THE APPLICATION PROCESS Flashcards
WHERE CAN AN APPLICANT APPLY?
An applicant can apply online, by phone, or at their local Field Office or Contact Station
WHAT DOES SSA NEED FOR AN APPLICATION FOR SSDI?
FOR SSDI:
Social Security needs a variety of materials from the claimant to process the application properly. Here is a shortlist of material reqyired from the claimant to process the case:
Birth Certificate or Proof of Age
Social Security Number
Completed SSA Application for Disability Form
Completed Disability Report Form - SSA Form 3368
Completed Disability Work History Report Form - SSA Form 3369
Completed Disability Report Form - SSA Form 3368
List of Medical Sources used by the claimant
Release for Medical Records - SSA Form 827
WHAT DOES SSA NEED FOR AN APPLICATION FOR SSI?
FOR SSI:
Birth Certificate or Proof of Age
Social Security Number
Completed Disability Report Form - SSA - 8000 BK
List of Medical Sources Used
Release Form for Medical Records
Employment Data
Activities of Daily Living
School Records
Disability Onset Date
2 TYPES OF DISABILITY ONSET DATES:
There are two types of onset dates. The AOD (alleged onset date) and the EOD (established onset date).
The AOD is the date the claimant alleges he became disabled. In an SSDI case, the claimant sets the AOD. But the SSA won’t allow benefits for any time when the claimant was engaged in SGA or substantial gainful activity. SSA determines the EOD. The EOD is the actual date used to establish benefit payments.
ACCEPTABLE MEDICAL SOURCE:
To evaluate a Social security disability claim, SSA considers an acceptable medical source to be Sources who can provide evidence to establish impairment(s). We need evidence from acceptable medical sources to establish whether the claimant has a medically determinable impairment9s). Acceptable medical sources are:
Licensed physicians (medical or osteopathic doctors)
Licensed or certified psychologists
Licensed optometrists
Licensed podiatrists
Qualified speech-language pathologists
A chiropractor is an example of a medical source that cannot be used to make a final decision in a disability claim.
Acceptable SSA documentation options are:
Physician’s Medical Reports
Hospital Records
Laboratory Reports, etc.
FACTORS THAT REDUCE BENEFIT AMOUNT:
Any payments made to a claimant from a federal, state or local government that covers conditions that are not job-related can affect benefits eligibility. An example would be payments made to a claimant from a local government assistance program.
OFFSET:
An offset is a term used to describe the amount of benefit lost as a result of another disability insurance or retirement program.
BENEFIT PROGRAMS THAT DO NOT REDUCE DISABILITY BENEFITS:
- Veterans Administration benefits
- Social Security covered federal benefits if the work was done
- State and local government benefits if SSA covered the work.
- Private pensions or insurance benefits.
- Supplemental Security Income (SSI) benefits.
ACCESS TO CLIENT EVIDENCE OF RECORD:
Under the Privacy Act, you or your authorized representative has the right to examine federal government records on a claimant’s case. The authorized representative is the person appointed by the claimant to represent the case. This acting representative can be any responsible person appointed by the claimant in writing.
REPRESENTATIVE’S RIGHTS TO ACCESS:
An authorized representative may request to see all records associated with their client’s disability claim. The representative holds the same weight under the law as the client regarding record requests or disclosure.
RECORD DISCLOSURE CONSENT:
Disclosure of a claimant’s evidence can only be done by consent. Consent must be in writing be signed by the claimant or their authorized guardian, be dated, and the exact data or contents specified.
Social Security must obtain the claimant’s consent to:
- contact a claimant’s treating sources to request records.
- release a claimant’s records, particularly their medical records, and
- disclose information about a claimants case to any third party.
DISCLOSURE WITHOUT CONSENT:
under the U.S Privacy Act, SSA can disclose a claimant’s records without their consent in certain circumstances. The SSA must keep a record of all such disclosures. Permissible reasons are:
- Information is shared within an SSA agency on a need-to-know basis
- Information is shared to comply with a court order, State or Federal law.
PENALTIES FOR DISCLOSURE WITHOUT CONSENT:
A claimant’s privacy rights are protected under law. Under the Social Security Act, the following violations are punishable as misdemeanors with fines up to $1,000 and/or a year in prison:
-disclosure by an SSA employee of any Social Security records except as permitted by Federal law.
- misrepresentation by anyone to obtain a claimant’s records with the intent to elicit information regarding the claimant’s date of birth, employment, wages, or benefits.
SUING SSA FOR DISCLOSURE ISSUES:
A claimant or their representative may sue SSA over an issue associated with claimant record disclosure. The claimant can take this action if SSA:
- refuses to amend your Social Security record
- refuses to let the claimant or representative view the reco4ds and/or obtain a copy of the claimant’s records.
- fails to disclose that the claimant or rep disputed information in the claimant’s file.
- fails to maintain the claimant’s records accurately.
If the court determines that the SSA acted intentionally or willfully. It may assess attorney’s fees, costs, and actual damages sustained by the claimant.
RAILROAD RETIREMENT ACT:
The Railroad Retirement Act (RRA) sets up a benefits system for railroad employees and their dependents and survivors. The RRA works with the Social Security Act to provide disability (as well as retirement, survivor, and dependent) benefits payable based on a person’s work in the railroad industry and work covered by the Social Security Act.
ADVOCATE CASE DISQUALIFIER:
A case disqualifier is any factor that can help you determine the viability of a case. Viability is defined as the level of case winnability. Anything that interferes with your ability to win is considered a case disqualifier. Some of these disqualifying factors are:
- The client is currently on SSA disability benefits
- The client is still working at SHA
- The client already has a representative
- The client was incarcerated during the period of disability
- The client acquired his impairment during the commission of a crime
- The primary impairment involves drugs & alcohol
- You suspect the client is dishonest
- The claimant has no medical evidence in an SSDI claim
- The claimant does not have a valid SSN
The above disqualifiers will quickly enable you to reject cases without wasting valuable time.
