To Apply For SSI or SSD Disability Benefits, Where do I Start?

Recently, an individual posted this statement in a Social Security Disability forum. "I need to apply for SSI or SSD but I do not know where to start, I have no medical insurance or anything'I do not even have enough money to pay for the medication that the clinic gives me."

This should not stop anyone from filing for disability benefits with the Social Security Administration. Social Security has two disability programs that can help individuals who have become unable to work due to a disabling condition. Both Social Security Disability (SSD) and Supplemental Security Income disability (SSI) have the same application process, as well as the same medical disability evaluation process.

So where does an individual start? All disability applicants must first file an application with Social Security. At the time of their disability interview, a Social Security claims representative will evaluate their case to determine if they might be eligible for SSD, SSI, or both programs.

Once the claims representative, or CR, gathers all of an individual's medical information and work history they send the disability claim along with all necessary disability forms to a state disability agency for a medical determination. This agency is known in most states as DDS, or disability determination services and it is here that that claims are assigned to disability examiners for decision processing.

While it is better for an individual to have a medical treatment history, it is not necessary for a disability determination strictly from a Social Security standpoint. Social Security basically needs to have a current medical status of an individual's medical and/or mental condition and how the impairment or impairments are affecting their ability to function.

Social Security Disability is based upon residual functional capacity rather than specific conditions. Disability examiners use a standardized disability evaluation handbook that contains impairment listings for all body systems that include the medical evidence and limitations needed to meet or equal an impairment listing.

If a disability examiner determines that the applicant does not have enough current medical information to make a disability determination, they have to obtain that information through a consultative examination, or possibly several consultative examinations. Consultative examinations are performed by physicians who are paid by Social Security to give them a status of an individual's current medical and/or mental condition.

And while these examinations give the disability examiner what they need for their disability decision, they are not meant to be any kind to treatment for the disability applicant and, for that matter, they generally do not lead to an approval of disability benefits for the applicant.

This is why it is always advisable to have some type of medical treatment records to support a disability claim, even if it is just hospital or medical clinic notes. At least these physicians have spent more than a couple of minutes with the disability applicant and may have had objective medical testing done.

That being said, consultative examinations are better than no medical information at all. Sometimes they do lead to an approval of disability benefits and these examinations do provide medical information for an applicant's disability case should they decide to appeal their claim.

Once the disability examiner gets enough current medical and functional information (usually obtained from questionnaires completed by the applicant and the person they have listed as their third party contact), they can determine if an individual meets or equals an impairment listing.

If they do not, the disability examiner must consider if the disability applicant is able to perform any of their past work, or if they are capable of performing any other kind of work in the general economy considering their residual functional capacity (i.e. what they can still do physically or mentally), education, age, and work history. If they are not able to perform any work due to the restrictiveness of their disabling conditions, they may be found disabled.

Now, back to the above individual's specific situation. This individual does appear to have some medical information from the clinic they are receiving medical treatment from, even if they cannot afford their medication. These clinic notes will mostly likely mention what medications the individual should be taking and the clinic doctors have at least spent some time with the disability applicant--which is better for their disability case than the opinion of a consultative examination doctor who has never treated them and has only spent ten minutes with them.

The most important point to remember is that if an individual is not able to work because of a disabling condition, they should file for disability even if they have very little or no medical information. Even if they are denied initially, the odds of being approved are good if a disability applicant follows the Social Security Disability appeal process to the point of having an administrative law judge disability hearing.

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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