What Does a Social Security Claims Representative Do on a Disability Claim?

by Jun 14, 2017

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The Social Security Administration (SSA) employs claims representatives to help them take and process disability applications, including claims for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). When you apply for these benefits over the phone or at your local Social Security office, you will talk to the claims representative on your case. This claims representative will manage a number of tasks related to your application.

What does a Social Security Claims Representative do on a disability claim?

When you make an appointment to apply for Social Security Disability (SSD) benefits, the claims representative for your case will schedule an interview. You should take all available medical records and other proof of your impairment with you if you are meeting with the claims representative in person, or have it handy for your phone interview.

In this interview, you will discuss a wide variety of topics related to your education, work history, injury or illness, treatment, and medical care providers. The claims representative takes careful notes during this interview and enters your information into a federal database. The interview itself does not usually last more than an hour. However, this is only the beginning of the work the claims representative does on your application.

Will the representative consider my work history and income?

One of the first things a claims representative typically does is to run preliminary eligibility checks on any new application for benefits. This includes ensuring you have the proper number of work credits to qualify and verifying you do not earn more than the current substantial gainful activity limit.

The Work Credits Test

If you worked a full-time job for most of your career before you suffered your injury or illness and paid taxes on your earnings, you probably meet the work credits criteria.

Generally, you need 40 credits to qualify, and half of those credits must come from work performed during the past 10 years. You can earn a maximum of four credits per year of work. Even most part-time workers earn enough each year to gain their four credits. There are different limits for younger workers who are unlikely to have 10 years in the workforce.

The Substantial Work Test

To qualify for disability benefits, you must have an impairment that prevents you from making a living. The SSA sets a limit each year on how much you can make and still qualify for benefits. This limit, known as substantial gainful activity (SGA), is $1,170 per month for 2017.

By looking at your financial records, the claims representative can determine if you earn more than this each month, which would disqualify you for benefits. The claims representative will also review your SSI eligibility at this time.

Can my claims representative expedite the process?

One way the claims representative can really help you is by tagging your claim for expedited processing. The SSA has several programs that send SSDI applications to the top of the stack, ensuring they receive priority processing.

Based on what the claims representative hears in the interview and finds in your file, he or she may expedite your application through one of the following programs:

Each of these programs has its own criteria, but all allow qualifying applications to go through the determination process much faster. For example, some TERI claims receive approval in under a month while it sometimes takes several months for an untagged file to receive its review.

There are also similar programs to expedite SSI claims and get qualified applicants their benefits faster.

What is Disability Determination Services (DDS)?

Only after the claims representative completes all the initial eligibility evaluations do they forward your application on to your state’s DDS agency. This agency examines your file and determines if your medical condition, prognosis, and related impairments qualify you for disability benefits. This is when your medical records and other supporting documents become critical evidence to support your claim.

Even after your claims representative sends your application to your state DDS agency, you can contact them with questions about the process or to check the status of your claim. They serve as your contact at the SSA throughout the application and determination process and will call you if you need to see an SSA-appointed doctor or attend another interview.

Do I need to talk to a disability attorney about my application?

Many people do find their claims representative compassionate and helpful and they are able to get answers to many of their questions using them as a resource. However, it is important not to lose sight of the fact that the SSA employs the claims representative.

Claims representatives may seem unbiased, but ultimately they have to represent their employer first and foremost. This includes strictly following all the rules and regulations to the letter, even if they believe you might qualify with additional documentation.

The best way to ensure you have all the necessary documentation to prove your claim is to let one of our disability attorneys look at it before you meet with the claims representative. If you run into problems later and the SSA denies your claim, it is imperative to talk about your situation with one of our knowledgeable lawyers, who can help you throughout the appeals process.

The attorneys at the Disability Advantage Group can guide you through the application or appeals process, helping you get the benefits you deserve. Call us today at 865-566-0800 to schedule a free case evaluation.