Idaho Disability Determinations Service

Social Security Disability Insurance (SSDI)

Social Security Disability Insurance provides monetary and medical benefits for people found to be disabled who have also met the non-disability requirements of contributing to the Social Security Trust Fund through taxes on their earnings.

Supplemental Security Income (SSI)

Supplemental Security Income (SSI) provides monetary and medical benefits to adults and children who are blind or disabled and who have also met the non-disability income and resources requirements.

The definition of disability under Social Security is different than other programs. Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability.

Disability under Social Security is based on your inability to work. We consider you disabled under Social Security rules if:

• You cannot do work that you did before;
• We decide that you cannot adjust to other work because of your medical condition(s); and
• Your disability has lasted or is expected to last for at least one year or to result in death.

This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers’ compensation, insurance, savings and investments.

For more information, visit the Social Security website.

1. A trained disability examiner reviews your forms and writes to your medical sources to obtain evidence. Your medical sources are asked about the following:
   • What illnesses, injuries or conditions limit your ability to work?
   • How do the illnesses, injuries or conditions limit your activities?
   • When did you become unable to work?
   • What have medical examinations and tests shown?
   • What treatment has been provided?

   Your medical sources will not be asked whether you are disabled. That determination is made by a state agency team, which includes a disability examiner and a medical consultant.

2. Usually, the team gets enough evidence from your medical sources to make a decision. However, if more evidence is needed, a special exam will be arranged and paid for by DDS. After all the needed evidence is obtained, the examiner and medical consultant will:
   
   • Consider all the facts in your case, including the severity of your condition; when it began; how long it has lasted; how it affects your ability to work; and your age, education, and work experience; and
   • Follow a step-by-step procedure that includes the following five questions:
     1. Are you working?
        If you are and your earnings average more than $1,000 a month, you generally cannot be considered disabled.
     2. Is your condition “severe”?
        Your impairments must interfere with basic work-related activities for your claim to be considered.
     3. Is your condition found in the list of disabling impairments?
        SSA maintains a list of impairments for each of the major body systems that are so severe they automatically mean you are disabled. If your condition is not on the list, we have to decide if it is of equal severity to an impairment on the list. If it is, your claim is approved. If it is not, we go to the next step (below).
     4. Can you do the work you did previously?
        We must determine whether your impairment interferes with your ability to do the work you did in the last 15 years. If it does not, your claim will be denied. If it does, your claim will be considered further.
     5. Can you do any other type of work?
        If you cannot do the work you did in the last 15 years, we then look to see if you can do any other type of work. We consider your age, education, past work experience, and transferable skills, and we review the job demands of occupations as determined by the Department of Labor. If you cannot do any other kind of work, your claim will be approved. If you can, your claim will be denied.
3. The time frame for DDS to make the medical determination varies, depending on how quickly your medical sources respond to requests for records and the need for special exams.
4. Once DDS has made a determination, Social Security will send you a letter informing you of the decision.

Submitting medical information

As a physician or other health professional, you may receive requests from DDS to submit copies of your treatment records and reports on behalf of your patients.

The medical information you provide helps us to make a timely, accurate decision on your patient’s claim for Social Security disability benefits. Idaho DDS pays for medical records that are required to process the disability claims.

Electronic Records Express (ERE)

Do you have electronic health care records? Would you like to save time and money by submitting requested information to DDS electronically?

• Faster decisions for disability claimants.
  Fast and reliable electronic delivery increases the likelihood of faster decisions.
• Increased provider satisfaction.
  Electronic records get to DDS with less labor, and more quickly and reliably. The need for follow-up requests is greatly reduced and payment processing can start sooner.
• Improved use of public funds.
  The transfer, management and storage of paper are costly for U.S. taxpayers.

Electronic Records Express is a Social Security Administration (SSA) initiative that offers a range of options for submitting medical records to the state DDS. You choose the method, or methods, that work best for your organization.

Transfer records through the Social Security Administration (SSA) Electronic Services secure web site using your existing Internet connection. The only software needed is a Web browser. You type in a small amount of case information from the DDS request letter, then attach your electronic data — scanned paper records, a report generated by your electronic records system, or a report typed in your favorite word processor.

File types accepted: .wpd, .doc, .jpg, .bmp, .txt, .xls, .pdf, .tif, .tiff as well as .zip files that contain any of these file types.

For a DEMO of this site, please visit: http://www.ssa.gov/ere/ere_demo_public/index.html.

For more information about submitting your records electronically, or to obtain a PIN and password to use the secure website, please contact Idaho DDS:
Disability Determinations Service
Professional Relations Officer
P.O. Box 21
Boise, ID 83707
Phone: (208) 327-7333
Toll free: 1-800-626-2681
Fax: 1-800-742-6995
Email: DDS.PRO@labor.idaho.gov

Fax

Use your office fax to send records any time, day or night. Fax software programs may also be used if you can make the first page of the fax the DDS bar-coded cover sheet letter. The bar-coded cover sheet must always be page one. The faxes are digitized for claims processing.

Billing and payment

Questions about billing or payments for medical records should be directed to: 1-800-626-2681 ext. 2393.

For more information about the payment process for medical records, please access the Idaho State Controller’s Office website. From the home page, click ‘Support,’ then ‘Vendors’ and ‘Vendor Remittance’ to access direct deposit, remittance advice forms and the FAQs related to these forms.

More than 200 physicians and psychologists throughout Idaho perform physical and mental consultative examinations (CEs) that contribute to DDS disability decisions. As part of the medical development process, DDS tries to obtain evidence from the claimant’s own treating sources first.

However, if that evidence is unavailable or insufficient to determine whether he or she is disabled, DDS will arrange for a CE in order to obtain the additional information needed. In these instances, DDS authorizes physicians, psychologists and other health professionals to perform these examinations. Generally, sources are selected based on appointment availability, distance from a claimant’s home, and ability to perform specific examinations and tests.

The CEs are conducted at no charge to the claimant. The provider performing the examination submits a voucher directly to DDS for payment. All CE providers must be currently licensed in the state of Idaho.

DDS fee schedule

For more information about CE report requirements, read SSA’s Consultative Examinations: A Guide for Health Professionals.

Current CE provider recruitment needs, statewide

• Psychiatrists.
• Orthopedists.
• Neurologists.
• Internists.
• Cardiologists.
• Ophthalmologists.
• Psychologists.

For more information about the payment process for consultative examinations, please access the Idaho State Controller’s Office website. From the home page, click ‘Support,’ then ‘Vendors’ and ‘Vendor Remittance’ to access direct deposit, remittance advice forms and the FAQs related to these forms.