"What if?" : questions and answers about disability benefits

"What If?"
GAo
L2.00.R&4 MI
200( 1)5~
Questions and
Answers about
Disability Benefits
Disability Adjudication Services
GEORGIA DEPARTMENT OF LABOR MICHAEL L. THURMOND, COMMISSIONER

Ifyou have appliedfor disability benefits from the Social Security Administration (SSA) or are thinking about applying, you may wonder what happens when you take that step. This brochure answers some of the questions about the Disability Program's requirements and how a decision about benefits is made.
What is the definition of disability?
It is different from definitions used by the Veterans Administration, Worker's Compensation and private insurance. Under the Social Security program, the law defines disability as the "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which has lasted or can be expected to last for a continuous period of not less than 12 months, or result in death." This means that:
you must be unable to work and earn over a certain amount (determined by SSA) each month; and
you are not able to work because you have a physical or mental problem that can be medically proven; and
your physical or mental problem has already lasted or is medically expected to last for a continuous period of at least one year, or result in death.
A major purpose of the disability program is to assist disabled citizens until they can recover and/or complete a rehabilitation program which allows them to return to work.
Do I have to have paid into Social Security to be eligible for disability benefits? There are two disability programs
under which you may qualify for benefits: Social Security Disability Insurance (SSDD and Supplemental Security Income (SSl). To be eligible for SSDI, you must have worked and paid

into the Social Security Trust Fund through the FICA tax on your earnings for at least 20 out of the last 40 quarters. A "quarter" is a quarter of a year, or three months. (If you are under the age of 31, you may meet a special insured test requiring less than 20 quarters of earnings. Ask at your local Social Security office.) SSI is for the disabled person who has never worked or who worked but did not have enough money withheld for the Trust Fund. You do not have to have paid into the Trust Fund to be eligible for the minimum income provided by SSI, but you must be in financial need, as defined by law.
Where do I apply? You may apply in person
or by phone at your local Social Security office. Be prepared to give information about:
the medical problem(s) that prevents you from working and the date you stopped working
names, addresses, and telephone numbers of all the doctors, hospitals and clinics you have been to for medical treatment (You will be asked to sign forms which authorize these sources to release your medical records to the Disability Adjudication Section.)
information on your medical tests, including the time and place you had them
your jobs for the last 15 years, including the physical and mental demands of each job
your education your current daily activities.
What happens after I apply? Your
application is sent to the Disability Adjudication Services (DAS) in Decatur, part of the Georgia Department ofLabor. Under an agreement with SSA, DAS follows federal regulations to process and make decisions on disability claims. DAS is a state agency administering a federal program.

What does DAS do with my application? An adjudicator who is trained in
the SSA Disability Program will be responsible for developing your case by writing the treating sources listed on your application and requesting your medical records. You may have to be called for more information on your medical condition(s), your jobs or your education, so we need a telephone number where we can reach you. You may also be scheduled for an examination by your doctor or another consulting doctor if one of the following situations occurs:
there is not enough medical information about your disabling problem(s) from the past three months
your current medical records do not include all the necessary information required by SSA for a decision
your treating sources do not send the medical records to DAS within 21 days after we ask for them.
This examination will be authorized and paid for byDAS. A team at DAS will review all medical information in your file to compare it to the medical disability rules of SSA. Some decisions are made on the medical findings alone. In other instances, the DAS doctor will have to evaluate what physical and/or mental abilities a person still has to do work-related tasks, despite hislher medical problems. This information is then compared to The Dictionary of Occupational Titles, a publication of the federal Department of Labor, which describes all the existing jobs in the United States and what abilities a person has to have to perform them. Age, education, job training, and experience are also considered.

Although your doctors' reports and the reports of consulting doctors are carefully considered, they do not make the decision as to whether you will be found disabled under the law. The review
team, composed of the DAS disability adjudicator and the DAS medical consultant, Teaches a final decision (based on all the medical, vocational, and personal data in your file) on whether you are qualified to receive benefits. If you are not found to be legally disabled, you may be advised that SSA guidelines indicate you are able to do your usual past work or some other kind of work. As the law is now written, you can be denied benefits even if the other work is not available where you live, or there are no job openings, or you are not hired for a job.
What do I do if I don't agree with the DAS decision? An applicant always has the
right to appeal any decision. Within 60 days of your first decision, you may go back to your local Social Security office and apply for a reconsideration of your case. The same process at DAS will be repeated, but a different adjudicator and medical consultant will review your file and make the second decision. If you do not agree with that decision, you may file an appeal at the Social Security office to have your case heard by an Administrative Law Judge. Anyone may go with you and represent you at the hearing.
Rehabilitation Services administers and conducts all programs and activities in accord with the U.S. civil rights acts which provide that no person shall, on grounds of race, color, national origin, sex or handicap be excluded the benefit of, or be subjected to, discrimination under any program of acti vity receiving federal financial assistance.
DOL-5000 (8/01)