What exactly happens when you file for disability?

The Initial Level

How to Start the Process

There are three different methods to apply for Social Security disability insurance benefits and Supplemental Security Income for adults.

• If you are able to, you can visit your local Social Security office. You can visit the Social Security office any time when it is open, but to reduce the chance that you will have to make more than one visit, we recommend that you call Social Security at 1-800-772-1213 to schedule an appointment first.
• If you are an adult, applying for yourself, you can apply online.
• You can apply over the phone by calling the Social Security Administration at 1-800-772-1213 (TDD 1-800-325-0778).

The Social Security online form cannot be used to apply for children’s benefits.

Our attorneys recommend that most clients start the initial application process over the phone.

After the phone call

To complete the initial application, the Social Security Administration (SSA) will either call you back or schedule an appointment for an initial interview. During this interview, you will be asked questions that will assist the Social Security Administration in determining your eligibility; for example, you may be asked about your employment history, and your medical condition.

The Social Security Administration provides a convenient list of documentation or supporting information you should try to bring if you are asked to come in for a face-to-face interview. (If you are applying on behalf of your minor child, a separate list is provided.) If you do not have the requested documentation, you can provide it later.

What happens next?

The staff in the local Social Security Administration (SSA) office will make an initial determination regarding the non-medical aspects of your eligibility; for example:

• if you applied for Social Security Disability Insurance Benefits (DIB), do you have sufficient work credits?
• If you applied for Supplemental Security Income, are your income and assets low enough?

If you meet these non-medical requirements, your case will be sent to the disability determination service. If not, your claim will be denied. In addition, if you currently work and earn more money than the “substantial gainful activity” amount, your claim may be denied at this point, but more commonly, it will be sent to the disability determination service.

Disability Determination Services

If you have sufficient work credits for Social Security Disability Insurance Benefits or if your income and assets are low enough for you to get Supplemental Security Income, the Social Security Administration sends your case file to the Disability Determination Service (DDS) that covers your geographical area. In most states, the DDS is an agency of the state government; for example, if you are in Albuquerque, your case will be sent to the New Mexico disability determination service, which is part of the state government’s Division of Vocational Rehabilitation. (In certain places the Social Security Administration may route your case to a different DDS, or may perform the initial disability determination internally.)

Once the case reaches the Disability Determination Service, it is assigned to an adjudicator, who contacts your doctor to obtain medical records. The Disability Determination Service will then perform the five steps of determining disability; if your medical records do not prove that you are disabled, then the DDS will ask you to go to a consultative examination, in which a doctor examines you at government expense. Whether or not there is a consultative exam, another doctor who works for the DDS will make a medical determination of the severity of your disability. If your disability is severe, but not severe enough to meet or equal a listing, the adjudicator assigned to your case will determine whether the condition you have is severe enough to prevent you from doing your past relevant work, and whether it is severe enough to prevent you from doing any substantial gainful work at all. The Disability Determination Service then issues a decision and returns your folder to the Social Security Administration.

Before you are notified of the decision, the Social Security Administration may review or modify it. Thus, even though the initial decision is made by the Disability Determination Service, the Social Security Administration is responsible for it. Congress has mandated that at least half of all favorable decisions be reviewed by SSA before being issued.

Next step: Reconsideration