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Social Security Disability Benefits in West Virginia – A Flow Chart

To help you understand the Social Security disability (SSD) benefits application and appeal process in West Virginia, we present the following flow chart.

Whether you are at the initial application stage or dealing with a denied claim, a lawyer can provide invaluable assistance. Contact us to discuss the specific facts in your case and to learn more about how our lawyers can help you.

At Mani Ellis & Layne, PLLC, we take pride in providing our clients in Charleston and throughout the state with highly professional and compassionate service.

With more than 35 years of combined legal experience, we know what it takes to successfully pursue a disability benefits claim. We would be glad to provide a free review of your case today.

1.

You suffer a disabling injury or illness.

Due to a physical or mental impairment – or a combination of impairments – you reach a point where you can no longer work. This is your disability onset date.

It can happen to anyone. In fact, the Social Security Administration (SSA) reports that 1-in-4 20-year-old workers in the U.S. will become disabled by the time they reach retirement age.

Many people suffer disabilities due to events such as a car accident or an accident at work. Many others become disabled due to a condition that progresses through the years such as a musculoskeletal disorder, inflammatory bowel disease or carpal tunnel syndrome.

In its most recent Annual Statistical Report on the Social Security Disability Insurance (SSDI) program, the SSA reports that the most common impairments among SSDI recipients were:

Impairment Pct.


You can find a listing of disabling conditions that may qualify you to receive Social Security disability benefits in the SSA’s Blue Book.

2.

Your doctor diagnoses your impairment.

You should see a doctor as soon as possible if your condition prevents you from working. The doctor can perform initial tests and may refer you to a specialist. You may undergo tests such as:

  • X-rays
  • MRIs
  • CT scans
  • Biopsies
  • Blood and/or other bodily fluid tests.

Test results, your diagnosis and your treatment plan can all serve as medical evidence in your benefits claim. Your treating doctor can also provide an assessment of your condition and how it impacts your ability to work. This assessment can play a major role in your benefits claim.

3.

You meet with an attorney.

As soon you are able to do so, you should discuss your case with an experienced West Virginia SSD benefits lawyer. The lawyer can help you to collect documentation, prepare and ultimately submit your benefits claim.

Additionally, your lawyer can file a “protective filing date” letter with the SSA. This date will play a major role later on as you seek backpay.

Finally, a lawyer can also help you to pursue any other SSDI, Supplemental Security Income (SSI) or other benefits that you, your spouse and your children may be eligible to receive. For instance, you may able to file for West Virginia workers’ compensation benefits or Veterans’ Administration (VA) benefits.

4.

You submit your application.

You can apply for disability benefits in three ways:

Online – You can fill out forms available at the SSA website.
In person – You can apply at one of 16 local SSA offices in West Virginia. Go to the SSA website and type in your zip code to find the office located nearest to you.
By phone – You can apply by phone and then mail in your documentation or take them to your nearest SSA office. You can call (800) 772-1213 or (800) 325-0778 (TTY).

 

5.

Your claim is reviewed.

The review of your SSD benefits claim will involve two aspects:

Non-medical eligibility – Have you worked long enough and recently enough to qualify for SSDI benefits? Do you have limited and resources that make you eligible for SSI benefits?
Medical eligibility – Do you suffer from a physical and/or mental impairment that meets the SSA’s definition of a “disability?”

The key issue in most claims involves the medical eligibility determination. A claims examiner and a medical consultant at the West Virginia Disability Determination Services (DDS) office in Charleston or Clarksburg will review your case. The review will go through a “five-step sequential evaluation” process.

Five-Step Sequential Evaluation Process

1.

Are you engaged in substantial gainful activity?

Do you earn less than $1,170 per month ($1,950 if blind)?
Yes

Move on to Step 2

No

You are not disabled.

2.

Do you suffer from a “severe” condition?

Yes

Move on to Step 3

No

You are not disabled.

3.

Does your condition match, or is it equal in severity to, a condition listed in the Blue Book?

Yes

You are disabled.

No

Move on to Step 4 for a residual functional capacity assessment

4.

Can you return to your previous work?

Yes

You are not disabled.

No

Move on to Step 5

5.

Can you do any other work?

Yes

You are not disabled.

No

You are disabled.

During this stage, DDS may seek additional information from you and may order you to undergo a consultative examination.

After DDS reaches it decision, you will get a letter in the mail.

Notice of Award – If your claim is approved.
Notice of Disapproved Claim – If your claim is denied.
6.

If your claim is denied …

You can appeal. Within 60 days after the date on your Notice of Disapproved Claim, you must file a written request to have your case reviewed by a different DDS claims examiner and/or medical consultant. This is the first level of appeal in West Virginia. It is called a request for reconsideration.

You can continue to appeal through three more levels:

  • Hearing – You can request a hearing before an administrative law judge, or ALJ. The hearing would be held by video or at the Office of Disability Adjudication and Review (ODAR) in Charleston, Huntington or Morgantown (whichever is nearest to you). Nearly half of the claims that go to this stage are approved. However, the current average waiting time for a hearing in West Virginia is 20 months.
  • Appeals Council – Your case may be reviewed by the Appeals Council in Falls Church, Virginia. The Council can deny or allow your request. If allowed, the Council may deny your claim, approve your claim or send your case back to the ALJ with instructions, which can lead to a new decision.
  • U.S. District Court – You can file a lawsuit in your nearest federal District Court:
  • U.S. District Court for the Southern District of West Virginia – Court locations in Charleston, Huntington, Beckley and Bluefield
  • U.S. District Court for the Northern District of West Virginia – Court locations in Clarksburg, Elkins, Martinsburg and Wheeling
7.

If your claim is approved …

Congratulations! Your Notice of Award letter will tell you:

  • Your disability onset date
  • Date you became eligible for benefits (five months after your disability onset date)
  • Amount of backpay you will be awarded and when you will be paid
  • Amount you will receive in monthly benefits and when you will be paid
  • Date of your first continuing disability review (CDR).

Average Monthly SSD Benefits

(November 2016)
Beneficiary Type Avg.

Please see our Frequently Asked Questions for a discussion of how the SSA determines the amount you can receive in monthly SSDI or SSI benefits as well as how backpay is determined.

8.

You must go through continuing disability reviews.

The SSA will continue to monitor your status in order to make sure that you are still disabled and eligible for SSD benefits. The severity of your disability determines how often you must undergo review.

  • If medical improvement is expected – CDR 6-18 months from the start of your benefits
  • If improvement is possible – CDR every three years
  • If no improvement is expected – CDR every five to seven years.
9.

You return to work?

SSD benefits can play a major role in your life. They can allow you to keep paying your monthly bills and to get the medical care you need. Still, they are no match for what you could earn by working a full-time job.

If you want to return to work – and if you are able to do so – you should take advantage of the SSA’s Ticket to Work program. The program offers:

  • Career counseling
  • Vocational rehabilitation
  • Job placement and training
  • Other incentives such as protection from continuing disability reviews (as long as you are making progress in your return to work).

Want More Information? Need Help with Your SSD Benefits Claim? Call Us Today

The West Virginia SSD benefits lawyers of Mani Ellis & Layne, PLLC, are ready to explain your rights, explore your options and help you to pursue the all of the benefits you are entitled to receive. Our goal will be to obtain the maximum amount for you and your family. We know how important these benefits are to you.

To schedule a free consultation, call us today. We serve clients in Charleston and throughout West Virginia. You will pay nothing unless we obtain benefits for you.