How to Claim Disability Benefits through Social Security

If you have a medical disability that is so severe that it prevents you from performing normal daily activities including substantial work activity, you may qualify for disability benefits.

In order to determine if you are eligible for benefits under SSD or SSI (the program you file under will be determined at the time of application), you first must contact Social Security to initiate a claim for disability. You can do this online, or by contacting a local social security office and arranging for either an in-person disability application interview, or by arranging to have a telephone interview conducted by a field office claims representative.

While the online process may seem simpler, in actuality it saves no processing time on a case. Additionally, the online process does not allow claimants to ask important questions about filing their claim.

And, finally, the online process does not allow an SSI claim to be taken with a protected filing date, which is very important when one considers that SSI disability back pay is determined from the date of the SSI application.

Regarding the two disability programs operated by the Social Security Administration--Social Security Disability and Supplemental Security Income (SSI) disability--some disability applicants will meet the eligibility requirements of both SSI and SSDI while others will be eligible for one and not the other. Your eligibility for the individual disability programs will be determined when you file your disability application.

Qualifications and Requirements for Disability Benefits

What are some of the qualifications or requirements used by Social Security to determine if you are able to get on disability?

1. Both the Social Security and SSI disability programs are based upon your inability to perform substantial gainful work activity, or SGA, for twelve continuous months; or the expectation that you will not be able to work for at least twelve continuous months because of your medical disability; or the expectation that your medical disability is expected to end in death.

2. Both Social Security Disability and Supplemental Security Income disability claims are sent to a state disability agency for a medical determination. The agency is DDS, or disability determination services.

At DDS, disability examiners use medical records obtained from the medical treatment sources you provide during your initial disability application interview, reports of consultative examinations (assuming you are scheduled for one), and other information gathered from work history report forms and activities of daily living questionnaires to make their disability determinations.

3. Disability examiners also use a disability guidebook which contains impairment listings, essentially a list of impairments, if you will, to assess the severity of your disabling condition.

If you meet the requirements of an impairment listing you may qualify for disability benefits. If you do not meet the requirements of an impairment listing, you may still qualify for disability through a decision process that A) determines, based on your medical records, what you are still able to do (your residual functional capacity) and then B) compares this functional assessment to your work history. This is done to answer the question of whether or not you are able to return to work activity. This decision process is both medical and vocational in nature.

The Medical Vocational Allowance Decision

Medical vocational allowances require a disability examiner to determine your residual functional capacity (i.e. the functional capabilities that you have remaining).

In order to get an idea of your functional limitations, they use your medical information along with the information provided on your activities of daily living questionnaire--which is completed by you--and a third party ADL questionnaire, which is completed by someone who is aware of your condition and how it affects you. The third-party questionaire is usually completed by a relative, neighbor, or friend.

It is at this point in the evaluation process that your work history report forms come into play. The work history report form allows you to describe the mental and physical demands of your past jobs. After the examiner determines your residual functional capacity rating, or RFC rating, they must evaluate your ability to perform any of your past jobs.

If the disability examiner finds that you are unable to perform any of your past work, they are able to move to the final step of determining if you are able to do any other work when considering the following factors: your residual functional capacity, job skills, age and education. If the disability examiner finds that are unable to work at any other kind of job, as well as being unable to return to your past due to your condition, you may be able to get on disability.

Notifications of Decisions

After the disability examiner makes a decision on your disability claim, they will immediately mail you a formal denial letter if your disability claim is denied. If your disability determination results in a medical disability approval, your disability claim will be sent back to your local Social Security office for final adjudication.

Once your disability claim has been sent back to your local Social Security office, a Social security claims representative will review your disability claim to determine if you still meet all the non-medical requirements of the Social Security Disability program.

At this point, Social Security Disability claimants have only one non-medical requirement it is that they must not be engaging in SGA work activity. However, SSI disability claimants must also meet the income and resource (assets) limits of the SSI program.

If Social Security determines that you qualify for SSI and/or Social Security Disability benefits, they will mail you an official award letter. The award letter most often states that you have been approved for disability benefits, how much you can expect your monthly benefits to be, and when you should expect your disability benefits to begin.

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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