An Introduction to Federal Disability Benefits, Continued…

Last week, I wrote a post introducing readers to the federal government disability program, and several of the more common types of benefits available to disabled workers. This week I am going to explain the disability application process from a birds-eye view. Subsequent posts will get into more detail about the process. Please note, however, that nothing in this post is intended to be legal advice. If you are interested in obtaining legal advice, please contact us to make an appointment to talk about your case.

First, an applicant must fill out a disability benefit application. The application itself is not too complex or time consuming. However, it should be filled out with precision because the slightest error and the application will likely be denied.

Once complete, applications are sent to the Social Security Administration (SSA) field office, where they undergo an initial determination that the applicant meets the most basic requirements (age, employment status, Social Security coverage, etc.). From here, the SSA forwards the application to the Division of Disability Determinations (DDD). The DDD conducts a more in-depth, extensive investigation into the specific facts of the applicant’s case.

Specifically, the DDD will get in touch with treating doctors, hospitals, and clinics and ask the following questions:

What medical condition does the applicant have?
When did the medical condition begin?
How has medical condition limited the applicant’s activities?
What have the applicant’s medical tests shown?
What treatment has the applicant received?

At the conclusion of this process, the DDD may have enough information to make a decision if an applicant is eligible for disability benefits. However, if these questions cannot be adequately answered through existing records, or additional verification is required, the DDD will ask that an applicant go through additional testing, conducted at the government’s expense.

Once the DDD has all the relevant information it needs to make the decision, it looks to five factors to make its decision:

1. Is the applicant working?
2. Is the applicant’s medical condition severe?
3. Is the applicant’s medical condition on the DDS’s “listing of impairments”?
4. Can the applicant do the work s/he did before?
5. Can the applicant do any other type of work?

Eventually, the DDD makes a determination and the application is then forwarded back to the SSA, where, if the applicant is qualified, a final benefits determination is made. If the applicant is denied benefits, they are entitled to appeal that ruling.

A 2012 report by the Congressional Budget Office found that 61% of first-time applications were denied. Of those who were initially denied, about half appealed the Administration’s ruling. Roughly half of those applicants who appealed obtained a favorable result on appeal, either on reconsideration or on appeal in front of an Administrative Law Judge.

To increase the chances that a first-time application is granted, there are several things an applicant can do. Maintaining good employment and medical records is crucial. Additionally, hiring an experienced disability attorney will help ensure that the application is properly filled out and submitted.