Social Security Disability Insurance (SSDI) APPLICATION PROCESS
This document is a checklist provided to walk you through the SSDI application process. As you read, and complete each section, check it off so that you can keep track of where you are in the process.
What and Why SSDI?
You have successful filed for, and have been accepted for, Long Term Disability (LTD) insurance. OR, you do not have access to LTD, or have been declined for LTD. (Note: a denial on behalf of an insurance company for LTD, does not have an impact on your ability to successfully apply for, and be accepted for, Social Security Disability Insurance coverage. The Social Security Administration uses the same and different criteria to determine eligibility..)
If you are a worker who has qualified for SSDI by working a sufficient length of time, (place link to SSA personal statement page here) suffering from a disability, you may be able to receive monetary benefits from the Social Security Administration. Also, in some situations these disability benefits may be awarded to you and your dependents. To determine if your dependents are eligible for benefits, please refer to place SSA link here. This document describes the steps involved in applying for benefits for yourself, as a worker, suffering from a disability.
In general, the Social Security Administration will pay cash benefits to people who are unable to work for a year or more because of a physical or mental disability. In order to receive these benefits, you must prove that you are in fact disabled or suffering from a disability. This document describes the process of “proving disability” in step-by-step detail. As a further assistance, included are forms to help in your proof; both completed documents by someone with the same disease as you have, to serve as examples, and the blank forms available for you to use to describe your own situation.
Disability under Social Security is based on your inability to work. You will be considered disabled if you cannot do the work that you did before (i.e., the job or occupation that you performed at the time when your illness/condition became disabling), and that you cannot adjust to other types of work (given your specific age, level of impairment, past work history, and level of education) because of your medical condition(s). Your disability also must last or be expected to last for at least a year or to result in death.
Why is it so hard to Qualify for SSDI?
There are three primary reasons why it is so difficult to qualify for SSDI:
Ø The applicant thinks that s/he is disabled, but the symptoms have not sufficiently impaired the applicant’s ability to perform “work” as defined by the Social Security Administration.
Ø The applicant has not successfully “proven” that s/he is disabled.
Ø The applicant leaves the “evidence of proof of disability” up to the Social Security Administration, or to another third party, rather than compiling and presenting the evidence to the Adjudicator her/himself.
An individual will be determined to be disabled if his or her impairment "meets" or "equals" the requirements of the Listing of Impairments (found in what is called the Social Security “Blue Book”). This is a list of physical and mental illnesses that the Social Security Administration (SSA) considers to be so severe that they warrant an automatic finding of disability. The link to the Social Security “Blue Book” matrix of illnesses and what they consider “proof of impairment” can be found here: http://22.214.171.124/listings.html
However, if an impairment does not meet or equal the Listing Requirements, the patient will be determined disabled only if s/he is unable to perform work s/he did in the past 15 years and s/he is unable to do any other type of work considering residual functional capacity, age, education, and work experience. It is important to know that the proof of impairment – the documentation of this impairment – is the responsibility of the claimant and his/her supporting Medical team.
This requirement on the part of the claimant to “prove” the claim is the primary reason for so many denials. Recent documents indicate that the denial for first time applicants is up to 60%. Denials for second time applicants are up to 80%.
However, applicants who take the time and effort to understand their illness; who take the time to help their doctors, friends and families help them describe in detail how the impairments of the disease have so impacted you that you cannot perform either your job or any job; and, who take the time to compile all of the data for themselves and present the completed file to the Social Security Administration; these are the applicants that have a much higher chance of obtaining approval the first time around. The proof of this statement is that the author, Carolyn Magura, developed this process; developed and used the evidentiary forms and letters; and was approved for SSDI the first time around in under 30 days.
q I understand the why it is so hard to qualify for SSDI.
q I also understand that I must be able to demonstrate that my symptoms impair my normal daily functions in such a way that I meet the Social Security Administration’s definition of “disability”.
q Finally, I understand that I need to document, in great detail, how my symptoms have impaired me.
q I have obtained a copy of my Social Security qualification document.
q If I qualify for SSDI I will be eligible for approximately ____________ amount per month.
Understanding the SSDI Qualification Process
Prior to compiling and completing the documents that will supplement the actual SSDI Application, it is important to consider the following criteria that the Social Security Administration has placed on prospective applicants.
“1. Are you working?
If you are working in 2002 and your earnings average more than $780 a month, you generally cannot be considered disabled. If you are working in 2003 and your earnings average more than $800 a month, you generally cannot be considered disabled. If you are not working, we go to Step 2.
2. Is your condition "severe"?
Your condition must interfere with basic work-related activities for your claim to be considered. If it does not, we will find that you are not disabled. If your condition does interfere with basic work-related activities, we go to Step #3.
3. Is your condition found in the list of disabling conditions?
For each of the major body systems, we maintain a list of medical conditions that are so severe they automatically mean that you are disabled. If your condition is not on the list, we have to decide if it is of equal severity to a medical condition that is on the list. If it is, we will find that you are disabled. If it is not, we then go to Step 4.
4. Can you do the work you did previously?
If your condition is severe but not at the same or equal level of severity as a medical condition on the list, then we must determine if it interferes with your ability to do the work you did previously. If it does not, your claim will be denied. If it does, we proceed to Step 5.
5. Can you do any other type of work?
If you cannot do the work you did in the past, we see if you are able to adjust to other work. We consider your medical conditions and your age, education, past work experience and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied.” Note: copied directly from the SSA Online website at this link: http://www.ssa.gov/dibplan/dqualify5.htm
In addition, to these general rules, there are specific rules for what the SSA calls “special conditions”. Check here to see if you qualify for one of these special conditions. http://www.ssa.gov/dibplan/dqualify7.htm
Compiling and documenting the evidence of your Disability
The following process will walk you, step-by-step through the documents to focus your evidence to show:
Ø That you have an illness (Multiple Sclerosis) and are suffering from documented symptoms, over time.
Ø That these symptoms meet the SSA definition of “disability”.
Ø That these symptoms impair your normal daily living activities.
Ø That this impairment will last for at least 12 months.
Ø That this impairment will keep you from performing “any occupation”.
Note: this process only will work if, in fact, you do have the illness; you do have the symptoms; the symptoms can be documented and proven by supporting information by Doctors, friends, family, and co-workers; and, that you actually are impaired from performing work of any occupation. This is NOT a process for use in attempting to defraud the Social Security Administration.
Having read the SSA definitions above, I believe that I am disabled; and that this disability does impair me from working.
My Doctors, family, friends, and co-workers also agree, and are willing to support me in this process.
Step #1: Complete the Symptom Matrix in great detail. Use attachment # 333, and use attachment #444 as an example. Remember, this is your best opportunity to describe how you feel; how your illness, MS, impacts you. This is NOT the time to portray a “stiff upper lip”; it is the time to “complain all that you want”!
I have completed the first draft of my Symptom Matrix.
Step #2: Review your current job description. Hopefully, your job description will contain what is called “physical capacity criteria” that indicate what specific physical, mental, and social “levels of interaction” are required when performing your job. (See attachment ----, an example of a job description that includes the physical capacity criteria.)
If your job description does not include such criteria, you will need to develop them. For example, in your job:
1. If you need to use a computer, this activity could require you to be able to carry out small motor skills proficiently for 2-4 hours per day, or longer.
2. In using this computer, you would be required to sit for 2-4, and up to 6 hours per day.
3. In using this computer, you would be required to have visual skills capable of viewing a computer screen for 2-6 hours per day.
4. If your job requires you to inspect a warehouse, this activity requires you to walk for 2-4 hours at a time; for distances up to 2 miles; to conduct activities in a non-office work environment that could reflect temperature differences between heat and cold.
5. This warehouse inspection could require you to climb the equivalent of 5 flights of stairs at least 4 times per day.
6. As a Welder of iron plating, you could be required to stand, sit, bend, for 4-7 hours per day.
These are just a few examples of how activities of a job correlate to the physical activities of normal daily living. What you need to do is to develop the physical requirements of your job. Please see appendix___________ as an example.
q I have developed the physical requirements of my job.
Step #3: Your next step is to complete the “Before and After” activity matrix found at attachment _______. It is important to keep in mind what your end result needs to be. You are documenting YOUR LIFE, to communicate to someone who does not know you what you did before your disease/accident had an impact on your life.
As you review the MS-specific example of Before and After, you will see that the Before section describes Ms. Magura’s physical activities associated with her job as Vice President of Human Resources for Cascade General, the Portland Ship Repair Yard. Please read Ms. Magura’s example carefully. Note that she discusses the job activities in great detail:
1. When the workday began.
2. What type of activities needed to be performed.
3. What type, frequency, duration, and intensity of interpersonal actions with others needed to be performed.
4. The diversity of activities being performed; the length of each workday; the volume of activities; the requirement for multi-tasking, etc.
5. The number of hours being worked each day;
6. What activities were accomplished after work each day; during the weekend.
7. Please see that she “described”, in the “Before” the job activities. By comparing the before and after, one can see that the symptoms, as described in the Symptom Matrix, are, in the after, not able to be performed.
In summary, what you are doing is “painting a picture” of your life BEFORE your illness/accident forced you to change your activities. You need to be as specific and as detailed as you can be. What you are doing is explain what your “Normal Daily Living” looked like!
Next, you need to complete the “After” side. Again, read Ms. Magura’s example to see how detailed she is in explaining the impact that MS symptoms have had on her ability to perform her normal daily living activities and the physical, mental, and interpersonal actions of her job.
Review the Symptom Matrix (Attachment ____________) that you have already completed to document your symptoms when documenting your “After” side of this matrix. Again, be as specific and as detailed as you possibly can.
When you are finished, provide the Before and After matrix, your job description, and your Symptom matrix to someone who knows you and ask them to critique the matrixes as they compare both to your job description, and to how they have observed your change over time. Ask them the following question: “If you were an Insurance Adjuster, do these matrixes provide enough information for you to get a clear picture of the impact that my illness has had on me; of the level of impairment that the illness has had on my normal daily living?” If the answer is yes, then you are ready to continue. If no, revise the matrixes until the answer is yes.
After your friends, family, and co-worker(s) have reviewed the documents, select no less than 2, and preferably 3, to write a letter on your behalf to the Social Security Administration. As an example, see attachments 99999 and 8888.
q I have completed my Before and After matrix.
q I have provided copies of my matrixes and my job description to friends and families. They critiqued them.
q My matrixes adequately describes the impact that my illness has on me, and of the level of impairment that the illness has had on my normal daily living.
q I have copies of letters from friends and co-workers describing how they have witnessed my symptoms’ impact my daily normal living over time.
Working with your Doctor
Step #4: is to review the information about what your Doctor needs to know to help you by completing the Physical Capacity Evaluation or Residual Capacity Assessment Form. (See Appendix ------ for the instructions for your doctor. See Appendix ------ for a copy of a letter that you can copy to explain to your doctor what you need for him/her to do to assist you with your SSDI application. See Appendix ----- for a copy of a Physical Capacity Evaluation (PCE) Form for your Doctor to use. )
Make sure that you have 2 copies of the PCE form. Complete one yourself, as you see yourself impaired by your illness. Your previously completed matrixes will help you here. After filling out your copy, as you see yourself, review your job description once again.
Provide a copy of your matrixes, a copy of the instructions to your doctor along with the cover letter, a copy of your letters from friends and co-workers, along with the blank PCE form, to your doctor.
REMEMBER: If your doctor has any differences of opinion about your symptoms and limitations; make sure that the two of you resolve the differences before the doctor completes the Insurance forms for you.
When you get the letter(s), the PCE form and the chart notes from your doctor(s), be sure that you read them carefully. You will need to be sure that whatever symptoms, conditions, and issues noted by the doctor(s) are adequately addressed in your matrices.
One more key step in the “proof” arena. If you have had any “tests” performed to determine the presence of MS (i.e., MRI, spinal tap, eye tests, etc.) make sure that the test results also are included in the chart note information received from your doctor(s). Also, print from this website, to include in your documentation, how to interpret the test results when MS is the diagnosis: http://www.mscentralsupport.com/diagnosing.html
You have resolved any differences of opinion about your symptoms and your limitations with your Doctor(s).
q You have received back from your Doctor(s), the completed PCE form, the letter(s), and the chart notes.
q You have read the chart notes, and have made sure that anything noted is reflected in your matrixes.
q If you have had tests conducted, you have printed out the information that shows how to interpret the test results when MS is the diagnosis.
Completing the SSDI Application
It is recommended that you now make an appointment with your local Social Security Administration. Your local SSA office can be located through the following link.
After you have made the appointment (probably for some time in the future, because they are usually backed-up) please see the link below and download the actual application.
Complete as much of it as you can. This is another document to take with you to your appointment.
Next, the SSA recommends that you also include the following:
· A copy of your social security card, showing your number;
· Names, addresses and phone numbers of doctors, hospitals, clinics and institutions that treated you and dates of treatment;
· Names of all medications you are taking;
· Medical records from your doctors, therapists, hospitals, clinics and caseworkers;
· Laboratory and test results;
· A summary of where you worked and the kind of work you did;
· A copy of your W-2 Form (Wage and Tax Statement), or, if you are self-employed, your federal tax return for the past year;
· A certified copy of your divorce decree if you are divorced; and,
· An original of your birth certificate.
In addition to these documents, you also will be taking copies of the documents that you have just finished compiling:
· Your Symptom Matrix;
· Your Before and After Matrix;
· Your Doctor Completed PCE
· Your letters from your doctor(s); your friend(s); from your co-worker(s);
· Your doctor chart notes; and,
· If tests were performed, an explanation of how to read the test results when MS is the diagnosis.
You might want to compile all of the information into a binder. The SSA will have you take the documents out of the binder, and place them in a file folder.
q You have compiled all of the documentation that proves that you have a disability; that the symptoms of that disability impair your normal daily living; and, that you cannot return to work.
q You have made sure that you have kept an entire set of documentation for yourself.
CONGRATULATIONS! You are now ready for your appointment with the Social Security Administration!