Transcript Social Security Disability:

Traumatic Brain Injury and the Social Security Disability Process
An Overview
Kelly Blad, MA, EDPNA
Social Security Disability Programs
 Retirement, Survivors, and Disability Insurance (RSDI,
Title II)
 Work based disability program
 Must prove disability prior to Date Last Insured
 Supplemental Security Income (SSI, Title XVI)
 Federal welfare program for the disabled, blind, and
elderly
 Must meet income and asset requirements
Retirement, Survivors, and
Disability Insurance
 Monthly benefit amount based on earnings record
 Must be disabled and insured
 5 month waiting period for eligibility
 Auxiliary benefits available
 Medicare coverage after 24 months of eligibility
 Not reduced by income or assets
Supplemental Security Income
 $721 for an individual and $1,081 for a couple and may
be reduced depending on
 Living situation
 Income
 Medical assistance coverage
Income/Asset limits for 2014
Concurrent Claims
 Both SSI and RSDI
Disability
 Inability to engage in substantial gainful activity by
reason of a medically determinable impairment that
has lasted or is expected to last at least 12 months or
result in death.
Sequential Evaluation Process
 Step 1: Is the claimant engaged in SGA?
Substantial Gainful Activity
 Work done for pay or profit
 $1,070 gross per month
Substantial Gainful Activity
Sequential Evaluation Process
 Step 1: Is the claimant engaged in SGA?
 Step 2: Does the claimant have a severe
impairment?
Severe Impairment
More than a minimal limitation on one’s
ability to work
Sequential Evaluation Process
 Step 1: Is the claimant engaged in SGA?
 Step 2: Does the claimant have a severe impairment?
work?
 Step 3: Does the impairment meet or
equal a medical listing?
Medical Listings
 Social Security Website, “Blue Book”
 Organized by body system
 Separate listings for children and adults
 First step in which someone may be approved
Blue Book Listings - Adult
Blue Book Listings - Child
Step 3.5 – Residual Functional
Capacity
Maximum ability to do work related
activities on a sustained basis
Sequential Evaluation Process
 Step 1: Is the claimant engaged in SGA?
 Step 2: Does the claimant have a severe impairment?
work?
 Step 3: Does the impairment meet or equal a medical
listing?
 Step 4: Can the claimant perform his or
her past relevant work?
Past Relevant work
Work performed gainfully within the last 15
years and performed long enough to be
learned
Sequential Evaluation Process
 Step 1: Is the claimant engaged in SGA?
 Step 2: Does the claimant have a severe impairment?
work?
 Step 3: Does the impairment meet or equal a medical
listing?
 Step 4: Can the claimant perform his or her past
relevant work?
 Step 5: Can the claimant perform any
other work?
Other Work
 Work in the national economy
 Age affects this step
 Last step in which someone may be approved
Grid Rulings
 Special rules for older workers
 Take into account RFC, age, education, and
transferable skills
Sedentary RFC, Advanced Age
Application Process
 Initial Application
 Online or in person application taken by district office
 State agency collects medical records and makes
determination
 Clear medical records, no red flags
First Appeal: Reconsideration
 60 deadline
 State agency takes into account new evidence
Second Appeal: Request for
Hearing
 60 day deadline
 Claimant/claimant’s representative is responsible for
providing medical records
 Testimony and medical records are used to make
determination
Third Appeal: Appeals Council
 60 day deadline
 Not a new determination
Fourth Appeal: Federal District
Court
 60 day deadline
 Civil suit against Social Security
 Must be represented by an attorney
Potential Claim Issues
 Chemical Dependency
 Lack of medical treatment
 Noncompliance with treatment
 Criminal background
Provider’s Role in SSA’s
Determination
 SSA uses medical, education, and rehabilitation
records in the determination
 Providers record diagnoses and symptoms
 Providers can provide medial opinions
Screening
 Is the individual unable to work full time?
 Is it due to a medically determinable impairment?
 Ultimate decision is with Social Security
An Overview
Kelly Blad, MA, EDPNA