Social Security Disability: What Happens When an Application is Pending
In a previous post (here), I discussed the general process that someone might go through to get benefits, including the various levels of appeal both within and outside of the Social Security Administration. It can be a long process, with various twists and turns. During that procedure, however, the Administration can, should and will do various things to gather and process information related to social security disability insurance (SSDI) or supplemental security income (SSI) claims. Here are a few examples of what the Administration does when it processes a claim:
a. Gather Medical Information.
When a person first applies for social security benefits, they almost always authorize the Administration to gather medical information. That means treatment records, tests, diagnostic scans, notes and any other record that any person or facility treating that person might have kept. The Administration can get records from physicians, hospitals, physical therapists, counselors, social workers and others. In a significant way, these records are the raw data that the Administration uses in making determinations about a person’s disability. To get these records, the Administration required claimants to complete and sign Authorizations to Disclose Records. You may be asked to complete this form more than once.
b. Ask questions.
Both when a person initially applies, and throughout the process, social security will periodically ask a claimant questions about their medical conditions, work status and daily life. Many of these questions come in a single form, the Adult Disability Report. The Administration also uses other forms and questionnaires. For any given claim, a person may have to complete one or several Adult Disability Reports. They are usually required for each appeal.
Generally, a claimant is not expected to know everything about their treatment or condition. The questions are more generally about how the conditions affect the claimant’s daily life and ability to function. It is important to fully answer each question and provide the names and locations of each treating provider, so that the Administration is able to get the necessary records.
c. Request exams.
In some cases, particularly if there is a gap in the medical records or the Administrative needs a medical opinion, they might send a claimant to a Consultative Examination. These are examinations by licensed providers, who give opinions about the claimant’s condition afterward. A claimant may receive a Consultative Examination for any type of condition (i.e. physician, mental, speech). The examinations are generally held close to the claimant’s home and do not take much time. Refusal to participate may result in a denial of benefits.
d. Compile work history and wage information.
Wage information, past and current, is important in determining eligibility for different social security benefits. The Administration tracks this compiles this information as part of every claim to make sure that the claimant meets certain standards and is not working beyond a certain level.
Throughout the process of applying for benefits and while awaiting a decision, a claimant or their representative can always submit additional records, opinions and other evidence that the Administration should consider. It is just as important, if not more so, to make sure that the Administration gets the information that it is seeking. Failure to respond may result in a denial of benefits at any stage. If you have any questions about a social security claim, or about the process of applying, you may want to talk to an experienced attorney in the area who may be able to answer your questions.