There is no maximum that you can receive in disability backpay from the Social Security…
How to apply for Disability in NC
This page is based on my years of experience as a disability examiner working on Social Security Disability and SSI claims. It provides a complete guide on how to successfully apply for disability in North Carolina, how claims are worked on, and what information you will need to provide to Social Security.
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 – The majority of disability claims filed in North Carolina will be denied at the disability application level. Typically, in any given year less than a third of all disability claims are approved.
For the remaining seventy percent of claimants who have been denied, it will be necessary to file appeals before receiving a Social Security Disability Award or SSI disability award.
Filing a disability claim in NC
Applying for disability benefits in North Carolina is a two-part process. Ideally, it begins with filing an application at a local Social Security office and not using the SSA toll free line or the online filing process. I would recommend against those last options because they typically cause problems.
For those who have difficulty in physically going to a Social Security office, there is the option of having the disability interview conducted over the phone. And, in actuality, this is what our office typically advises. Calling Social Security and having them set an appointment to call you back and conduct your entire disability interview on the phone will make the process less stressful, save you a trip to the Social Security office, and allow you to prepare for the interview in the comfort of your home.
When Social Security sets the appointment day and time for the interview, they will often text this information to you in addition to calling you to notify you of the appointment.
After the inteview is completed, the SSA claims representative will mail the necessary documents to you to sign and return.
Who interviews you for your disability application?
The person at the Social Security field office who conducts the interview is a CR, or claims representative. The CR is the person who does the intake portion of the claim. The CR is responsible for ensuring that the claim is complete and that all the information necessary for processing the claim (such as the medical history and the work history) has been obtained. However, the CR is not the person who actually works on your claim and makes the decision.
What information do I need to give Social Security to decide my claim?
To process the claim, Social Security will need to contact medical treatment providers–hospital, doctors, clinics–and gather medical evidence. Additionally, SSA will need to identify the skills and requirements of the types of work that the claimant has done in the past.
Note: Many individuals filing for disability will find it useful to write down their medical history and work history information prior to the appointment for the disability interview. This will allow for greater detail and accuracy, which can have an impact on the outcome of the claim.
With regard to the medical treatment history, the claimant should supply the names and addresses of all hospitals, clinics, and doctor’s offices. The names of treating physician’s should also be included.
Providing this information will reduce the likelihood that the disability examiner who processes the case will have difficulty obtaining records that are needed to A) establish that the individual is disabled and B) prove the earliest onset date possible, which will allow for the greatest amount of disability back pay benefits.
With regard to the vocational work history, the claimant should provide a detailed listing of all jobs performed in the last 15 years, which SSA terms the relevant work period. It will be important to include dates worked for each job, as well as job titles and descriptions of the work peformed for each job.
This information will be used to assess the demands of the claimant’s past work and the skills they possess as a result of their accumulated work history. The accuracy of this information is essential since claims are denied when the determination is made that a claimant possesses the ability to return to the workforce, either in the performance of their past work, or in the performance of some new type of work.
Who makes the decision on the disability claim?
After the intake portion of the claim is completed at a Social Security office in North Carolina, the second part of the application process begins.
It is at this point, the claim will be transferred to North Carolina Disability Determination Services where it will be assigned to a disability examiner. The examiner typically begins working on the claim by immediately sending out requests for medical records.
The medical records usually take quite some time to arrive. The wait for medical records ordinarily constitutes the longest part of the time required to process a decision on a case.
Note: claimants have the option of obtaining their own medical records and submitting them at the time of filing for disability. To be useful, however, the claimant should obtain records that go back at least as far the alleged onset date for the person’s disability. Additionally, at least some of the records should be recent, meaning not older than 90 days.
Social Security Medical Exams
In cases where there are no recent medical records to review, the examiner may be required to send the claimant to a consulative medical examination, or CE.
The consultative exam may be physical (such as a neurological exam or xray imaging) or mental (such as IQ testing, memory testing, or a mental status exam). The purpose of a CE is not to provide treatment, but, rather, to obtain recent medical evidence when it cannot be obtained from the claimant’s treatment sources. This allows the examiner to render a determination and issue a decision on the disability claim.
There are two ways of being approved for disability
The decision on the SSD or SSI disability claim will be made in one of two separate ways. First, a case may be approved on the basis of a listing (in the Social Security list of impairments). To meet or equal the requirements of a listing, a claimant must have a condition that is contained in the impairment listing manual and their medical records must contain information that satisfies the approval criteria for the listing.
Satisfying a listing is fairly difficult since the criteria is very specific. Not surprisingly, most approved claims are not approved on the basis of a listing. Typically, when a case is approved, it is through the five step sequential evaluation process and the decision is made in the form of a medical vocational allowance.
How most disability claims in NC are approved
A medical vocational allowance is granted when it is determined that a claimant has a medically determinable (meaning substantiated by medical evidence and the opinion of a licensed physician) impairment that lasts one full year and is severe enough to prevent an individual from engaging in work activity that earns SGA, or a substantial and gainful income.
When the determination is made that a claimant cannot return to their past work, or switch to some type of other work, based on their skills, education, age, and current functional capacity, they will meet the medical qualifications for disability. Assuming that they further meet the non-medical qualifications of the program under which their claim is filed, they will be approved to receive disability benefits.
Disability application denial rate: 75.5 percent.
Disability application approval rate: 24.5 percent.
- Filing a Social Security Disability Application – How to File
and the Information needed by SSA
- What Happens when you file a disability application?
- What happens after you file a disability claim?
Level II: Request for Reconsideration – A claimant who has denied on a disability application in North Carolina should immediately file a request for reconsideration.
Reconsideration is the first phase in the Social Security appeal system. How is the reconsideration process different from the initial claim process? In actuality, there are very few differences. At both levels, the claim decision is made by a a disability examiner using the same process of determination (i.e. does the claimant meet a listing and, if not, are their limitations severe enough to rule out a return to work activity).
The qualifications for disability are the same. However, there are differences worth noting:
1) Reconsideration appeals generally take less time. This is because most of the needed documentation–medical and vocational–has already been gathered at the application level. For this reason, reconsideration decisions are often received within 4-6 weeks and seldom take as long as 6 months or longer, which is quite common with initial claims.
2) Reconsiderations have a much higher rate of denial than applications for disability. This is because the reconsideration level examiner will have no reason to effectively overturn the decision of the first examiner unless new and convincing medical information is introduced, or some substantial fault was found in the initial claim decision.
Requesting a reconsideration appeal
Reconsiderations must be requested within 60 days of the date of denial of the disability application. This date is usually stamped in the upper right hand corner of the denial letter.
The appeal is requested by contacting the Social Security office where the claim was first filed. After the appeal is requested, SSA will send the appropriate forms to the claimant. Once these have been completed, signed, and returned to Social Security, the case will, once again, be sent to NC DDS (disability determination services) for a decision.
Note: Before submitting the appeal, claimants should make a copy to keep in the event that the appeal is not received by SSA. Also, within 10-14 days of submitting the appeal, a claimant should make a followup status call to be sure the appeal was, in fact, received so that a situation involving a late appeal will not arise.
As stated, most reconsideration appeals are denied. At the second appeal, however, the disability hearing level, the chances of winning and being approved for disability benefits tend to lean in the claimant’s favor.
Most individuals in North Carolina who pursue their case to the hearing level and who present a case supported by strong evidence (medical records and supporting physician statements–most disability representatives will attempt to obtain one or more such statements prior to the hearing) will meet the SSD or SSI requirements and qualify for disability benefits.
Reconsideration appeal denial rate: 90.7 percent.
Reconsideration appeal approval rate: 9.3 percent.
- The Disability reconsideration Appeal – what is it and how do you file for it?
- What happens if a reconsideration for Social Security Disability or SSI is denied?
- Tips for getting disability approved when you File
- Should you get a doctor statement for your Disability Case?
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.
A 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.
Basic facts about disability hearings
1. Where will my disability hearing be held? – When circumstances warrant (such as the traditional hearing site for an area being too far from where the claimant lives, or the claimant having physical mobility issues), a hearing may be conducted at a satellite location closer to where a claimant actually lives, or even via video at a satellite location, e.g. at the office of the claimant’s own disability attorney.
However, under usual circumstances, the disability hearing will be held at the hearing office, known as ODAR, or the office of disability adjudication and review. Very often, there are several hearing office locations within a particular state to accomodate the size of that state’s population and to make access to a hearing location reasonable.
2. Who makes the decision at a disability hearing? – At the first two levels of the disability system, the decision on a Social Security Disability claim or SSI disability claim will be made by a disability examiner.
Examiners are normally the equivalent of medical claims adjusters, the difference being that they review the merits of a disability claim in the context of the Social Security Administration’s disability requirements, qualifications, rules, and rulings (there are higher court rulings that influence procedural and adjudicatory standards for disability claims, though these come into play more at the hearing level).
Examiners operate in a closed system that also involves unit supervisors who may override their decisions, medical doctors and psychologists who provide consultative input for their decisions (and often, effectively, really make the decision on the case), and quality control units, both internal (meaning part of the disability determination services agency that the examiner is based at) and external (meaning the DQB, or disability quality branch, that serves to review decisions on disability claims).
This in total makes it very arguable as to whether a disability examiner actually renders a decision on a case at all. After all, their decisions may be revised, guided according to whatever subjective standards are set in place by their immediate supervisors, and even reversed.
Social Security Disability judges, on the other hand, are entirely autonomous. They may, at their own discretion, ask a medical expert or a vocational expert to appear at a hearing to provide expert testimony when they feel there are issues involved in a disability claim that require further investigation or development. But judges make their own decisions.
This is perhaps one of the reasons why there are significant differences in approval and denial rates at the disability hearing level versus the earlier levels of the system. The unit supervisors at DDS expert a very strong influence on how decisions are made by the examiners working in their case processing units, and typically this influence works to hold down the number of approvals that are made.
Judges, by contrast, effectively answer to no one and, therefore, are free to make decisions on claims as they see fit.
3. Is it harder to win disability benefits from a judge at a hearing? – Statistically speaking, ALJs award a higher percentage of the cases they decide than do disability examiners who deliver decisions at the disability application and reconsideration appeal levels. This is because, as stated, administrative law judges function independently and autonomously.
Also, there is the fact that most claimants at hearings have representation: because representatives, including disability attorneys and non-attorney disability representatives, are not paid a fee for handling a disability case unless the case is won (which provides an extremely strong incentive for the representative to properly prepare the case for a hearing), cases that are brought before judges tend to have the necessary medical record documentation and often include strong supporting statements from a claimant’s doctor, or treating physician as SSA refers to this individual.
This is in addition to the representative providing a logical rationale for the approval of the claim, in the context of Social Security rules, such as the grid rules that direct decisions on claims that are not eligible for approval on the basis of a disability listing.
All this said, sometimes it can be very difficult to win benefits at a hearing. Sometimes this may be due to the fact that the claimant has not provided a case that has sufficient or recent medical record documentation. In many instances, it may be due to the fact that the judge in question has a history of making fewer allowances.
In either case, the principal thing to remember is that at hearings a claim for disability must be actively proven by the claimant and/or their representative, versus the earlier levels where the claimant will simply file for disability and then wait for a decision letter to arrive.
Disability Hearing denial rate: 44.6 percent
Disability Hearing approval rate: 55.4 percent
- Can a disability attorney speed up my disability hearing?
- Preparing for a Disability Hearing to Win Social Security or SSI Benefits
- How do you Win Benefits under Social Security Disability or SSI or SSI?
Note: Disability hearings generally result in a Social Security Disability or SSI award fifty percent of the time and the odds of winning benefits at a hearing rise when a claimant is represented. The disability award rate quoted above is a state-wide average for North Carolina. Actual rates of approval are as low as 50.1 percent and as high as 63.9 percent. This, of course, underscores the importance of proper preparation for a hearing since, on average, more than forty percent of hearings are denied in NC.
The Charlotte NC hearing office has a disability award rate of 61.6 percent; the Fayetteville NC hearing office has a disability award rate of 49.3 percent; the Greensboro NC hearing office has a disability award rate of 63.9 percent; the Raleigh NC hearing office has a disability award rate of 50.1 percent.