What Can I Do to Improve My Chances of Winning Disability Benefits?

It's a good idea for those applying for disability to do all they can to ensure that their claim is decided quickly and favorably.

The question is, what, if anything, can disability applicants do to improve the chances of winning disability benefits? The answer to this question depends on which level of consideration the claim is at in the disability determination process.

1. If you are just starting out in the process and filing a claim for SSD or SSI benefits with social security for the first time, you can help your case a lot by making sure that you provide a complete, detailed medical and work history for the disability examiner in your case.

With regard to your history of treatment, this will include all appropriate contact information, including correct names, addresses, and phone numbers of treating physicians, medical facilities, work supervisors, etc.

Social Security examiners have access to a database that includes addresses for doctors and hospitals. However, this list does not include all treatment sources and is constantly being updated. Therefore, there is the real possibility that if a claimant does not supply enough identifying information about their treatment source, the examiner may have difficulty obtaining the records. In some cases, they may not be able to get the records until several months have passed, causing an extraordinary dely on the case.

Why are the medical records so very important? They are important in several ways. Obviously, the medical records establish the existence of your condition or conditions.

However, they also prove A) whether or not you are currently disabled (which is why SSA needs current medical records, not older than 90 days) and B) how far back you may have been disabled---which can have an immediate and dramatic effect on how much back pay you are entitled to and whether or not your waiting period for certain benefits (such as medicare, or the start of monthly payments) will already have been served.

For those who are unaware, Social Security Disability has a five month waiting period for benefits while medicare has a 24 month waiting period. Establishing through the medical records that your condition began long ago can effectively eliminate these waiting periods.

The information contained in medical records can indicate to what extent, and in what ways, you are functionally limited. And this can influence whether or not Social Security will determine that you are capable of returning to work activity, or if you meet the requirements for disability. Which brings us to the second item on the list.

2. You can also strengthen your case by providing a written statement from your doctor(s) describing your condition in detail, and telling exactly how it limits your ability to perform at work. In fact, it's not entirely a bad idea to tell your doctor up front that you are filing for disability, and see if he or she is supportive in this matter (if not, you may wish to consider seeing a new doctor for treatment of your medical symptoms).

Your doctor's opinion

The opinion of your treating physician is given deference in your case. At the disability application and reconsideration levels, it may only be one of several factors under consideration since, at those levels, SSA typically gives preference to the opinions of its own doctors (the medical consultants who are part of the same case-processing units as disability examiners). At the hearing level, however, the opinion of your doctor, provided as a medical source statement, can make the difference between winning or losing a case.

3. All disability cases (at the first two levels of the system) are determined by a disability examiner based on what is written in your medical records, so a good way to help your case in the initial disability application stage is to get as much relevant medical information to your disability examiner as quickly as possible. There will be instances where it will make sense to obtain copies of your own records and submit them at the time of application. More than any other factor, the wait for medical records constitutes the biggest delay in processing time.

However, keep in mind that if you do not submit records from all of the sources that you list on your disabilty report form, or do not submit records for the relevant time periods concerning your case (i.e. your alleged date of onset), or the records you turn in do not include recent documentation (not older than 90 days), the examiner will still be required to obtain copies of your records.

4. If you feel that a reaching a decision in your case is taking too long, it doesn't hurt to call the examiner assigned to your case to ask if there's anything you can do to help move things along'sometimes physicians, even those sympathetic to disability claims, are very slow to respond to requests for medical records. You may be able to help your case simply by going down to your doctor's office and picking up the documents yourself, then hand-delivering them to the state disability determinations office.

Or it may be that there are other issues involved for which you can provide information to the disability examiner (such as your normal daily activities or work history) To learn what can happen in instances where a claimant does not check the status of their claim: Social Security Disability Status.

5. If, after reviewing your medical information, the disability examiner has denied your application for disability, and your case has been rejected by the next disability examiner yet again on the reconsideration appeal, then your next step is to request a disability hearing.

When it makes sense to get a lawyer

While representation may or may not be a necessity at the lower levels of the system, at the hearing level it is advisable to opt for representation. Typically, claimants can improve their chances of winning disability benefits by retaining an experienced disability representative or lawyer to present the case to an administrative judge at the hearing. Statistics show that disability cases in which a claimant is represented by an attorney have a 60 percent chance of being approved versus a forty percent chance if they appear at a hearing unrepresented (approval stats are subject to change, of course, and in recent years have trended downward at hearings offices across the country).

It goes without saying that a competent disability representative can help you to evaluate your case and determine any weaknesses in your medical history, as well as submit your most recent medical records for the judge's review prior to the hearing.

Most importantly, though, your representative will present your case in the strongest possible light. And having a thorough knowledge of Social Security regulations, rulings, and the medical-vocational rules (the grid) that direct decisions of "disabled" or "not disabled", the representative may be able to develop a strong argument for approval.

This may involve pointing out errors in the disability examiner's original conclusions that may have prevented you from winning disability benefits the first time around. It may also involve illustrating that your particular physical or mental limitations effectively reduce the number of other jobs you could potentially switch to so that the only reasonable decision is to award you 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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