Criteria for how Social Security Disability is Awarded

Many individuals who apply for Social Security Disability (SSD) or supplemental security income (SSI) are turned down for benefits. In fact, statistics show that about 70 percent of all initial claims for disability are denied, and those that are denied are no more likely to be approved if they file a new application unless they have significant new medical evidence to add to their file, or if their initial claim was denied on a technicality; e.g., they earned too much income, the total value of their personal assets was too great when they filed the first time, etc.

However, there is a way that individuals who are turned down for disability can improve their chances of being awarded SSD the next time around, and that is to take advantage of the disability appeals process.

If your initial claim is denied, you should immediately file a request for reconsideration with DDS (the Disability Determination Services agency that makes all disability decisions for the social security administration). This first appeal is highly likely to be denied as well (about 80 percent of them are), but it is worth the effort because after a reconsideration appeal, a claimant can request a hearing before an administrative law judge (ALJ).

For those who have been denied disability by DDS, this hearing is the best chance they have of receiving a favorable decision. The House Subcommittee on Social Security has reported that over 60 percent of all cases heard by ALJs result in the disability examiner's denial being overturned, and the claimant being approved for benefits.

All disability adjudicators (DDS examiners and judges) decide disability cases based on three basic criteria: 1) the claimant can demonstrate, through medical documentation, that they have a physical or mental impairment; 2) that medical symptoms associated with their condition are severe enough to prevent them from participating in substantial gainful activity; and 3) that their medical condition is ongoing, and has lasted or is expected to last for at least 12 months.

It is impossible to prove any of the three criteria without solid medical evidence, so claimants should take care to supply the social security administration with a detailed medical history that includes names, addresses, and contact numbers for all medical facilities and physicians from which they have received treatment. Without this information, the DDS disability examiner will have difficulty requesting medical records from your physician (s), and this can significantly delay a decision in your case.

After receiving the medical records, the examiner will review them and form an opinion about the claimant's residual functional capacity (RFC), or what activities the claimant is capable of performing given their current medical condition.

The examiner will then go over the work history that the claimant supplied to social security to see if it is possible to perform a past job or any other type of work to which the claimant may be suited, taking into account their age, education, skill set, etc. For this reason it is critical that those applying for disability provide a work history that is every bit as detailed as their medical history. This should include all places and dates of employment, and all positions/titles held (as well as the job duties associated with those positions) for the past 15 years.

By filing detailed medical and work histories and taking full advantage of the appeals process, disability claimants can greatly improve their chances of, eventually, being awarded Social Security Disability.

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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