THE TEXAS Social Security Disability SSI PROCESS

How does the SSI or Social Security Disability process work in Texas?

How does the SSI, Social Security Disability process work? You could sufficiently answer this question by simply stating "not very well". And it would be difficult to argue against this fact. Currently, with the backlogs in the system, it can take an SSD or SSI claimant well over two years to get through the application phase and appeal phases. Could anyone successfully argue that this is a good system? Hardly. It is instead a bureaucratic government nightmare that puts disabled individuals through a torturous ringer that is, for many, both emotionally draining and financially devastating.

Having said that, here is a simple explanation of the SSI and Social Security Disability process. It starts, obviously, with an individual developing a condition or illness. For social security administration purposes, the illness must be severe and not only "severe", but severe enough that it lasts at least twelve months AND prevents an individual from being able to work at a level at which they can earn a substantial and gainful income.

"Work" for Social Security purposes includes not the work the individual has done in the past, but also any type of other work the person might ordinarily be suited for.

How long must you be out of work before filing?

Many individuals who hear this definition of disability will ask the question, "Do I have to be disabled and unable to work for twelve months before I can file for disability?" And the answer to that question is no. As soon as your condition prevents you from being able to work, you should immediately file for Social Security Disability or SSI disability.

The twelve month rule will still apply--however, a disability examiner or administrative law judge can review an applicant's medical records and make a projection as to whether or not an applicant's disabling condition will last the full twelve months (in some cases where a claimant is disabled for less than twelve months, the claimant may be ineligible for ongoing disability benefits, but still be eligible for a closed period, which is essentially x number of months of benefits).

An individual who does this meet this definition of disability can have an application for Social Security Disability or an application for SSI disability benefits taken at the social security office. It's best to contact the nearest social security office, of course, since this office will have jurisdiction over the processing of the claim.

Common questions about filing for disability in Texas
Technical denials

What happens to individuals who file for disability who do not meet the SSA definition of disability? They receive a technical denial. Here's an example of a technical denial. A claimant who has been seriously ill for several months, but has still managed to keep working goes to their social security office to file for SSD or SSI benefits. The application for the claim is taken, not given a medical evaluation, i.e. no medical records are gathered.

In fact, the claim is never even sent to the agency that actually renders decisions on claims (disability determination services or the bureau of disability determination, depending on which state you live in). Instead, the claimant simply receives (very quickly receives) a technical denial letter from the social security office.

The processing of a disability claim

Individuals who fully meet the Social Security Administration's disability definition will not only have an application for SSI or SSD taken, but this application will be forwarded to the state agency that handles disability determinations. There it will stay while a disability applicant's medical records are gathered and evaluated. During the processing of an SSD or SSI claim, a couple of things may (or may not) happen:

1. A disability claimant may receive a call from the examiner assigned to their case and in this call the examiner may inquire about the claimant's ability to engage in normal daily activities. Typical questions might include "Are you able to use a vacuum cleaner?", "Are you able to dress by yourself?", "Are you able to prepare and cook meals?"

On the face of it, such questions might seem fairly innocuous. However, a claimant who receives an ADL, or "activities of daily living", call should be careful regarding their answers. For example, a claimant with a severe back condition who states that they are able to use a vacuum cleaner should also make it very clear to the examiner what effect this type of activity has on them later. Many claimants with back problems, for instance, are able to use a vacuum cleaner occasionally, but also have severe lower back pain afterwards, sometimes for days.

2. A disability claimant may receive a letter notifying them that a medical examination has been scheduled for them. This is, in fact, fairly common and such examinations are known as CE's, or consultative exams.

Here are a few things that claimants should know about these exams. First of all, though they are often referred to as social security examinations, they are not conducted by doctors employed by the social security administration. Instead, they are conducted by independent physicians who have been paid to perform such exams. Additionally, these disability exams are not conducted for the purpose of delivering medical treatment, but rather to get a snapshot of a claimant's current condition.

Most claimants will notice that a visit to a "social security doctor" will be very short (sometimes lasting only 10 minutes) and, typically, the examining doctor will ask very few questions of the claimant. Unfortunately, as well, many claimants will notice that these doctors tend to be rude and short with individuals who are applying for benefits.

3. Once a disability examiner has everything they need to close a case, i.e. make a decision, a social security applicant should very shortly receive a notice in the mail. If the notice indicates an approval, then the claimant will simply need to wait while their case is being put into benefit receipt status. If the letter is a notice of denial, the claimant will need to file an appeal and do this within 60 days of the date of the denial.

For most individuals, of course, the disability process will entail a series of denials on a claim and will, inevitably, result in the need for a claimant to have their case heard by an administrative law judge.

It is at this stage of the disability claim process that an individual is afforded the opportunity to become "more than a file". It is also at this stage that an SSI or SSD claimant can have an attorney present who will advocate on their behalf.

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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