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How Social Security claims get 'worked on' and evaluated

When a medical disability makes it impossible or very difficult for an individual in West Virginia to earn a living, they may file a claim to receive Social Security payments. Such claims are first sent to the state's disability determination services (DDS) agency. A specialist referred to as a disability examiner will then be assigned the case. This is the person who reviews the medical documents included with the application along with their sources.

Because a Social Security disability determination needs to be made with current medical information, an examiner may schedule a consultative examination or series of examinations so they can get updated information on a claimant's current physical and/or mental health status. While these consultative exams (CEs) aren't always the best source of medical information, they are sometimes necessary if sufficient recent documentation isn't available. For this reason, it's often recommended that claimants obtain medical reports from doctors familiar with their situations.

The disability examiner may also contact third-party individuals listed on the application to obtain firsthand accounts of a claimant's abilities. Another method for getting this type of information involves sending out activities of daily living questionnaires to both the claimant and listed third parties.

Gathered information is used to determine an individual's residual functional capacity, or what they can currently do given existing limitations or disabilities. This assessment is based on the type of work a claimant did prior to their disability, which is why a detailed work history needs to be included with an application. The examiner will determine if a claimant is capable of performing similar work-related tasks in a way that could lead to gainful employment.

An attorney can prove to be an important ally for an individual seeking Social Security benefits in West Virginia. A disability lawyer is typically able to review an application before it's submitted and make recommendations about documents to include with it. A lawyer can also initiate the appeals process if a disability examiner denies an initial claim.

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Shawn Taylor, PLLC
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