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Shareen Young-Chavez Quality Assurance Specialist/Case Consultant Social Security Disability Determination Services.

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Presentation on theme: "Shareen Young-Chavez Quality Assurance Specialist/Case Consultant Social Security Disability Determination Services."— Presentation transcript:

1 Shareen Young-Chavez Quality Assurance Specialist/Case Consultant Social Security Disability Determination Services

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3 Social Security Disability differs conceptually and fundamentally from other forms of disability to include: Short term disability, Long term disability, Workmans Compensation, Partial or Temporary disability. The criteria is extremely different. Think of Social Security Disability in terms of a Fund of Last Resort.

4 but Ive paid into the system. Ive worked since I was 16 and now Im 50. I know Ive accrued enough money, and its my money, why wont they just give it to me? There is no account set up in your name reserved for you for the day that you become disabled so that you may draw from it.

5 Disability Determination Services office Case Developer Analyst Note: You only have ten days to respond to any letters sent from your adjudicator.

6 Substantial Gainful Activity (SGA) Medically Determined Impairment (MDI) MEETS or EQUALS Past Relevant Work (PRW) Other Work (OW)

7 SGA (Substantial Gainful Activity) Is the claimant working?...Can he support himself with the amount of money that he is making?

8 MDI (Medically Determinable Impairment) Does the claimant have a Medically Determinable Impairment?

9 MEETS or Equ Social Security Disability uses a book that lists various physical and Mental Health Impairments. This Book is called The Blue Book. MEETS or Equals Social Security Disability uses a book that lists various physical and Mental Health Impairments. This Book is called The Blue Book. If a claimant has any condition that is listed in this book, they automatically meet the criteria to receive SSI/SSDI benefits.

10 Past Relevant Work Is the claimant capable of completing or returning to any of the jobs he had within the past fifteen years? Is the claimant capable of completing or returning to any of the jobs he had within the past fifteen years?

11 Other Work Can the claimant complete any work other than the work he has completed within the past fifteen years? Is the claimant 55years of age or older? What is the claimants past work? What is the claimants education level? Does the claimant have any transferrable skills?

12 Appeals Process Initial Level Reconsideration Level Hearing Level (Administrative Law Judge Level-ALJ) Appeals Council Level Federal Court Level

13 RECONSIDERATION LEVEL If you have applied for disability and your claim was denied at the initial level you will have sixty days to file an appeal keeping your initial claim open. You are asking Social Security Disability to reexamine your claim.

14 ADMINISTRATIVE LAW JUDGE (ALJ) LEVEL You have the opportunity to explain before a judge why you feel you are disabled and unable to work. Some at this level seek representation from a third party agency or lawyer representation. You have 60 days to appeal the decision.

15 APPEALSCouncil APPEALS Council If you are denied at the ALJ you may petition the Appeals Council to review your claim.

16 FEDERAL COURT If your claim was denied at the Appeals Council level or if your claim was rejected you have the right under the law to file a law suit in a Federal court.

17 Questions?

18 Thank You! Thank You! For more information visit our website at:


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