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
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
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
* 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
* 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
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.
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.
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.