Are SSI Disability Claims Handled Differently Than Social Security Disability Claims?

SSI disability and Social Security Disability claims are handled differently with regard to non-disability eligibility requirements. For example, SSI disability is a need-based disability program that requires a person to meet income and resource limits.

Social Security claims representatives evaluate income and resources during the disability interview. If the disability claimant meets the SSI income and resource limits, their disability claim is sent to a state disability agency (DDS, or disability determination services) for a medical disability determination.

If their claim is then approved for disability based on a review of their medical records and work history (which would take into account the duties of their past jobs and their work skills in order to determine if they can still employ those skills in some type of work activity), they will have what is known as an "end line interview". The end line interview is performed to make sure the claimant still meets the income and resource limits for the SSI program.

SSD, or Social Security Disability, applicants, on the other hand, are not subject to the same conditions. They must, however, be insured to be eligible for disability benefits. Insured status is earned through work activity prior to the onset of disability -- i.e. when an individual became unable to perform gainful employment (SGA, or substantial gainful activity) because of their disabling condition.

If the applicant has performed enough work activity to be insured for Social Security Disability, their claim will be sent for a disability medical determination.

The medical determination process is the same for both SSI and Social Security Disability claims. Disability applicants for both programs must file an application for disability either by phone or in person at their local Social Security office (currently the online disability application process is only available for SSD, or Social Security Disability, applications, NOT FOR SSI CLAIMS).

During the disability application interview, disability applicants provide information about their medical sources, medication, testing, and work history. Once the disability interview is completed and all necessary forms are signed, the disability claim is sent to the state disability claim processing agency (DDS) for a medical decision. This is where it is assigned to a disability examiner.

The examiner will request medical information provided by the applicant during their disability interview. If the disability examiner determines there is no medical information to gather (meaning a person has not been treated for a condition at all by a qualified medical provider) or there is no current medical information (meaning medical records that are no older than ninety days), the examiner may schedule a CE, or consultative examination.

Note: A CE is a social security medical exam that is performed by a doctor in private practice--this doctor can even be the claimant's own doctor if that doctor agrees to do the CE.

Social Security must have current medical information to make their disability determination. When current information cannot be obtained from the claimant's medical records, consultative examinations are used to provide a current status of an individual's mental or physical impairment. Once the medical records and/or the consultative examination report are in-file, the examiner can make a disability determination (i.e. a decision).

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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