Social Security Disability Issues and Representation

People who file for Social Security Disability or SSI benefits and have been turned down by their state disability determination services (DDS) agency (disability examiners at DDS make the actual decisions for the social security administration) should obtain legal disability representation as soon as possible. Why? Because, if your initial claim is turned down, your appeal (this first appeal is called request for reconsideration) is likely to be unsuccessful as well. Unfortunately, reconsideration appeals are also decided by DDS, and a staggering 81% of them are denied.

If your request for reconsideration is denied, your smartest move is definitely not to give up, but to file a second appeal to have your case heard before a federal administrative law judge (ALJ). Studies have shown that ALJs are much more likely to approve disability claims than disability examiners, especially when claimants have legal representation. In fact, some statistics show that claimants who have legal representation are about twice as likely to win benefits as those who choose to represent themselves.

Why would any claimant choose to represent themselves before a federal judge? Perhaps because many do not want to pay for legal services, but this is not a valid reason to put the outcome of your disability claim in jeopardy. In disability cases, lawyers are paid only if they win the case, and there is no upfront money involved. Also, the fee that disability lawyers can charge is capped at 21% of the claimant's total backpay, up to a maximum of $6000. This is far less than attorney fees for other types of cases.

Other individuals who represent themselves may think that their appearance will be a simple matter of going before the judge and telling their story. However, disability hearings require far more proof than a verbal recitation of your medical condition and symptoms. In order to persuade an ALJ, you must disprove the disability examiner's claim that you are able to do your past job or other work by arguing that your skills, age, education, or other limitations prevent you from doing so.

This requires a firm grasp of the Medical Vocational Grid. A good disability attorney will review everything in your medical records and work history to find evidence that the disability examiner erred in his or her decision, and help persuade a judge that in actuality you do not fall anywhere on that grid. Most claimants have no idea what is in their disability file or the precise reasoning behind their denial, and even if they read over the information they will not have the legal background necessary to form a sound legal argument based on what they learn.

A disability attorney can also review your files to see if there are any additional medical tests or statements that could strengthen your case, or that could help you meet a blue book listing (the book of impairments that SSA uses to classify disabilities). If it is a child that is under consideration, there may be certain psychological reports or tests, even statements from teachers, needed to refute a denial. The average claimant may not even be aware of these options or know how to obtain them.

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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