Can you be approved for disability without having to go to a hearing?

You can be approved for disability without having to go to a hearing. The disability hearing is the third level of the Social Security Disability process, and while a fairly large percentage of disability applicants must go to a hearing to be approved for disability, it is certainly not the rule. In fact, approximately thirty percent of claimants who file for disability will be approved on their initial claim and will never see a hearing office or an administrative law judge.

The flip side of this, of course, is that most claimants will need to go to a hearing, and will increase the chances of winning with good disability attorney representation.

The odds of being approved for disability without a hearing

Prior to a disability hearing, a disabled individual may be approved for disability at their initial disability claim or during their reconsideration appeal (the reconsideration is the first appeal). In fact, you have a fairly good chance of being approved for disability benefits prior to a disability hearing.

Though the statistics vary considerably by state, national Social Security approval rates show that approximately that about a third of all disability applicants are approved for disability benefits at their initial disability claim, while another ten to fifteen percent are approved on a reconsideration appeal. Bear in mind, however, that this still means that seventy of claims will be denied at the disability application level and that the odds of being approved on the first Social Security appeal'the request for reconsideration'are fairly low.

Improving the odds of approval when appealing

If you want your disability claim to have a better chance of being approved at your initial disability claim or at your request for reconsideration appeal there are a few things you can do. To improve your chances of approval, you should, if at all possible, have your own medical treatment sources rather than rely on the social security administration to send you to a medical exam (referred to as a consultative exam).

Note: Consultative exams are generally scheduled by a disability examiner when a claimant has not been seen by a doctor for more than three months. The exams are scheduled because SSA actually requires that recent, or current, medical evidence be available in the claimant's file before they can be determined disabled and awarded disability benefits.

Social Security prefers to have a twelve month medical history that contains both past and current (treatment within the past ninety days) medical treatment records to make their medical determinations.

If you can get your treating doctor to complete a statement that includes your diagnosis, prognosis, response to treatment, a description of your limitations and an opinion as to your ability to work, your chance of being approved for disability may dramatically improve. This statement is not equivalent to a short hand-written note from the treating physician and is often referred to as an RFC form or medical source statement.

Social Security guidelines require disability examiners to give heavy weight to the opinions of treating physicians if their opinion is substantiated by objective medical evidence. However, having said this, and speaking as a former disability examiner, I should point out that disability examiners often disregard the opinion of a claimant's treating physician. Which is unfortunate, but often the case.

At a social security hearing, on the other hand, a disability judge, or ALJ (administrative law judge) will be much more likely to take the doctor's qualified opinion into account and let it influence the outcome of the case. This is provided, of course, that the doctor is a 'treating physician', meaning a doctor who has a history of providing treatment to a patient versus a doctor that a patient has only seen once or twice (such as would be the case involving a quick visit to an urgent care).

When your disability file is lacking in information

If the disability examiner does not have enough current information in the file after gathering records from all the treatment sources listed on the disability application, the disability claim may be decided on the basis of a consultative examination.

Consultative examinations are status examinations performed by doctors or medical professionals (psychologists would be included when the CE, or consultative exam, involves mental testing) paid for by Social Security. Generally, these short examinations do not lead to an approval for disability except in disability cases that involve the most severe conditions.

The importance of describing your work history properly

You should also describe your past jobs thoroughly. Through my experience as a Social Security Disability examiner, I found that most disability applicants understate the demands of their employment. Social Security uses a sequential evaluation process based on functional ability rather than specific conditions. In order to be approved for disability you must have a severe impairment (it can be a physical or mental impairment) that prevents you from doing your past work.

This is the reason it is important for you to give a thorough description of your past work as your performed it. If the disability examiner finds that you cannot perform any of your past work they can move to last step of their sequential evaluation process. The last step is an evaluation to determine if you are able to perform other kinds of work with your residual functional capacity (what you are able to do in spite of the limitations of your disabling conditions), education, age, and the transferability of your job skills. If you are found unable to do your past work or any other kind of work, your disability claim may be approved through a medical vocational allowance.

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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