What the Social Security Administration Does With the Initial Application

Welcome to Season 1, Episode 17 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into the complicated topic of "What the Social Security Administration Does With the Initial Application."

Join host Nancy L. Cavey, an experienced disability attorney, as she unpacks one of the most important - and misunderstood - parts of the Social Security Disability process: what really happens after you file your application. Whether you applied online, by phone, in person, or with an attorney’s help, your claim enters a complex review system most applicants never see. In this episode, she walks you through how your application moves from the local SSA office to Disability Determination Services (DDS), where the medical decision is made. You’ll learn what DDS looks for, how they gather records, and why most initial claims are denied - even when the disability seems clear. She also explains consultative exams, electronic record retrieval, and how COVID continues to affect the process. If your claim status says “under review” and you’re not sure what that means, this episode offers the clarity you need. Let’s get into it - because understanding the system is key to a successful claim.

In this episode, we'll cover the following topics:

1 -  What Does the Social Security Administration Do With My Initial Application for Social Security Disability?

2 - What Every Social Security Disability Applicant Needs to Know About the Social Security Administration’s Electronic Record Retrieval System

3 - Why You Should Not Speak With the Social Security Administration Claim Adjudicator Assigned to Your Social Security Disability Claim

4 - How to Keep Updated on the Status of Your Social Security Disability Application

5 - The Three Common Mistakes You Can Make in Your Social Security Disability Claim While Your Claim Is Pending

6 - What Does “Benefit Application Under Review” Mean When You Check the Status of Your Social Security Disability Application?

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Nancy Cavey [00:00:00]:
 Foreign welcome back to Winning Isn't Easy Social Security Disability Benefits in this podcast, we break down everything you need to know about navigating the Social Security disability claims system. I'm your host, Nancy Cavey, and before we get started, I've got to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar association says I have to say this, and now that I've said it, nothing will ever prevent me from giving you an easy to understand overview of the Social Security Disability claims process, the games that are played during it, and what you need to know to get the disability benefits you deserve. So off we go with today's episode. Now, in the last episode, I answered some common Social Security disability questions. In today's episode, we're going to move on. We're going to dive into an important and often misunderstood part of the Social Security Disability claims process.
 
 Nancy Cavey [00:01:07]:
 What happens after you file that initial application? Now, whether you've applied online, by phone or in person at your local Social Security office, or with the help of an attorney such as myself, your claim is going to enter into a complex system of reviews that involves multiple layers, forms, and evaluations. But what does the Social Security Administration really do with all that paperwork? So in this episode, I'm going to walk you through the exact steps your application takes from the local Social Security field office to Disability Determination Services dds, where the medical decision is made. And we're going to cover what DDS is looking for, how they gather medical records, and why the majority of initial applications are denied. I'm also going to talk about the electronic medical record retrieval system, the role of consulted medical exams, and how Covid and the changes in our political world have impacted this entire process. So if you've ever wondered who's evaluating your claim, how decisions are made, or why your application status says under review, this episode will give you the clarity you need. So let's get started. Specifically, I'm going to talk about six things. Number one, what does the Social Security Administration do with my initial application for Social Security Disability benefits? Number two, what every Social Security Disability applicant needs to know about the Social Security Administration's electronic record retrieval system.
 
 Nancy Cavey [00:02:36]:
 Three, why I don't think you should be speaking with the Social Security Administration's Claims Adjudicator assigned to your claim. Claim number four, how you can keep updated on the status of your Social Security Disability application. Number five, the three common mistakes that you can make in your Social Security claim while your claim is pending. And lastly, what does benefit application under review really mean when you check the status of your Social Security application. Now we're going to take a quick break and when you come back, I would suggest that you bring some paper and a pencil so that you can start taking some notes because we've got a lot of great information to go over today. Got it. Let's take a break. Welcome back to Winning isn't easy.
 
 Nancy Cavey [00:03:37]:
 Ready to get started? Do you have your pad and your pencil? So let's first talk about what the Social Security Administration does with your initial application. As you have probably figured out or you're going to learn, the Social Security disability claims process is all about forms. It doesn't matter if you call your claim in, make an appointment and finally get to go into your local office where you have an attorney represent you. It's all about forms. But what does the Social Security Administration do with that initial application and all the forms? Okay, ready? Here we go. The local Social Security administration has a field office. We are all aware of what's happening in our world with closed offices, changes in staffing, and what I'm about to tell you is what's going on today that may not be what's going on tomorrow or the day after. So please consider this to be an overview.
 
 Nancy Cavey [00:04:36]:
 All right. The initial application for Social Security disability benefits starts at the local Social Security field office for a non medical determination. Now the local representative is responsible for verifying non medical eligibility requirements which include a determination of your age as that can impact the quarters of coverage. You have to have to be insured for Social Security disability purposes. Remember that FICA withholdings from your paycheck. That's what this is about. Now they're secondly going to check on your employment status and wages because you really can't earn as of the time of this episode, more than about $15.50 per month in gross wages and still be eligible for Social Security benefits. Now this number changes every year.
 
 Nancy Cavey [00:05:23]:
 They're also going to check your marital status as if you're not insured. For Social Security disability purposes, you might be eligible for what's called SSI depending on your assets and your spouse's income. They're also going to check for the receipt of unemployment compensation benefits which may make you ineligible for benefits. So as they go through this analysis, so long as you meet the non medical requirements, the local Social Security field office will then send your claim to the disability determination services for an evaluation of your disability. Now if you get what we call a technical denial of your claim because of these issues, you're going to have 60 days in which to file an appeal. And you need to do that or, you know, you get to start all over and, you know, get in line again. The Social Security Administration has a nationwide contract with local state agencies known as Disability Determination Services. Dds, they review the initial application using that five step sequential evaluation test that we've been talking about.
 
 Nancy Cavey [00:06:20]:
 And DDS is responsible for making the initial determination as to whether you are blind or disabled under the five step sequential evaluation. Now, this state agency is fully funded by the federal government. However, what we saw certainly post Covid and what we're seeing now is that many states have a hiring freeze on hiring folks. And quite frankly, if they don't have a hiring freeze, they haven't budgeted enough money to adequately staff DDs, which I think is absolutely criminal. And certainly we anticipate that this is going to be impacted, particularly if the Republican tax changes are enacted that will basically gut Social Security, Medicaid and other Medicare and other benefit programs. And I'm not trying to be political, I'm just trying to be straight up here. Now, ultimately, when Disability Determination Services starts to look at your application, they're going to be doing an analysis. Now you got to remember before our recent election, the inauguration, it was taking about a year for the initial application to be reviewed by a claims examiner, which again is unacceptable and again which should be the subject of full funding, not cutting funding.
 
 Nancy Cavey [00:07:49]:
 But these forms that you filled out asked all sorts of questions about the medical reason you're claiming disability and the names and contact information of your medical providers. Now, DDS contacts your medical providers and ask for those records, including testing and lab work. What I find over my many years of practice is that some medical providers just don't provide your medical records or don't provide the entire chart, or unfortunately, your medical records really aren't sufficient to address the five step sequential evaluation. Now, all of that can be problematic if there aren't any medical records or DDS determines that your records are not sufficient, DDS may schedule you for a consultative medical examination, a CME. I'm not necessarily a fan of CMEs as the physician is not always an expert in your medical condition, doesn't really look at your medical records, and performs a short cursory medical exam. CME is paid for by ssa. Now, if I have a situation where DDS is requesting a cme, I try to get them to agree that the treating physician can be the CME. The problem, of course, is that I think the CME is now paid about $150, maybe $175.
 
 Nancy Cavey [00:09:03]:
 A lot of physicians don't want to take that small amount of money to fill out a lot of forms. But I always ask my clients whether they think their doctor would be willing to be designated as the CME and accept such a fee. Now, after the CME's report is issued, and by the way, we don't get a copy. You don't get a copy. We don't get access to it until we have access to the electronic records. But after completing its review, DDS is going to make a disability determination as to either grant or deny your application. Unfortunately, over 66% of initial applications are denied by DDS. And we'll talk about the many reasons in this episode in later episodes.
 
 Nancy Cavey [00:09:49]:
 Now if DDS finds that you're entitled to your benefits, they're going to return the claim back to the local office for further non medical disability development. If your benefits are awarded, you're going to get a letter. It's called a notice of award and happy days are here. Right? Got it. Let's take a break before we move on to the rest of this process. Okay.
 
 Speaker B [00:10:10]:
 Are you considering filing for Social Security Disability or has your claim been denied already? Either way, you require a copy of your rights to Social Security disability benefits, which will cover everything you need to know about the Social Security disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Nancy Cavey [00:10:34]:
 Welcome back to Winning Isn't Easy. Now let's talk about what every Social Security disability applicant needs to know about the Social Security Administration's electronic record retrieval system. Medical records are the key to getting your benefits. You have to establish that you have a severe medically determinable impairment that meets what's called a medical listing at step three or or prevent you from doing your past work in the five years before you became disabled and your benefits were adjudicated as well as any other work in the mythical, not real world national economy in view of your age, education, skills restrictions and limitations. And it doesn't matter if nobody would hire you, there aren't any jobs in your geographic area or you don't even like that kind of work. But what's happening here is your medical records can help you meet your burden of proof. The Social Security Administration has an electronic records retrieval system and SSA's HIT initiative is an electronic records transmission program that lets Social Security ask for and get your medical records from certain participating medical providers instantaneously and at no cost to you or your representative. Right now, only the Agency staff can use hit directly now beginning in February of 2021, at least at the hearing level.
 
 Nancy Cavey [00:11:53]:
 The Office of Hearings also has been doing an automatic records request. This isn't available for me to use or you to use. And as a result we still have to request the records from every provider. Now, the availability of the ERE is limited by the medical providers who choose to participate in the ERE system. Many small medical providers don't participate, so we still have to do written requests. And it takes 45 to 60 days to get the medical records. I will tell you that also requires on our part a lot of follow up phone calls and letters, but to finally get the chart in its entirety. So we also need to understand that denials are going to be based on what's in those records or not in those records.
 
 Nancy Cavey [00:12:38]:
 Sometimes my clients say, well, you know, I can get, I can give you access to my portal, my medical portal. And I say, well, that's nice, yes, we'd like it, but I still have to get the entire chart. And they ask, well, why are you just trying to cost me money? To which we say, oh no, wait a second. Well, unfortunately, a lot of these portals don't give us access to all of the relevant information like lab works and tests or specialty reports. Those are the kinds of reports that can make all the difference in your claim. So I want the entire chart. Got it. That's why we would rather, at least in my case, advance the money to get those medical records so we can win this case as opposed to relying on what the providers send or don't send us.
 
 Nancy Cavey [00:13:23]:
 Got it. Let's take a quick break. Foreign welcome back to Winning Isn't Easy. Why you shouldn't speak with the Social Security Administration's claim adjudicator assigned to your file. Now, I know this is a bit of a controversial issue, but hear me out. When you file a claim for Social Security disability benefits, your claim is going to be assigned by an adjudicator with dds. As we've talked about before, DDS is a state agency contracted by the Social Security Administration to handle initial Social Security applications and appeals of denied applications, known as requests for reconsideration. So the question is, is the claims adjudicator your friend or foe? I don't know the answer to that.
 
 Nancy Cavey [00:14:24]:
 We found that speaking with claims adjudicators can destroy your claim before it gets out of the box. And I generally tell my clients not to speak with the adjudicator. But that advice has been tempered by what's been going on politically. And what do I mean? I mean that when you have been submitting an application electronically, our clients and clients across the United States of our firm and every other Social Security firm gets a letter from Social Security with a copy of the application, stupidly, I think. And then you're asked to call them to confirm that you are who you are and that you really want to file this application. In that instance, please, please get on the phone with them because otherwise they're going to deep six the application. We've been through these gyrations in the last number of weeks about whether they have to confirm you are who you are in person. That, of course, has been incredibly problematic with office closures, staff layoffs, and, you know, people trying to get on the phone to get an appointment, standing outside, trying to get in the building.
 
 Nancy Cavey [00:15:42]:
 A bit of that has been cleaned up. But in the context of the initial application, if you get that kind of letter, yes, please call them. And if you get a call from the local office about it, talk with them. I want you to talk with them because otherwise, as I said, this is going to be, you know, where they're going to deep six your application. So how about the claims adjudicator being your foe? There are some really great claims adjudicators who I trust. There are some that are not so trustful. They will often misconstrue conversations you have with them or in written documents you submit. Sometimes they seem to do that on purpose.
 
 Nancy Cavey [00:16:26]:
 Remember that 66% of initial applications are denied. You're filling out forms, including those about your work history, your activities of daily living. Please don't send any forms to Social Security unless your attorney reviews and approves them. And better yet, let them send the forms to Social Security. Now, sometimes we will get calls from the adjudicator saying, you know, I have a question about this person's job duties. Can you get me some answers? And in that instance, either we get the answers or if we're able to get them back on the phone, will will set up a three way with ourselves and our client and the adjudicator to answer those questions about the past work and physical activity involved. You may be asked, how much did you lift? How long did you sit at one time? How long did you stand? And again, those kinds of questions and answers can help in the adjudication process. But again, you have to give them an accurate answer.
 
 Nancy Cavey [00:17:24]:
 Don't be Superman or Superwoman and minimize what it is your job required you to do physically and cognitively and Interacting with the people from a psychological standpoint. They may ask you about your activities of daily living. You might say, hey, you know, I do some cooking or I do some cleaning. And they may ask you questions about that, because cooking is, you know, could be cooking Thanksgiving dinner for 30 or just microwaving something. They may also ask you, well, you know, do you have any grandchildren? Do you watch them? And as a result, if you say, yes, I watch them, which is truthful, they may conclude that you can work as a companion. Now, never mind that you might be watching your grandchildren in a controlled environment in your home for only a couple hours at a time, and then you need days to recover. They might conclude that you could be a companion. Or they might also conclude that you could work in fast food because you microwave a meal at your home for your grandkids or for yourself.
 
 Nancy Cavey [00:18:25]:
 That's not the same thing, but I have obviously seen claims adjudicators make that leap. So if you are represented and you start getting those kinds of questions, I would suggest that you tell the claims adjudicator that you would like to have your attorney on the line and you would be more than happy to answer those kinds of questions. Again, if they're calling you to confirm that you've in fact filed that initial application and you are who you are, you, you know, please go ahead and take that call because as I said, it can result in a claims denial if you don't. All right, so what should you do if you get that claim? Simply tell them you're represented and that you should contact your attorney. If we feel it's appropriate for you to speak with a claims adjudicator, we will let you know. And in that initial application process, I will tell you, they don't always tell us that they're contacting you. They contact you directly without us. Again, in that instance, I don't have a problem with you talking to them, saying, yes, it's me.
 
 Nancy Cavey [00:19:25]:
 Yes, I filed the application. Yes, I want my attorney to represent me. Then call us or call your attorney and say, hey, I just got a phone call. But if they ask for any more than that, I think that you do need some protection, as I talked about. All right, let's take a break for a moment, and then we're going to come back and talk about how to keep updated on the status of your Social Security disability application.
 
 Speaker B [00:19:52]:
 Struggling with your Social Security disability case. The right attorney can make all the difference. Get our booklet. The key to hiring a great attorney for your Social Security disability case. Discover how to find an experienced attorney who will fight for your rights and navigate the process with ease. Please don't leave your future to chance. Request your free copy@kvlaw.com today and ensure you have the expert support you deserve.
 
 Nancy Cavey [00:20:22]:
 Welcome back to Winning Isn't Easy. How do you keep updated on the status of your Social Security disability application? Now look, I know it was a pain to complete the application and now that it's been filed, you want to check the status every day. Well, there are three ways to check. Number one, you can go online to the SSA website and log into your account. Two, you can call the Social Security Administration at 1-800-772-1213. And again, as I've talked about, in view of the political things that are going on, the wait time for calls is just outrageous. I've heard stories of it being as long as 200 minutes. We are routinely on hold with Social Security and of course we find it frustrating.
 
 Nancy Cavey [00:21:08]:
 And I know that you will find it frustrating. You could go to your local office, but these days you have to call to schedule an appointment to go to the local office and 200 minute phone call. Getting hung up on trying to call again to get an appointment to go down is obviously very frustrating and should not be. What's going on you, if you just show up at the Social Security office, they're going to say, okay, too bad, so sad you don't have an appointment. Get online, call us, do whatever you need to do to schedule an appointment. And you can't, unfortunately, do an appointment online. You actually have to call. So I find that if you want to check on the status of your application, the most efficient way is to check online.
 
 Nancy Cavey [00:21:53]:
 Now, Social Security, as I said, is going to send you a letter in the mail acknowledging your application. So you know that at least they got it. You might also get a call from the representative of Social Security asking for additional information to process your application and begin payments. They may call you about completing an application for your children because if you have minor children, they obviously want to get benefits. They may call you about a deposit into your bank account, including a back payment if appropriate. And those calls are, you know, generally acceptable to take. But if the call talks about your work history or what you do during the course of a normal day, that sort of thing, I think that if you're represented, you should be saying to them, hey, I'm represented. Can we set up a conference call with myself and the attorney and I'll be more than happy to answer whatever it is you want me to answer? Okay.
 
 Nancy Cavey [00:22:52]:
 Now, at some point you're going to get a letter from Social Security either approving or denying your application. And if you've been denied, you're obviously not going to be happy. So in my next segment, I'm going to talk about some of the common mistakes that you can make that can result in a claims denial. Okay, let's take a break. Welcome back to Winning Isn't Easy. What are the three common mistakes that you can make in your Social Security claim while your claim is pending? Now, there are lots of mistakes that you can make in the application process. Failing to identify all of the medical conditions even though you may not think they're all disabling. Failing to give Social Security the information about the names of your doctors or treating providers or facilities with the correct address.
 
 Nancy Cavey [00:23:50]:
 Not giving a complete work history. Not really giving your doctor a history of your symptoms and functionality. Those are the common mistakes that I see in the application process, but they're also common mistakes that you can make while the claim is pending. Your goal is obviously not to make any mistakes. So number one is failing to show medical evidence of disability. You've got the burden to prove you meet the five step sequential evaluation. So that means that you have to establish that you have a medical condition that's so severe that it meets or equals a listing at step three. Or you can't return to the lightest job you held in the five years before your claim's adjudicated and can't engage in any other work in the national economy if you have your age, education and skills and restrictions and limitations.
 
 Nancy Cavey [00:24:42]:
 So how on earth do you do that? A letter from your doctor saying you're disabled is worthless. That is not going to do it. The way you do this is with medical evidence of disability. You want to make sure that your medical records document your disabling symptoms and how they impact your ability to function. So, for example, let's say you have a back condition, you've had a herniated disc, you've got surgery and you have difficulty standing at the sink, doing dishes for more than 10 minutes, or difficulty sitting at one time for more than 45 minutes. Your medical record should tell the story of those symptoms and how those symptoms impact your ability to function. Hopefully your doctor is willing to complete some forms that we Social Security lawyers have developed called residual functional capacity forms. I think we've got about over 70 of these different medical condition forms, including psychiatric forms.
 
 Nancy Cavey [00:25:37]:
 The RFC form is going to document the nature of your physical or psychiatric limitations. It's going to address the severity of your impairment, whether you potentially meet a listing and your restrictions limitations both from a physical standpoint and a psychiatric standpoint. It's going to document your exertional limits, how long you can stand to walk bend, how much you can lift, and non exertional impairments like difficulty with bilateral manual dexterity or a need to take breaks or absenteeism or even side effects of medication. So these forms are designed to really fully develop the kinds of medical evidence that will help you win either at step three or steps four and five. An experienced Social Security attorney such as myself can help select the right RFC forms or forms for your medical condition and I find that these can make or break a claim. Mistake number two Failing to follow the prescribed medical treatment. Social Security expects you to follow your doctor's recommendations and that means that you should take your medication as prescribed, attend physical therapy, follow other treatment recommendations. Now you're not expected to undergo invasive treatment like injections or surgery, but you need to be able to provide a valid reason for refusing that treatment.
 
 Nancy Cavey [00:26:54]:
 You might be afraid of a bad result or unable to afford treatment, but if you don't undergo this prescribed treatment, Social Security is going to assess your functionality as if you did and that may not help your case. In other words, their reasoning is, hey you, if you really were as bad off as you were, you would be getting medical treatment. So you really must not be as bad off as you say. Voila. Claim denied. Mistake 3 failing to cooperate with the Social Security Administration now when you file for your benefits, you're going to be sent lots of questionnaires about your day to day activities, your work history, your pain. And these requests come with deadlines. Missing them or failing to respond can result in a denial for lack of cooperation.
 
 Nancy Cavey [00:27:40]:
 They're even going to get to the question of whether you're disabled. Now, Social Security may ask you to undergo consultative exams and failing to attend or cooperate during the exam can also result in a claim denial. So please don't make that mistake. If you are represented by an attorney and they are scheduling you for a consultative exam, call them your attorney and let them know what's going on. Sometimes we can actually get your treating physician and the Social Security Administration agree, do agree to be that CE as opposed to some random doctor who really doesn't have an interest in your claim. Got it? Let's take a break. Welcome back to Winning Isn't Easy. So what does benefit application under review mean when you check on the status of your Social Security Disability application.
 
 Nancy Cavey [00:28:43]:
 When you apply for your benefits, you can check on the status of your application by logging into your account online, and you might see the following benefit application under review. A medical decision has been made, and we're working to process your benefit application. So what does that mean in English? The Social Security Administration assigns both initial applications and requests for reconsiderations to DDS Disability Determination Services for a claims review. Now, medical decisions, either favorable or unfavorable, are made at this level. And that message means that DDS has made a medical decision on your claim and your file is being sent back to the local office. The local office will issue an approval or a denial, which you'll receive by mail, or. And. Or you can check on your application status.
 
 Nancy Cavey [00:29:33]:
 So what happens if DDS denies your claim? You're going to be sent a notice of disapproved claim, and you got two choices. You can accept that denial, walk away and say, hasta la vista, baby, I'm out of here. Okay? If you disagree with the denial or the start of the disability award, you have to appeal to the Social Security Administration. And that appeal is called a request for reconsideration. It's got to be done within 60 days of the date you've got the denial notice. Or, too bad, so sad, you get to start all over again. I know my clients find the process of applying for Social Security disability benefits frustrating, but you need to understand that it really does take teamwork to get the benefits to you deserve. And you have to be patient with this process.
 
 Nancy Cavey [00:30:23]:
 We're as frustrated with this process and the length of time it takes as you are. In fact, we're probably even more so frustrated because we've got lots of claims we're handling, lots of balls in the air, and we would love it if we sent in the application with all the supporting documentation and somebody looked at it right away and made the right decision. That, unfortunately, is not reality. But we don't want you to give up. You've paid into the Social Security Disability system, and we believe that you are entitled to the Social Security disability benefits you deserve. Got it. Thank you for tuning in to this week's episode of Winning Isn't Easy. If you found this episode helpful, please take a moment to like our page, leave a review, and share it with your family and friends.
 
 Nancy Cavey [00:31:08]:
 Please subscribe to our podcast so you'll be notified when a new episode drops. And of course, we'd love to hear from you. At the beginning of each episode description, you'll find a link where you can send us questions or comments, and I might even feature them in a future episode. Please join us next week for another insightful discussion. An episode of Winning Isn't Easy. We're going to talk about the Compassion Allowance Program, and I think that this is an important program that you should be knowledgeable about because it will speed up the Social Security disability claims process if you meet one of the criteria for the Compassion Allowances. Got it. Thanks for listening.