Social Security Disability

1. Social Security Disability How Claims are Evaluated Shiwanda Leonard, Professional Relations Officer

2. Disability Determination Services • The State Agency that makes the medical determinations for Social Security Disability

3. Definition of DISABILITY • The inability to engage in any substantial gainful activity as a result of any medically determinable physical or mental impairment(s) • Which has lasted or can be expected to last for a continuous period of not less than 12 months • Or result in death

4. Disability in Children • A child under age 18 if he or she has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations • Which has lasted or can be expected to last for a continuous period of not less than 12 months • Or result in death

5. Substantial Gainful Activity • $1,220.00 for non-blind individuals • $2,040.00 for blind individuals • If you are working and your earnings average more than $1,220.00 per month, you generally cannot be considered disabled.

6. How Do You Apply? • In person at one of the 37 local Social Security Offices • By phone at 1-800-772-1213 • On the Internet at www.SocialSecurity.gov

7. What can applicants do to expedite the process? Provide complete information about treating sources & include the following: • Names • Addresses • Phone Numbers • List of Medications • Submit any medical records that they may already have

8. Fast-Track • Quick Disability Determinations (QDD) • Compassionate Allowances (CAL) • http://www.socialsecurity.gov/disabilityresearch/fast-track.htm

9. What’s Next? • Once the application is completed, the local Social Security Office will determine if the basic administrative requirements are met. • Title II {Insured Status} • Title XVI {Income & Resources}

10. Where Does the Claim Go? NC Disability Determination Services Is located in Raleigh, NC

11. What the DDS does: • Obtains medical evidence from doctors, hospitals, clinics and institutions where treated • Reviews vocational information • Makes medical disability determination via a team consisting of a Disability Analyst and Licensed Physician and/or Psychologist

12. Agency Statistics • 760+ employees when fully staffed (including 50+ doctors, psychologists, and SLPs) • 7th largest of 52 DDS’ based on volume of claims processed • 131,930 cases closed out of DDS in FY2018 • 36,305 Medicaid cases received in FY2018 • Currently receiving approximately 2,730 federal cases per week

13. What Should Doctors Send? • What is the impairment(s)? • History of the condition • When did the impairment begin? • How does it limit activities/functioning? • Type(s) of treatment and responses • Specific physical findings • Results of medical testing (e.g. lab work, x-ray, etc)

14. How to Send Records SSA offers a range of electronic options for submitting medical records to DDS Options: • Fax – 1-866-885-3235 (secure & toll free) • Web – Electronic Records Express (ERE)

15. Keep In Mind: • The treating physician is not asked to decide if the person is disabled. • It is an administrative decision made by DDS. • If more information is needed, a consultative examination will be purchased.

16. Consultative Examination • An examination purchased at the expense of Social Security to secure information about the person’s condition. • About 1,600 Consultative Exams ordered per week in fiscal year 2018.

17. SEQUENTIAL EVALUATIONA Five Step Process • Is the person engaging in SGA? • Is the person’s impairment(s) severe? • Does the person’s impairment(s) meet or equal a listing? • Does the person’s impairment preclude the ability to perform their past work? • Does the person’s impairment(s) prevent them from performing another type of work?

18. Listing of Impairments • http://www.ssa.gov/disability/professionals/bluebook//

19. Onset • Established Onset Date (EOD) – the date DDS determines an impairment meets the definition of disability and the claimant is no longer working • Title XVI – benefits start with filing date or EOD if established as a later date • Title II – there is a 5 month waiting period from the EOD before benefits begin • Death in the Waiting Period

20. Medicaid Vs. Medicare • Medicaid (State) – If a claimant is found disabled under Title XVI (SSI) they often times qualify for Medicaid but must file at their local DSS. • Medicare (Federal) – If a claimant is found disabled under Title II (Insured), they will get Medicare coverage automatically after they have received disability benefits for two years.

21. Four Levels of Appeals • Reconsideration – NC DDS (appeal within 60 days) • Hearing by ALJ (ODAR) – face to face hearing within 75 miles of home or video hearing, attorney/representative can explain your case, can have witnesses • Review by Appeals Council • Federal Court Review

22. Average Monthly Payment • TITLE II {SSDI} $1,165.00 • Title XVI {SSI} $735.00

23. Questions? Shiwanda Leonard Professional Relations Supervisor 919-814-2779 800-443-9360 ext 2779 Shiwanda.Leonard@ssa.gov