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How to Apply for Social Security Disability Benefits

By: Pitt Dickey - Attorney

Preface: Since Social Security Disability is directed under Federal law, the information in this column will apply anywhere in the United States.  However each Office of Hearings and Appeals and District Office have their own ways of doing things as does the various Federal District and Circuit Courts.   I have kept this column primarily dealing the the mechanics of how the Social Security District Offices and Office of Hearings and Appeals evaluates disability claims. 
- Pitt Dickey


This column will deal with the mechanics of how a disabled worker actually applies for Social Security Disability benefits and what happens after the application is filed. As an example we will use the case of Bill Smith. 

Bill has worked at a manufacturing plant for 20 years doing heavy lifting. One day at home he falls while carrying groceries and ruptures two discs in his lumbar spine. He is out of work for a year while undergoing conservative treatment for his back such as medication, physical therapy and utilization of a TENS unit. 

Ultimately the pain is so severe he undergoes a laminectomy to try to repair the damage. Unfortunately the surgery does not relieve his pain and as his disability insurance policy begins to run out he learns that he may be eligible for Disability Insurance Benefits from the Social Security Administration (SSA).

The first step for Bill is to go to the local Social Security office nearest to him. In Fayetteville, the SSA local office is located at 111 Lamon Street. The head of the office is Tom Martin. When Bill goes to apply for disability benefits he will be asked to complete numerous forms to start building his case file in order that his claim can be evaluated to determine if he should receive the disability benefits from the SSA.

Bill can assist his claim in being processed as quickly as possible by taking certain documents with him to the initial interview. He should take his birth certificate, a list of the employers and their address where he has worked for the last fifteen years, and a list containing the names and addresses of any medical providers who have treated him for his back problems.

The staff member at the local SSA office will need this information to begin the application process. Bill will have to complete a personal information form which sets out the basis for his claim dealing with such things as where he has worked, the types of jobs he has performed, the physical requirements of the jobs ó such as amount and frequency of weight lifted, number of hours sitting and standing. 

This form also will require him to provide information about his level of formal education. The form will require him to provide the names, addresses and dates of treatment by medical care providers such as doctors, hospitals, out patient clinics, physical therapists, chiropractors, pain clinics or other health care providers.

If Bill has any medical reports from prior treatment he should take these reports with him when he goes to the SSA office. He should provide a copy of the reports to the SSA office. 

Never, ever give your only copies of health records to the SSA as on occasion documents can be misplaced. If Bill has had disability benefits awarded to him from some other source such as workers compensation, disability insurance or the Veterans Administration he should provide a copy to the SSA to be made part of his file.

Bill should let the SSA know about all of his health history including things that may seem unrelated to his back problems such as diabetes, hypertension or other health problems. 

Sometimes claimants who have multiple health problems may not tell the SSA about what they think are unrelated problems. People do not exist in a vacuum. The complications from diabetes may be enough to cause Billís back problems to result in a favorable decision. 

However if Bill does not tell the SSA about his health problems then they may not be considered. All of Billís health information is relevant so the SSA should be told everything. Bill will be asked to sign numerous medical release forms so that the SSA can then contact his medical sources to get information on his health.

The SSA will develop a case file at the local office and obtain a computer print out of all of his FICA wages over his work history. This document will be used to calculate the amount of Billís disability benefits if his claim is approved.

After the preliminary information is received from Bill, his file will be submitted to the N.C. Disability Determination Agency which is a state agency in Raleigh that will make the initial decision to approve or deny his claim. 

The agency will request information from his medical care providers such as hospital admission history, discharge summary, physical exam, office notes, out patient notes, operative notes, radiological reports, and other clinical reports.

Bill will have to submit an Activities of Daily Life report to the State Agency which will have him respond to such questions as:

* What is it about your condition that keeps you from working?

* Describe what you do in a typical day

* How does your condition effect your daily activities?

* What symptoms do you have?

* Describe any emotional or memory difficulties you are experiencing

* List any treatment you are having for emotional or memory problems

* List all your medications and any side effects

* List any difficulties in handling personal needs such as grooming or dressing

* What household chores can you perform?

* List any organizations you belong to and how has your illness effected your participation

* Describe any difficulty that you have performing routine tasks

* List any other medical treatment you have had since you first applied for benefits

The State agency can refer Bill to a doctor it selects for what is called a consultative exam. It is mandatory that Bill go to be examined by this doctor if the SSA requires such an exam. The SSA does not always require such exams in every disability case.

This consultative exams are paid for by the SSA and a doctor will examine Bill to diagnosis his health problems. If a claimant has alleged some sort of mental health problems, the SSA can also arrange for the claimant to be examined by a psychiatrist or a psychologist. 

The doctor will then prepare a written report to the SSA regarding his diagnosis of Billís health situation and limitations. The doctor who performs the consultative exam is not going to treat Bill. His interaction with Bill will typically consist of a one time office exam where he will have Bill perform various physical movements and examine him.

Billís treating physicians will be his best source of help in obtaining Disability benefits. Bill should advise his doctor that he has applied for disability. 

The State Disability Determination agency may contact Bill by telephone to discuss his medical condition and may contact members of his family to obtain further information about Bill. 

Once this information is assembled the State Agency will then make a decision as to approve or deny Billís disability application. The Agency will then notify Bill in writing of this decision.

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over twenty years. He practices with the firm of Smith, Dickey, Smith, Hasty & Dempster, P.A. at 555 Executive Place and can be reached at 910-485-8020 or at pitt@smithdickey.com . Or at the firm web site of www.smithdickey.com .

Copyright © 2002 Pitt Dickey - Used with permission

 

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