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The SSDI application process and eligibility determinations

Most social security disability claimants have neither the knowledge nor the understanding of how the SSDI claims process works, hence the need for the assistance of an experienced disability attorney in order to help you with the early stages of the SSDI claims process. There are numerous questions that claimants need answered when they are at this stage of the process, one of which is who actually determines whether your medical condition has disabled you to the extent that you can no longer work and perform everyday tasks.

Ironically, whether or not you are eligible and qualify for SSDI benefits is not determined by the SSA or one of their adjudicators. This responsibility normally falls into the hands of a 3rd party or outside agency in your state, and they will determine if you do qualify for benefits at this stage in the application and claims process. This portion of the process follows your claim for a disability classification.

How does the eligibility determination process work?

One of the most common questions we are asked is “who determines whether or not I am eligible for SSDI benefits?” The agency in your state that normally makes this determination is known as the Disability Determination Service. They are responsible for making the initial decision where your disability benefits are concerned once you have been diagnosed with a disabling medical or mental condition. Interestingly enough, the Federal Government’s laws and regulations which govern eligibility are the same as those of your home state.

Once the decision has been made by the state authority reviewing your claim it is then forwarded to the Social Security Administration who will eventually contact you regarding the decision on your claim. It is up to the state authority to initially determine and confirm whether or not you have been rendered disabled and unable to work based on the medical and/or mental condition you are suffering with.

The next question we are normally asked is “who is responsible for rendering the final decision on my claim?” A DE or Disability Examiner is the person that this responsibility falls on the shoulders of. The DE normally works hand in hand with a Medical Consultant when reviewing your case. Initially, these are the people involved in the determination of eligibility process where you SSDI claim is concerned. Just remember that up to 75% of the initial applications get denied, so don’t let this discourage you.


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Statistics regarding SSDI approvals and denials

The SSA recently divulged statistics attesting to the fact that eventually, 34% of all the SSDI benefit applications get approved and benefits are awarded to the applicant. Conversely, when applications are in their initial stages, approximately 75% of all claims are denied. Additionally, it is difficult to estimate whether an individual will be approved or denied because the aforementioned percentages are not broken down based on what type of medical or mental problem you have. On average, it could take up to 2 years before a decision is rendered.

Why do claims get denied?

Many SSDI claims are justified and worthy ones. Unfortunately, SSDI judges fail to approve many of these claims initially. This is due (in part) to the fact that many of these judges perform limited evaluations of the evidence at hand. Even if you have a good case, the following are the more common reasons that a judge will deny you benefits:

-The applicant has filed previous applications for benefits (when many judges see this, they automatically deny a claim for SSDI benefits)

-The disability application lists numerous impairments, but not a main problem

-Your medical problem may not meet the SSA listing for that specific problem (judges simply reject cases that are deemed as non-listing level ones)

-If you have worked after the onset date of your condition, judges oftentimes deny SSDI benefit claims

-Sadly, the huge workload of disability claims and benefits applications causes some just to randomly deny claims in order to save time

Additional considerations

Knowing the statistics mentioned in the sections above, it becomes important for an individual to realize why their application could be denied. After all, you want to overcome that possibility if you can so that you are awarded the SSDI benefits you deserve and need. Just don’t get discouraged if you are denied initially because it doesn’t mean that your case has to end there.

Herein lays the importance of having an experienced and knowledgeable disability attorney to help you get the benefits you need. Individuals should always consider hiring the services of a trained professional in order to assist them with their SSDI claim. They are skilled at handling these types of cases and know what the SSA judges are looking for when hearing your case. We have always recommended that individuals should consider hiring a disability attorney before starting the application process.


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Claims Management Software should utilize technology to create innovative solutions – revolutionary methods for Insurance claims software, workers compensation software, and custom services where insurance claims software and all associative professions would realize greater efficiency. A responsive technology and development crew specifically required to respond to every insurance software request has always been an intricate part of the decision-making when choosing a software vendor. “When do you need it?” is the appropriate response for every request. Talented developers and highly skilled professionals must rise to every challenge.

“Solutions Providers”, found in the mission statement, is a required consideration when choosing a vendor. Years of developing claims management software products should not overshadow the core mission – providing a continued high standard of service with a unique problem solving support staff.

Your vendor must understand the competitive nature of claims management software in today’s marketplace, the intricacies of the economy and the credibility issues that can only be overcome through the long term commitment to client service. Today, as in the past, any small slip can result in a giant fall. This is especially true in insurance claims software where due diligence and community reign high. Vendors make choices based upon referrals. “Follow Through In Everything You Do”, should be the vendor motto.

If you are an adjuster and the phone is ringing off the hook, you need Claims Management Software, Workers Compensation Software for all your insurance claims, with built-in but data mapping and presentation based on the line of business. Be sure your system has sophisticated search capabilities to locate the claim file you need. Also, capture all relevant claim information, document all file activity, incorporate all reports and correspondence and maintain permanent transaction records for multiple claims and/or multiple clients? A one stop shop system is preferable.

Some things to look for:* Total documentation for all activity* Powerful user access rights to control user levels and authorities* Encryption capabilities especially for browser based applications* Highly efficient time log/diary/alarms/claim notes. Many programs are now interfacing with outlook calendars* Supports related activities like bill review, case management, policy admin interfaces* Capability for custom interfaces like HR &Accounting* Standard user interface for all lines of business* Multiple carrier client line of business relationships and single database* Document depository in workflow management systems* Audit trails, due diligence Sarbanes (SOX) compliant when used with other programs* A TPA likes software with time and expense billing capabilities with invoice and accounts receivable generation.

Finally, with Internet applications, client portals, vendor portals, and other web based accessibility portals should be available for related activities. Consider options like vendor invoice uploads (eliminates clerical time and allows vendors to monitor invoice and payment activities without calling). Reinsurers can monitor claim activity and produce reports adhering to carrier and TPA guidelines since all remote access should be controlled.

A final thought: most niche Software Products satisfy the majority of the user’s needs, but rarely all. It’s a comfortable feeling to know that the developer is willing to make minor or major modifications to the software to accommodate current and future needs that may not have been addressed in original package.


Article Source:Codec Windows Media