SSD – Discussion of the initial application process and what happens from there.

The Initial Application:

The initial application is the Application for Disability Insurance Benefits, Form SSA-16-BK, or Application for Supplemental Security Income, Form SSA-8000-BK. The application for SSDI requests personal identifying and contact information about the applicant, a listing of physical or mental conditions, work activity, education and training, job history, medicines, medical treatment including a listing of care providers and their contact information, a listing and contact information for other persons or entities that may have medical information, and vocational rehabilitation, employment or other support services.

The application for SSI requests basic information about the applicant as well as information about income/expenses/assets and living arrangements. The applicant should provide any personal documentation, medical records, employment and other information: Personal documentation of the symptoms of the illness or injury and how it affects daily activities including any job loss; medical evidence about disability – If medical records are not provided with the application, the Disability Determination Service (DDS) will request the records, which will delay the processing; employment information; information about activities of daily living; school records; and income and asset information including information about other disability
payments.

Questions to rule out disqualification:

• Does the applicant work above the substantial gainful activity (SGA) limit? (Earn too much income.) See 20 CFR §§ 404.1520(b), 416.920(b); 20 CFR §§ 404.1573, 416.973; 20 CFR §§ 404.1574(b)(2)-(3), 416.974(b)(2)-(3). Does the applicant have too many assets?

• Is the disability only temporary, or is it severe enough to last 12 months or result in death?

• Is applicant cooperative? E.g., Will applicant refuse to release required records and information or refuse to follow prescribed therapy?

• Is disability based on drug addiction or alcoholism (DAA)? DAA cannot be a contributing factor – would the applicant’s condition improve if they stopped drinking because if so, then they would be disqualified?

• Has applicant been convicted of a crime that will prevent them from receiving SS benefits?

• Is the applicant honest? SSA can terminate benefits and prosecute for fraud if the benefits are obtained by dishonest means.

Additional questions to consider:

• Is the applicant an adult or child and what is their age? Is there nonmedical eligibility?

• Is applicant covered under RSDI, or qualified to apply for SSI because of low income and resources? Criteria include age, employment, marital status, Social Security coverage information, and other factors. Child can be eligible for auxiliary dependent or survivor’s benefits or in her own right if medically disabled before age 22.

• What is the date of onset? Alleged (AOD) versus established (EOD) – can’t be engaged in substantial gainful activity and earning too much money.

• Is the adult able to prove they are incapable of substantial and gainful work? See 42 USC § 423(d), 1382(c)(3). Does the child have a marked impairment with presumed or considered severe functional limitations in the ADLs?

• Are there other disability payments that may affect benefits?

• Is there a presumptive disability such that the SSI applicant may get benefits during the application process? Is this a case of extreme hardship (immediate threat to health or safety) such that an emergency one-time cash advance payment is allowed?

What happens after initial application:

Once filed with the local SSA field office, if nonmedical eligibility is met, the applicant’s file is sent to the Disability Determination Service (DDS) state agency to determine if the applicant is medically eligible – that is, if their disorder is severe enough to qualify for benefits. The DDS assigns a claims examiner to push the file forward. The examiner will obtain medical records, decide date stopped work for disability purposes, determine vocational factors, arrange for consultative examinations and/or laboratory testing, and confer with medical consultants. The applicant or representative must establish a patient and cooperative rapport with the with the claims examiner in this process, or risk denial of benefits.

If the applicant’s claim is denied, they may appeal by first timely filing a request for reconsideration. The appeal process then flows to an Administrative Law Judge (ALJ) up to the SSA Appeals Council, and finally to a federal district court judge.

References: Nolo’s Guide to Social Security Disability, Getting & Keeping Your Benefits (2014), David A. Morton, III, M.D. There is a great resource for this subject matter with citations and practice tips, in Advising the Older Client or Client with a Disability, Fourth Edition including the 2014 Supplement, edited by Lauretta K. Murphy and Alison E. Hirschel and published by ICLE, starting at page 6-27, §§ 6.48 – 6.170, and available at your local law library.

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