Minor Glitches in Insurance Benefits Claims

Social security insurance benefits sometimes encounter problems in the processing of documents. These problems may be minor ones but they could cause a major delay in the delivery of much needed benefits to claimants.

The two main causes of delay in insurance benefits claims are in the initial stage of determining the eligibility and in the appeals process.

Determining disability

In the initial stage of a claim, most claimants fail to pass eligibility. The social security agency uses a five-step evaluation process in determining the disability.

• Substantial gainful activity - The agency investigates an applicant to know if he is engaged in work or any gainful activity. An application found to be engaged in any gainful work or occupation is likely to fail eligibility test.

• Severe impairment - The agency determines if the applicant has severe impairment, which means that the impairment could significantly affect the person's physical or mental ability.

• List of impairment - To check further, the agency has provided a list of impairment. An applicant whose condition meets that requirement of the list becomes eligible for the claims.

• Past relevant work - a medical assessment can help evaluate whether the impairment had prevented the applicant form performing past relevant work. It will also reveal the progression of his medical impairment.

• Other work - The investigation will also determine whether the applicant can perform other available existing work.

In any case, when an applicant fails to qualify in the criteria, he would have to undergo the appeals process. Because of the complex nature of the appeals process, a claimant would need legal assistance in pursuing his claim.

The appeals process is a three-step procedure:

1. Reconsideration. The reconsideration entails a complete review of the initial decision. A social security representative who may include new evidence submitted by claimant will conduct the review.

2. Hearing. An administrative law judge conducts a hearing. The hearing will give you the opportunity to present all valuable information you have, most importantly the medical statement from the doctor who attended to you.

3. Appeals Council Review. The council can either render a decision on the matter or send it back to the administrative law judge for further review.

A claimant who is dissatisfied with the final appeal may take his case to federal court within 60 days of the decision. In each stage of the appeal, the agency will notify you of the decision in which you are given time to respond