DISABILITY DETERMINATIONS

When you file an Application for Social Security Disability or SSI, a local Social Security employee gathers information from you or your attorney to determine whether you meet the income and contribution requirements for benefits. I usually prefer to gather all of the necessary information and work with the my client to file an application online so they do not have to spend hours waiting at their local Social Security Administration Office. We will need to provide information to verify your identity, age, quarters/credits of coverage, whether you are working and how much income you are earning, the exact date that your disability began and a brief outline of the medical conditions that your claim is based upon.

Your application and the information that supports your claim is then assigned to a claims examiner at the Louisiana Office of Disability Determination Services (DDS), who determines whether you meet the Social Security Administration's medical and vocational requirements for Disability.

The claims examiner at DDS will attempt to gather medical information from all doctors, hospitals and clinics where received treatment. While you might think this would be a fairly simple and rapid process, three problems often arise.

• First, claimants often fail to tell Social Security about all of their relevant medical treatment. At the time of the interview, many people do not remember their entire medical history or don't know the exact dates and types of treatment they received. One of the things that our office focuses upon is making certain that we have a complete record of any medical treatment that may support your claim.
   
• Secondly, some offices and hospitals just do not respond when DDS mails them a request for medical records. The DDS claims examiner will send a second request, but the system's time constraints allow only limited follow-up. Unfortunately, it's very common for DDS to deny Disability and SSI applications simply because they never received the records that prove the claimant's medical condition.
   
• Finally, a claimant's medical condition may change over time or an important medical test may not be performed until after DDS has received the records from the healthcare providers. Thus, it is very important to keep the claims examiner up to date on any changes in your condition or new tests ordered by your doctors.

More medical information may be needed before DDS can decide you claim. If the information is not available from the your current doctors, DDS may ask you to go to a special examination, called a "consultative examination," that is paid for by the Social Security Administration (SSA).

DDS will also usually want detailed written documentation about your lifestyle and activities, including:

• Your "activities of daily living," i.e., a description of the things that you can do on a typical day.
   
• Information about your "residual functional capacity" to sit, stand and walk for specific lengths of time, as well as your ability to concentrate on, and complete, tasks.
   
• Your responsibility for, and your relationship with, people who live with you.
   
• Detailed information about your education and work experience.  

DDS will consider the written answers to these questions provided by your attorney along with the medical information provided by your doctors when they decide whether you qualify for Disability or SSI.

At each step in the disability determination process, Disability Determinations Services and the Social Security Administration use a series of five questions to determine if you are disabled, including:

1.     Are You Currently Working?

If you earned more than $980.00 per month from employment during 2009, you will usually not be considered disabled. Current income of less than $980.00 per month is not necessarily considered to be "substantial gainful activity" and therefore may disqualify you from receiving Disability benefits. The current substantial gainful activity income limit for people who are blind is is $1,640.00 for people who are blind.

Social Security law contains a list of impairments for 14 major body systems. A severe impairments to any of these systems should result in a determination that you are disabled. If the condition is not on the list of impairments, DDS should try to determine if the claimant's medical condition equals the severity of a listed impairment. If so, the person is found disabled. If not, the DDS examiner moves on to the next step

4.    Can You Do The Work You Did Before?

If your condition is severe, but isn't in the Listing of Impairments, DDS will then consider whether you are capable of returning to any of the types of jobs that you had in the last fifteen years.

5.     Can You Do Any Other Type Of Work?

Finally, to determine if a claimant is able to do other work, Disability Determination Services considers the person's medical conditions, age, education, training, work experience and transferable skills. If DDS decides the person cannot do other work, the claim will be approved. If the DDS examiner decides that the person can do other work, the claim will be denied.

Many people are repeatedly denied Disability benefits though they appear to meet the medical and legal requirements. All sorts of factors, including your age, education and work experience, can influence the outcome of your claim.

But all too often, the most important factor is that some people prove their case with convincing evidence, while other people just leave it up to the Social Security Administration to develop and decide their claim for them.

If you are disabled, it is a mistake to depend upon the Social Security Administration to develop and decide your claim. The Social Security system is dramatically understaffed and overburdened. Many claims, even those involving complex medical and legal issues, receive only brief consideration.

It is often not enough to provide the documentation that proves your medical condition. You will also need to explain how your medical circumstances meet the legal standards for disability.

Don't leave your benefits and the funding for your medical treatment up to chance. Get an experienced attorney on your side to help you win your claim.

Next: Hearings & Appeals