Social Security Disability Claims Examiner  Speaks Plainly 

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Discover how to get an accurate Social Security Disability or SSI Claim Decision in the least amount of time. 

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"Claims ESP is an informative site useful for persons with disabilities who seek to acquire Social Security Disability benefits and Supplemental Security Income benefits in the least amount of time from the Disability Determination Services unit -- a contractual division of the Social Security Administration. Get an insider's view of the process here, and discover how to increase your odds of winning your disability claim right now..."

--Lo Crosby, Editor and Ex Disability Claims Examiner

You have come to the right place to discover insider tips for getting your Social Security Disability Insurance Benefits and SSI Disability claims decisions reviewed by your disability examiner in a timely and accurate matter.

While the information on this site may not assist you in winning your Social Security Disability Insurance claim or your SSI disability benefits claim if you are not otherwise disabled under the Social Security rules and regulations which govern who qualifies for benefits,

Nonetheless...

If you follow the simple tips and advice posted at this online Social Security Disability (disabilty, dissability) claims resource information center, you will be empowered with ways to assist your claims examiner with:

Decreasing the "processing time" needed to reach a decision on your claim and Increasing your chances of getting the best decision on your claim. 

Dear Disability Applicant or Representative: 

Let's face it, there are lots of social security disability attorney and lawyer websites, and disability advocate sites which promise to help you win your claim. This is not one of them. Visit my  resource links page if you need an attorney, lawyer, legal representative, paralegal or disability advocate to help you appeal a negative disability claim decision.

Instead, the editor of this site is an ex Social Security Disability / SSI claims examiner who has handled hundreds of initial adult claims for the Social Security Administration while working under one of their Disability Determination Services' offices (aka Disability Adjudication Services) in two southeastern states.

Disability claims examiners do not work directly for the federal Social Security Administration (SSA), but instead they work for a state agency that Social Security contracts with to handle the medical and vocational part of a disability claim.

The claims examiner, oftentimes in collaboration with a disability medical consultant on staff, will decide if you meet the medical and vocational criteria for disability as set forth in the rules and regulations established by SSA.

Your initial application for benefits is generally processed by the Social Security local office, which determines which programs you might qualify for and then forwards the accepted applications on to the state agency charged with determining whether or not you are medically and vocationally disabled under the Social Security disability rules. If you are determined to be disabled, then you will be granted an "allowance" for benefits. If it is determined that you are not disabled, then your claim will be "denied" by the  DDS office.

That said, at the disability determination level of your application, your role in the process is a relatively simple one.

Basically there are only three to four things you are able to do that will assist the disability claims examiner in reaching a good and timely decision on your initial claim. They are:

1. You should complete all claims forms accurately (whether it be a   work history form, the Activity of Daily Living function report or the various other questionnaires sent to you for seizures, pain, cardiac problems or the like). Not providing all the information you are asked for can hurt your claim. Why? In many instances, it is as simple as the examiner not having (or making) the time to give you a follow up call to get the missing information. This site will pinpoint some of the crucial questions that you must answer and how to answer them correctly when completing SSA disability forms.
   
   
2. You can offer to assist in getting critical medical records if the examiner has not been able to get a response from your doctors or medical practitioners (your medical records are called MER--medical evidence of record). How will you know that the examiner has not been able to get the information? See #4 below (and my article entitled   Checking the Status of Your Disability Claim). If you do provide medical records when you apply for disability, I can show you how to keep that act -- which you consider helping -- from working against your processing time. Because it is the exception rather than the rule that medical records are received with a case record by the claims examiner, many examiners will put those claims aside for a period of time because it involves a little extra initial work. I can show you how to keep that from happening by simply adding one cover sheet listing a little information regarding the dates of treatment, etc.
   
   
3. You should keep any consultative examination (CE) appointments that you have been given with a doctor that the examiner asks you to attend, and be on time. Generally, if you are asked to attend a CE, it means that the examiner has not been able to "allow" or issue a favorable decision on your claim based on the medical information already in your case record. There are many reasons why failing to keep a CE appointment frustrates your examiner to no end. But the number one reason actually has nothing to do with you or even the reason you say you could not keep the exam. I will explain why keeping your CE appointment at all costs is critical to maintaining a positive relationship with your disability examiner.
   
   
4. Periodically, check the status of your disability claim. You can do this strategically to ensure a decision at the earliest possible date. At what point in the determination process should you make the first call, the second, the third?

In addition to providing specific examples of how to complete forms in a way that provides the most useful information to your examiner, I will also explain how each of the forms are used in the sequential evaluation process. Sample forms for review will be available.

For example, in completing the work history form, many claimants do not indicate the number of hours he/she "stoops" on a job or has to "stand" or "sit" on a job, or do not indicate the amount of "reaching" done on a job. Electing not to calculate or estimate the amount of time you spent doing a specific activity during your 8-hour workday can actually mean the difference between an allowance and a denial on your claim, especially if you fall in the age category of an "older" individual.

Examiners should call you to get additional work history that address this information when you leave it off your work history form. But...you may never get the call if your examiner is managing a growing caseload of 150-200 claims. So where does the examiner get the information from if they don't call you to clarify? Good question and the answers will be revealed as this site is developed.

Yes, I'm just beginning to add articles to this site, but here is

The Examiner's Role & Tools Used to Decide Your Claim 

• Medical/Vocational Evidence (How to make sure your information is telling.)
• Residual Functioning Capacity Forms--RFCF--(For Physical Disabilities)
• Mental Residual Functioning Capacity Forms--MRFC & Psychiatric Review Technique Forms--PRTF--(For Mental Disabilities)
• Range of Motion Form--ROM--(For Muscular-Skeletal Impairments)
• Questionnaires (Cardiac Impairments, Seizures, Asthma, Pain, etc.)

Activities of Daily Living / Third Party Functioning Reports (Mental Allegations or Claimant on drugs normally prescribed for Mental Impairments), Vocational Analysis and Sequential Evaluation

The Staff Medical Consultant's (MC) Role 

• Medical Consultants review medical and psychological summaries written by Disability Examiners and / or they may write case summaries in complicated cases 
• Medical Consultants sign forms / authorize certain Xrays such as PFTs (Pulmonary Function Tests or lung study tests) or stress test in cardiac cases

Medical Consultants (MCs) on staff in the Disability Determination Services (DDS) office include doctors specializing in a variety of disciplines, such as internists, orthopedists, ophthalmologists, rheumatologists and others. These doctors sign off on a good number of disability claims in many states. By "sign off" is meant that once the examiner writes up/completes the RFC form or the PRTF or the MRFC summary, the doctors must sign the form to indicate their agreement with the examiner's assessment. And this is how it should be since examiners are generally not doctors and mostly are just guessing at an assessment unless they have many years of experience in adjudicating claims.

Unless your disability examiner has been certified and designated as a Single Decision Maker (SDM), MCs can influence how your case is summarized. Some MCs are more conservative than others. Examiners quickly learn what will and will not get pass a MC review and then start to issue decisions which they know the MC will sign off on. Though it shouldn't be that way, that is the way it is. This makes it very important that your medical records objectively portray a disability so that even conservative MCs will concur with the examiner's conclusions.

Quality Assurance Role

This department in the DDS office randomly polices/reviews the work of staff disability examiners/adjudicators and Medical Consultants and has the authority to "send cases back" for further information gathering or further development if they feel the records are incomplete or inconclusive.

Of course the problem is that this department is more likely to review an "allowance" decision than a "denial" decision. Go figure. And this is just one of the reasons when a claimant asks an examiner what the decision on their claim is in the DDS office, the examiner must say, "we are not allowed to say." Because even if the examiner has approved the claim (i.e. issued a favorable decision), that decision might be a denial by the time it gets out the door and is returned to your local Social Security office so that it can be mailed to you. More in this area to come...

What it boils down to is that the quality of information you provide or that is collected on you from your medical doctors can and will influence the outcome of your claim. You should begin to focus on communicating what your functional limitations are ( i.e. what you can and can not do as a result of your mental or physical disability.) For example, you may be diagnosed "HIV positive"; however, even though this diagnosis can be potentially disabling in its full blown stage, it may not yet have begun to affect your ability to work or function. You may in fact be without symptoms. Except for some very specific diagnoses which are listed in the Social Security "blue book" listings of impairments, the majority of conditions are evaluated based on how they effect your ability to function -- or not function -- in critical areas which Social Security deems necessary for work related activities.

Some claims examiners do not use all the tools at their disposal to gather pertinent information on your claim, either through lack of knowledge or they don't understand the importance of using the available resources. With the high turnover rate of examiners, there are many new examiners who don't have the necessary skills to get an approval on a "borderline" claim.

The goal of this site is to help you help your disability (dissability) examiner get you an accurate decision in the least amount of time, whether they are experienced or not, and with or without the use of a social security disability attorney, legal representative, advocate or lawyer.

Additionally there will be ....

A section on things you should know, like:

• Providing a list of which medical conditions qualify you to get disability benefits immediately, even if no medical evidence has been submitted (these are called "PD" cases or Presumptive Disability claims) and are only available for SSI claims which have a greater chance of being approved 
• Providing a list of conditions that "won't buy you a cup of coffee" in the eyes of Social Security when it comes to qualifying for disability benefits (i.e. high blood pressure and diabetes where there is no end organ damage (EOD)--I'll explain what EOD is later) 
• Reviewing Common Disease Conditions and impairments with information on how disability examiners evaluate them 
• Explaining when you don't need an attorney. Conditions that you can "bank on" and not have to give an attorney 25% of your back benefits and how you can list that condition on your initial application so that the disability examiner doesn't have to wait to see your records, but may be able to issue a presumptive disability decision (PD), allowing you to get benefits immediately if you have an SSI claim.
• Why  you need to know which age category you fall into. For instance, A 54.5 year old with the exact same impairments and vocational history as a 55 year old might be denied benefits while the 55 year old with identical maladies will be allowed benefits. More on this area in the vocational analysis and GRID rules section...

My extensive disability resource section, now under development, will also be useful to you in finding what you need online to meet your Social Security Disability goals and to get your questions answered by people in the field. Our disability FAQ section is a good starting place for this. There is also a recommended reading section which includes the best books I've found to help you get started in understanding the claims process.

While this site will not attempt to give you definitions of the difference between T2 (title 2) and T16 (title 16) Social Security disability and SSI disability programs, it will direct you to online resources that have already provided such answers. But, basically, title 2 is an insurance entitlement program based on premiums you have paid into the system, while title 16 disability benefit eligibility is based on economic need.

The scope of this site is necessarily narrow since it is a free resource and tools put together voluntarily by an ex claims examiner. But, nonetheless, I intend to make it a comprehensive and as complete as possible, over time.

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As an old psychology professor of mine used to say: "The mark of an educated man is not that he knows everything, but that he knows where to find answers."  I can only promise to help you find answers to your questions as they relate to your role and the role of your disability examiner and the Disability Determination Services office in the processing of your initial adult social security disability claim.

Information on finding competent lawyers, attorneys, advocates and more will be posted as it becomes available. I will also share with you online resources, including governmental, non-profit and private, as well as book reviews from time to time which may prove useful to you as you proactively assist in the preparation of your claim.

Please sign up for the free Claims ESP newsletter if you would like to receive updates on when new articles are added to this site.

Here's to your health and to the health of your social security disability claim.

Sincerely,



Your Editor,

Lo Crosby

Welcome to
Social Security Disability Claims ESP

 

"Where you get the tools you need to help your disability claims examiner give you an accurate decision in the least amount of time -- with or without the use of an advocate, attorney, lawyer or legal representative." 

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Site Disclaimer: This site is not a part of the Federal Social Security's government site, or affiliated with the official site in any way.