Questions about Social Security Determination

 

2009 Conference Presetation provided by: Connie Valt and Bob Hunt

Social Security Administration

Connie DaValt
connie.davalt@ssa.gov

WI Disability Determination Bureau

Bob Hunt
Robert.L.Hunt@ssa.gov

SSDI & SSI Disability Overview

Both programs make payments to people with disabilities.
SSD1

Social Security Disability Insurance (SSDI)

Provides benefits to disabled or blind people who are “insured” by workers’ contributions to the SSA trust fund.

Supplemental Security Income

Makes cash assistance payments to the aged, blind and disabled who have limited income and assets.

Who Can Get Social Security Disability Benefits?

Young Family

Worker

Must have paid into Social Security five out of last 10 years.

Spouse

At age 62
At any age if caring for child under 16 or disabled
Divorced spouses may qualify

Child

Not married under 18 (under 19 if still in high school)
Not married and disabled
before age 22

SSDI

When do benefits begin?

  • The disability board determines a date of onset that the condition begins.
  • SSDI can be paid retroactively up to 12 months prior to the date the claim was taken
  • 5 month waiting period when no benefits are payable
  • Checks are paid the month after they are due (Feb check paid in March)

Who Can Get SSI?

  • Age 65 or older
  • Blind – any age
  • Disabled – any age
  • Limited income
  • Limited resources

Eligibility can begin the month after Social Security is contacted (but we still need to wait for a medical decision). Checks come on the 1st of the month for that month.

SSI Financial Eligibility
2009 Rates

Have low income and savings

  • “Countable” income:
    • Less than $674.00 per month (individual)
    • Less than $1011.00 per month (couple)
  • “Countable” assets:
    • $2,000.00 for single person
    • $3,000.00 for couple

Health Insurence

SSDI

Medicare coverage – after 24 months of benefits

SSI

Medical Assistance coverage – in Wisconsin, comes automatically with SSI federal benefits

Method of Application

  • Online at www.socialsecurity.gov
  • telephone appointment (1-800-772-1213)

Application Process

  • Paperless, no claims signature
  • Signature needed on medical release
  • Prepare for claim
  • Complete pre-interview guide – worksheet
  • Enter disability info on internet

Disability Determination Services

Each State has its own DDS – a state agency that contracts with SSA to make disability determinations for SSDI and SSI.

Each DDS applies the same rules for disability determination, based on SSA laws and regulations.

Individual determinations are team decisions made by a disability examiner and one or more medical consultants (MDs and PhD Psychologists)

The Disability Determination

Sequential Evaluation steps:

  1. Are you performing substantial gainful activity (earning at least $980/month)?
  2. Is your condition “severe”?
  3. Does your condition meet a Listing?
  4. Can you still perform past relevant work?
  5. Can you perform other less strenuous or less stressful work?

SSA’s Listing of Impairments

Find them at: http://www.ssa.gov/disability/professionals/bluebook/ If a Listing is met (or equaled), and the applicant is not performing Substantial Gainful Activity, the finding will be “disabled” based on medical considerations alone.
If no Listing is met/equaled, evaluation moves on to the past/other work steps.

Listing 11.19 Syringomyelia

Syringomyelia with:

A. Significant bulbar signs;
B. Disorganization of motor function (i.e., significant and persistent disorganization of motor function in two extremities, resulting in sustained disturbance of gross and dexterous movements or sustained disturbance of gait and station).

When a Listing Isn’t Met/Equaled

The disability examiner determines the applicant’s “residual functional capacity” (RFC), considering:

  • the medical findings
  • details about daily activities
  • effects of pain and other symptoms
  • the opinions of treating and examining doctors
  • any other relevant information

RFC is then used at the past/other work steps

Capacity for Physical Work

  • Exertional capacity – sedentary, light, medium, heavy
  • Ability to stand, walk, sit, lift, carry, handle, reach, crawl, see, hear, communicate
  • Endurance for a 40 hour work week
  • Ability to perform work functions without frequent rest break

Capacity for Mental Work

  • Ability to understand, remember, and follow directions independently
  • Ability to respond appropriately to supervisor, co-workers, and usual work situations
  • Ability to cope with routine changes or stresses in the work setting
  • Ability to concentrate and complete tasks in a timely manner

Information the Applicant can Provide

  • When and where treatment has been provided (at least during the past year)
  • Details about how the condition affects daily activities (in SSA’s Function Report)
  • Details about the impact of pain and other symptoms
  • If possible, a letter from a treating doctor – listing specific limitations and the supporting medical findings

Consultative Examinations

  • If insufficient information is available from treating sources, a CE may be scheduled.
  • If so, attendance is very important. Failure to attend will likely result in a denial of the claim for insufficient evidence.
  • If unable to attend, contact the disability examiner right away so that other arrangements can be made.

For More Information

Visit Social Security’s website at: http://socialsecurity.gov/
While there, locate the nearest SSA office by clicking on the “Find a Social Security Office” link, then enter your ZIP code. Call Social Security’s toll free number: 1-800-772-1213

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