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Role of the Physician and Healthcare Professional in Helping a Patient Obtain Disability Benefits

David Wayne Smith, DED DABPS, FACFE, Jeffrey Lisse, MD, John Polle, BFA  |  Issue: April 2012  |  

The SSA has also established a Virtual Screening Unit, which is an internal review system for evaluating claims in which a request for a hearing has been filed and, because of the medical and vocational factors, the claim may be suitable for an on-the-record decision without the need for a hearing. If a claim is selected for review by this unit it is very important that the medical and other evidence of disability be submitted as soon as possible because there is a very quick turnaround for claims selected for this review. If the Virtual Screening Unit is not able to issue a favorable decision, the claim is again sent for a hearing before the ALJ.

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Disability Benefits Flowchart

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Disability Benefits Flowchart

›› Level Four: Appeals Council
If the hearing before an ALJ ends in a denial, the attorney will review the evidence and the judge’s decision. If the attorney believes the case warrants an appeal, this can be filed to the Appeals Council. However, after review, the Appeals Council will often return the case for a second hearing to the same judge who made the unfavorable ruling.

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›› Level Five: Federal District Court
The final level of appeal is Federal District Court. Less than 1% of denials are appealed at this level.

Supplemental Security Income Disability

One must not confuse SSDI and SSI. In order to qualify for SSDI benefits, one must meet the test of having amassed 40 quarters of work during a recent 10-year period of employment. In contrast, SSI is a welfare disability program for persons who do not meet the SSDI test. However, the rules for qualifying for SSDI and SSI are the same.

 

Dr. Smith is director of the Disability Assessment Research Clinic in the Arizona Arthritis Center; Dr. Lisse is chief of rheumatology at the University of Arizona Medical School, and member of the Arizona Arthritis Center; and John Polle, BFA, is an information specialist for the University of Arizona Arthritis Center.

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