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Account Services Training Module 3: SSDI 301

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Courtney Scott

on 20 June 2018

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Transcript of Account Services Training Module 3: SSDI 301

Agenda
The Advocator Group

Defining Disability

Five Step Sequential Evaluation Process

The Grids

Special Cases

The Sequential Evaluation Process
Three Key Takeaways
Five Step Sequential Evaluation Process
The Grids: Medical-Vocational Guidelines
Questions?
Contact Information
Courtney Spencer
Account Services Manager
877.261.1947 x2009

Kevin Shunney
Account Services Executive
(781)-570-8920
Toll free number: (877) 261-1947
Facsimile: (877) 899-1345
Website: www.advocator.com
Benefits of filing for SSDI with The Advocator Group
Claimant benefits of filing for SSDI

Increased retirement benefits
Cost of Living Adjustment (COLA) raises
Potential tax-free income
Medicare coverage
Reduced health insurance premiums
Return to work incentives
Dependent and spousal benefits

Data & analytics
Business process & technology
External SSA pressure on approval rates and timing
How can we manage the pipeline better to get
more
awards
faster?
How can we create an integrated claimant experience throughout?
Coordinated messaging
Customized business processes
Overall claimant experience
"The Equation"
LTD Approvals
Claims
Reviewed
Percentage Accepted
Percentage Deemed Viable
Percentage Converted
Percentage Awarded
Reimburse-ment Facilitated
The Advocator Group closely monitors and manages all metrics associated with our partnership with Dearborn National in order to ensure that we are partnering effectively to achieve fast and favorable awards.
Key Metrics & Benchmarking
1. Disability can be challenging to define.

2. The Social Security Administation utilizes a standardized, five-step method of evaluating disability claims.

3. Certain cases receive special handling due to their severity.
Defining Disability
Disability – A Term of Art
For SSDI purposes, Congress has defined the term “disability” as:

An inability “to engage in any
substantial gainful activity
by reason of
any medically determinable physical or mental impairment
which can be expected to
result in death
or

which has lasted or can be expected to last for a
continuous period of not less than 12 months.”

The sequential evaluation process is a series of five "steps" that must be proved by the claimant, in order, to be found disabled under the Social Security Act.
The claimant is not engaging in “substantial gainful activity” (SGA);
and

The claimant has a “severe” impairment;
and

The impairment meets or “equals” one of the impairments described in the regulations as the “Listing of Impairments”;
or

Considering the claimant’s “residual functional capacity” (RFC) the claimant is unable to do Past Relevant Work;
and

The claimant is unable to do any other work considering his RFC, age, education, and work experience.
1. Substantial Gainful Activity
Work is “substantial” if it involves doing significant physical or mental activities, or a combination of both.
For work activity to be substantial, it does not need to be performed on a full-time basis.
Work activity performed on a part-time basis may also be substantial gainful activity.

In 2017, earnings over $1,130/mo. for work done are considered gainful work activity.

An impairment is severe if it significantly limits the physical or mental ability to do basic work activities (the abilities and aptitudes necessary to do most jobs).

Examples of basic work activities include:
Physical functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling;
Capacities for seeing, hearing, and speaking;
Understanding, carrying out, and remembering simple instructions;
Use of judgment;
Responding appropriately to supervision, co-workers and usual work situations; and
Dealing with changes in a routine work setting.
2. "Severe" Impairment
An impairment must also be
continuously
severe:

Expected to result in death; or
Have lasted or be expected to last for a continuous period of 12 months.
In order to be found disabled at step 3 of the sequential evaluation process, a claimant’s condition must meet or equal one of the “Listing of Impairments.”

If listing is met, no inquiry in ability to do past or other work will be made.

3. Listing of Impairments
Work performed in the last 15 years above the SGA level and long enough to have learned it.

If a claimant retains the ability to do past relevant work, they will not be found disabled.
4. Past Relevant Work
If the client has the ability to perform other work on a full-time basis, they will not be found disabled.

Age, education, and work experience begin to factor in at age 45 per the medical vocational guidelines (“Grids”).
5. Other Work
Age
Education
Younger person (under age 50)
Closely approcahing advanced age (50-54)
Advanced Age (55+)
Closely apprioaching retirement age (60-64)
Must not be mechanically applied
Formal schooling or other vocational training.
Illeracy
Marginal education (6th grade level or less)
Limit education (7th-11th grade)
High school education & above
Inability to communicate in English
The Grids, continued
Work Experience
Work—Vocational Expert Testimony
Skills & abilities acquired through work.
Must have been done within the last 15 years, lasted long enough to learn how to do it, and was SGA.
Physical exertion levels:

Very heavy
Heavy
Medium
Light
Sedentary
The Grids, continued
A skill is knowledge of a work activity which requires the exercise of significant judgment that goes beyond the carrying out of simple job duties and is acquired through performance of an occupation which is above the unskilled level (requires more than 30 days to learn).

It is practical and familiar knowledge of an art, science, or trade, combined with the ability to apply them in practice in a proper and approved manner. A skill gives a person a special advantage over unskilled workers in the labor market.

Unskilled (SVP 1–2)
Semiskilled (SVP 3–4)
Skilled (SVP 5–9)

Skill Levels
Transferability of Skills
Applying work skills which a person has demonstrated in vocationally relevant past jobs to meet the erquierments of other skilled or semi-skilled jobs. Skills can be transferred among jobs in which:

The same or lesser degree of skill is required (same of lower SVP).
The same or similar tools & machines are used.
The same or similar raw materials, products, processes, or services are involved.
Special Cases
Social Security has an obligation to provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously meet disability standards.

Compassionate Allowances (CAL) are a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information.

Compassionate Allowances allow Social Security to target the most obviously disabled individuals for allowances based on objective medical information that we can obtain quickly.

Examples:
Acute Leukemia, ALS, Pancreatic Cancer
A case is designated critical when the claimant's illness is alleged or identified as terminal (i.e., untreatable, irreversible, and expected to end in death).

TERI designations are monitored by the ODAR regional office to ensure the case is expedited.

The presence of TERI criteria does not mandate a finding of disability. An adjudicator must evaluate the claim under the sequential evaluation process.
Compassionate Allowances (CALs)
Terminal Illnesses (TERIs)
Introduction to The Advocator Group
Introduction to The Advocator Group
Why refer to The Advocator Group?
Strong Partnership
Employee Benefits & SSDI Expertise
Continuous Improvement
Key differentiator in a successful relationship.
Unique blend of experience allows us to deeply understand your business objectives.
Tightly managing and enhancing business processes and claimant communication.

Claimant
Alleviate the burden of the application process

No out of pocket expense

Faster time to award & Medicare benefits

Customer service
Prudential
Manage costs

Higher & more consistent award rates

Education & training on SSA related news & trends

Reporting and data analytics
We are here to help
People & Culture
Full transcript