Applying for Disability in Colorado
How to apply and qualify for SSD, SSI in Colorado (CO)
Note: If you have already filed a claim and been denied for disability, or are wondering what to do in the event of a Social Security denial, proceed to the reconsideration and hearing appeal sections below.
Level I: Disability Application - Social Security Disability and SSI Disability cases in Colorado are approved at a rate of 31.8 percent. When benefits are awarded, cases may be approved on the basis of satisfying the disability requirements of a listing in the Social Security listing of impairments.
In most instances, however, cases are generally approved on the basis of a medical vocational decision, a type of approval that involves a decision process that determines that a claimant---
A) Has a medically determinable mental condition or physical problem (typically, most claimants file with more than one condition alleged on the disability application and very often the conditions are a mix of physical and mental impairments) that has lasted, or can, through a review of the medical evidence, be projected to last for at least a full year
B) The condition, or conditions, are found to be severe enough that they result in enough functional limitations (limitations in function are rated on something known as an RFC from--RFC stands for residual functional capacity and this is essentially an assessment of what a person is still capable of doing despite their condition) that prevent the claimant being able to work and earn a substantial and gainful income.
Note: To satisfy the definition of disability used by SSA, the claimant must be unable to work at a substantial and gainful level (which simply means that they cannot have the ability to earn this amount: SGA) at one of their past jobs or doing any type of other work for which their vocational profile might ordinarily qualify them.
Evaluating a disability claim
While an application for disability typically begins at a Social Security office, the claim is not medically processed there. After the claim has been taken, it is transferred to a disability examiner at the state agency responsible for rendering disability determinations in a particular state. In most states, the agency is known as DDS, or disability determination services. It is also referred to by this name in the Social Security Act authorized by Congress.
The disability examiner's objective is to determine if the claimant satisifes the Social Security guidelines for receiving disability benefits, under the SSI disability program, or the Social Security Disability program. The medical requirements for disability are identical under both programs and it is common for a claimant to be evaluated for eligibility in both programs simultaneously (known as a concurrent claim).
The examiner, immediately after receiving a case from the Social Security office where it was initiated, will begin sending out requests for medical records to all the various hospitals and doctor offices listed by the claimant. The examiner will depend heavily on the accuracy of the information supplied by the claimant and this is why the claimant should endeavor to provide full names and addresses for all medical treatment sources.
In fact, it is typically a good idea for the claimant to write down all their treatment sources before their disability interview is even conducted, to make sure that important information is not accidentally left out.
How long does it take to receive a disability decision in Colorado?
A claimant filing for disability in Colorado can generally expect to receive a notice of decision in under four months. Occasionally, a decision will take longer if the disability examiner has difficulty obtaining medical records, or the claimant needs to be scheduled for multiple consultative medical examinations (scheduled and paid for by Social Security).
Individuals who do not meet the qualifications for disability can elect to file an appeal within 60 days of receiving a notice of denial.
Qualifying for disability in Colorado
Under the Social Security Administration's guidelines, applying for disability in Colorado as an adult is, typically, both a medical and vocational decision process.
As stated, to qualify for disability in Colorado, an adult claimant must demonstrate functional limitations that rule out the ability to engage in work activity. For an adult, the process of evaluation is conducted by analyzing the medical records to see if the claimant satisfies a listing.
If this is not the case, the examiner will review both the claimant's medical history and the details of their work history to determine if they might have the ability to return to a former job, or switch to a new form of work. Adults will qualify for disability on the basis of a listing or by being found unable to engage in work activity.
Concerning a disability application filed for a child, the child's ability to engage in normal daily activities, relative to their age-appropriate peers, is evaluated in substitution of the work history. SSD and SSI claims in Colorado are processed by disability examiners who will often, during the processing of a case, contact the claimant to discuss aspects of their work history, medical treatment, or to inquire about their ADLs, or activities of daily living.
To qualify for disability, a child applicant must either satisfy a listing, or demonstrate functional limitations that rule out the ability to engage in on-pace tasks with peers.
Level II: Request for Reconsideration - If a claimant does not qualify for disability in Colorado at the disability application level, the next step will be to file the first available appeal. This is the request for reconsideration.
The criteria for receiving a disability award does not change at this step and reconsideration appeals are processed no differently than disability applications. Reconsiderations are processed by disability examiners who specialize on these appeals and, as with an initial claim, the evaluation process will involve interpreting the claimant's medical evidence.
The reconsideration process is usually faster
Generally speaking, a claimant can expect to receive a reconsideration appeal decision in under 60 days. In many cases, the reconsideration examiner will not need to gather medical evidence since it will already have been gathered by the intial claim examiner.
However, in other cases, it may be that the claimant has returned to one of their medical treatment sources, or has obtained a new source of treatment. In those instances, the recon examiner may need to request these records. The reconsideration examiner may also need to send the claimant to a consultative medical examination, scheduled and paid for by SSA.
Qualifying for disability in Colorado at the reconsideration level will typically more difficult than at the initial claim level. The majority of claimants who file these appeals will be denied and will be forced to request a hearing before a judge.
Note: Reconsideration appeals are presently suspended in the state of Colorado. Conjecture holds that the reconsideration appeal may return; however, currently, individuals who have been denied on a disability application may immediately file a request for a disability hearing.
Level III: Request for Hearing before an Administrative Law Judge - A request for hearing is filed when a claimant does not meet SSA disability requirements at the reconsideration appeal level.
The process for receiving a decision at the hearing levelis very different than the process used when applying for disability in Colorado. At the hearing level, there will ordinarily be a long wait between the time a hearing appeal request is sent in and the time that an actual hearing is scheduled. Usually, this will be a matter of months.
Also, disability judges do not perform case development. Translation: the judge will not request updated medical evidence for the hearing. This will mean that the existing medical records in the file will be outdated by the time of the hearing unless the claimant or their disability attorney or non-attorney disability representative obtain updated records and submit them to the judge.
Note: There are presently two separate hearing offices in Colorado. The hearings office in Colorado Springs has an award rate of 47.8 percent, while the hearings office in Denver has an award rate of 47.2 percent. Both of these hearings offices issue disability awards at less than the national average approval rate of 50 percent.
The Colorado Springs CO hearing office has a disability award rate of 48.8 percent while the Denver CO hearing office has a disability award rate of 47.2 percent.
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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