How do you Win Benefits under Social Security Disability or SSI?
Many who apply for SSD or SSI benefits are positive that they will be denied the first time they file for disability. (Steps for Filing a disability application).
However, that's not always the case. Depending on the state in which you live, the approval and denial statistics may vary somewhat. But on a national average basis, a third of claimants will get approved on their application and win disability benefits, and less than 15 percent of claimants will get approved on their reconsideration appeal.
At the disability hearing level, roughly half of all cases will be approved, which is a great improvement over the first two levels. Breaking the hearing approval statistic down further, past statistics have indicated that approximately 40 percent of unrepresented claimants at hearings are approved, while a bit more than 60 percent of claimants with representation at a hearing will be awarded benefits.
Which cases initially win?
In a percentage of cases, individuals who win their disability claim the first time that they file have impairments that are either terminal, or meet or equal the approval criteria of an impairment listing in the blue book, a.k.a. the Social Security Disability list of impairments.
The blue book is essentially a directory of a limited number of medical conditions, both physical and mental, for which SSA has provided specific approval criteria. Satisfying the criteria for one of these conditions is fairly difficult because, to do so, it requires that very specific information be contained in your record of medical treatment. Most claimants who are approved will not be approved via the listing book.
Other individuals--the majority--who are initially approved (note: when we say 'initially', we mean at the disability application level) will have medical evidence which sufficiently establishes the existence of physical limitations and/or mental limitations that rule out the ability of the individual to go back to A) past work as well as B) perform some type of other work.
This means that the individual will have received what SSA refers to as a medical vocational allowance, meaning that the claimant is awarded disability benefits on the basis of a medical vocational rule on what is referred to as "the grid" (a system of rules that takes into your age, education, work skills, and level of functional capacity, or capability).
How does social security make this type of determination, i.e. whether or not a person can perform work activity? By reviewing a claimant's work and medical records to determine what they are currently capable, and incapable, of doing.
For more on this topic, see How does Social Security determine if a person can still work?
This evaluation of the medical history will allow a disability examiner, or a judge if the case is at the hearing level, to give a claimant an RFC, or residual functional capacity, rating which will be measured against the following:
If an individual does not win their benefits at the disability claim level, they must make a decision as to whether or not they plan to pursue their Social Security Disability or SSI benefit claim by filing the first appeal, the request for reconsideration. This is when it becomes important to consider what is needed to win the disability benefits claim.
Factors involved in Winning SSDI or SSI Claims
Many factors affect your ability to win disability benefits. A key factor to the success of any disability case is information. If you want to win your disability benefits, you should provide detailed information about your education, medical treatment, medications, and testing.
As a practical matter, before even filing, you should write down the name, address, and phone number for each of your medical treatment sources (and retain this list for future reference, such as for the filing of appeals). Additionally, try to write down your treatment dates with each source, the medication each prescribed, and the testing they performed.
Note: Do not assume that the social security administration can accurately retrieve your medical history without you listing all of your treatment sources. Also, do not assume that you should not provide older sources of treatment since these may be essential to establishing how far back your disability exists, which can have a substantial effect on how much back pay you may be owed when your claim is won.
Don't forgot to list all doctors, hospitals, and clinics
Through my experience as a disability examiner, I routinely received phone calls about medical treatment sources that disability applicants forgot to provide when they first filed but later recalled. Sometimes the disability applicant provided the information timely and sometimes they did not, meaning a disability decision had already been made.
Obviously, it would have been better for the case if those treatment sources had been disclosed earlier so medical records could have been obtained from them. Regarding missed records, there was always the possibility that a disability decision could have been different had an important piece of medical information had been in the file when the decision was made.
Getting a letter from your doctor
In addition to good information about medical sources and their treatment, it would be very helpful if your treating physician gave his or her professional opinion as to the functional limitations your condition or conditions cause. A thorough physician's statement can very well help you win benefits under SSDI or SSI (a treating physician is a doctor who has an established history of providing you treatment and is, therefore, qualified to comment as to your condition).
A treating physician's statement contains information about your diagnosis, response to treatment, and prognosis, along with objective medical testing information (i.e. imaging, blood work, biopsy, etc.). And it provides a disability examiner or an administrative law judge with a way to rate your current and projected physical or mental limitations. In other words, it will help to determine whether or not you are capable of work activity.
Social Security Disability, SSI, and your Work History
Involved in a Social Security Disability determination is an assessment of the work (the individual jobs) you have performed in the last fifteen years. You can improve your chances of winning by providing a good description of the jobs as you performed them when the disability examiner sends a work report for you to complete.
Disability examiners use job descriptions from the DOT (Dictionary Of occupational Titles) to determine how the job is performed in the general economy. The DOT description describes the exertional requirements (i.e. lifting, standing, walking, bending, stooping, climbing, etc.) and mental requirements (i.e. concentration, educational, etc.) of each relevant job you list.
What does SSA mean by 'relevant'? Not every job that you've ever worked will be considered as a job that you could return to. A relevant job for the purposes of a SSDI or SSI claim is any job at which you earned substantial work earnings, performed the job for three months or more, and in which you had time to learn the functions of the job.
Properly describing your past work
While disability examiners use the DOT description to come up with an official job title, they still have to consider the job as you performed it when they make the disability determination. This is why your description of what you did on the job is so important.
The job descriptions that you provide could set the stage for a denial of your claim. They could also allow the disability examiner to determine that you are unable to do any of your past work. And this would enable the disability examiner to move one step close to a finding of disability.
Will Social Security say you can do other work?
The last element of the Social Security five step sequential disability process is an evaluation of your ability to perform other types of work. It is at this point that your physician's statement as to your functional limitations can be very helpful.
The fifth step of 'other work evaluation' requires the disability examiner to consider your age (see Age, Social Security Disability, and SSI), functional limitations, education, and job skill transferability. If the examiner is able to determine that you are unable to do any other kind of work, you may win disability benefits from Social Security. Always keep in mind, of course, that your potential qualifications for other work will be substantially influenced by the work you have done in the past (acquired job skills). Again, this highlights the importance of supplying detailed and accurate information about your prior work.
If your disability claim has to be appealed to an administrative law judge, meaning that your claim has been denied at the disability application level, and again at the request for reconsideration level, you should consider disability representation via a Social Security Disability attorney or non-attorney disability representative.
Winning at a disability hearing
Disability hearings are like any other kind of hearing in the sense that having a representative usually improves your chance of winning your case. While disability hearings are held in somewhat less formal surroundings they still involve a hearing room, the presentation of your case, and a judge. National disability hearing win-loss statistics show that disability applicants with representation are about twenty to twenty-five percent more likely to win disability benefits on SSDI and SSI claims than those who are not represented.
As we stated, a percentage of cases will be approved initially, meaning that those claimants will receive their benefits fairly quickly and will not have to file lengthy appeals or submit additional evidence and statements from their treating physicians. But, for the majority of applicants, this will not be the case. And, in such cases, the two primary determinants for winning disability benefits are:
1) Perseverance ' Not giving up on the case and continuing to pursue the claim through the appeals process.
2) Thorough Case Preparation ' Supplying the social security administration with the information that establishes the physical and/or mental limitations that rule out the claimant's ability to work and earn a substantial and gainful income, thus making them disabled according to the disability determination rules and guidelines used by SSA.
PART II - How to prove you are disabled and win disability benefits
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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