Social Security Disability is awarded based on Functional Limitations
A person recently asked the following series of questions regarding a possible application for social security disability or SSI. "How is social security disability awarded? Do they base it on your diagnosis? Do they send you to a disability medical examination?", "Does it have to do with how you did at your job?".
Here are the answers, given from my perspective as a former disability examiner for the social security administration.
Disability Examinations
A social security medical examination may or may not be required in a disability case and whether or not one is required will largely depend on--
A) whether or not a claimant has received medical treatment for their disabling condition,
B) whether or not a claimant's medical records sufficiently address their condition and
C) whether or not they have received recent medical treatment.
Part C is actually what triggers the scheduling of a social security consultative exam in most cases. This happens (and, by "happens", I mean that a claimant is sent to an exam paid for by SSA and conducted by a private practice physician or psychologist) when a claimant has not been seen by their treatment provider in the last three months.
Why? Because, from the social security administration's standpoint, a decision on a claim cannot be arrived at without evidence that is fairly recent. Medical records that are older may simply not be as valid (a condition may have improved, or gotten worse).
However, it happens quite frequently that a disability exam is needed when a condition is listed on a disability application and the claimant has never received treatment for it. For example, a claimant may list list depression or anxiety, though they've never actually been treated by a mental health professional (often, they've simply been given a medication by their general practitioner).
Whatever the reason, if a disability exam is scheduled, it is in the claimant's best interests to go to the exam. Missing the exam will only delay the case. And a refusal to go may result in the claim being denied.
Your Medical Diagnosis
Does social security base whether or not you will receive disability benefits on your medical diagnosis? No. Your diagnosed conditions will "point" a disability examiner or disability judge in a certain direction on your case. By this, I mean if you have Lupus, the disability decision maker will look in the social security disability list of impairments to see if your case meets the listing book's disability approval criteria. However, in the end, a person cannot be approved for any condition unless that condition rules out their ability to work at their past jobs and also rules out their ability to engage in suitable forms of other work.
What do your past jobs have to do with your disability claim?
They have very much to do with how your case is processed, and whether or not you will be awarded disability benefits. Social Security Disability and SSI are programs that award benefits on the basis of function, as in residual functional capacity. This basically means--
A) Does your mental or physical condition limit you enough that you can't do the jobs you've done in the past and
B) Is your mental or physical condition limiting enough that you can't be expected to switch to some form of other work.
Though many claimants may not be aware of this, a person's work history is easily as important as the medical evidence they provide on their case. For this reason, individuals who file for disability should do the following:
1. Supply a detailed work history, including the names of past jobs, what was done on those jobs, job titles, and the dates those jobs were worked. Supplying a great amount of information about past jobs will allow a disability examiner examiner or disability judge to determine whether or not a claimant can return to one of those jobs. It will also allow the decision maker to determine the claimant's work skills, which will have an impact on deciding whether or not the claimant can be expected to perform some other type of work.
2. Supply detailed information about medical treatment sources. The more information about your physical conditions or mental impairments, the better. And the more detailed it is, the more easily a disability examiner or judge will be able to rate the limitations that result from a condition (the greater the limitations, the more likely it is that a claimant will be determined disabled and, thus, eligible to receive disability benefits).
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Social Security Disability Secrets
Social Security Disability Benefit Questions
Here are the answers, given from my perspective as a former disability examiner for the social security administration.
Disability Examinations
A social security medical examination may or may not be required in a disability case and whether or not one is required will largely depend on--
A) whether or not a claimant has received medical treatment for their disabling condition,
B) whether or not a claimant's medical records sufficiently address their condition and
C) whether or not they have received recent medical treatment.
Part C is actually what triggers the scheduling of a social security consultative exam in most cases. This happens (and, by "happens", I mean that a claimant is sent to an exam paid for by SSA and conducted by a private practice physician or psychologist) when a claimant has not been seen by their treatment provider in the last three months.
Why? Because, from the social security administration's standpoint, a decision on a claim cannot be arrived at without evidence that is fairly recent. Medical records that are older may simply not be as valid (a condition may have improved, or gotten worse).
However, it happens quite frequently that a disability exam is needed when a condition is listed on a disability application and the claimant has never received treatment for it. For example, a claimant may list list depression or anxiety, though they've never actually been treated by a mental health professional (often, they've simply been given a medication by their general practitioner).
Whatever the reason, if a disability exam is scheduled, it is in the claimant's best interests to go to the exam. Missing the exam will only delay the case. And a refusal to go may result in the claim being denied.
Your Medical Diagnosis
Does social security base whether or not you will receive disability benefits on your medical diagnosis? No. Your diagnosed conditions will "point" a disability examiner or disability judge in a certain direction on your case. By this, I mean if you have Lupus, the disability decision maker will look in the social security disability list of impairments to see if your case meets the listing book's disability approval criteria. However, in the end, a person cannot be approved for any condition unless that condition rules out their ability to work at their past jobs and also rules out their ability to engage in suitable forms of other work.
What do your past jobs have to do with your disability claim?
They have very much to do with how your case is processed, and whether or not you will be awarded disability benefits. Social Security Disability and SSI are programs that award benefits on the basis of function, as in residual functional capacity. This basically means--
A) Does your mental or physical condition limit you enough that you can't do the jobs you've done in the past and
B) Is your mental or physical condition limiting enough that you can't be expected to switch to some form of other work.
Though many claimants may not be aware of this, a person's work history is easily as important as the medical evidence they provide on their case. For this reason, individuals who file for disability should do the following:
1. Supply a detailed work history, including the names of past jobs, what was done on those jobs, job titles, and the dates those jobs were worked. Supplying a great amount of information about past jobs will allow a disability examiner examiner or disability judge to determine whether or not a claimant can return to one of those jobs. It will also allow the decision maker to determine the claimant's work skills, which will have an impact on deciding whether or not the claimant can be expected to perform some other type of work.
2. Supply detailed information about medical treatment sources. The more information about your physical conditions or mental impairments, the better. And the more detailed it is, the more easily a disability examiner or judge will be able to rate the limitations that result from a condition (the greater the limitations, the more likely it is that a claimant will be determined disabled and, thus, eligible to receive disability benefits).
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