Phases - Part 1
Application
What is the second phase of SSDI/SSI?
Reconsideration
What is a CE?
Consultive exam - an appointment that SSA would request if unable to generate enough evidence from the claimant's own treating providers
What is standard Medicare age?
65
What does ALJ stand for?
Administrative Law Judge
What is sent to obtain additional information regarding the claimant's work?
work history
Who does the review of the claim?
DDS examiner (DE)
What does DDS stand for?
Disability Determination Services
If a claimant was awarded SSDI, when would Medicare benefits begin?
24 months after the entitlement date
What does OHO stand for?
Office of Hearing Operations (OHO)
Who makes the non-medical decision on the case? They review insured status, SGA, DOB, US citizen, etc.
SSA District Office
How long do you have to file an appeal?
60 days (5 days with mail)
What is the earliest SSD benefits can start after the disability onset date?
There is a 5-month waiting period that begins the month after the month in which the disability began.
What should we consider when determining the onset date?
•When did condition(s) become severe that the claimant could no longer perform full time work?
Who reviews the claim at the Hearing level?
ALJ
Disability Determination Service (DDS)
What form is sent to inquire more about the claimant's daily activities?
adult function report
What are the 4 ways to be eligible for Medicare?
•Standard Medicare age 65
•Awarded SSDI – Medicare begins 24 months after the entitlement date
•End Stage Renal Disease (ESRD)
•Have Amyotrophic Lateral Sclerosis (Lou Gehrig's) disease
An unsuccessful work attempt is an effort by a disabled individual to do substantial work that either stopped or produced earnings below the Substantial Gainful Activity level after (blank) months or less
6
What 2 phases are we NOT accepting new claims at?
Appeals Council / Federal court