Note: The SSDI, SSI disability system is federal and nationally standardized, though there are state…
by Tim Moore, Disability Representative, former NC Disability Examiner. Free Case Evaluation Form at the bottom or click here.
Disability Representation in North Carolina
If you need help to get your disability claim started, you may wish to get representation in North Carolina. Our office, in particular, will set up an appointment for your local Social Security office to call you and do a telephone application interview. This way, you do not have to go to the Social Security office. You also don’t have to deal with applying through the Social Security website which is not a good way to apply for several reasons.
Have you already been denied?
If you have already been denied on a disability application, in fact, it would be unwise not to get help. This is because the appeal that comes after that, the request for reconsideration, has a very high denial rate (80 percent), which means you will probably have to have a hearing before a judge. And doing that alone is very unwise.
Who can represent me?
Social Security Representation can be provided through an NC disability lawyer or a specialized non-attorney disability representative. Many non-attorney representatives are former Social Security Administration Claims Specialists and Disability Examiners with an extended history of working from within the federal system. The author of SSDRC.com, Tim Moore is a former disability examiner and an ADR, or Accredited Disability Representative, through the National Association of Disability Representatives.
Being represented can significantly help your case
Claimants filing for disability in North Carolina can expect to find an approval rate of between 24-30 percent, meaning that between 70 and 76 percent of claimants will face the likelihood of entering the appeal process. However, individuals who are represented on SSD and SSI disability claims in North Carolina tend to have a higher rate of approval, a need for fewer appeals, and more favorable “dates of onset” (the date the claimant’s disability is proven to have started) that can result in higher amounts of back pay.
What a qualified disability representative will know
A qualified disability representative will have a knowledge of Social Security administrative law, particularly with regard to how claims are approved through the Social Security listings and the medical vocational grid rules.
A qualified and competent disability representative or lawyer will also be skilled in the ability to obtain the most relevant case evidence, analyze it correctly, and incorporate it as part of a winning strategy for a claim.
Simply getting medical records is not enough
It is in this area that unrepresented claimants often place themselves at a disadvantage because, to win a case, it is not sufficient to simply submit medical records, even in great quantity.
The medical evidence must be recent in order to establish that the individual is currently disabled. It must also address the issue of onset, i.e. when the disability began, so that the claimant will be able to obtain the full amount of back pay for which they are eligible.
How disability cases are won
However, most importantly, the evidence must be reviewed and analyzed to determine if the claim can be won either on the basis of:
A) The claimant having a medical condition that is contained within the Social Security list of impairments (most claims are not won this way), or
B) The claimant having enough functional limitations that they cannot be expected to resume work activity, either in doing a past job, or some type of other work based on their skills, age, and education.
This type of approval is known as a medical-vocational allowance and it is through this means that the majority of approved claims are won.
Because the majority of disability claims are not self-evident and must be proven, it is in this area of focus that a winning case is actually “built”. And this is why representation is critical at the disability hearing level, and at the lower levels (disability application and reconsideration appeal) may be crucial as well in many instances.
The experience most NC claimants have after filing for disability
Disability claimants in North Carolina typically experience the Social Security system in this manner: a claim is filed, the claim is denied at the disability application level, a request for reconsideration appeal is filed, that appeal is also denied, and then the second appeal, the request for hearing before an administrative law judge is filed.
In the great majority of cases, if a claim is denied initially, meaning at the application level, then it is almost a sure bet that the claim will be denied on the first appeal, the request for reconsideration. This is because the process does not change at the reconsideration level, other than the fact that a different disability examiner will make the decision on the claim.
What percentage of disability appeals is denied?
In most states, in fact, more than 80 percent of reconsideration appeals are denied. In North Carolina in most years, approximately 86 percent of all reconsiderations are turned down.
Because the chances of being approved on a reconsideration appeal in North Carolina are rather slim, a claimant who has been denied on a disability application should consider finding representation, provided by either a disability attorney or a non-attorney disability representative.
This is for a number of reasons, the most obvious of which is the fact that at the next appeal level, the hearing level, it is completely inadvisable to appear before a judge without the benefit of a representative who is knowledgeable about applicable federal regulations, Social Security court rulings, and the medical-vocational grid rules that direct decisions on the majority of claims.
Going to a disability hearing alone is risky
Going to a disability hearing alone presupposes that a claimant has an indepth understanding of Social Security administrative law and procedure. And this is almost never the case.
However, there are other reasons for being represented on a claim, as well as reasons for being represented prior to the hearing level, and even prior to being denied the first time.
An NC disability representative will ensure that appeal filing deadlines are met, that questions and inquiries brought by up the Social Security office or disability determination services (DDS is where all disability examiners, who make decisions on SSD and SSI claims, are based) are appropriately responded to, and that the status of the case is known at all times.
How a disability representative can best help your case
A disability representative in North Carolina may assist a claimant with completing their initial claim paperwork, ensuring that the information provided is detailed, accurate, and, thus, optimal for the claim. A disability representative may also, in certain instances, be able to engage in case development that results in the claim being won at an earlier level, i.e. without the need for a hearing. When this occurs, a claimant may save many months of valuable case processing time and receive their benefits and back pay considerably sooner.
It is important to remember that this is not always the case, but the real purpose of a disability representative, lawyer or non-attorney, is to shepherd the claimant’s case so that they receive the most favorable outcome possible.