Applying for Disability in South Dakota
How to apply and qualify for SSD, SSI in South Dakota (SD)
Note: If you have already filed a claim and been denied for disability, or are wondering what to do in the event of a Social Security denial, proceed to the reconsideration and hearing appeal sections below.
Level I: Disability Application - In South Dakota, an individual applying for disability will have a 29 percent chance of meeting the qualifications and criteria needed to win Social Security Disability (title 2 program) or SSI disability (title 16 program) benefits when they submit their initial claim.
Filing for disability in South Dakota involves submitting a claim to a local Social Security office and then having the claim evaluated by the state's disability determination services, or DDS, agency.
This makes the process of qualifying for disability a two-step process. The disability application interview is conducted by a CR, or claims representative, at a local Social Security field office. The disability examiner who receives the case later reviews the medical and vocational evidence so that a decision can be made.
The disability claim may be filed online. However, it is practical for a claimant to have their claim taken in person at a Social Security field office.
The online process does not provide an opportunity for questions to be asked and answered. Nor does it allow an SSI disability claim to be taken.
This fact is important because some disability claims will be filed under the SSD program, some will be filed under the SSI program, some will be filed concurrently under both programs, and claimants will not know in advance which program applies to their case. This makes the online application process less advantageous than filing a claim in person.
At the application interview, a claimant will be interviewed regarding their work history, medical treatment history, activities of daily living, and when their disability is thought to have begun (known as their AOD, or alleged onset date). It is important for the claimant to provide as much information as possible regarding both their history of employment and their history of medical treatment.
The information obtained from the claimant's medical records will be used to determine A) whether or not they are currently disabled and B) how far back their disability may have begun.
Note: Establishing the onset date of disability can have an immediate impact on how much back pay the claimant may be eligible to receive as well as whether or not they will be affected by the medicare waiting period.
The information obtained from the claimant's work history will be used to determine if they possess the skills and functional capacity to either return to their past work, or perform some type of other work.
Because Social Security relies entirely on the claimant to provide this type of information, a person filing for disability may find it practical to write down both their work history and their medical treatment history prior to the appointment for the disability interview. Generally, this will allow them to submit more complete and detailed information which may increase the odds of winning benefits.
The work history should include all jobs worked for the past 15 years. This is what SSA refers to as the relevant period. Especially important will be the inclusion of job titles and the descriptions of work duties performed.
The medical history should include the names and addresses of all hospitals and clinics where treatment was received. It should also include the names of treating physicians and dates of treatment.
After the initial intake is completed at the Social Security office, the claim is transferred to a disability examiner at DDS, or disability determination services, who will begin the medical evaluation and vocational evaluation.
The process used by the disability examiner will focus on gathering the claimant's medical records and evaluating them to ascertain what physical and/or mental limitations the claimant may possess. These limitations are used to determine an RFC, or residual functional capacity, rating for the claimant. Residual functional capacity is what a person is still capable of doing despite their condition.
If the individual attempting to qualify for disability is an adult, the assessment of the claimant's limitations, or RFC rating, will be compared to whatever work they performed within the last 15 years. This is to determine if they can return to their past work or perform some type of other work.
A person whose limitations are severe enough to rule out their ability to do their past work, as well as their ability to switch to some form of other work, will meet the necessary eligibility qualifications and requirements for disability.
If the individual filing for disability in South Dakota is a child, the RFC rating will be compared to whatever activities are deemed to be age-appropriate to determine if the child applicant is capable of performing at the same level as his or her peers.
Children who are unable to engage in age-appropriate activities will meet the requirements for disability under the SSI program. This is assuming that their family income and assets do not exceed the program's limits (which exist because SSI is need-based).
Level II: Request for Reconsideration - If a claimant is denied for disability at the application level, they have the right to file an appeal. The appeal that follows the disability application denial is the request for reconsideration.
A request for reconsideration may be initiated by contacting the same Social Security office where the initial claim, or disability application was filed. After the appeal has been requested, SSA will send out the necessary appeal paperwork, including medical release forms, the appeal request, and a disability report form. Claimants should be careful to note any additional medical treatment or changes in their medical condition on the disability report form so that Social Security will be put on notice to gather this information as evidence.
The deadline for filing this, or any, appeal is 60 days. SSA also allows an extra five days for mailing time, however. Therefore, the appeal period expires 65 days from the date of the denial of the application. This does not mean, though, that the appeal can be mailed in by the 65th day. In actuality, it must be received by the Social Security office by the 65th day.
Claimants who have disability representation provided by a disability lawyer or a non-attorney disability representative will not have to submit the appeal themselves. This action will be taken by their attorney or representative and Social Security is required to notify all parties of all case actions, including when a case is denied. Just the same, claimants who receive a denial notice should probably contact their representative to ensure that both parties are aware of the denial so that the appeal deadline will not be missed.
Claimants who are not yet represented should do the following: 1) Prior to sending in the appeal, a copy should be made and kept; 2) After submitting the appeal, a followup status call should be made to the Social Security office to verify that the appeal was received.
When appeal deadlines are missed and the claimant does not have a sufficient reason for missing the deadline, the claimant will be forced to start over with a new claim. This adds months of additional processing time but also results in a later filing date and possibly a smaller amount of Social Security back pay as a result.
The decision on the reconsideration
The disability reconsideration is handled exactly the way the disability application is handled. In each case, a disability examiner will review the medical evidence to determine if the case can be approved by either A) satisfying the requirements and qualifications of a listing in the Social Security list of impairments or B) satisfying the five step sequential evaluation process in order to receive a medical vocational allowance, a type of approval in which the determination is made that the claimant is unable to return to substantial and gainful work activity.
Reconsideration decisions typically are made in a shorter amount of time as compared to disability applications. Most reconsiderations will be decided within 60 days. However, most of these appeals will be denied, making it necessary for a claimant to file the second appeal, a request for a disability hearing.
Level III: Request for Hearing before an Administrative Law Judge - The disability hearing is the second Social Security appeal available to claimants and may be requested only after a reconsideration appeal has been denied.
Like all appeals, the hearing must be requested within 60 days of the date of the prior denial, but, ideally, should be requested immediately after receiving notification of the denial of the reconsideration appeal to avoid unnecessary case processing delays, as well as the possibility of a missed appeal deadline.
Basic facts about disability hearings
Note: The SSA Region to which South Dakota is attached (Region 8) has an average disability hearing processing time of 374 days. This is longer than the national average processing time for hearings which is 342 days.
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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