A Short Checklist for Filing A Disability Claim Under SSI or SSD

If you are considering filing for Social Security Disability (SSD), also known as Supplemental Security Disability Insurance (SSDI), then you may be wondering if you qualify for disability, or even how to go about filing for disability in the first place.

Are you currently working, and at what level?

If you have worked enough to qualify for SSD aka SSDI via paying a certain amount into the system through FICA taxes deducted from your paycheck--and, granted, you may not know the answer to this question--then the next step is to consider your gross monthly earnings to see if you would even be permitted to file a claim and have it reviewed by a disability examiner.

So, are you still employed? If so, the fact that you are working does not necessarily preclude you from collecting disability. It all depends on what you make each month.

If you make less than what the Social Security Administration (SSA) considers to be substantial gainful activity, then you may qualify for disability, depending on what your medical records have to say about your impairment.

The substantial gainful activity (SGA) amount is set by SSA each year according to the price/wage index. If you earn more than this amount each month, you are not eligible for disability benefits, regardless of the severity of your impairment.

Have you received documented treatment for your condition or conditions?

Assuming you make less than the SGA amount each month, your next question should be, do I have a solid medical history (and ideally this means medical records from your treating physician) that backs up my claim for disability?

Even if you feel you do have the medical evidence needed, you should check with your treating physician to see if he or she is willing to support you in your disability application.

Unfortunately, many doctors do not wish to become involved with disability cases, for whatever reason (paperwork, an ideological belief that there should be no government handouts, etc.).

Of course, it's always better to be upfront with these matters--'there is too much at stake to tip-toe around. If your physician is not receptive to your bid for disability, you may wish to consider seeking treatment elsewhere, at least from a physician who is receptive to the fact that you have a condition that has limited you in your ability to work at a substantial and gainful elvel.

It is inconvenient, yes, but it may ultimately be in your best interest if you are truly in need of financial relief as a result of a physical or mental impairment.

Getting a list of your treatment sources together

Because all disability decisions are based upon information contained in your medical records, you should begin compiling a complete medical history as soon as you begin to contemplate filing for disability. Be sure to include up-to-date contact information for all medical sources at which you have received treatment for your disability, including visits to urgent care or the hospital ER.

Disability examiners, who work for your state disability determination services (DDS) agency and decide all initial applications and first appeals for the SSA, base their decisions on what is documented in your medical records.

Medical records must go far back enough in time to establish the onset of your disability. Proving the earliest possible onset date will impact how much you may receive in back pay. It may also help in eliminating the medicare waiting period of 24 months if you are awarded SSD (SSI comes with medicaid, not medicare). Medical records must also contain some recent information so that SSA can establish that you are "currently" disabled. Without recent documentation, you cannot be approved.

Without access to pertinent medical records, the examiner will not have a true picture of either your medical condition or the limitations it places upon your ability to work. This is why the medical history that you include with your initial disability application is so important, and why it pays to be accurate when it comes to listing contact information.

There have been many disability claims that are denied simply because the disability examiner was not able to recover enough medical documentation to allow him to render a decision on a claim.

It bears repeating that SSD and SSI are not awarded to those who are demonstrably physically (or mentally) impaired, but to those who are able to demonstrate that their impairment prevents them from earning the SGA amount at their current job, past job, or any other work to which they may be suited.

To make this determination, a disability examiner (or a judge at a hearing if the case has gone that far) must have records that allow them to determine to what extent a person is physically or mentally limited.

Getting your work history information written down

Thus, if you are filing for disability, your work history should be as complete as possible. Just as with the medical history, include correct contact information for present and past supervisors (any job held within the past 15 years) whenever possible, and list not only job titles but duties associated with those titles. In this way you spell out for the disability examiner your job skills, rather than allowing the examiner to assume that you know how to do things that you do not.

There is a fair chance that you will probably be asked for a copy of you work history more than once, so always keep an extra copy on hand.

In fact, you should keep a copy on hand of everything you send to the SSA in case it gets lost in the mail (or on someone's desk). This could save you considerable time and frustration in the future.

Filing online versus at a Social Security office

SSDI (aka SSD) applications may be filed online; however, it is usually best to speak with your local Social Security office in person. Just about everyone new to filing claims for disability has some questions, and these are best (and most promptly) answered by a knowledgeable claims representative.

However, there are other strongly important reasons for using an SSA field office:

1. SSI claims cannot be filed online. SSI claims require more investigation into a person's income and resources and therefore a live-interview must be conducted. Why is this a concern? Even if you are convinced that you are eligible for SSD via your work earnings, it is still true that a very large percentage of disability claims are, in fact, "concurrent", meaning that they involve both SSD and SSI.

Unfortunately, most individuals will have no idea as to whether their claim will be for SSD, SSI, or both SSD AND SSI. Translation: attempting to file online may simply not be the most productive use of your time.

2. Disability claims that are taken online are sometimes quickly denied because...if the Social Security office has a question about the information you have submitted and they have even a little difficulty contacting you to resolve the discrepancy, they are empowered to send you a close-out letter. Again, this is a very compelling reason to simply file at a local office.

If you have retained a disability attorney or non-attorney representative, you can ask him or her to file your claim for disability for you. True, there are some disability representatives who will not take a case until the initial application and first appeal (request for reconsideration) are denied.

However, increasingly, disability representatives take cases at all levels of the system (after a disability application denial, just prior to a request for hearing, and even before the initial claim has been formally filed). And in some instances a representative may be able to win a case without the need for a hearing.

This occurs more frequently, as of late, when cases have been remanded back from a judge (to a disability examiner) because the judge has concluded that the case evidence leans strongly toward an approval.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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