In some states, a person who has been denied for disability on their initial claim may immediately request a disability hearing.
In North Carolina, though, a person must go through a separate “request for reconsideration” appeal before asking for a hearing appeal.
The reconsideration appeal process is basically the same process used on the disability application. At both these levels, the person filing for disability is not really involved in the process very much, other than giving answers to questions and supplying certain information when asked for.
In stark contrast to this, the claimant and their disability representative will do the following to prepare for a disability hearing in North Carolina:
A. Gather the proper medical evidence.
At this level, SSA no longer gathers medical records for you; in other words building the case is left completely up to you and your representative, and if you do not perform this function by the time you show up at a hearing the only records in your file will be many months out of date.
B. Review the file for the case that has been developed by Social Security.
This includes looking at all prior decisions on the case, any communications that took place between the claimant and the disability examiner, the information regarding the claimant’s work history and medical treatment history (which can give some idea as to whether or not any medical treatment sources were not addressed; in other words, whether or not the disability examiner failed to obtain records from one of those sources), and the classification of the claimant’s past jobs (did the disability examiner assume that the claimant had more work skills than they really had?)
C. Attempt to obtain a statement from a treating physician.
The treating physician is a medical doctor who has an established history of providing treatment to a claimant.
In the eyes of the Social Security Administration, the treating physician is qualified to rate the claimant’s functional limitations; in other words, to indicate all the various ways that the individual is affected and limited by their condition, or conditions.
Examples of this would include the following: how much weight the individual is capable of lifting, how long the individual can sit, stand, or walk, etc.
A statement from a treating physician may have little effect at the first two levels of the system. This is because disability examiners in NC are not completely independent in their decision-making. They must answer to unit supervisors who are often pressured to keep the number of approvals down.
At disability hearings, though, judges follow Social Security administration regulations concerning how the opinion of a qualified treating physician must be evaluated. And if the opinion of the person’s treating physician is considered valid, and not inconsistent with the rest of the medical evidence, that opinion can determine the outcome of the case.
In other words, a statement from a doctor can easily help win the disability case at a hearing. And this is why so many disability representatives work very hard to obtain detailed, concrete statements from doctors on special forms that have been created for this specific purpose.
D. Submit all evidence that has been obtained to the judge who is assigned to hear the case.
Note: In some cases, a judge, prior to the hearing, may decide that the evidence is so strong that there is no need for an actual hearing to be held. In such cases, the judge may decide to issue what is known as an on-the-record decision.
In other cases, the judge may conclude at the start of the hearing, that there is no need to go through the full length of the hearing–in other words, the judge has already made up his or her mind–and will issue what is known as a “bench decision”.
E. Your disability representative will formulate what is known as a “case theory”. What is this? This is simply the reason as to why you should be given a Social Security Disability award, or SSI disability award.
It may be that the old evidence, combined with the new evidence obtained by the representative, points to an approval being made on the basis of the listing (if you meet or equal a disability listing, this means you have a condition contained in the Social Security bluebook, and your medical evidence satisfies the very specific criteria of that listing).
Or it may be that a thorough evaluation of your medical evidence indicates that you have enough restrictions in your mental or physical functional capacity to the extent that it eliminates your ability to go back to any of your past jobs performed within the last 15 years, as well as eliminating your ability to take your combination of education and job skills and transfer them to some type of other work.
If your disability representative takes this approach, they will be attempting to win for you what is known as a “medical-vocational allowance” approval.
These approvals are won by finding which rule, among the various grid framework rules, that applies to you and directs a decision of “disabled ” — based on your age, your education, the skill level rating of your job skills (for example, unskilled, semi-skilled, skilled), and the limitations that have been assessed for you.