Real life SSI/SSDI claims-have you laughed yet today?

[clousehaus]

Okay, let me preface this by stating that I am not a nurse. I have a dual degree in Psychology and Criminology. I have always had a strong interest in medicine though, so very fittingly, my first job upon graduation was with the State as a Disability Claims Adjudicator. Here are some true stories...

I had a claimant apply because he was of low intelligence. As I'm interviewing him over the phone, he told me that before he applied, he managed to land a job as a cement truck driver. The job worked out well for the first few weeks because the company was sending him to job sites around town, and he was relatively familiar with how to get from point A to point B. His downfall was the day the company sent him to an unfamiliar job site. He somehow managed to get lost with a truck full of cement for an entire day. When he finally manged to get back to the company's headquarters, he was fired on the spot. He ended up as an approval.

I had a claimant apply in part because he was a Transsexual. He had recently been released from prison, and he applied and interviewed for a job at a restaurant and was hired on while dressed as a male. The next day, he showed up to work as a female. He was fired on the spot. We denied him because, well, being a transsexual is not really a qualifying disorder, and his mental problems weren't severe to warrant a grant.

I had an older gentleman apply because his right hand was out of commission due to a congenital birth defect. What prompted him to apply was that he broke his left wrist. When I was talking to him over the phone he shared with me that he went to the ER for the broken wrist, and the doctor came in and told the guy that he wanted to put him in a cast. The claimant stated that he stared at the doctor incredulously and said, "Are you effing kidding me?!?" He ended up being a med-voc grant.

I had a claimant apply because he got bit in the arm by a police dog. We definitely denied this guy.

A fellow adjudicator shared with me one day over coffee break that one of her claimants stated on the application that he, "existed in alternate dimensions." After several unsuccessful attempts to contact the claimant by phone, the adjudicator started to think he was telling the truth.

And last but not least, another adjudicator in my training class was interviewing a claimant by phone, and during the course of the interview, the claimant offered the fact that all of her medical records were in her posession in the form of a CD-ROM. Being a good adjudicator, the girl processing the claim responded by asking the claimant if she could make a copy of the medical records and fax them to our agency. The claimant readily agreed to doing so, and actually followed through. Unfortunately, when she made a copy of her medical records, what she really did was make a photocopy of the CD itself. She promptly faxed the photocopy of the CD to our office with a cover sheet marked as "medical evidence". The adjudicator thought it so classic, she posted the actual fax outside her cubicle to share with everyone.

[clousehaus]

In all my haste, I forgot to mention my story. I was diagnosed at the age of 19 with Major depression and Genralized anxiety. After getting my GED (I was withdrawn from school midway through the senior year), landing a part-time job, and enrolling in a local junior college, I quit my anti-depressant cold turkey because I didn't know any better. I relapsed with the depression when I transferred to a four year institution. I was dropped for poor academic performance by the second quarter at that school. I was highly suicidal at that time. Yes, I myself was on SSDI beginning in about 2004. Well, after many years of therapy, and many hospitalizations later, my treatment team thougth me stable enough that they began encouraging me to go back to school. So, I did. In the winter of my senior year of college, I recieved a notice that SSA was reviewing my disability claim to check for any medical improvement. I was actually offered the job with the state the very same week that SSA informed me that they were going to stop my SSDI payments due to medical improvement.

I always found it ironic that I ended up working as an adjudicator with the same agency that found me disabled many years ago. Unfortunately, the job of an adjudicator is very stressful and is a very, very time sensitive job (i.e. you are expected to close as many claims as you can, as fast as possible as you can). I don't know how other states handle it, but in my state, the probationary period for new hires is 12 months. I managed to make it 11 months before I was overwhelmed by 190 claims on my desk, and in general, just not being able to get things done as fast as the agency wanted.

I am currently looking for another full-time, salaried position, but this economy is really, really, really bad right now (I actually believe we are in a depression). Anyways the point of sharing all of this is if you ever deal with the depressed patient wondering if life ever gets better, I can say from first hand experience that it definitely does.

Thanks for letting me rant a little bit.

[nursefrances, BSN, RN]

[quote name=

I had a claimant apply because he got bit in the arm by a police dog. We definitely denied this guy.

And last but not least, another adjudicator in my training class was interviewing a claimant by phone, and during the course of the interview, the claimant offered the fact that all of her medical records were in her posession in the form of a CD-ROM. Being a good adjudicator, the girl processing the claim responded by asking the claimant if she could make a copy of the medical records and fax them to our agency. The claimant readily agreed to doing so, and actually followed through. Unfortunately, when she made a copy of her medical records, what she really did was make a photocopy of the CD itself. She promptly faxed the photocopy of the CD to our office with a cover sheet marked as "medical evidence". The adjudicator thought it so classic, she posted the actual fax outside her cubicle to share with everyone.[/quote]

Thanks for sharing.

Love the dog bite story, and the copy of the CD cover. Thanks for the laugh.