What does Social Security Disability Representation Provide?

The chief goal of Social Security Disability and SSI representation is to maximize a claimant's chances of winning benefits and also maximize how much they may receive in past due benefits, or back pay. Ordinarily, this is achieved by having one's representative (who may be a disability lawyer or a non attorney disability representative) handle the following:

1. The preparation of a disability case for a social security hearing.

2. The presentation of a disability case for being heard by a federal administrative law judge, or ALJ, at a disability hearing.

Both aspects of getting ready for a disability hearing are equally important. Preparation includes analyzing what happened previously on a case (i.e. the decisions that were made by disability examiners at the disability application and reconsideration appeal levels) and obtaining further medical documentation that substantiate an onset date that provides for A) the establishment of monthly disability benefits and B) the payment of past due benefits, or disability back pay.

Medical documentation, of course, will include various types of medical evidence, such as the office notes of a claimant's regular physician or physicians, reports of blood work and imaging studies (xrays, MRIs, CT scans), and admission and discharge summaries from hospitals, as well as any documentation that might involve therapy, counseling, or specialized testing (such as spirometry, a.k.a. a breathing test).

This is the same type of information that is gathered by the social security administration prior to the hearing level. However, by the time a hearing takes place, SSA will no longer do any this type of evidence gathering and the responsibility for doing this will fall solely to the claimant or their disability attorney.

How important is it to obtain updated medical information and submit this to the judge who is deciding a case? It is crucial to the outcome since only new information will advise the administrative law judge of any changes in the claimant's condition, recent testing that has been performed, or any changes in medical providers, such as doctors and hospitals where treatment is being received.

More imporantly, though, the social security administration cannot qualify a person for disability benefits unless they can provide at least some medical records that are not older than 90 days.

The reason for this is that, to determine that a person is disabled and eligible to receive disability benefits, the social security administration must show that they are currently disabled, as in the present moment. Older medical records are very important as well since they will establish how far back a person has been disabled according to social security guidelines and this will directly impact how much they can receive in social security back pay.

However, an approval cannot be made on a Social Security Disability or SSI case unless the records show that the individual is currently disabled.

Unfortunately, most claimants who appear at a disability hearing without representation will be unaware of the importance of providing recent documentation. They will likewise be unaware of how far back their medical evidence should be obtained to support the most favorable onset date (which, as was stated, will provide for the maximum in back pay). By contrast, one of the chief goals of a disability representative, an attorney or otherwise, will be to obtain records that support these objectives.

Additionally, it should be noted that medical evidence is not simply limited to medical records. It also includes opinions that are obtained from doctors who can be classified as treating physicians. While doctor's opinions are sometimes obtained by unrepresented claimants, very often they are little more than short handwritten or typed statements in which the doctor states that their patient is disabled and unable to work. Because Social Security Disability and SSI decisions are based on the functional limitations that resulted from a person's medical (or mental) conditions, such brief statements do little to help a case, if they do anything at all.

Disability representatives, on the other hand, will typically attempt to obtain a completed medical source statement (i.e. a residual functional capacity form) from a claimant's doctor or doctors and with the level of detail involved in such statements, a case that might otherwise have been lost can often be won at the hearing level.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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