of up to seventy percent. To counter this nonproductive workload low potential profit situation, most advocates avoid initial cases altogether. There is nothing wrong with avoiding initial cases if and only if you reject them in a way that eventually works to the financial benefit of your service. Here is one of the most effective methods you can use to process cases at the initial application level: 1. Interview and assess the case as usual. 2. Regardless of the assessment score, encourage the client to go ahead and make application for benefits on his own. If the claimant has a strong case and he insist of representation, consider using the advance fee approach in an SSDI claim. 3. Tell the client that you would like SSA to make a decision at least once before you officially enter the case. Also tell the client that you will provide him with case guidance through the initial application level at no charge. If the case is denied, you will step in as the client’s authorized representative and move to save the day. Claimant’s love this approach! It is also useful when you get really busy and cannot take on new cases right away. 4. Although you want to direct the client at the initial level, you do not want to work for the client at zero pay. Therefore, your guidance must be mostly hands-off and indirect. You deliver this level of guidance in the form of what we call a Guidance Packet. b) Client has applied, but has not received a decision: Approach this case in
exactly the same way that you would approach a case on someone who has never
applied. Send your Guidance Packet and instruct the client to collect
copies of all evidence of record. If you accept the case on appeal, you'll
need a copy of the client's evidence. Tell the claimant that this request
is in preparation of representation if Social Security turns them down. If the client's case has merit, you may immediately become the client's authorized representative in this circumstance. The guidance approach is not required at any of the appeal levels.
The purpose of our Guidance Packet is two fold. First, the Guidance Packet directs the client in the application for Social Security disability benefits. It tells the client how to prepare his case and what to expect from the disability process. The Guidance Packet is also a marketing kit for your advocacy service. The suggestions you provide in the Packet should lead the client directly back to your doorstep if the case is denied. Our Guidance Packet approach has proven itself to be one of the most effective operational techniques you can use to assure the long term growth of your advocacy service.
The Guidance Packet can of course contain anything you’d like. However, at minimum, we suggest that your Guidance Packet contain these items:
It is important that you present the Guidance Packet as part of your “Guidance Support Program” for clients who are applying for benefits for the first time. Make sure that the client knows that the Guidance Program is free and is not actual representation. The client must also be informed that you are not going to act on the case unless an initial denial of benefits is made. If the client has followed your instructions in the Guidance Packet, you’ll be ready to spring into action on his behalf the moment he receives his denial notice. Using our Guidance Packet approach for initial cases makes the client feel that you’ll be there for him in the event his case is rejected by Social Security. This approach forms a lasting bond between you and the client that will all but assure that he will sign-on if the case is denied. He knows that if he becomes a member of your “Guidance Program” he’ll have free and continuous access to serious help if his case is denied. This is not only reassuring to the client, it is also good business for your service.
Include a brochure that explains your Guidance Program and your basic services. Be sure to mention that services are free until the case is won. Also explain your basic fees and when the fees are due. Do not send a contract or the fee petition form yet!
List the contents of the guidance packet and explain what to do with each element within the packet. Do not have the client sign and return any forms until you officially accept the case. You can still provide the client with such forms as the SSA Form 1696 Appointment of Representative form and the medical release form for later signing by the client if you wish.
It is important that you explain the disability process in lay-terms to the client. Tell him what to expect and exactly what he should do if Social Security denies his case at the initial level. It is extremely important to the effectiveness of the Guidance approach that you provide the client with a convenient method of signing on when his case is denied. Doing this will significantly increase the number of denied client’s seeking your assistance after being denied benefits.
By creating a follow-up and communication schedule with the potential client, you are acting to remind the client of your availability should the case be denied. We recommend a contact level of once every four too six weeks during the initial processing period.
Most clients will contact your office by phone. If your company is using our Case Assessment Navigator marketing approach, the client will be seeking a free case assessment to determine his chances of receiving Social Security disability benefits. This is your opportunity to:
The above approach describes how we handle our first customer contacts. Please note that the above customer contact approach and schedule is a suggestion. You may organize and execute your first customer contacts in any way you like. We will discuss other aspects of customer contact in the next lesson.
An Information Packet is a collection of materials used to formally sign up a client for your service. As with most other service businesses, a disability advocate must formulate a formal business relationship with a client before he/she can begin the work. A formal business relationship is created by having the client sign various forms and agreements that explain the terms of the business relationship. An information packet usually contains:
You may add anything to the Information Packet that you feel will help and encourage the client to complete and return the packet. The forms within the packet, including your contract, must be signed by the client you intend to represent. You cannot begin your activity as the client's advocate until the appropriate forms with signature have been received and forwarded to Social Security.
Once you have received the Information Packet from the client, you're ready to begin the process of becoming the client's authorized representative. You become the client's authorized representative by filing certain forms with Social Security. These forms include, but are not limited to:
The Cover letter to Social Security should clearly state who you are and what your relationship is to the client. You may need to include the client's Social Security number, so make sure that the materials are sent via certified mail to the District Office that will handle the client's case. Once these materials are received by Social Security, you become the clients authorized representative. Do not expect a formal acknowledgement by Social Security indicating that you have been accepted as the client's authorized representative. If you don't hear otherwise, you can usually assume that you have been listed as the client's representative at the Social Security office. However, if you’re in doubt, there will be other opportunities to check on your representative status during the processing of the case. If there is a problem with your representative status,
Social Security will usually inform you of the problem in writing. It is
also possible that Social Security will contact you requesting additional
information about the case. Follow Social Security's instructions and keep
the client informed of your actions. Without intending to be redundant, I believe this is a good time to revisit those action steps required in signing on or contracting with a client for representative services.
Schedule a second phone call or face-to-face interview with a good candidate after the Information packet has been returned. If the claimant has not returned the packet, call the claimant with a reminder to return materials. This second interview can occur at anytime after the client has returns the information packet. If the information packet doesn't contain medical records or medical source contact information, you can use the second interview to acquire this information. If you send copies of a Social Security form that requested medical source information, when the form is returned to you, you have the source information you need. Of course, you may also solicit medical source information from the client by phone.
After formally becoming the client's representative, it's time to begin developing the client's case. Case development is nothing more that the act of requesting copies of the claimant's relevant medical documentation. All applicants for Social Security disability benefits are claiming to be totally disabled and unable to continue working. However, in order to receive benefits, the client must prove that he/she is totally disabled. It is your job as the client's representative, to make the case that the client is indeed totally disabled and unable to sustain work. Before you can create an argument in support of the client's condition, you must have medical and vocational proof supporting both the existence and limiting affects of the client's condition.
Once you have received the signed, dated and completed forms along with a check for the development fee, you're ready to begin the development phase of case processing. In the case development phase, you are requesting and collecting copies of the claimant's medical and vocational evidence. You need the client's medical evidence in order to perform a case evaluation later in the process. Sometimes, you can extract most of the client's medical source information via a phone contact.
1. Identify all relevant medical evidence pertaining to the primary and secondary impairments. 2. Send a request along with a signed medical release form to the medical source. 3. Include evidence dates and briefly explain any specific request. 4. If requesting information from Social Security, a release form is not required. However, you may want to send a copy of the signed SSA Form 1696 so that the Examiner knows he is working with the authorized representative. 5. Use the ACM Pro or place your evidence in a single client folder for later evaluation. Be sure to store client records in a secure file. Over the life of a case, there will be times when you’ll need to go back and request new or additional evidence. The process for requesting new or additional evidence is exactly the same as requesting evidence at any other time in the disability process.
Also, it’s a good idea to explain the application process to the claimant. The more the claimant understands about the disability process, the less the chance for later misunderstandings. If the claimant has a mental disorder or is a dependent, handle the case through a third party.
The trick to effective case development is learning when to stop the process. It can take years of experience to really know when you have enough evidence to create an effective argument on behalf of a client. However, there are a few considerations that can help you to become a better case developer. Here are just few:
The period of disability is usually from the onset of the claimant's impairment to the most current date. However, the onset date can also be the date that the claimant's condition forced him/her to stop or alter work activity. Altering work implies that either the amount of time spent on the job is significantly reduced or the way in which the job is performed has been altered to accommodate the worker. If special conditions are created in order to allow a person to continue working, Social Security refers to this as a special circumstance. Social Security cannot deny a person back to a past job where he/she was given special accommodations to perform the work.
If your client alleges a total disability as a result of heart disease, it would make little sense to request medical evidence about his vision. Usually when a person applies for Social Security disability benefits, he/she will allege a primary diagnosis and secondary diagnosis. The primary diagnosis is the disease or injury that is preventing the client from performing work and has resulted in the need to apply for disability benefits. The claimant may also have a secondary diagnosis. The secondary diagnosis is the second worse condition suffered by the claimant. Hopefully, the secondary diagnosis will also cause limitations in the claimant’s ability to work. If there are limitations resulting from both diagnosis, Social Security must combine the affects of both disorders in determining the claimant’s proposed RFC. Combining the affects of two or more disorders helps an advocate to further reduce the claimant’s perceived RFC. Combining disorders also makes it easier to argue that the claimant is unable to perform work. A proposed RFC is the RFC created by Social Security. The perceived RFC is the RFC created by the advocate. If your perceived RFC is consistently backed by the claimant’s medical evidence, Social Security may accept the perceived RFC and allow benefits. By using the primary and secondary diagnosis to reduce the claimant's RFC, you are in affect providing a quantitative analysis of the reasons why the claimant can no longer perform work.
If your client is suffering from heart disease, request evidence specific to his heart condition. For example, Cardiologist examination, hospital summary reports, surgical summary reports, laboratory test, heart test and chest x-ray reports would all be relevant for a claimant with heart disease. However, a Chiropractic report would not be specific or relevant to a claimant alleging heart disease. Once you've received a copy of the claimant's medical and vocational evidence, it's time to begin the case evaluation process. For more information about medical evidence and how it is used in the disability process, see Lesson 4 of the Study Guide.
After collecting the claimant's medical and vocational evidence, you're ready to begin the case evaluation process. We have already covered many of the details involved in this process in lesson six of the Study Guide. However, information associated with a case evaluation is well worth repeating. In a case evaluation, you must:
1. Review the medical evidence to identify key issues that will support
your
2. Be prepared to discuss how the limitations caused by the impairment
3. Then show how the limitations also prevent the claimant from
doing other
4. Summarize your argument and request that Social Security grant an
5. Submit the argument to Social Security and ask that it be made part of
the 6. Retain a copy of your
argument. Optionally, you can also send the claimant
We strongly suggest that you place your own letterhead on correspondence to your clients, Social Security or medical sources. You may use your letterhead on all correspondence, with the exception of any Social Security forms or official government documents. Government forms are in the public domain, so placing your letter head on such a form would be inappropriate.
As a new advocate, you want to improve your chances of enjoying early wins.
You can improve your chances of early wins by using our Navigator software
for assessments. We suggest that you also start with cases with assessment
scores above seventy. As you gain experience, you can lower this score to
sixty and still win the majority of the cases you represent. If you
experience early losses, keep me in mind. When I first started, I lost the
first nine cases I represented. I was so depressed that I almost quit the
business. Thank God I didn’t! I keep struggling along until I tasted my
first win. It was one of the best days of my life. On Rejecting a Case: If the claimant's case is weak, tell him why in laymen's terms. Send the claimant a kind rejection letter encouraging him to contact you if his condition worsens. You should create your rejection letter ahead of time and use the same letter for all rejections. If possible, build a database of rejected clients. This approach allows you to build a database of potential cases that are not yet ready for representation. Use this list to do follow-up calls if your service slows down. This approach also makes your service appear to be serving the needs of even those you have rejected, making for good public relations. The practice of maintaining contact with rejected claimants can significantly energize your company down the road. If the claimant's condition worsens, he will remember your kind concern and ask for your assistance again. This follow-up assessment approach represents high quality community based marketing!
In lesson four, we'll discuss that all-important first interaction between a disability advocate and the Social Security Administration. ********************
|
|
