Why does Representation increase the win ratio at a Social Security Disability or SSI Hearing?

Why does representation result in a higher win ratio at a hearing? The answer is fairly simple. Disability hearings are similar to various types of court proceedings in which A) solid case preparation and B) a proper presentation of the relevant arguments and positions--specifically, pertaining to why the individual should be approved to receive disability benefits--are both necessary in order to win the case.

To explain, we should sum up what a disability attorney or non-attorney actually does to prepare for a hearing.

1. Before the hearing, the representative will begin to gather updated medical records.

These updates will be reviewed and evaluated to see if the case can be strengthened. They will also be sent to the administrative law judge (ALJ) who has been assigned to hear the case.

Getting medical record updates is crucial because, by the time a case gets to a hearing, there will be no recent medical records in the file. To see what we mean by recent records and to learn why this is so important, you may wish to read the following page: Recent Medical Records for a Social Security Disability or SSI case.

Why will there be a lack of recent medical evidence in the file? Because the case development that is done on a disability claim--such as getting the records together, obtaining information on the claimant's work history, contacting individuals who are knowledgable as to the claimant's condition and daily activities, etc--stops after the reconsideration appeal phase is completed.

To reiterate, once a case has been denied on a reconsideration appeal, the social security administration will no longer do any work on the case. Which means that when a case gets to the hearing level, the only records that will be in the case file will be many months old, making the chance of getting an approval very slim to nonexistent.

Many claimants who arrive at a hearing unrepresented may be completely unaware of the fact that all case development becomes the responsibility of the claimant or their attorney once the case gets to the hearing level, or, rather, once it moves beyond the reconsideration appeal level. And this can have the effect of making the case completely unwinnable.

2. Sometime before the hearing, the disability representative will usually attempt to obtain a medical source statement statement from a claimant's treating physician.

While it may be true that not all disability claim representatives do this, it would be hard to imagine a skilled and competent one that didn't. A medical source statement from a claimant's treating physician can help summarize the claimant's various physical or mental shortcomings (their residual functional capacity) and can effectively illustrate just how and why it is that the claimant cannot be expected to return to work.

Is the medical source statement the same thing as getting a handwritten or typed statement from one's doctor? Very often, claimants who are not represented will attempt to procure a statement from one of their doctors. And, generally, because the claimant is completely unfamiliar with what the social security administration is looking for (with regard to evidentiary requirements), they will be given a short statement from their doctor that simply states that they cannot return to work. This is not at all what a disability examiner or a disability judge is looking for.

To the contrary, an adjudicator will not even be able to use such a statement because it will not be supported by the doctor's history of providing treatment, nor will such a short statement point to any objective signs or observations as to the claimant's range of physical or mental abilities.

By comparison, when a disability attorney or a non-attorney representative attempts to obtain a medical source statement, they send a prequalified form to either one or several of the claimant's treating physicians. Typically, the form will be geared to whether or not the impairment in question is physical or mental. And in some cases the form may be completely geared to a specific condition such as degenerative disc disease.

Disability representatives, whether of the attorney or non-attorney variety, will usually employ time-proven, systematic techniques for establishing the credentials of a case. This fact alone tends to answer the question "Why does Representation increase the win ratio at a Social Security Disability or SSI Hearing?". Going to a disability hearing is, in many ways, no different than developing an investment portfolio or developing a game plan. It all begins with having the proper management (a disability representative would be analogous to a portfolio manager or a coach) and then following a strategy that has demonstrated past success.

This is not to say, of course, that unrepresented claimants do not win disability cases. Many claimants who go to hearings alone manage to win their claims, but usually this is because the case was strong enough that the administrative law judge had already decided, based on the strength of the evidence, and often prior to the hearing taking place, to award disability benefits. And most likely these are not the sort of cases in which it was necessary to actually present a theory of the case and prove that the evidence satisfied the Social security administration definition of disability.

Here is a short list of considerations for claimants who go to hearings without the benefit of representation.

1. Be prepared to answer questions from the administrative law judge and your own representative (if you have elected to have representation). This includes questions regarding your daily activities and your work history.

2. Have a thorough knowledge of what is contained in your medical records; some individuals are surprised to know what their physicians have written about them.

3. Make sure that you know how to get to your local hearings office, because you need to be at your hearing on time. Being late even by ten minutes can mean that your disability hearing may have to be rescheduled (because most judges schedule multiple hearings back-to-back), which can take weeks or months.

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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