In early February Kristy Parker* was in an automobile accident that left her with a severe brain injury. A few days later a hospital social worker at Palmetto Richland Hospital helped Kristy’s family file a disability claim.
Kristy’s condition stabilized, but she wasn’t improving. She needed to be moved to an extended care facility to receive proper long-term treatment. The social worker found a place for Kristy, but she couldn’t be moved because her Medicaid and Social Security Disability Insurance (SSDI) had not been established.
Terry Banks of the Columbia DDS.
The social worker called Disability Determination Services (DDS) to follow up on Kristy’s disability claim. She learned from Team Supervisor Terry Banks that additional medical information was needed before a determination could be made about Kristy’s Social Security Insurance (SSI) application.
“When you enter the hospital, once you’re stabilized, it becomes much harder to get updated, current information,” explains Banks. “So what happened is that at some point we began receiving duplicate records from the hospital.”
Because DDS didn’t have current medical records from the hospital that would allow her claim to be approved, “we were in a position where we would have to med defer.”
A medical deferment, or med defer, means that DDS has to place a hold on a claim and give the claimant 90 days to recover. In this case it would mean that Kristy would have to wait an extended period of time before a decision could be made.
So Banks got the social worker, Kristy’s doctor and her family’s legal representatives together and explained exactly what type of information DDS needed in order to make a determination on the claim.
“We needed records showing that Kristy’s current condition would not change over the next 12 months,” said Banks.
“You have to have patience to get all of these individuals together,” says Banks. “We have to understand what each other needs and what rules and regulations are involved so we can take care of the claimant.”
Once the needed information was faxed to DDS, Banks contacted the Social Security Administration (SSA) Field Office Claims Representative on a Thursday to let him know that the application was approved. Because this was a SSI application, the Field Office had to locate a family member to finalize who would be Kristy’s power of attorney and receive and manage her disability checks.
The SSA Claims Representative emailed Banks Friday afternoon that this was completed. Kristy’s family would begin receiving her disability payments and Kristy’s Medicaid eligibility was established.
“I’m just glad we could get the right people together at the right time to make a decision about this claim,” says Banks.
“We rarely know when we make a decision how it helps the claimant,” he adds. “Or their family.”
But this time Banks knew that his actions and those of everyone involved would allow Kristy to be moved from Palmetto Richland to a nursing facility qualified to care for her needs, as well as provide comfort and financial relief to her family.
“The bottom line,” says Banks, “is that sometimes it takes a village. Especially when you’re involved with a claimant who can’t speak for herself.”
* Real name withheld