Demystifying the Disability Process - New Mexico Coalition ... · Make list of treating sources ......
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Transcript of Demystifying the Disability Process - New Mexico Coalition ... · Make list of treating sources ......
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.