SSA PROCESS

Question 1

PRIMARY OBJECTIVE OF CLAIMANT AND REPRESENTATIVE

Answer 1

The primary objective of a claimant and his representative is to convince SSA that the claimant is totally/completely disabled and is not capable of performing work of any kind.

Question 2

SSA DEFINITION OF “DISABILITY”

Answer 2

A severe impairment that (1) prevents all work activity (2) for at least one full year (Expected to last 12 continuous months or longer, (3) or the impairment will result in death (terminal), and (4) the impairment can be medically documented.

The impairment can be physical or mental. There is no consideration for “partial disability” or “hardship disability” in Social Security Disability (SSDI) cases.

Question 3

SSDI APPLICATION PROCESS

Answer 3

the claimant with a sever impairment contacts his local Social Security Office to begin the process. A person can apply for benefits by phone, mail, online, or in person. An applicant can apply on his own or with the assistance of a representative. The forms used at the application level are completed by the claimant or representative and submitted to SSA.

The claimant’s application is sent to a central processing c4enter, and a paper copy is generated for the claimant’s signature. An electronic signature is also available online to shorten the process.

Question 4

WHEN IS AN SSDI CASE OFFICIALLY OPEN

Answer 4

An SSDI case is officially open when all signed forms are returned to SSA.

Question 5

WHAT FORM MUST THE ADVOCATE COMPLETE TO REPRESENT THE CLAIMANT OFFICIALLY?

Answer 5

The advocate must complete an Authorization To Represent form (SSA-Form 1696

Question 6

WHAT ARE THE 2 LEVELS OF ELIGIBILITY THAT A CLAIMANT MUST MEED TO APPLY AND RECEIVE BENEFITS?

Answer 6

1. Eligibility to apply, which is based on income and resources criteria.
2. Eligibility to receive benefits based on the severity of the applicant’s impairment and vocational status.

Question 7

CAN A DISABILITY ADVOCATE HELP A CLAIMANT WHO DOES NOT MEET SSA’s INCOME ELIGIBILITY REQUIREMENT?

Answer 7

A disability advocate cannot help a claimant meet SSA’s income eligibility requirements. But an advocate can help a claimant meet SSA’s medical and vocational criteria.

Question 8

Regarding eligibility, What can the advocate help the claimant with?

Answer 8

The advocate can help the applicant meet Social Security’s medical eligibility requirement to receive benefits.

Question 9

What is the primary duty of a disability advocate to assist the applicant with?

Answer 9

It is the primary duty of a disability advocate to assist the applicant in meeting SSA’s medical criteria. This is done by making sure the SSA considers all aspects of the applicant’s impairment before a final decision is rendered.

Question 10

What are the 2 different types of disability claims?

Answer 10

There are two general case categories:
1. Social Security Disability Income (SSKI) Title II
2. Supplemental Security Income (SSI) Title XVI

Question 11

What do SSDI - Title II cases involve?

Answer 11

SSDI - Title II cases involve those who have paid into the FICA system during their working years. If an employed person pays into the SSDI system for a long enough period, they are insured. Insured means that the claimant is eligible to apply for the much higher SSDI cash benefit; as apposed to the SSI - Title XVI.

Question 12

What do SSI - Title XVI cases involve?

Answer 12

SSI - Title XVI cases: A Supplemental Security Income (SSI) is a benefit reserved for children or persons with minimal work histories. these individuals will not have paid enough into the system to be insured. However, if these individuals meet SSA’s minor income and resource criteria, they can receive SSI benefits.

Question 13

What are the four Social Security Disability application levels?

Answer 13

The four Social Security Disability application levels are:
1. Initial Level
2. Reconsideration/ - 1st Appeal/Hearing
3. Administrative Law Judge (ALJ)
4. Appeal Counsel

Question 14

INITIAL APPLICATION: What happens at the initial application level?

Answer 14

Ann initial application occurs when a claimant first applies for disability benefits. The initial claim is usually made online or at the claimant’s local District Office (DO). Once processed, the application is either adjudicated or forwarded to the Disability Determination Section (DDS).

Question 15

INITITAL APPLICATION: What happens once the application is processed?

Answer 15

Once processed, the application is either adjudicated or forwarded to the Disability Determination Section(DDS). At the DDS, a Claims Examiner is assigned to the case. This person is responsible for developing, evaluating, and making a final decision in the case. The examiner makes this decision in conjunction with a medical professional, usually and MD or Psychiatrist.

Question 16

What does the DDS Claims Examiner Do?

Answer 16

With the assistance of an in-house medical adviser, the DDs Examiner will review the client’s medical records and make a decision. the Disability advocate will review the same medical and vocational data looking for evidence that supports the claimant’s inability to perform work. This is called informally as “The Game”

In “Th Game,” the Disability Advocate is pitting their argument against the SSA employee.

Question 17

THE INITIAL APPLICATION - THE INITIAL DECISION

Answer 17

When the DDS Examiner receives all of the client’s available medical and vocational evidence, the case is reviewed to determine if it meet SSA’s criteria for a total disability as defined in the Code of Federal Regulations.

The steps the Examiner follows in determining disability are called the Sequential analysis process. Using the Sequential Analysis process, the Examiner makes a decision to allow or deny the claim. the Examiner may seek assistance from a staff physician to determine the level of impairment severity, but thee final decision is ultimately the Examiner’s responsibility.

Question 18

INITIAL APPLICATION LEVEL - What happens if the Claims Examiner denies the Claimant’s application?

Answer 18

If the case is denied, the Examiner prepares a Personalized Denial Notice (PDN) and a Technical Rational (TR) explaining why the claim was denied. The case materials and decision notices are sent back tot eh claimant’s local District Office (DO). The DO then mails the decision notice to the claimant and authorized representative. The case will remain at the local DO for Sixty (60) days or until the claimant or representative requests and appeal.

Question 19

RECONSIDERATION LEVEL - How long does the claimant have to appeal the denial notice?

Answer 19

If the claimant Chooses to appeal, the claimant or representative must file the Appeal within sixty days of receiving the denial notice This will initiate a reconsideration appeal