Filing an Application for Disability Benefits under SSD or SSI

If you are thinking of applying for disability or have even filed your claim, the process probably seems confusing and intimidating. This is understandable because the system is thoroughly confusing and Social Security does not offer much help in explaining how the disability claim system works. This page answers important questions about disability claims. To get more specific about the process of filing an SSD or SSI claim, go here: Filing for Social Security Disability or SSI.

This page discusses 1. What Social Security means by "disability", 2. Important points about disability including when you should probably file for disability (answer: when your medical condition prevents you from earning a livable income), 3. how to prepare your disability claim, 4. how your disability decision will be made, and 5. what happens if your case is approved or denied.

What does Social Security consider to be a disability?

Many individuals mistakenly assume that Social Security offers short-term disability benefits or partial disability benefits. However, filing for disability benefits through the Social Security Administration presupposes that your disabling condition is both severe and completely disabling. What does SSA consider to be completely disabling?

The definition of disability used by the social security administration for both the SSD and SSI program states that:

A) Your condition must last for at least one full year (or at the time of your approval must be projected to eventually last for a full twelve months)


B) Your condition, or conditions, must impose enough mental or physical limitations--or a combination of both types of limitations--such that you cannot effectively return to either your past work (potentially any job you performed within the last 15 years) and cannot do any other type of work for which you might ordinarly be able to employ your education and work skills (were it not for the functional limitations caused by your condition).

Important points about filing for disability

1. If your condition is keeping you from working and earning a livable wage, you should probably file for disability. If you are currently working full-time, but your condition is getting worse, then you should file for disability as soon as your earnings drop below the SGA limit (the earnings limit for SSD benefits and SSI benefits) and definitely as soon as you stop work altogether. If you visit the social security office, however, and try to apply when you are still working, your claim will be immediately given a technical denial.

2. If you feel you meet the definition of disability (you cannot work one of your past jobs or do other work and your condition will last for at least a full year), you need to get the process of filing for benefits started. Claims for disability that are initiated with the social security administration will fall under the title II Social Security Disability or title 16 SSI program. If the applicant is a minor-age child or a person who has never worked, or has not worked in several years, the claim will be for SSI.

However, many individuals who have a work history will have their claim taken in both programs. This type of disability application is known as a concurrent claim and it is taken to ensure that a person may receive at least a minimal benefit if their Social Security Disability check, by itself, would be rather small, based on their earnings over several years.

3. You may file for disability online. You may also file by contacting your local SSA office. If you do this, you can then complete your disability application interview over the phone or in person. Contacting a local office is often the most practical, and efficient, means of applying for disabilty.

Preparation for Filing an SSD claim or SSI claim

Prior to your disability application interview, you should gather the following documents to supply to the CR (the claims rep at the social security office who will do the intake for your claim). This will make the process go much more smoothly if you have this information ready, which is the following:

A) Birth Certificate
B) Income verification including from wages, the VA, long or short-term disability benefits other than from social security, as well as any other income sources.
C) Asset source information including life insurance policies, bank accounts, investment acounts (IRA's, 401k's, stocks, bonds, funds), real property (land, homes).
D) Proof of marriage or divorce.
E) Proof of Military service.

In addition, you will benefit by compiling information regarding your work history and medical treatment sources prior to the appointment. Social Security uses both medical and vocational data (job information) to render a decision on your claim. Essentially, your medical records will be used to determine what your physical or mental--or both--functional limitations are (known as your RFC, or residual functional capacity).

How your disability decision will be made

The rating of your limitations (and, conversely, your capabilities) will be compared to your work history. The goal of the disability examiner (examiners make decisions on disability applications and reconsideration appeals while ALJs, or administrative law judges make decisions at social security hearings) will be to do the following:

A) Determine if you can return to any of your relevant past work, i.e. jobs you worked in the last 15 year period during which you were able to earn an SGA-level income and had time enough on the job to learn the skills pertaining to the job.

B) Determine if you have the necessary skills and education to do some type of other work, giving consideration to your age and functional limitations (social security takes the position that added age and functional limitations will make it more difficult for a person to switch to some type of other work).

Based on this view of the process, it should be easy to see that the quality of the medical and vocational information that you provide may make a considerable difference in how your SSD or SSI (or both if you have a concurrent claim) case is handled and decided.

Supplying your medical history

Regarding your medical history, you should supply the names, addresses, and contact information for all doctors and hospitals you have visited. This list should go back at least as far as when you allege your disability began. Do not make the mistake of thinking that the social security administration can magically locate any medical treatment sources that you neglect to supply complete or even partial information about. The truth is that the disability examiner relies entirely on a claimant to provide this information and records from doctors and hospitals will not be gathered and evaluated if the claimant does not provide the necessary information.

In fact, the largest component of having to wait for a disability decision has to do with how long it can take a disability examiner to obtain enough medical evidence so a decision can be made. And this is often complicated when claimants supply incorrect information, partial information, or no information about specific medical treatment sources.

Supplying your work history

Regarding your work history, you should supply information for every job you worked in the last 15 years. It will be very important to write a full description of what you did on each job and your job title. Again, speaking as a former disability examiner, it was difficult not to notice that many applicants failed to provide accurate information, or only supplied just the most basic work history information.

Unfortunately, what they were not aware of was the fact that a disability examiner who is working to decide a claim will use the claimant's submitted information and attempt to match it to a job that is listed in a reference source known as the DOT, or dictionary of occupational titles.

Getting the wrong match, of course, (which can, and does, happen, especially when claimants supply slim details) can mean that it will be presumed that one of their last jobs was easier to perform than it actually was. This can result in a denial on the basis of being able to return to past work. If, on the other hand, a claimnat is presumed to have more job skills than they have, they stand the risk of being denied on the basis of being able to perform some type of other work.

Supplying detailed medical and vocational information at the time of applying is vital. And doing so can help to win a disability claim.

Processing your disability claim

After a claim for disability is taken, it is transferred to a state agency that in most states is known as DDS. This is the facility at which a claim is given to a disability examiner. The examiner's first act will typically be to request the claimant's medical records. The examiner will also review the work history information, and, on rare occasions, may even contact an employer to ask about the claimant's job duties and performance. However, this will usually wait until the records have come in and this can take weeks, sometimes even months.

It can take 90-120 days to get a decision on a claim for disability. However, some cases will take longer due to certain variables such as difficulty in getting records from doctors, or the need to send a claimant to a consultative examination. In cases where it seems to be taking a long time to get an answer, the claimant may wish to call for the status of their claim. Note: claimants should not call the social security office for this, but should contact DDS to speak to the disability examiner. The number for DDS can usually be gotten from the social security office.

If your disability claim is approved or denied

If the claim is approved, the applicant will receive written notification. The social security notice of award will explain the schedule for receiving future payments. If the claim is denied, the notice of disapproved claim will explain the claimant's appeal rights and the claimant should probably consider looking into finding disability representation (a disability attorney or disability representative).

In the event of a denial, the appeal (a request for reconsideration) should be filed immediately. SSA will allow 60 days for the filing of a disability appeal, but it makes no sense to wait since getting the appeal sent in quickly can move the process along more quickly.

More information at the following page: 4 Tips for Getting Disability Approved When you File with Social Security.

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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