What Does a Social Security Claims Representative Do on a Disability Claim?

On This Page

1. What Will My Claims Representative Do During the Initial Interview?
2. How Will the Claims Representative Verify My Technical Qualifications?
3. Can I Qualify for Expedited Processing?
4. What Happens Once My Application Reaches the Office of Disability Determination Services?
5. What Can I Do If My Claims Representative Denied My Claim?

REVIEWED BY

C. William Kenny

December 12, 2023

Board certified by National Board of Trial Advocacy

Your Social Security claims representative will likely be the first person you come into contact with during the disability benefits application process. They will serve as the “face” of the Social Security Administration (SSA) while the organization processes your claim. They will conduct your initial interview, clear your technical qualifications, and reach out to you if the SSA needs more information to process your claim.

At Berger and Green, our disability lawyers can help you understand what your Social Security claims representative will do on a disability claim. We can help you work with your representative and provide the information they need to move your application along.

Call 412-661-1400 for a free consultation.

What Will My Claims Representative Do During the Initial Interview?

If Berger and Green helps you apply, your claims representative will review your application and call you if they have any questions. They will send the completed application to you to sign and return.

If you apply for disability in person or over the phone, your claims representative will accept your application and conduct an interview to learn more about your impairment and how it affects your ability to work. They might also ask about your work history and other relevant details.

This is usually the first time you speak to your claims representative.

How Will the Claims Representative Verify My Technical Qualifications?

Before your claims representative forwards your application on to the Office of Disability Determination Services, they check to ensure you meet all the technical requirements for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

Work History and Work Credits

SSDI requires you to earn a number of work credits before you suffered your impairing injury or illness. You earn these work credits by paying taxes on your salary or other earnings. In general, working even part time over the last 10 years should get you enough credits to qualify. You will generally need to have at least 20 credits to qualify for benefits.

If you do not meet the work credits test, your claims representative will issue a technical denial for SSDI benefits.

The Earnings Limit

While SSDI is not an income-based program, there is a limit to how much you can earn and still qualify. Known as the substantial gainful activity (SGA) limit, this number changes each year. The SGA does not count veterans benefits, investment income, or other types of income that does not come from working.

Your claims representative will look at the financial information you submit to ensure you meet this limit. If you earn more than the current SGA, you will likely receive a technical denial. It is important to note that the SGA is higher for blind individuals than others.

Strict Limits for SSI

SSI is a needs-based program. You must have a low income and few assets to qualify. Your claims representative will investigate your financial information and ensure you meet these limits before forwarding your claim to the Office of Disability Determination Services. If you do not, you may receive a technical denial at this point in the process.

Can I Qualify for Expedited Processing?

The SSA offers several programs that allow your application to go to the front of the line once it arrives at the Office of Disability Determination Services. These options are usually only available to applicants with a very serious impairment or terminal illness. If you believe you might qualify, you can ask your claims representative about expedited processing.

What Happens Once My Application Reaches the Office of Disability Determination Services?

The job of your claims representative does not end after they forward your claim to the Office of Disability Determination Services. They will continue to serve as your contact about the status of your claim.

During this time, a disability examiner will review your application and medical records to confirm that you suffer from a qualifying impairment, or your Residual Functional Capacity (RFC) prevents you from working and earning a living. You can reach out to your claims representative at any time to check the status of your claim or ask any other questions you might have.

What Can I Do If My Claims Representative Denied My Claim?

If the SSA denies your SSDI or SSI claim, your claims representative can give you general information about appealing. However, you will likely want more help navigating the disability appeals process. The attorneys at Berger and Green are standing by to review your case and help you understand your options for appealing the SSA’s decision. We will help you fight for the disability benefits you need to care for yourself and your family.

If your disability was the result of an accident someone else caused, our personal injury team might also be able to help you recover additional damages.

Call our office today at 412-661-1400 for your free case evaluation.