Answers to winning a disability case in NC| Social Security Disability Resource Center

Proving the requirements for disability in North Carolina

Note: The SSDI, SSI disability system is federal and nationally standardized, though there are state differences in approval rates, wait times, the number of appeals available–as of the time of this writing–and even the name given to the stage disability agency (DDS, or the Bureau or Division of Disability Determination). Now, to answer the question…

Continued from: What are the disability qualifications in North Carolina?

The inevitable question, of course, is how do you prove that your functional limitations are great enough that you cannot perform work activity.

At the first two levels of the system, application and reconsideration appeal, claimants are not really given much of a chance to prove anything. The decision is made by a disability examiner and then sent to the claimant after it has been made. All in all, the process is fairly one-decided.

Having said this, when claimants have representation at the application or reconsideration stage, there may be an opportunity to analyze the evidence of the case and find that it is well supported for an approval. This will usually involve a disability representative contacting the disability examiner to provide either additional medical evidence, or an interpretation of the evidence that argues for approval.

And at the hearing level, of course, this is exactly the role of the disability representative, but even more so. When a case gets to the hearing level, where the decision will be made by federal judge, the Social Security Administration no longer gathers medical evidence for the case. Responsibility for obtaining medical record updates then falls completely to the claimant, or their representative.

This is important to note because, by the time a case gets to the hearing level, usually at least a year will have taken place between the time of the last denial and the hearing. This means that the records in the case file will be old, and from the standpoint of attempting to win benefits, will be relatively useless. Under Social Security guidelines, for a person to be approved for continuing monthly disability benefits, they must present at least some evidence that is not older than 90 days.

In addition to presenting recent evidence, however, there must be a presentation of evidence that explicitly makes clear that the claimant’s functional limitations are great enough that they cannot be expected to return to work activity. As we have previously stated, most medical records fail to indicate specific functional limitations and are of limited value in proving the requirements for disability are met.

This is why a disability representative will typically attempt to obtain a medical source statement from one of the claimant’s physicians. On this, the physician will be asked to indicate in specific ways how the claimant is limited. This will allow the decision-maker, the judge, to determine if the physician effectively supports the case.

Does the opinion of the claimants treating physician really matter? At a disability hearing, the opinion of a medical doctor who has a history of providing treatment to the claimant can actually be classified as “controlling weight “evidence. This basically means that the doctor’s opinion can decide the outcome of the case, as long as the doctor’s opinion is not contradicted by the doctor’s own medical records.

Unfortunately, at the first two levels of the system, a statement from a doctor, even when it is objective and highly detailed, will often be ignored by disability examiner.

At NC DDS (North Carolina disability determination services), this is, sadly, often the case. Why? Because disability determination services in North Carolina has a built-in “culture of denial”, and they do not necessarily follow the Social Security guidelines to the absolute letter.

Judges, though, at the various hearing offices in North Carolina tend to give full consideration to the opinions of treating physicians, as is prescribed by Social Security regulations.

At a hearing, a disability representative will typically present compelling medical evidence that usually includes a medical source statement from one of the claimant’s own doctors.

However, they will also present a case that is supported by the appropriate regulations and rules of the system, all of which is necessary to prove the case and win the claimant their benefits.

Contact Tim Moore and Mac Travis in North Carolina for help with your SSD or SSI claim. Complete the form or call 919-278-7874. After submitting, scroll to the bottom to see the confirmation.
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