When you file a claim for Social Security Disability (SSD), there are many steps that you will have to follow and many agencies involved in determining whether or not you qualify for benefits. First, the Social Security Administration (SSA) will file your application and initial meeting with a claims representative (CR) at a local Social Security office. This party will meet with you and gather specific information that matters to your claim, including:
- Worksheets related to your job and job requirements;
- A medical worksheet, which includes information about the condition or conditions causing your disability; and
- Your medical treatment history.
The claims representative then passes your file along to a state agency to process your claim. This agency goes by many names, depending on the state, including Disability Determination Services (DDS).
DDS are state agencies that draw funding from the federal government to assist field officers in making disability determinations.
What does DDS do with my claim?
Much like an insurance adjuster, DDS will assign you a disability examiner. This person will make disability determinations based on your medical records and your job worksheets. They will determine whether or not you are disabled, per the definition of the SSA.
To qualify for disability benefits, the SSA requires that you meet two criteria:
- An inability to do substantial work because of a medical condition; and
- Your medical condition must have lasted or will last for at least one year or result in your death.
How does DDS determine my eligibility for benefits?
The SSA has a guidebook that examiners use to help them determine whether or not a condition qualifies as disabling. Many of the qualifying disability impairments are very specific in nature. If your claim does not fall into one of the listed impairments, your file will need to pass through a process to determine if you are eligible for disability benefits.
How does DDS review my claim?
Once you have filed your claim, the examiner will spend time gathering your medical history and records from the sources you have supplied, including your physician, specialists, hospitals, and others. You must provide the office with a statement outlining the disabilities that prevent you from working.
You will also complete a questionnaire that contains specific questions about your activity before and after the disability, including your current day-to-day activities. You may also have to describe how your disability has affected your ability to perform basic functions, such as personal care and hygiene activities, errands, housework, work functions, mobility, and your ability to drive.
They will also review your work history to determine if your age, education, and skills allow you to work despite your disability. An examiner may investigate your disability further, looking into your activities of daily living (ADL), to determine whether your physical or mental limitations are as extensive as you are claiming.
If your medical records are complete and compelling enough for the examiner, they may be able to make a determination of disability based on your prior medical records. If not, they may order a consultative exam (CE) to make a further determination or gather additional data. Your CE could include:
- A physical exam;
- Psychological testing;
- IQ testing; and
- Comprehensive physical and psychological evaluations.
Once the examiner has gathered sufficient data for your file, they will work with a physician and psychologist to render a determination for your disability claim. They will then forward their determination back to the local Social Security office.
If you qualify as disabled, the SSA officer will then calculate the amount of back pay and benefits, if any, and initiate SSD payments. If the SSA denies your claim, however, they will store your file at the local office for use in any future appeals.
What determines whether the SSA approves or denies my claim?
To qualify for disability benefits, your disability must rise to the level outlined in the SSA’s criteria. The SSA considers a combination of factors, including your own medical records—and your history of complying with medical advice and treatments—as well as a study of your work history and how the disability impacts your job functions and your daily activities.
If you submit a claim improperly, leave sections incomplete, or forget to include necessary medical history to support your allegation of a long-term disability, the SSA will likely deny it, delaying your case for a year or longer.
If the DDS suspects fraud or believes that your ADL are not consistent with your disability, they may conduct an independent investigation. Investigative personnel will provide further information to DDS about whether your daily activities are consistent with your application. If your application cites an inability to perform certain physical activity or job functions but a witness observes you being active in those tasks, it may lead to a denial for your claim.
How long does the process take?
According to the SSA, an initial determination regarding your claim can take three to five months, depending on how long it takes for the DDS examiner to get the information they request from you or your medical providers.
If the SSA denied your initial claim, it can take a year or longer to appeal your claim before an administrative law judge. Hiring an attorney to help you with your initial claim can help you avoid costly delays in an already lengthy process.
Ensuring that your application, medical history, and questionnaires are complete and accurate is essential to minimizing the time lag between application and approval. A disability attorney can help you from the first steps in your claim to minimize costly delays in the process.
The Law Offices of Ogle, Elrod & Baril, PLLC can help you navigate the disability process and advocate for you to get the benefits you need. Call us for a free consultation at 865-546-1111.