Navigating The Social Security Disability Claim Process

Have you worked hard for several years or perhaps decades but are now dealing with an insurmountable disability? You likely have given a lot of thought to applying for Social Security Disability benefits, also referred to as SSDI. The fact is, if you paid into the fund, you should be able to reap the benefits. Unfortunately, another fact is that it can be quite challenging to get those benefits. Here are a few things you should know about the claims process.

What are the fundamental facts?

  • From the submission of the application to the initial decision, claims are processed through a network of offices. Some are local field offices and others are state-based agencies called Disability Determination Services offices or DDSs.
  • As the word ‘Determination’ implies, the workers at DDS offices are the people who determine whether you are disabled or not. Although your doctors might state emphatically that you cannot work, they don’t have the final say. This is true even if you were considered disabled under other government or private programs or policies.
  • Here is the basic definition of a qualifying disability:¬†“the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

If I am disabled, why is it so hard for me to get benefits?

  • The bottom line: although you might dealing with a variety of physical, mental, or emotional impairments, DDS is assessing the situation solely based on social security disability law. This is the main factor that can make the claim process challenging.
  • No doubt, DDS employees are people with feelings. However, they cannot allow those feelings to interfere with the way they do their job. It might seem a bit cold, but they simply make a determination based on the facts presented, not on how distressing an applicant’s situation might sound.
  • While a disabled individual can well describe their symptoms, they might leave out key facts that will affect the decision. Attorneys that are well-versed in social security disability law understand the process thoroughly and can prepare your application properly, and handle any requests. They are completely prepared to fight for benefits that are deserved.

How does the process work?

  • Before getting to specifics, it is important to remember that any document, statement, or other piece of information that is submitted can affect the decision. Conversely, the same is true regarding pertinent pieces of information that are inadvertently left out.
  • Applications can be completed online, by telephone, in person, or by mail. This is how a claimant provides basic facts such as their name and contact information, as well as names and contact information for doctors or other health professionals.
  • Before the medical issues are even addressed, the field office has to determine nonmedical eligibility. This would be based on things like your employment, citizenship, and history of your ‘paying into the SSDI fund’.

What happens after all this information has been collected?

  • The field office, after determining nonmedical eligibility, sends everything to a DDS. This is where they will decide if a claimant is or is not disabled according to the law.¬†Most claimants choose to submit some medical records with their initial application. But along with the medical information you submit personally, Social Security will likely need to request records from multiple doctors.
  • It is great when medical office staff readily respond to such requests, whether from you or from the DDS. But there just isn’t any way for SSDI applicants to ensure that things happen that way. Even when a doctor provides excellent medical care, working with Social Security isn’t generally a favorite activity. This is one major area where an attorney can definitely save you a lot of time, energy, and stress.
  • If, after reviewing information from the sources you provided, the DDS still cannot make a determination regarding your disability, they will usually arrange for an examination with an independent medical source. You would receive a letter or letters in the mail informing you of any appointments that have been scheduled for these exams.
  • The DDS uses all of the records, statements, and other facts to make a determination. The team that makes the determination, called an adjudication team, usually includes a medical and/or psychological consultant. Many times they are able to make a decision at this stage. But if they need more information from one of the medical sources, whether your doctors, or the independent sources, they will make the request at that time.

Finally, you will receive a letter in the mail. Either it will make the statement you have been yearning for, ‘you have been approved’, or it will state that your claim has been denied. If you are approved, you will start receiving payments for the sixth month after your disability began. The initial letter will state how often you should expect a review of your conditions to determine continued eligibility.

While it is an awesome feeling to get approved, a denial is by and large the most popular response to an SSDI application. After waiting months or years for a decision, filling out paperwork, requesting medical records, and sometimes desperately hoping for more income in order to properly care for their needs, millions of people receive this heartbreaking news. There is, of course, an appeal process. But many claimants are so frustrated at this point that they give up.

If you feel like you are entitled to benefits, there is no need to go through this grueling process alone. While you might be inclined to do your best to obtain a favorable decision without an attorney, you can likely see, from these facts, why it would be quite helpful to have a qualified and efficient legal representative by your side. Please contact us today at Villaume & Schiek to find out how we can help you file an initial claim or appeal an adverse decision.