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DISABILITY
DETERMINATIONS
When you file an Application for Social Security
Disability or SSI, a local Social Security employee
gathers information from you or your attorney to determine whether
you meet the income and contribution requirements for benefits. I usually
prefer to complete the initial application interview through a
telephone conference
call between our office, the local Social Security
office and the claimant. We will need to provide information to
verify your identity, age, quarters/credits of coverage, whether
you are working and how much income you are earning, the exact
date that your disability began and a brief outline of the medical
conditions that your claim is based upon.
Your
application and the information that supports your claim is then
assigned to a claims examiner at the
Louisiana Office of
Disability Determination Services (DDS), who determines whether
you meet the Social Security Administration's medical and
vocational requirements for Disability.
The claims examiner at DDS will
attempt to gather medical information from all doctors, hospitals
and clinics where received treatment. While you might
think this would be a fairly simple and rapid process, three
problems often arise.
- First, claimants often fail to
tell Social Security about all of their relevant medical
treatment. At the time of the interview, many people do not remember their entire medical history or don't know the exact
dates and types of treatment they received. One of the things
that our office focuses upon is making certain that we have a
complete record of any medical treatment that may support your
claim.
- Secondly, some
offices and hospitals just do not respond when DDS mails them a
request for medical records. The DDS claims examiner will send a
second request, but the system's time constraints allow only
limited follow-up.
Unfortunately, it's very common for DDS to deny Disability and SSI applications simply because they never received the records
that prove the claimant's medical condition.
- Finally, a
claimant's medical condition may change over time or an
important medical test may not be performed until after DDS has
received the records from the healthcare providers. Thus, it is
very important to keep the claims examiner up to date on any
changes in your condition or new tests ordered by your doctors.
More medical information may be
needed before DDS can decide you claim. If the information is not
available from the your current doctors, DDS may ask you to go to
a special examination, called a "consultative examination," that
is paid for by the Social Security Administration (SSA).
DDS will also usually want
detailed written documentation about your lifestyle and
activities, including:
- Your "activities of daily living,"
i.e., a description of the things that you can do on a
typical day.
-
Information about your "residual functional capacity" to sit,
stand and walk for specific lengths of time, as well as your
ability to concentrate on, and complete, tasks.
Your
responsibility for, and
your relationship with, people who live with you.
Detailed information about your
education and work experience.
DDS will consider the written
answers to these questions provided by your attorney along with
the medical information provided by your doctors when they decide
whether you qualify for Disability or SSI.
At each step in the
disability determination process, Disability Determinations
Services and the Social Security Administration use a series of
five questions to determine if you are disabled, including:
1.
Are You
Currently Working?
If you earned more
than
$860.00 per month from employment during 2006, you will
usually not be considered disabled. Current income of less than
$860.00 per month is not necessarily considered to be "substantial gainful
activity" and therefore may disqualify you from
receiving Disability benefits. The current substantial gainful activity
income limit for people who are blind is is $1,450.00 for people who are blind.
2.
Is Your
Condition Severe?
Your condition
must be significant enough to prohibit or substantially
interfere with your performance of basic work-related activities
3.
Do you have an impairment that meets or equals an
impairment described in the Listing of Impairments?
Social Security
law contains a list of impairments for 14 major body systems.
A severe impairments to any of these systems should result in a
determination that you are disabled. If the condition is
not on the list of impairments, DDS should try to determine if the claimant's
medical condition equals the severity of a listed impairment.
If so, the person is found disabled. If not, the DDS examiner
moves on to the next step
4. Can You Do
The Work You Did Before?
If your condition is
severe, but isn't in the Listing of Impairments, DDS will then
consider whether you are capable of returning to any of the types
of jobs that you had in the last fifteen years.
5.
Can You
Do Any Other Type Of Work?
Finally, to determine if a
claimant is able to do other work, Disability Determination
Services considers the person's
medical conditions, age, education, training, work experience
and transferable skills. If DDS decides the person cannot do
other work, the claim will be approved. If the DDS examiner decides that
the person can do other work, the claim will be denied.
Many people are
repeatedly denied Disability benefits though they appear to meet
the medical and legal requirements. All sorts of factors,
including your age, education and work experience, can influence
the outcome of your claim.
But all too often,
the most important factor is that some people prove their case
with convincing evidence, while other people just leave it up to
the Social Security Administration to develop and decide their
claim for them.
If you are
disabled, it is a mistake to depend upon the Social Security
Administration to develop and decide your claim. The Social
Security system is dramatically understaffed and overburdened.
Many claims, even those involving complex medical and legal
issues, receive only brief consideration.
It is often not
enough to provide the documentation that proves your medical
condition. You will also need to explain how your medical
circumstances meet the legal standards for disability.
Don't leave your
benefits and the funding for your medical treatment up to chance.
Get an experienced attorney on your side to help you win your
claim.
Next:
Hearings & Appeals
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______________________________________________________________________
David
Buie, Louisiana Workers' Compensation Attorney and Social Security
Disability Attorney, 650 Poydras Street, Suite 1400, New Orleans, LA
70131
(800) 851-9405 / Fax: (866) 702-5297 /
David@DavidBuie.com
Representing claimants in:
Alexandria,
Baton Rouge,
Bossier City,
Covington,
Gretna,
Hammond,
Harvey,
Houma,
Kenner,
Lafayette,
Lake
Charles,
Laplace,
Marrero,
Metairie,
Monroe,
New Iberia,
New Orleans,
Opelousas,
Ruston,
Shreveport,
Slidell,
Terrytown.
Some images courtesy of the
Louisiana Office of Tourism.
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