Note: The SSDI, SSI disability system is federal and nationally standardized, though there are state differences in approval rates, wait times, the number of appeals available–as of the time of this writing–and even the name given to the stage disability agency (DDS, or the Bureau or Division of Disability Determination). Now, to answer the question…
The Social Security Administration operates two disability programs: Social Security Disability, or SSD, and SSI, which stands for supplemental security income, which is need-based.
Though the nonmedical criteria for each program is somewhat different, the medical eligibility criteria for SSD and SSI are exactly the same, with no differences between the two programs whatsoever.
This is exactly why it presents no problem to a disability examiner who is working on a concurrent claim, which means a claim in which a person has an application for Social Security Disability and an application for SSI disability simultaneously.
Note: whether or not a claim will be for SSD, SSI, or concurrent, will be determined at the time of filing at the Social Security office.
To meet the qualifications for disability in North Carolina, you will have to go through an evaluation process that, typically, begins with filing a claim at a local Social Security field office.
Filing a claim in North Carolina
You actually have several options for filing a claim. You can initiate your claim through the Social Security toll free line. You can initiate your claim using the SSA website. Or, you can contact a local Social Security office and arrange to have an appointment date set for a disability application.
The third option is the most preferable.
First of all, Social Security Teleclaims representatives have a fairly bad reputation when it comes to dispensing information. Very often, in fact, they have been known to dispense incorrect information.
Attempting to file a claim through the SSA website presents its own problems. The most pressing is the fact that an SSI claim cannot be filed online. Unfortunately, most individuals will have no way of knowing whether their claim will be for SSD, SSI, or if their claim will be concurrent and will involve both programs. For this reason, it may be best to avoid the online process simply because it may not be the best use of an applicant’s time.
Filing in person, however, will allow a claimant to deliver their information regarding their medical history and work history in detail, and will also allow them the opportunity to ask whatever questions they may have regarding the application and appeal process, as well as questions regarding what to do in specific situations should those situations arise in their case (such as being denied, or attempting work activity while a case is pending, or is being appealed).
Meeting the qualifications for disability
After a disability application is taken at the Social Security office, it is then sent to NC DDS, which stands for North Carolina disability determination services.
Practically as soon as a case arrives at NC DDS, it becomes part of a disability examiner’s caseload.
The examiner’s first task will usually be to look at the file and review the medical treatment sources listed by the claimant at the time of application. The examiner will send out medical record request letters to each doctor, clinic, and hospital listed. After this is done, there will be relatively little for the examiner to do.
However, once the medical records arrive (and this may be several weeks to several months, depending on how fast each medical treatment source responds to request for records), the disability examiner will review them.
What will the disability examiner be looking for in the medical records? They will be looking for objective signs and symptoms, supported by medical observations, lab values, and test results, of your physical or mental functional limitations.
What are functional limitations? Simply the various ways in which your condition, or conditions, restrict your ability to engage in normal daily activities, extending to your ability to engage in work activity.
Examples of functional limitations might include a reduced ability to crouch, bend, reach, grasp, manipulate objects, a reduced ability to lift more than a certain amount of weight, or an inability to sit, stand, or walk longer than a certain amount of time.
A functional limitation might also relate to a decrease in your ability to hear, see, or smell.
Or, of course, it could relate to difficulties you are experiencing in short-term memory, concentration, the ability to learn and retain new information, and even the ability to sufficiently interact with coworkers and supervisors in a work setting.
How your limitations affect your claim
Once your medical records have been reviewed, and your functional limitations have been noted, you will be rated on a functional capacity form. There is a functional capacity form for your physical impairments, and a functional capacity form for your mental impairments.
The ratings you receive on these forms will be compared to whatever types of work you have done in the past to determine a) if you have the ability to go back to one of your past jobs, and b) if you have the ability to do some type of other work.
If your functional limitations limit you enough, and it is determined that you cannot go back to a past job or do some type of other work, then you will be approved for disability benefits in North Carolina.
Proving your case
Obviously, to meet the qualifications for disability, your medical records must show sufficient evidence to prove that you no longer have the ability to perform work activity.
Unfortunately, and this is where some of the difficulty lies in most disability claims, the vast majority of medical records do not contain specific information about a person’s functional limitations.
Quite the contrary, medical records generally contain a diagnosis, current observations–as they are made with each visit to the doctor, hospital, or clinic–and the prognosis for the condition.
Physicians,though, are generally not in the habit of noting the various ways in which a condition restricts an individual’s ability to perform the full range of normal daily activities, including work activities.
This constitutes a major reason as to why the rate of denial at the disability application level inNorth Carolina, or any state, is so very high (typically 70% of initial claims are turned down).
For the majority of NC disability claimants, it will not be possible to be awarded disability benefits until the claimant, or their representative, has been successful in proving that their case meets the requirements for disability.
A hearing is often required, but not always
But, it is not until a case gets to the level of a disability hearing that a claimant, or their representative, can actually actively present a viewpoint–backed up by medical evidence as well as an interpretation of the medical evidence and work history information–of the case to an adjudicator, who, in this case, is a federally appointed administrative law judge, or AL J.
As far as hearing outcomes are concerned, the majority of individuals who appear at hearings in North Carolina will receive a disability award when their case is handled properly, meaning that it is substantiated by detailed evidence, and is supported by the rules and regulations of the Social Security system.
Cases can even be won at the disability application stage, or the reconsideration appeal stage (the first appeal in NC), when the evidence is substantial and a solid case is built.