When you apply for Social Security Disability Insurance Benefits (SSDI) and/or Supplemental Security Income Payments (SSI) it is important that you understand how the disability determination is made. The decision of whether you are medically disabled is not actually made at your local Social Security Administration Office. The role of the Social Security Administration District Office in your disability application is making a determination of whether you qualify for the non-medical requirements and actually processing your application. The medical eligibility determination is made at the Disability Determination Service, the Office of Disability Adjudication and Review, the Appeals Council, or the United States District Court.
Social Security Administration District Office Responsibilities
When you apply for benefits (either directly at your local Social Security Office, by telephone, or on the Internet), your application is processed at your nearest Social Security Administration Office. The local office is responsible for determining if all required materials have been submitted, and checking for your eligibility for every disability program that the Social Security Administration administers. Although the Social Security Administration will accept any medical evidence that you have with you, the local office does not actually review your medical records or request additional records that are needed to determine your medical eligibility.
The main role of your local Social Security District Office is to process your application when you apply for benefits, and to process your decision. To determine your non-medical eligibility, your local Social Security Administration Office reviews your work history, your current financial status, and in some situations information about your spouse, deceased spouse, ex-spouse, and/or your parents. The local office also assist you in determining the correct date to use as your alleged onset date (the date you became unable to work) and in completing forms that are needed to make the medical determination on your claim. Once all the information is received by the local office, a determination is made of whether you meet the non-medical requirements for at least one disability program. As long as you qualify on a non-medical basis for a disability program, your file is transmitted to the Disability Determination Service for a medical eligibility decision.
Disability Determination Service Responsibilities
The Disability Determination Service is a State Agency contracted by the Social Security Administration to determine your medical eligibility for disability benefits. The Disability Determination Service is funded by the Federal Government, and its employees are trained in applying Social Security Administration Regulations and operating procedures. Although each State has its own Disability Determination Service, the medical requirements to be found disabled are the same throughout the United States.
While your application is pending, it is usually in your best interest to provide information directly to the Disability Determination Service (unless it is requested by your Social Security Administration Office). If medical updates or other information is needed to determine your medical eligibility, you will receive a phone call or letter from the Disability Determination Service requesting the information. If you submit any information directly to the Social Security Administration Office, it is supposed to be transmitted to the Disability Determination Service for consideration; however, since your local Social Security Administration Office and the Disability Determination Service are rarely in the same location, it is in your best interest to provide information directly to the Disability Determination Service.
Processing after Medical Determination is Made
Once a medical decision is made on your claim, your file is transmitted back to your local Social Security Administration Office for processing. If you are denied benefits, a denial letter is issued on Social Security Administration letterhead explaining the evidence that was used to deny your claim and why you do not qualify for benefits. If you file an appeal, your local Social Security Administration Office is responsible for processing your appeal and transmitting your file to the proper location for further consideration of your disability.
If you are approved for disability benefits, the local Social Security Administration Office again confirms that you meet the non-medical requirements (based on the medical approval), and your payments are calculated. If you are only eligible for Social Security Disability Insurance or Widow/Widower’s Disability Benefits, your benefits are processed in a national payment center and a Notice of Award is issued. If you qualify for Supplemental Security Income Payments or you also receive Workers’ Compensation Payments, additional information must be provided to your local Social Security District Office before your benefits and award notice can be released.
What the Social Security Administration District Office Does Not Do
The most important thing to understand about the disability determination process is that your local Social Security Administration Office is not responsible for the medical determination of your disability. Opinions given on the strength of your claim at the local office are not relevant. Many of the Claims Representatives do not even fully understand the rules to be found disabled (nor should they be required to). Statements by Social Security Administration employees advising you to not pursue benefits, do not bother appealing your denial, you do not need an attorney, or there is no reason why you will not be approved, are not usually supported by facts. The Social Security Administration Claim’s Representatives are not supposed to provide you legal advice on how to pursue your claim, or discourage you from filing an application if you meet the non-medical requirements. Even if you do not currently meet the non-medical requirements, you may still qualify based on your status from the past.
Ask for Help Understanding the Process
I personally represent individuals at all stages of the Social Security Disability Process. One of the benefits of having an attorney assist you with your disability claim is that I eliminate the majority of your personal contact with the Social Security Administration District Office. Although all of the Social Security Administration employees that I work with are dedicated hard workers, I hear too often from my clients that they are misled or confused by information provided by the Social Security Administration Office. Based on my experience on all aspects of the Social Security Administration Disability Process, I am normally able to assist you in understanding and navigating the process while providing you with a better chance of being approved for disability benefits.
If you are considering applying for Social Security Disability Benefits, or you are already in the process of applying for benefits, I normally recommend that you contact an attorney to discuss your specific claim. If you are confused by the process, or believe that you have received misleading information, it is important to discuss your unique situation with an attorney that is experienced in the Social Security Administration Disability Process.
This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.