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New to the forum need some advice for SSDI

tabbygirl26ttabbygirl26 Posts: 3
edited 06/11/2012 - 7:24 AM in Health Insurance Issues
Hello Everyone,

I am new to this foruum. I just thought I would give this a try was impressed with this site. I was just hoping somebody has dealtt with something similar in the disabilty process. I have had back pain since my adolscence. I went 2 years ago for MRI's because I could no longer endure the pain. A neurosurgeon told me I have spondylolithesis from birth. I have the pars defect. I was also diagnosed with a spinal cord disease. I have had 2 spinal fusion surgeries at L5 S1 in 2007. I have also had my disc removed at this level and have had a laminectomy. I am almost 1 year post op and I am in more pain than I ever was. I applied for disabilty in April of 2008. I was having high hopes until august of this year my claim was in QA for needing more medical records. I helped the determination examiner in obtaining those medical records. She called me in september and said she was forwarding my stuff to the doctor and that I would hear something on my claim. I called last week and she told me my claim was still in QA in their office. She told me to call in another week and hopefully it will get to my satellite office in my city for my determination letter. I called yesterday my claim is up for review again out of their office. She said it is a secret office and she has no information on why it is in QA . I could call back every week or every other week to see if it is still in that office. She said after it leaves there it will go to my office for a decision. She told me this does not happen often. Has anyone ever experienced anything like this. I hope it is not a denial. Any feedback would be helpful. Thank you !!!



  • I worked for the disability office for 11 years (I know - big whoop!).

    The QA section is of course, the Quality Assurance section. They make sure the I's are dotted, and cross those T's. They make sure policy and procedure are followed. USUALLY, if the QA section asks for more information, it's because an allowance on your claim has been proposed. The additional information may have been needed to either support that proposal, or to verify the date you became disabled.

    If it went to a "secret office" - and that secret office is QA, then they are either training the disability examiner, or disagree with something in the file. IF the "secret office" is offsite, that may be the Headquarters in Dallas. When the disability office approves claims, files are randomly chosen to go to Dallas for review. This is just their way of being sure the disability personnel are doing their jobs correctly. One of 3 things could happen: They may disagree with the decision and send it back to the disability office for further processing. 2) They may agree you are disabled, but disagree on the date. If they can't find you disabled on the date you say you became disabled, then this is known as a Less than Fully Favorable decision and further processing is needed to verify the date of onset. OR 3) They will agree fully with the decision and send your file to your local office for processing payments (this is of course called a Fully Favorable Decision).

    The reason the disability office did not tell you all this is because lots of times a claim is approved, but Dallas disagrees. Then the disability examiner has to call the claimant and give them the bad/contradictory news, the claimant gets upset (understandably so) and there's hell to pay somewhere down the line.

    BUT, if anyone asks, you didn't hear this from me, no! :SS

    SO, I said all that to say this: it's too early to tell yet, until QA or Dallas makes their decision (depending on which office your file is). Your best bet is to do like you are doing and contact the office weekly. Tuesdays and Wednesdays are usually good days to call. They have a quota in the number of claims processed/decisions made each week and the cut off day for tallying purposes is Thursday afternoon - in other words, Wednesday afternoons and all day Thursdays is a very busy period.

    Best of luck to you!!!! I hope I am not getting your hopes up for nothing and that your claim is approved.

  • I can say no more. The best disability advice and info that you will find here will come from jeaux. Good luck and keep us posted.
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    Thanks again for welcoming me and I wish you the best with everything. I am glad that everyone here is willing to help. take care and I will let you all know what I come up with. :)
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