SSDRC

Filing an Application for Disability Benefits

Social Security Disability List of Impairments

Social Security Disability and SSI Back pay

Social Security Disability Status

SSI Disability Benefits

Social Security Disability and SSI Requirements

Social Security, SSI, and Mental Disability

How Long Does It Take To Get Disability Benefits?

Qualifying: What do you Need to Prove to Qualify for Disability?

How do you Win Benefits under Social Security Disability or SSI?

Many who apply for SSD or SSI benefits are positive that they will be denied the first time they file for disability. However, while the majority of individuals are initially denied—nationally, an average of seventy percent of initial claims are turned down at the first level--some do win their Social Security disability benefits the first time they apply.

Which cases initially win?

Very often, individuals who win their disability claim the first time that they file have impairments that are either terminal or meet or equal the approval criteria of an impairment listing in the blue book, a.k.a. the social security disability list of impairments.

Other individuals who are initially approved (note: when we say “initially”, we mean at the disability application level) have medical evidence which sufficiently establishes the existence of physical limitations and/or mental limitations that rule out the ability of the individual to go back to A) past work as well as B) perform some type of other work.

How does social security make this type of determination, i.e. whether or not a person can person perform work activity? By reviewing a claimant’s work and medical records to determine what they are currently capable, and incapable, of doing.

This evaluation of the medical history will allow a disability examiner, or a judge if the case is at the hearing level, to give a claimant an RFC, or residual functional capacity, rating which will be measured against the following:

What is known about the claimant’s past jobs (the requirements of the jobs and skill levels involved).
The perception of how transferrable the claimant’s job skills might be to other kinds of jobs.

As was stated, typically, the majority of disability claims will be denied at the initial claim or reconsideration appeal level based on the conclusion that the claimant can either A) return to their past work or B) perform some type of other work. If an individual does not win their benefits at the disability claim level, they must make a decision as to whether or not they plan to pursue their Social Security disability or SSI claim by filing the first appeal, the request for reconsideration. This is when it becomes important to consider what is needed to win the disability benefits claim.

Factors involved in Winning SSDI or SSI Claims

Many factors affect your ability to win disability benefits. A key factor to the success of any disability case is information. If you want to win your disability benefits, you should provide detailed information about your education, medical treatment, medications, and testing. Before even filing, you should write down the name, address, and phone number for each of your medical treatment sources (and retain this list for future reference, such as the filing of appeals). Additionally, try to write down your treatment dates with each source, the medication each prescribed, and the testing they performed.

Note: Do not assume that the social security administration can accurately retrieve your medical history without you listing all of your treatment sources. Also, do not assume that you should not provide older sources of treatment since these may be essential to establishing how far back your disability exists, which can have a substantial effect on how much back pay you may be owed when your claim is won.

Through my experience as a disability examiner, I routinely received phone calls about medical treatment sources that disability applicants forgot to provide when they first filed but later recalled. Sometimes the disability applicant provided the information timely and sometimes they did not, meaning a disability decision had already been made.

Obviously, it would have been better for the case if those treatment sources had been disclosed earlier so medical records could have been obtained from them. Regarding missed records, there was always the possibility that a disability decision could have been different had an important piece of medical information had been in the file when the decision was made.

In addition to good information about medical sources and their treatment, it would be very helpful if your treating physician gave his or her professional opinion as to the functional limitations your condition or conditions cause. A thorough physician’s statement can very well help you win benefits under SSDI or SSI (a treating physician is a doctor who has an established history of providing you treatment and is, therefore, qualified to comment as to your condition).

A treating physician’s statement contains information about your diagnosis, response to treatment, and prognosis, along with objective medical testing information (i.e. imaging, blood work, biopsy, etc.). And it provides a disability examiner or an administrative law judge with a way to rate your current and projected physical or mental limitations. In other words, it will help to determine whether or not you are capable of work activity.

Social Security Disability, SSI, and your Work History

Involved in a Social Security disability determination is an assessment of the work (the individual jobs) you have performed in the last fifteen years. You can improve your chances of winning by providing a good description of the jobs as you performed them when the disability examiner sends a work report for you to complete.

Disability examiners use job descriptions from the DOT (Dictionary Of occupational Titles) to determine how the job is performed in the general economy. The DOT description describes the exertional requirements (i.e. lifting, standing, walking, bending, stooping, climbing, etc.) and mental requirements (i.e. concentration, educational, etc.) of each relevant job you list.

What does SSA mean by “relevant”? Not every job that you’ve ever worked will be considered as a job that you could return to. A relevant job for the purposes of a SSDI or SSI claim is any job at which you earned substantial work earnings, performed the job for three months or more, and in which you had time to learn the functions of the job.

While disability examiners use the DOT description to come up with an official job title, they still have to consider the job as you performed it when they make the disability determination. This is why your description of what you did on the job is so important.

The job descriptions that you provide could set the stage for a denial of your claim. They could also allow the disability examiner to determine that you are unable to do any of your past work. And this would enable the disability examiner to move one step close to a finding of disability.

The last element of the Social Security five step sequential disability process is an evaluation of your ability to perform other types of work. It is at this point that your physician’s statement as to your functional limitations can be very helpful.

The fifth step of “other work evaluation” requires the disability examiner to consider your age (see Age, Social Security Disability, and SSI), functional limitations, education, and job skill transferability. If the examiner is able to determine that you are unable to do any other kind of work, you may win disability benefits from Social Security. Always keep in mind, of course, that your potential qualifications for other work will be substantially influenced by the work you have done in the past (acquired job skills). Again, this highlights the importance of supplying detailed and accurate information about your prior work.

If your disability claim has to be appealed to an administrative law judge, meaning that your claim has been denied at the disability application level, and again at the request for reconsideration level, you should consider disability representation via a Social Security disability attorney or non-attorney disability representative.

Disability hearings are like any other kind of hearing in the sense that having a representative usually improves your chance of winning your case. While disability hearings are held in somewhat less formal surroundings they still involve a hearing room, the presentation of your case, and a judge. National disability hearing win-loss statistics show that disability applicants with representation are about twenty to twenty-five percent more likely to win disability benefits on SSDI and SSI claims than those who are not represented.

The information above lists just some of the things that you as a disability claimant can do to improve your chances of winning benefits under Social Security disability. The following links provide additional information on this topic as well.

Tips to Prepare for Filing for Social Security Disability or SSI

Preparing for a Disability Hearing to Win Social Security or SSI Benefits

Your evidence must address the following if you are to win disability benefits

As we stated, a percentage of cases will be approved initially, meaning that those claimants will receive their benefits fairly quickly and will not have to file lengthy appeals or submit additional evidence and statements from their treating physicians. But, for the majority of applicants, this will not be the case. And, in such cases, the two primary determinants for winning disability benefits are:

1) Perseverance – Not giving up on the case and continuing to pursue the claim through the appeals process.

2) Thorough Case Preparation – Supplying the social security administration with the information that establishes the physical and/or mental limitations that rule out the claimant’s ability to work and earn a substantial and gainful income, thus making them disabled according to the disability rules and guidelines used by SSA.