Demystifying

the Disability

Process Presenter:

Teddi Rivera Heading Home

What are the two disability

programs offered by the

Social Security Administration?

Federal disability program,

administered by SSA, that

provides benefits to blind or

disabled individuals who are

“insured” based on

contributions paid into the Social

Security trust fund, as authorized

by the Federal Insurance

Contributions Act (FICA)

Supplemental

Security Income

(SSI)

Social Security

Disability

Insurance (SSDI)

Federal disability program,

administered by SSA, that

provides benefits to low

income people who are

disabled, blind, or elderly

What is the definition of “Disability”

according to the Social Security

Administration?

Impairments must affect a person’s ability to work which

means they are unable to

perform substantial gainful

activity (SGA)

What are the similarities

between SSI and SSDI?

• Definition of Disability

• Substantial Gainful Activity (SGA)

• Application Process

• Health Insurance

• Medical Criteria

The Differences…. Supplementary Security Income (SSI)

Social Security Disability

Insurance (SSDI)

Benefit for disabled, elderly, and

blind individuals who have very low income

Benefit for insured individuals (or

certain relatives)

Benefit amount is the Federal Benefit

Rate (FBR)

Benefit amount based on FICA contributions

Limits on assets/resources No limits on assets/resources

Living arrangement may affect benefit amount and eligibility

Living arrangement has no effect on benefit amount or eligibility

Medicaid eligibility usually comes with SSI

Medicare eligibility usually comes after two years of SSDI benefits

Eligibility usually begins the 1st of the

full month following the date of application OR protective filing date

Eligibility generally dependent on date of onset of disability

Work incentives usually apply

immediately after work begins

Work incentives allow for 9-month

Trial Work Period (TWP) during which

full benefits are received

Summary

• People often confuse the two types of

disability benefits from the Social

Security Administration

• SSI and SSDI are separate disability

benefits with significant differences

• Benefits are a tool in recovery – a

means of helping a person stabilize his

or her life

What is the process and who is

involved?

Social Security

Administration

SSA

Disability

Determination

Services

DDS

Individual establishes

Protective Filing Date

Individual files application

SSA determines non-medical

eligibility

SSA sends medical information and releases to DDS, where a disability

examiner is assigned

DDS processes claim and makes

disability determination

Applicant’s electronic record is

returned to initiating SSA

office

SSA notifies applicant of decision by letter

The Process….

SSA – Non-Medical

Information

Earnings History

Personal Information

Preliminary Disability Information

Immigration Status

Battery or Cruelty

Legal Involvement

Living Arrangements

Resources and Income

DDS – Determines Medical

Eligibility

1. Medically Determinable Physical or Mental Impairment

Illness(es) must either meet or be equivalent to the “listing”

criteria used by DDS. Supporting information must be

documented in medical records

2. Duration

The impairment tied to the illnesses must have lasted OR

be expected to last 12 months or more OR result in death.

3. Functional Information

Applicant must demonstrate that significant functional

impairment related to the illness(es) exists.

Sequential Evaluation Step 1 – Is the person working?

Is person working at SGA level? Person is not working or is

working at less than SGA level Denied

Step 2 – Does person have a severe impairment?

Step 3 – Does impairment meet or equal the listing requirements?

Step 4 – Does impairment allow for past relevant work to be done?

Person cannot do past work

Person has severe impairment

Denied

Impairment does not meet or

equal the listing requirements.

Impairment does meets or equals

the listing requirements.

Denied

Person can do past work

Person has no severe impairment

Yes No

Denied

Approved

Approved

Step 5 – Can person do any other work, considering age, education and work history?

What Can You Do?

Take an active part in the process

Become your client’s representative in the

SSA Disability process

Collect Medical Evidence

Submit complete application

Stay in contact with adjudicator

Become Your

Client’s

Representative

This form can be found online

at www.ssa.gov under the

“Forms” tab

SSA-1696

Collect Medical Evidence Make list of treating sources

Have applicant sign two releases for each treating source

Send releases to medical records departments

Contact current treating providers

Follow up weekly on information not received

Organize records chronologically and review

Continue to identify new sources of information

Maintain contact with DDS after application is submitted to furnish updates

Submit a SSA 827 to SSA

This form is found online at www.ssa.gov under the “Forms” tab

Submit Complete Application

After gathering all medical records, make

an appointment to submit the application

to SSA

The more complete the packet, the less

time it might take for a decision to be

reached

Stay in Contact With DDS

Adjudicator

Once the application is transferred to

DDS, stay in contact with the adjudicator

to keep them up to date on any

medical/psych issues with your client

Check to see if there is anything else you

can get them to help with the claim

If a consultative exam is order,

accompany your client to the exam

If possible complete all

necessary forms before

submission Get access to forms online at

www.ssa.gov

SSA – 3373 (Adult Function Report)

SSA – 3369 (Work History Report)

SSA – 8000 (Supplemental Security Income

Application (SSI)

If you would rather not complete this with

client, make an appointment with SSA and go

in with your client to complete

General Assistance

What is the purpose of this service?

The objective of General Assistance (GA) is

to provide cash assistance to dependent

needy children and disabled adults who

are not eligible for assistance under other

cash assistance programs, such as New

Mexico Works (NMW) or the federal

program of Supplemental Security Income

(SSI).

Basic General Assistance

Rules You must apply for disability benefits (SSI) within 60

days of approval.

You must be: a citizen of the United States;

a naturalized citizen;

an alien that entered the United States as a legal permanent resident or PRUCOL before August 22, 1996; or

an alien who entered the United States on or after August 22, 1996, and who meets the definition of a qualified alien, and is subject to the five-year bar from participation in the federally funded TANF cash assistance program.

You must be living in the state of New Mexico, and have demonstrated intent to remain in the state through the duration of services.

You CANNOT be:

included as a benefit group member and receiving cash assistance from another department cash assistance program;

a SSI recipient;

a recipient of benefits from a federally-funded TANF program (including a tribal program) or Bureau of Indian Affairs - General Assistance program;

a recipient of a government-funded adoption subsidy program; or

a recipient of benefits from a TANF or GA program in another state.

You may not be the payee for more than one General Assistance payment.

How Can You Help?

You can also

become your

client’s

representative

with NM Income

Support

Submitting Current Records to

the Incapacity Review Unit

(IRU)

Since you will already have your client’s

medical records submit records from the

past 6 months to the Incapacity Review

Unit

This saves them time and the trouble of

requesting them from client’s medical

sources