Social Security Disability
I HAVE NEVER FILED
About The Process
As we shared with you in our home page, many Americans don’t really understand the applications and appeals process. These pages will hopefully give you an the simplest terms a semi-detailed overview of what you need to do, and what happens when you file a claim for Social Security disability, or SSI.
You Can’t Be Working
We get calls from people who tell us they’re disabled, and want to file a claim for disability, and they’re still working. The 1st thing you have to understand is if you’re working full-time, irrespective of your medical condition, you can’t be approved for SSDI. In many cases, our clients are working part-time and if the part-time work exceeds the statutory limit ($2,110.00 for 2020) then once again, irrespective of the medical condition you have, you can’t be approved for SSDI.
Some of our would-be clients are working part-time, and they believe if they stay below the statutory limit, they’ll be fine. This may not necessarily be true. While the regulations allow you to deduct what the agency Dobbs: impairment related work expenses from your pay, in some cases, people are staying below that statutory limit by choice, and not by medical condition. If the evaluators believe that you are deliberately staying below the amount but you can work more if you wanted to or tried or had additional job opportunities, then Megan to consider you not disabled.
So first and foremost, you can’t be working and file a claim for Social Security Disability
You Must Have A Serious (Severe) Medical Imparment
The next thing you have to consider is what is the disabling condition, or diagnosis that is keeping you from working. The agency has a definition for this. They call it a severe medically determinable impairment. That’s a lot of gibberish. It’s another bureaucratic acronym. The official SSA definition makes it look easy:
An impairment or combination of impairments that significantly limits the individual’s physical or mental abilities and, as a result, interfere with the individual’s ability to perform basic work activities.
While that seems like a pretty straightforward definition, don’t be fooled. What they mean by a severe impairment is one that’s going to prevent you from doing even the most mundane, dead-end, unskilled job. It’s not a job you can make a living, or feed your family.
The agency will use your doctor’s reports, but more importantly objective medical evidence such as blood work, MRIs, cardiac stress tests, etc. The statements you make on your application, or in the myriad of SSA forms they make you fill out, don’t really mean much to them. They will look primarily at the objective medical evidence in making that determination. Make no mistake, not all diagnoses will qualify, and just about every diagnosis in their books must be to a pretty severe and to a serious degree for SSA to approve your case.
If your disability is a psychiatric one, (click here)
In addition, during the application process at what we called the initial claim stage, the state agency called Disability Determination Services (DDS) will often send you what to what they call a Consultative Exam (CE). This consultative exam is at the government’s expense, and is often a superficial, summary exchange of information with you and a doctor. In fact, many decisions are made after the results of the CE are returned back to the DDS examiner. If you appeal your case to the Reconsideration level, you’ll most likely undergo a 2nd CE with the same results.
Your medical condition must be a severe one.
You File An Initial Claim
In order to start the process, you have to file what the Agency calls an Initial Application (IC). This application is generally filed online, but the original SSA forms can be mailed in to your local SSA Field Office. At SSLG, we help you, and would most certainly recommend hiring us to file this Initial Application. The Application is broken down into 2 parts. The medical portion and the nonmedical earnings portion
The Non-Medical / Earnings Portion
This part of the application process, deals strictly with questions that are not medical-related. These questions ask about the earnings for the current and prior years. Remember, if you’re currently working, they won’t waste their time and resources in taking your application. They will ask whether you’re married or have minor children. If you’re a widow(er). All of these questions impact the amount, type, and links of benefits if you’re approved.
They ask if you’ve worked with the Railroads or receive Worker’s Compensation, etc. These questions are meant to cross reference any additional benefits you may have, or to ensure you’re not receiving payments from another Federal or State program, like welfare. If you are, there is often coordination between these benefits. This means, that if you received food stamps or welfare, you may be required to pay some of that back to the state agencies from your SSA backpay if you’re approved. See the post award section of our website.
If you’re receiving Long-Term Disability, the Agency will want to know this information because earnings figures will start to show up on your work record, and they will think that you’re actually working when those earnings represent employee benefits like sick pay, vacation pay, etc. This part of the application process is pretty straightforward.
The Medical Portion
This part of the application process is much more detailed, and much more important. These questions ask about all the doctors that you’re treating with. They will require the dates, what a particular doctor treats you for, the reason for the treatment, the type of treatment you receive, etc. They will also want to know if you’ve undergone any tests like MRIs, Nerve Conduction Studies etc. They will also ask you to list any medications these doctors prescribed along with dosages, and any side effects these medications may give you.
They will ask the same questions about any hospitalizations you may have gone to. They will want to know whether the hospitalization was an Emergency Room visit, or an inpatient visit, there are detailed questions about this treatment as well. After they finished the medical sources portion, they then ask you about the specifics of your last job or the jobs you’ve had for the last 15 years. They will ask the types of tasks that you performed, how much you lifted, how long you sat etc. These 2 sub portions make up the initial application process.
When you hire the Social Security Law Group, we help you with this Initial Application (both portions). More importantly, our technology captures your answers so that these responses can be used throughout the entire SSDI process and you’re not filling out forms the same government forms asking for the same information 4 or 5 times over. You’ll find our technology incredibly easy to use, and you can update your medical profile continuously during the application and appeal phases.
The Initial Applications
Once your initial application is complete, it gets received by your local field office (FO) will then assigned it to a staffer within the FO called a Claims Representative. (CR) you may receive a phone call from the CR assigned your case asking for additional non-medical information. Occasionally, you may get a call from a Service Representative (SR) was also a member of your local Field Office.
From there, the CR assigned to your case will run some preliminary research into your SSN. They will determine if you have sufficient FICA contributions to qualify for SSDI. If you’re a widow, they will cross reference your deceased spouses SSN to see if you may be eligible for other types of benefits based on your deceased spouses work record. Widows benefits can be complex, so if you are a Widow(er) and have not filed any claim and have questions call us. If you are receiving widows benefits from Social Security, you need to call them.
The claims representative at the field office, may send you additional SSA forms to complete like a work activity report or some other type of nonmedical form that requires you to certify whether you’re working, or answer some tax and earnings related questions that they may have.
Once the field office is satisfied that they have done their preliminary portions, they will forward your claim to the disability determination services (DDS). The DDS is a state agency who will make the medical determination of whether you meet SSA’s definition of disability. Once again, your file will be assigned to a examiner at DDS. He or she is supposed to call us if they need any information, but very often they call you directly which we don’t want them to do. If we representing you, we naturally want you to forward all calls to us and we can attempt to get them the information they need. The DDS examiner is tasked with reaching out to all of the medical sources that you listed on your the medical portion of your application, and their job is to get all the medical records for the dates you specified in your application. The DDS will also send you a myriad and of SSA forms for you to complete. Here are some below:
Work History Report
Completing these forms is critical to their analysis of your disability. As a client of ours, we assist you with these forms and provide guidance as well. As we stated earlier, your DDS examiner will most likely schedule one or more examinations that they call Consultative Exams. These are visits with private practitioners, who wish t make money on the side, and have agreed to perform examinations for Social Security. Some examiners make a living out of strictly doing Social Security exams, so it’s important you’re aware of what these exams entail. We share the results of some of these examinations that we find noteworthy on the private pages of our website which our clients have access to.
Once the DDS examiner has compiled all of the medical evidence that your treating sources have furnished, they perform a task that they call the medical workup. The medical workup is a sheet that describes all of your impairments, the medical sources used, and the recommendations of the examiner. The examiner will then analyze your medical records to determine if your impairment(s) is severe enough to meet what they call a Social Security Listing. The Listings are medical severity determinations that Social Security has defined which if the criteria is met, you are entitled to what they call: Presumptive Disability. If your condition is severe enough to MEET the Listing, it means that absent any evidence to the contrary, your case is approved. We explain the Social Security Listings (MEET or EQUAL) in greater detail in a different section of this website.
The examiner can’t make the determination that your medical condition meets the Listing, only a doctor can. So if the examiner believes your medical condition is severe enough to meet the Listing, he or she will make a recommendation as to which Listing he or she believes your medical condition satisfies. They then send the workup and recommendation to a doctor inside of DDS whose Title is: Medical Advisor.
It’s the Medical Advisor who will make the final call as to whether your condition is severe enough to meet the Listing. The DDS examiner would not send a recommendation that your condition does not meet the listing, only to have the Medical Advisor overturn his or her decision. In order to meet the Listing, the medical condition must be accompanied by specific objective findings and if those findings are not present, then your condition doesn’t meet the Listing and the DDS examiner cannot recommend that your condition be approved on the basis that it meets a Social Security Listing.
If the DDS Examiner does not believe your medical condition is severe enough to meet a Social Security Listing, then he or she will make a recommendation of what they believe is your Residual Functional Capacity. (RFC). A person’s Residual Functional Capacity, is the amount of bandwidth/ability/endurance, etc. that a particular person is capable of, in spite of their medical conditions. For example, the DDS Examiner may make the determination that you cannot perform your past work which was considered light, but is of the opinion that you can perform sedentary work. As a result, he or she would make a recommendation to the Medical Advisor that you have the residual functional capacity for sedentary work.
Once the workup is delivered to the Medical Advisor, he or she, a doctor, will either agree that the medical condition is severe enough to meet the requirements of a particular Social Security Listing and certify that finding, and approve your case. If your condition does not meet the Listing, the Medical Advisor will then agree or disagree with the Residual Functional Capacity recommendation of the DDS examiner. On occasion, the Medical Advisor may not agree with the DDS Examiner’s opinion, and send the case back to he/she for further workup or additional workup.
If the Medical Advisor agrees with the DDS Examiner in that you have the Residual Functional Capacity for other work, the Medical Advisor will make that certification, and the DDS will deny your claim. The official terminology within DDS is that your claim has been: closed. When your claim has been closed, that means they have made a decision, and responsibility for sending out the decision is kicked back to the local field office, and the claims representative at your local field office. In reality, a computer generates all these notices and their mailed to you.
When they deny your claim, they will send you a Notice of Decision which will list the treatment sources that they obtained, any Consultative Exams you may have attended, and then provide a brief, very lame rationale for why they denied your claim at the Initial Application stage.
That stated, if after their initial workup the DDS Examiner believes that you your condition doesn’t meet a Listing but you don’t maintain the Residual Functional Capacity for any sedentary work, he/she is authorized under the regulations to make that recommendation to the Medical Advisor as well. This recommendation means that the DDS examiner believes that you are disabled and meet the definition under Social Security regulations.
The medical advisor would review the recommendation of the DDS Examiner and agree that your impairment while not severe enough to meet the Listing, is severe enough to prevent you from performing those unskilled sedentary jobs that we keep talking about and approve the claim.
Wait a minute. Just when you thought your case was approved, you may find yourself in front of one more set of rolling logs that you need to outmaneuver to get to the other side of the river. The Social Security Administration calls it: Quality Control. We call it one last attempt to cheat you out of your past-due benefits, and SSA backpay. It used to be called: Disability Quality Branch (DQB). It is now called: Quality Determination Review (QDR).
The QDR is not a branch of DDS, but rather a branch of the Social Security Administration. The QDR staff are examiners who are Social Security employees. They review favorable Initial and Reconsideration decisions to ensure that their claims procedures are being followed, and the claims DDS Examiners are approving, and ones they want them to. The QDR has the authority to agree with the DDS recommendation and send your claim into pay.
They also have the authority to return your favorable decision back to DDS for further evaluation. And unfortunately when this happens, they will often change the date of your disability which will result in a dramatic decrease in your backpay and past-due benefits. Finally, QDR can order your favorable decision be returned to DDS and be overturned into a denial.
Still think you can do this on your own?
You will know that your case was a victim of the QDR process if you get a notice in the mail whose first sentence reads:
You will know that your case was a victim of the QDR process if you get a notice in the mail whose first sentence reads:
If you keep reading, you’ll see that you were cheated out of past-due benefits and your date of disability.
If after this entire process, your claim is finally approved, they will once again Close the claim, and DDS will send it back to the Field Office. From there, the Field Office personnel make some computer entries, and the award process is pretty much automated. If you’re approved, you’ll receive a document from Social Security called a Notice of Award. The Notice of Award will break down your award figures, start date for disability, and other post award information.
Statistically, the SSA approves about 35% of claims at the Initial Application level. Don’t chance it and try this on your own, call the Social Security Law Group today.
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