Overview of Disability
Disability Back Pay
Requirements for Disability
Applications for disability
Tips and Advice for Disability Claims
How long does Disability take?
Winning Disability Benefits
Common Mistakes after a Denial
Mental Disability Benefits
Denials for Disability
Appeals for denied claims
Disability Benefits from SSA
Child Disability Benefits
Qualifications and How to Qualify
Working and Disability
Disability Awards and Notices
Disability Lawyers, Hiring Attorneys
Social Security List of Conditions
What Social Security considers disabling
Medical Evidence and Disability
Filing for Disability Benefits
Eligibility for Disability Benefits
SSD SSI Definitions
SSDRC authored by Tim Moore
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Applying for Disability in Massachusetts
How to apply, meet filing requirements, and the criteria to qualify for Benefits in MA
Approval and Denial Statistics for Disability Claims in Massachusetts
Note: If you have already filed a claim and been denied for disability, or are wondering what to do in the event of a Social Security denial, proceed to the reconsideration and hearing appeal sections below.
Level I: Disability Application - Approximately two-thirds of all disability claims are denied at the disability application level in Massachusetts. This high rate of denial effectively requires that the majority of claimants will need to file at least one appeal (and in most cases, two appeals will actually be required) in order to ultimately win disability benefits.
The first appeal is the request for reconsideration which typically has a denial rate that exceeds 80 percent in practically every state. The second appeal is a request for hearing which usually constitutes a claimant's best opportunity for winning benefits, provided the case is presented with evidence that satisfies the Social Security Administration's definition of disability.
Filing for disability
An individual applying for disability in Massachusetts will have the choice of filing for disability online, in person at a local Social Security office, or by using the Social Security Administration's toll free number to the teleclaims unit.
Applying in person is often the best option since it allows more information to be gathered from an SSA claims representative regarding the application and appeal process, and, furthermore allows the claimant to directly ask questions.
By comparison, the online filing process does not allow for one-to-one contact with a Social Security claims representative (CR), which is sometimes crucial for avoiding misconceptions and mistakes. In addition, the online process does not allow for an SSI disability application to be taken. Since many claims will be for SSI, or will be concurrent, meaning that they will involve both SSD and SSI--and since there is typically no way for a claimant to know in advance which programs will apply to their claim--applying in person is usually more productive.
However, for those individuals for whom an office visit is not a possibility due to transportation or medical issues, it is important to remember that you can still start your claim with a local office and have the disability application interview conducted over the phone. This may also be requested for claimants who simply prefer a phone interview.
Qualifying for disability in Massachusetts
To meet the requirements for disability, Social Security has established a definition as to what being disabled under the Social Security Act means:
1. To be found disabled, a person must have a medically determinable physical or mental impairment. Typically, most claimants will list several impairments on their application for disability when filing.
2. To be found disabled, a person's condition must exhibit a level of severity that interferes with the ability to peform normal daily activities and which also interferes with the ability to engage in basic work capabilities.
3. The disabling condition must either have lasted one full year, or, based on a review of the medical evidence, must be projected to last at least that long.
There are additional requirements for disability as well. A claimant must have a condition that is either listed in the Social Security disability list of impairments, or which prevents their return to substantial and gainful work activity in the performance of their past work, or in the performance of any other type of work for which their skills and education would ordinarily suit them.
How the disability decision is made in Massachusetts
Even though the application for disability is taken at a Social Security office, it is not processed there. The claim is transferred to the state's DDS, or disability determinations services, agency. At the DDS, it is assigned to a disability examiner. The examiner will review the medical evidence for signs that the claimant has a listing level medical impairment and, if not, indications of physical and mental functional limitations.
In cases where the claimant does not meet a listing, and this is usually the case, the claimant's limitations are assessed cumulatively in an RFC, or residual functional capacity, rating. This rating will allow the disability examiner to determine whether or not the claimant can return to their past work.
When the claimant cannot return to their past work, consideration is further given to the demands and skill levels of their past work to determine if the claimant has the capability to perform some type of other work.
When the determination is made that the claimant cannot do any type of work at a substantial and gainful activity level, they will meet the qualifications for disability benefits under either the Social Security Disability or SSI disability program.
Disability application denial rate: 61.4 percent.
Disability application approval rate: 38.6 percent.
Level II: Request for Reconsideration - A claimant who has been denied on an application for disability has the option of filing a new claim. However, this is practically never advantageous for several reasons.
When a new disability claim is filed, the case basically starts from scratch, meaning that months of valuable processing time will have been lost. Secondly, a new claim that is filed, versus an appeal, may result in a loss of disability back pay. Finally, claimants who are denied on a disability application and file a new claim are likely to receive another denial, probably for the same reasons.
The best course of action for a claimant who has been denied will be to follow the Social Security appeal process.
The first appeal is the request for reconsideration. The appeal can be requested after a denial notice, or notice of disapproved claim, is issued. It must be received by the Social Security Administration within 60 days (plus an additional five days that SSA allows for the mailing of forms) of the date of the denial. This date is usually stamped in the upper right hand corner of the denial notice.
Submitting the reconsideration appeal request
To request a reconsideration, a claimant should contact the Social Security office where their initial claim was filed. The field office will then mail out the necesssary paperwork to be completed and returned.
Any additional medical treatment that has been obtained, or new medical diagnoses that have been received, in the time following the denial of the disability application should be indicated on the appeal. This is particularly important because reconsideration appeals have an even higher rate of denial than disability applications. Generally speaking, a reconsideration will not be approved unless the reconsideration-level examiner finds fault with the first disability examiner's decision, or new and compelling medical record documentation is brought into the case.
Note: After a reconsideration appeal is submitted to the Social Security office, a claimant should make a followup status call. This is to verify that the appeal paperwork was received and to avoid a situation in which the paperwork is lost in the mail and the appeal deadline is missed. The followup status call should be made within 10-14 days.
In the same vein, before the reconsideration is mailed a personal copy should be made in the event that the original copy is not received.
The decision process at the reconsideration appeal level
The Social Security Disability and SSI disability system is federal and standardized. Therefore, the qualifications for disability at the reconsideration appeal level are the same as at the initial claim level.
Once again, the claim is decided by a disability examiner (not the same examiner, but a level II examiner). This means that the process of qualifying for disability will entail a review of the medical evidence to determine in what ways, and to what extent, the claimant is functionally limited. These limitations are used to construct an RFC, or residual functional capacity, assessment, which will be used to determine if the claimant has the capacity to return to their past work.
The RFC is also used to determine if they can perform some type of other work. When the examiner finds that the claimant can do neither their past work, nor other work, they will satisfy the requirements for disability.
It should be noted that some claimants will receive a Social Security Disability or SSI award without consideration of their ability to work, but, rather, because their records provide information that satisfies the criteria of a listing in the Social Security list of impairments, otherwise known as the blue book.
In the event of a reconsideration denial
As stated, the majority of reconsiderations are denied. For those who receive a notice of denial at this level, the appropriate course of action will be file the second appeal, a request for a disability hearing.
At the hearing level, claimants typically stand a much higher chance of being awarded benefits. This is especially the case when Social Security representation is involved, medical record updates have been provided to the administrative law judge hearing the claim, and a compelling theory of the case has been advanced to the judge.
Reconsideration appeal denial rate: 78.8 percent.
Reconsideration appeal approval rate: 21.2 percent.
Level III: Request for Hearing before an Administrative Law Judge - The disability hearing is the second Social Security appeal available to claimants and may be requested only after a reconsideration appeal has been denied.
Like all appeals, the hearing must be requested within 60 days of the date of the prior denial, but, ideally, should be requested immediately after receiving notification of the denial of the reconsideration appeal to avoid unnecessary case processing delays, as well as the possibility of a missed appeal deadline.
How long will it take to get a disability hearing?
Scheduling a hearing usually takes a number of months. How long it will take will depend on backlogs that exist for a particular state and hearing office. From the time a hearing is requested until the time it is scheduled, however, it may generally take between three and twelve months.
How is the hearing actually requested?
As with the prior appeal, the reconsideration, a claimant may contact the Social Security and ask that appeal forms be mailed out. Once again, there will be a 60 day deadline period in which to submit the appeal. If the claimant has a disability attorney or disability representative, this person will submit the appeal. They will also typically keep one copy of the appeal for their file records and mail one copy to the claimant for their personal records.
Getting the status of the hearing appeal
After the hearing request has been sent in (or filed electronically), the representative should contact Social Security at some point to get the status of the hearing request. In all candor, nothing will be happening with regard to a hearing for a number of months. But, initially, it is useful to call simply to verify that the appeal was received by SSA so that the claimant can be sure the appeal will be transferred to the hearing office. Also, it may be helpful after 90 days or so to call the hearing office to check the status of the case once more. In most cases, though, the only information that will be available is that the case has not been assigned to a judge yet.
The Social Security hearing office and the judge
The hearing office is called ODAR, or the office of disability adjudication and review. At ODAR, the case will eventually be assigned to an ALJ, or administrative law judge. The judge will use a similar decision-making process as the disability examiner.
That is, the judge will review the medical evidence to determine whether or not the claimant can be approved on the basis of a disability listing and, if not, if the claimant can be approved on the basis of a medical vocational allowance, a decision that is made when it is determined that the claimant cannot go back to their past work, or do any other type of work.
There are, it should be noted, major differences in how judges and examiners make decisions on disability claims.
First of all, the judge is independent and does not answer to a supervisor or to quality control. This by itself probably accounts for why judges give out substantially more awards of disability benefits versus examiners.
Secondly, judges interact with claimants and their disability lawyers, while examiners never meet the people who are the subject of each case.
Thirdly, judges review the entire file, i.e. what has happened before. This includes all previously gathered evidence as well as new medical evidence submitted by the claimant and their representative. This essentially makes the judge a reviewer for mistakes that may have been made in the decision process at the initial levels of the claim system.
Fourth, and perhaps most importantly, a judge will respect the opinion of a claimant's own doctor, or treating physician, as long as the opinion A) explains in proper detail how the claimant is functionally limited and unable to work and B) the statement provided by the physician is in sync with the information provided in the doctor's own medical records, i.e. the doctor's statement that the claimant is disabled will not be taken seriously if the same doctor's medical records indicate that the claimant is not significantly impaired.
Will I be be able to win my disability hearing?
Stastistically, far more claims are approved at the hearing level than the application or reconsideration appeal level. Slightly less than half of all unrepresented claimants win their benefits at a hearing, while approximately 60 percent of claimants who have a lawyer or representative win their disability benefits.
Why does disability representation increase the chances of winning at a hearing?
A disability lawyer or non-attorney representative will be familiar with Social Security laws, rulings, and regulations. They know what medical vocational rules (the grid rules) direct certain outcomes) and they know what specific information contained within medical record documentation will be important for proving that the case meets the Social Security definition of disability. Furthermore, a representative will know how to present a logical rationale for approval, and how to interact with any expert medical and/or vocational witnesses that the judge may choose to have appear at the hearing.
Disability Hearing denial rate: 46.6 percent
Disability Hearing approval rate: 50.4 percent
Note: While the individual hearing offices in Massachsuetts currently have an average disability award rate of slightly more than fifty percent, this is a bit lower than the disability award rate for SSA region 1. Additionally, two of the three hearing offices in Massachusetts have rates of approval that are lower than the average rate of approval for the state in general, as well as being lower than the national average.
The Boston MA hearing office has a disability award rate of 49.5 percent; the Lawrence MA hearing office has a disability award rate of 56.1 percent; the Springfield MA hearing office has a disability award rate of 47.3 percent.
Return to: Social Security Disability Resource Center, or read answers to Questions
Individual Questions and Answers
Will I Qualify For Disability Benefits in Massachusetts?
Hiring a Disability Lawyer in Massachusetts
Filing for disability by state of residence
Disability Lawyers by state