Successfully Applying for Disability Benefits in South Carolina

Applying for Disability in South Carolina

How to apply and qualify for SSD, SSI in Carolina (SC)

Note: If you have already filed a claim and been denied for disability, or are wondering what to do in the event of a Social Security denial, proceed to the reconsideration and hearing appeal sections below.

Level I: Disability Application - Approximately one-quarter of claims for disability are approved in South Carolina, meaning, conversely, that up to three-fourths of all claims are likewise denied.

The prospect of being denied for disability should not discourage a potential claimant from filing an application, particularly since the Social Security Administration offers an appeal process that, if followed at least as far as the disability hearing level, will usually result in a Social Security Disability award or SSI award being granted, provided, of course, that the case is well substantiated by medical evidence.

Applying for Disability

A disability claim may be filed online or at a Social Security office. The online process, however, does not allow an SSI claim to be filed. This presents a complicating factor for both SSI claimants as well as individuals whose disability case will be concurrent, meaning that it will involve both Social Security Disability and SSI simultaneously. A fairly high percentage of cases are concurrent, it should be noted.

Additionally, filing for disability online does not allow a claimant to directly ask questions and receive answers regarding the submission of medical evidence and vocational evidence, or regarding the application and appeal process.

Applying for disability in a local office will typically offer the most advantages. However, for claimants who have medical or transportation issues that will make it difficult to get to a Social Security office, the disability application interview may be conducted over the phone. This may also be requested for claimants who simply prefer a phone interview.

The disability interview

The disability interview is where a claim for disability usually begins. The primary purpose of the interview is for the claimant to provide all the information necessary to process the claim.

For both adult and child disability claims, this will mean a complete listing of medical treatment sources. This should include current treatment sources, but also older sources, at least as far back as the time that the disability is alleged to have begun.

The reason for this is that Social Security, in addition to having to verify whether or not a claimant is currently disabled will also need to establish when a person's disability began so whatever back pay they are potentially eligible to receive may be properly computed.

The list of treatment sources should include the names of treating physicians, all diagnoses received, the date of treatment for each medical facility, and the names and addresses of all facilities.

The names and addresses of hospitals and clinics will be particularly important since the disability examiner--who will actually work on the medical evaluation of the claim--will rely on this information to send out requests for medical records. The ability of the examiner to obtain the needed records will depend substantially on the information provided at the time of application on the disability report.

For adult claims, a claimant will also need to supply a complete work history. This is so the decision-maker can compare the demands of the claimant's past work to their current functional limitations.

Again, this list should be detailed and should include all jobs worked in the 15 year period prior to becoming disabled (what SSA refers to as the relevant period, before which a claimant's job skills are not considered transferrable to new types of work).

The list should also include accurate job titles and good descriptions of the work performed for each job. The accuracy of this information will allow the disability examiner to properly identify the claimant's past work and the skill levels they possess.

Note: It is usually a good idea for a claimant to write down both their work history and their medical treatment history before the disability application interview. This is to avoid the omission of important information. It can also allow the disability interview to go much smoother.

After the claim has been taken

After the intake has been completed by a CR, or claims representative, at the Social Security office, the claim will be transferred to the state disability agency, otherwise known as DDS (disability determination services) where it will be assigned to a disability examiner.

The examiner will use the information obtained on the application to request the claimant's medical records. How long it takes the examiner to get the requested records will vary substantially. Not surprisingly, the wait for records usually constitutes the single largest delay on a case. Once the records have arrived, however, the examiner will review them with two goals in mind.

The first goal is to see if the claimant has a condition that is contained in the Social Security Disability list of impairments, which may lead to an approval. Most cases, of course, are not approved in this manner since the requirements of a listing are often very specific. Also, there are many medical conditions that are simply not listed in the impairment manual, also known as the blue book.

The second goal of the examiner will be to review the medical evidence to determine what physical and/or mental limitations the claimant has, such as a reduced ability to sit, stand, walk, carry, reach, remember, concentrate, or interact with others. Limitations in functional capabilities are assessed on something known as an RFC, or residual functional capacity, rating.

The RFC rating, or ratings (when claims have both mental and physical impairments) are compared to the demands of the claimant's past work. This type of evaluation is medical-vocational.

In a medical vocational determination (which most cases involve) the requirements for disability are primarily based on proving that an individual has sufficient functional limitations (physical, mental, or both) that prevent them from engaging in work activity, at a substantial and gainful earnings level. This is with regard to either the performance of one of their past jobs, or in the performance of some other type of work that their combined education and job skills could potentially make them eligible for.

If, based on a review of the medical evidence, it is determined by a disability examiner or a judge--depending on the level of the claim--that a person's limitations will not allow for work activity, they will then qualify for disability benefits in either the SSD or SSI program, or in both programs if they are found to have what is known as a concurrent claim.

Social Security Disability versus SSI

Disability claims can be taken in either one of two programs, the Social Security Disability program, or the SSI disability program. Eligibility for Social Security Disability is based on one's earnings record and their history of employment.

Eligibility for SSI disability, while subject to the exact same disability qualifications and criteria, is based on need; in other words, individuals who are not insured for SSD, or have lost their insured status for SSD because they have not worked in some time, or are children (who do not become eligible for SSD because they do not work), may be able to collect SSI disability benefits provided they meet the necessary requirements for disability.

Applying for disability as a child

Children filing for disability in South Carolina are subject to the same disability evaluation process. However, to qualify for disability as a child, the decision-maker (an examiner or judge) will compare the child's functional limitations to the activities performed by their peers. If the child is considered to have limitations great enough to bar them from engaging in age-appropriate activities, they will be found to be disabled.

For child claims, in place of the work history, it will be important to supply information regarding the academic history (grade reports, IEPs, testing results, and teacher questionaires) so it can be determined whether or not the child is on-pace with their peers.

Disability application denial rate: 73.1 percent.

Disability application approval rate: 26.9 percent.

Level II: Request for Reconsideration - An individual who has been denied for disability at the application level may file the first appeal, the request for reconsideration.

1. The reconsideration is requested by contacting the Social Security office where the initial application was filed. Once the request has been made, Social Security will send out the required paperwork to be completed, signed, and returned.

2. Claimants should remember to notify Social Security of any recent medical treatment, newly diagnosed conditions, or changes in their condition on the disability report form for their appeal. This is so the reconsideration-level examiner will be aware of this information.

3. The appeal must be requested within 60 days of the date of the denial. SSA will allow an extra five days to account for mailing time; however, claimants should remember that the reconsideration must actually be received by the 65th day from the date of the denial, not simply mailed and postmarked. A failure to submit the appeal within the designated deadline period may result in having start over with a new claim. New claims, of course, are likely to be denied again for the same reasons as the initial claim. Additionally, starting over may result in a loss of potential back pay.

4. The reconsideration appeal has a higher rate of denial than the disability application. Nationally, more than 80 percent of these first appeals are denied. However, completing the reconsideration phase will allow a claimant to request the second appeal, the disability hearing. At that level, the odds of qualifying for disability benefits turn in the claimant's favor, provided they have a well-documented case and that their disability attorney or disability representative has assembled a credible argument for approval.

Note: After the reconsideration appeal has been submitted, a claimant should make a followup status call within 10-14 days to verify that the appeal has been received. This is to avoid a late appeal situation. Also, for the same reason, a claimant should keep a copy of their appeal before submitting it.

Finally, even if a claimant has disability representation and the representative will do their appeal for them, they should contact the representative as soon as they receive their letter of denial. This is verify that both parties have received the notification.

Reconsideration appeal denial rate: 89.3 percent.

Reconsideration appeal approval rate: 10.7 percent.

Level III: Request for Hearing before an Administrative Law Judge - The disability hearing is the second Social Security appeal available to claimants and may be requested only after a reconsideration appeal has been denied.

Like all appeals, the hearing must be requested within 60 days of the date of the prior denial, but, ideally, should be requested immediately after receiving notification of the denial of the reconsideration appeal to avoid unnecessary case processing delays, as well as the possibility of a missed appeal deadline.

Basic facts about disability hearings

Disability Hearing denial rate: 41.3 percent

Disability Hearing approval rate: 58.7 percent