All claims for Social Security Administration disability benefits start with the initial application. Once your application is completed, it is received by your local Social Security office. Your application can be completed online at ssa.gov, in person, or over the phone. Information collected on the application includes your basic information, educational and work history, medical conditions, and medical providers.
The local Social Security office verifies that your application is complete, then verifies that technical eligibility is met. If you are eligible for one of two programs (Retirement, Survivors, and Disability Insurance or Supplemental Security Income), they move on to your work status. If you are not eligible for either program, they issue a technical denial. If you are not working, or you are working and not engaged in substantial gainful activity (SGA), they forward your file along to the state agency. If you are working and are engaged in SGA, they will issue a denial. A person who is earning more than a certain monthly amount (gross income minus impairment-related work expenses) is ordinarily considered to be engaging in SGA. For non-blind individuals, the monthly SGA amount for 2014 is $1,070.
The state agency that determines your case is referred to as Disability Determination Services or Disability Determination Bureau. Once it has your file, it is assigned to an examiner, who collects your medical records and sends you forms to complete regarding your daily activities, work history, and any other information they may need. A Consultative Examination with an independent doctor may be scheduled if there is not enough information in your medical records to make a decision. Once your file is complete, it is forwarded it to medical consultants who review the file and determine what your limitations are based on your medical records. The file is then returned to the examiner who reviews your limitations and makes a decision based on Social Security law.
Once the decision is made by the examiner, the decision is forwarded to your local Social Security office, where a letter is generated and sent to you and your representative, if you have one.
At the initial application level, cases typically have to be “black and white” to be approved. While your case may seem that way to you, often there is a gray area, particularly since the decision is being made based information on paper rather than in person. It is, therefore, very common for a claim to be denied at this level. If you are denied and you disagree with the decision, you have 60 days to submit a written appeal.
Disability Specialists can assist you with every step of the process, including the initial application, forms requested by Social Security, and subsequent appeals. Disability Specialists also will request opinions from your medical providers on your behalf, and can offer advice regarding services, medical treatment, and community supports you may want to utilize to support your claim.