division of disability determination unit 7d – homeless and special project unit
TRANSCRIPT
Division of Disability DeterminationUnit 7D – Homeless and Special Project Unit
Opportunities for Ohioans with Disabilities
Social Security benefits for workers (SSDI) Social Security benefits for adults disabled
since childhood (CDB) Supplemental Security Income (SSI) for
children and adults
Types of Disability Programs
DDS Case Control Department receipts the claim in and notes any special flags.
7D Homeless / Special Project Supervisor monitors the queues
Claim is assigned to an adjudicator in the homeless unit
Application Has Been Submitted to FO and Is Now at the DDS
The adjudicator sends requests for medical evidence of record (MER) to the relevant sources of information listed on the application.
May determine a consultative examination is needed.
The adjudicative team (adjudicators, medical consultants and disability program specialists) analyzes all available evidence
The Journey of a Claim:Adjudicator Duties
The adjudicative team determines if the claimant has severe and marked limitations that meet SSA disability guidelines or that prevent all work related activities (using Sequential Evaluation).
Final decision◦ Claim typically returned to Field Office and claimant
notified of the decision. ◦ Claim can be randomly chosen for review by SSA’s
quality assurance department. If they disagree with the DDS’s decision they will return the claim for additional actions.
The Journey of a Claim:Adjudicator Duties
QDD (Quick Disability Determination) & CAL (Compassionate Allowances) are processed in our Fast Track Unit. Claims are screened in at the Field Office using software that searches for key words
Wounded Warrior/Military Casualty claims—any claimant that has served in the military from 2001-current. Processed in Fast Track and Homeless/Special Project Units Unit◦ http://www.ssa.gov/woundedwarriors/
Fast Track Claims—Screened internally as claims that appear to be a quick allowance
Homeless/Pre-Release/Special Projects Initiative—these claims are handled by one dedicated unit consisting of nine adjudicators
Special Claims
The inability to engage in Substantial Gainful Activity (i.e. work), due to a Medically Determinable Impairment (mental and/or physical), that is expected to or has lasted 12 full months or is expected to result in death.
Definition of Disability
Is the claimant engaging in Substantial Gainful Activity (SGA)?
Does the claimant have a severe impairment?
Does the impairment meet or equal the listings?◦ If no, determine the claimant’s residual
functioning capacity (Physical – RFC) and (Psychological – MRFC)
Does the impairment prevent past work? Does the impairment prevent other work?
5 Steps of Sequential Evaluation
1.00 Musculoskeletal 2.00 Special
senses/speech 3.00 Respiratory 4.00 Cardiovascular 5.00 Digestive 6.00 Genitourinary 7.00 Hematological
Physical Listings
• 8.00 Skin• 9.00 Endocrine• 10.00 Multiple
systems• 11.00 Neurological• 13.00 Neoplastic• 14.00 Immune
12.02 Organic Mental Disorders 12.03 Schizophrenia, other Psychotic
Disorders 12.04 Affective Disorders 12.05 Intellectual Disability 12.06 Anxiety Related Disorders 12.07 Somatoform Disorders 12.08 Personality Disorders 12.09 Substance Addiction Disorders 12.10 Autism and other PDD
Website for listings: http://www.ssa.gov/disability/professionals/bluebook/
MENTAL LISTINGS
Completing questions from DDD or sending medical records
Giving descriptive information about functioning and response to treatment
While only certain treating sources are considered acceptable medical sources for decision-making, all medical information is extremely valuable to the claim
The Role of Health Professionals
Psychiatrists
Acceptable Medical Sources
Licensed Clinical Psychologists
School Psychologists for Intellectual Disabilities and Other Learning Disorders
Doctors (MD/DO)
MH Counselors/Therapists Hospitals/Clinics Rehabilitation Centers Schools
Other Good Sources of Information
Dates of treatment Diagnosis and capability statement Testing/Imagery results Operative/Pathology reports Office notes Mental Status Exams IP/ER records Any available psychological testing Description of functional limitations due to
symptoms
What Information Are We Looking For?
Attend a consultative examination Contact sources for assistance in obtaining
records Forms
◦ ADL◦ Work History◦ Symptoms◦ 827 (Medical Release)
Things We May Need From the Claimant and/or Representative
Why?◦ Exams are ordered when there is not enough
information in file or the information in file is not sufficient to make a decision. Exams are only ordered after all time relevant records are requested, followed up on and all other avenues of obtaining the necessary information are exhausted. Sources never responded Medical records are not current (typically within the past
3-6 months) Possible exception would be a condition that would improve with time (e.g. ALS)
No information/evidence from an acceptable medical source
Conflicting information in file
Consultative Exams (CEs)
What?◦ We purchase one time evaluations from
psychologists, cardiologists, neurologists, medical doctors, x-rays, labs, and special studies.
◦ The doctor/facility provides a report on the evaluation.
◦ These doctors and facilities are located in areas throughout Ohio.
Consultative Exams, (CEs)
When?◦ Requests for these exams are entered into our
case processing system. ◦ The agency’s scheduling department processes
these requests and schedules the exams as close to the claimant as possible depending on the availability of that particular specialty in an area.
◦ Typically will schedule at least 10 days and not more than 30 days in the future.
Consultative Exams (CEs)
Special Requests◦ Please let the adjudicator know of any special
requests or time limitations when they ask if the claimant is willing to attend an exam. Please keep in mind that special requests and
limitations in availability may delay the scheduling of the CE, may increase the distance of the exam from the claimant and may not be able to be accommodated at all depending on the area and consultant availability.
Consultative Exams (CEs)
Responsibilities of the representative and/or claimant:◦ Must provide own transportation◦ Must confirm via telephone that they will attend
the appointment when they receive the exam notice If no telephone contact, the adjudicator is required to
call the representative and/or claimant If there is no response to the telephone calls,
adjudicator is required to send a call in letter to the claimant and/or representatives
Consultative Exams (CEs)
Complaints◦ Report any issues or problems with the exam to
the adjudicator as soon as possible (either by phone or letter)
◦ All complaints are taken very seriously and are investigated by our Professional Relations Officers
Consultative Exams (CEs)
This form is extremely important in the process and is used primarily at step 4 and 5 of Sequential Evaluation. ◦ The evidence in file shows there is a severe impairment. The
impariment is causing limitations but not of listing level severity. Despite those limitations, the claimant has other abilities that may be used in a work environment. Step 4 – With these remaining abilities can the claimant
perform their past work as they described it or as it is done in the national economy? If yes, denial. If no, go on to step 5.
Step 5 – given their remaining abilities, their past work experience, their age and education level – can they perform other work?
Work History Report (3369)
To clearly and completely evaluate the claim at step 4 and 5 the adjudicator must have a detailed work history report for the claimant
This is important for all claims but especially for individuals 50 and older
Why? - Because the rules guiding a finding of disability change as a person ages.
Work History Report (3369)
What does a not so detailed work history report look like?◦ Contains inconsistencies◦ Very brief with no details◦ Left blank, “I don’t know” answers, question
marks◦ Vague descriptions◦ Jobs listed in the remarks section
Work History Report (3369)
What does a detailed work history report look like?◦ Contains no inconsistencies◦ Is very detailed, contains dates◦ No blanks, no “I don’t know” answers, no question
marks◦ Clear, detailed descriptions of the job and job
duties, type of business◦ Additional job listed on extra sheets (i.e. not listed
in remarks section)
Work History Report (3369)
Please be sure to include all allegations on the claimant’s application. The allegations on the summary page should be the same as the allegations on the application.
Please pay attention to the date the claimant alleged disability began when supplying records.
Other Issues
A diagnosis does not equal disability. We are a function based program and it is the severe limitations in functioning that lead to a finding of disability.◦ Example: diabetes, controlled with medication
Prior allowances – just because a claimant was allowed in the past does not necessarily mean s/he will be allowed again. Many factors could change the outcome.◦ Examples: change in listings, change in age, severity
of the condition and its limitations in functioning have changed, technical denials
Other Issues (cont.)
Look for the unit 7D on the representative bar code that is sent
Use list to identify the adjudicator who is working on the claim◦ Is it a Homeless/Special Project Adjudicator?
Is My Claim In the Homeless Unit?
Liz McNany, Unit Supervisor code: EAM211, phone: 614-438-1941
Todd Gould, Claims Adjudicator 3 code: TJG896, phone: 614-438-1353
Shannon Hopp, Claims Adjudicator 3 code: SLH235, phone: 614-438-1629
Jennifer Koppelman, Claims Adjudicator 3 code: JAK536, phone: 614-438-1883
Jamie Labuda, Claims Adjudicator 3 code: JLR626, phone: 614-438-1852
Unit 7D Homeless - Special Projects - Pre-Release Claims
Debra Lorenz, Claims Adjudicator 2 code: DDL284, phone: 614-438-1231
Jennifer Nelson, Claims Adjudicator 3 code: JRE836, phone: 614-438-1573
Mary Vitek, Claims Adjudicator 2 code: MAV370, phone: 614-433-8286
Erin White, Claims Adjudicator 3 code: ENW033, phone: 614-438-1824
Dave Wolfe, Claims Adjudicator 3 code: DLW745, phone: 614-438-1364
Unit 7D Homeless - Special Projects - Pre-Release Claims
OBB COHHIO ODMH ODRC – Pre-Release Claims Wounded Warriors (if homeless or
represented by a partnership)
Special Projects/Partnerships
Resources for Third Partieshttp://www.ssa.gov/thirdparties.htm
Social Security Disabilityhttp://www.socialsecurity.gov/disability
Other Useful Resources