How Does the Case Representative Decide If a Claimant is Eligible for Social Security Disability?
01/15/10
Q: When you apply for social security disability, how does the agency decide to deny or approve benefits?
A: The thing the claims examiner will place the most importance on is medical data. It is vital that you have a physician who supports your decision to apply for social security disability. A statement that outlines your injury and how it impacts your employment will need to be written by your doctor. Your disability case will be based on that descriptive statement provided by your physician. If you do not believe your doctor thinks you should apply for social security disability insurance, then you will want to seek treatment from a different doctor. The claim representative will also look at your actual medical files to get a complete picture of your condition. It is important to confirm with the claims examiner (or your lawyer, if you have one) that the most current medical records have been sent. A wait for medical files is the biggest reason claims are delayed. Although medical data is what the claims examiner will use to determine your eligibility for disability insurance, you also want to make sure you have completed the application and any other required forms correctly and on time. A claimant who has strong medical evidence and has met all the deadlines is a good contender for disability benefits.
Q: What is the next step after your application is not awarded social security disability insurance?
A: The next step is to file an appeal. Do not simply submit a brand new application. Your claim will likely be denied again and you will lose valuable time that could have been spent on an appeal. It is important to submit the appeal paperwork within the sixty day deadline after you received notice that you were not awarded benefits. If you currently have a social security disability attorney, he or she will handle this for you. It is wise to communicate regularly with your attorney, though, and confirm that the appeal has been filed. A claimant who is not working with an attorney should speak with his or her disability examiner to assure deadlines and paperwork requirements are met.
Q: What is the difference between reconsideration and appeal?
A: When you submit an application for social security disability insurance and are not approved, you will likely plan to appeal your claim. Your claim will undergo a few steps when you appeal, and those different steps can cause confusion if you do not know what they mean. Having your case reconsidered is the appeal you will file after your application is first denied. There are a few states that are currently not using the reconsideration step, so check with your attorney or claims examiner to figure out if you should not file for reconsideration. A reconsideration is simply another review of your case with a new set of examiners. The majority of cases that are reconsidered are denied benefits. The next appeal after reconsideration is to request a hearing.
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