Successfully Applying for Disability Benefits in Florida

Applying for Disability in Florida

How to apply and qualify for SSD, SSI in Florida (FL)

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 - Approximately seven out of ten claims for disability in Florida are denied at the initial claim, or disability application, level in Florida. Because the prospect of being denied on a disability claim in Florida is so high, most claimants can expect to utilize the appeal process before they eventually receive disability benefits.

Applying for disability in Florida will involve having to complete a disability application interview with a claims representative in a local office.

The purpose of the interview is to provide the claims representative with all the information that may be necessary for properly evaluating the claim, and, potentially, meeting the necessary qualifications for receiving a disability award.

Qualifying for disability in Florida

Individuals filing for disability in Florida should keep in mind that while their cases will be decided primarily on the basis of information contained in their medical records, the decision will also be made using vocational information (i.e. information concerning one's job history) if they are an adult, and often academic information if they are a minor-age child on whose behalf the claim is being filed.

For adults applying for disability benefits, the goal will be establish that one's current and projected functional limitations (physical limitations or mental limitations) are severe enough to prevent the individual from engaging in their past work activity, or in other types of work activity at a level that earns them a substantial and gainful income.

Whether or not a claim for disability is considered to meet the qualications and requirements for disability will depend on the findings reached by a disability examiner.

A disability examiner is not the same individual who take claims in Social Security offices. Examiners work at state disability agencies (usually, depending on the state, referred to as DDS, disability determination services, or DDD, the disability determination division. The examiner who handles the disability determination for a claim will have the claim forwarded to them after the initial intake phase has been completed at a Social Security field office.

The examiner's chief goal is to gather records from the doctors and other sources of medical treatment listed on the disability application. The examiner then extracts the pertinent information from those records in order to determine if the claimant's case satisfies the SSA definition of disability, thereby qualifying the claimant to receive disability benefits under either the title II SSD or title 16 SSI program.

As stated above, the majority of claims will be denied at the initial claim level and individuals wishing to pursue their claim should file their first appeal, which is a request for reconsideration. Claimants who follow the appeal process will, statistically, be likely to have benefits approved by the time the second appeal, a hearing before an administrative law judge, takes place.

Filing for disability claim as a child

For children applying for disability in Florida, the disability qualifications are a bit different. The requirements for disability for children are predicated on the inability to engage in activities that would be considered normal for one's age, i.e. age-appropriate activities.

It is for this reason that on children's claims medical records are reviewed, but school records are also often reviewed when the child is of school age (including grade reports, IEPs, and reports of academic and intellectual testing).

  • Disability application denial rate: 73.2 percent.
  • Disability application approval rate: 26.8 percent.

    Level II: Request for Reconsideration - A reconsideration appeal is available to any claimant in Florida who has been denied for disability at the initial claim, or application for disability level.

    The reconsideration request must be received within 65 days of the date of the notice of denial on the initial claim. The denial notice will state (in the upper right hand corner of the notice) that the appeal period is 60 days. However, in actuality, SSA also provides an additional 5 days as a buffer to allow for mail time.

    A note of caution, however: the Social Security office must have received the reconsideration appeal by the 65th day. It is not sufficient to simply have mailed it to the Social Security office on the 65th day. In that scenario, it is likely that the appeal will be considered untimely and will be refused. Late appeals may be accepted, but only if the claimant presents a justifiable reason for good cause.

    Qualifying for disability at the first appeal level is essentially the same as at the initial claim level. The process does not change. The only substantial difference is that a different disability examiner will handle the detemination. That said, this appeal generally results in a denial for the exact same reasons. Ordinarily, only when substantially different medical evidence is brought forward on a reconsideration will the decision change.

    Claimants who are denied on a request for reconsideration should immediately file a request for a disability hearing.

  • Reconsideration appeal denial rate: 91.1 percent.
  • Reconsideration appeal approval rate: 8.9 percent.

    Level III: Request for Hearing before an Administrative Law Judge - The disability hearing is the second appeal level in the SSDI and SSI claim system. Unlike the first two levels, the decision is made by an independent administrative law judge.

    The judge will perform the same task as a disability examiner in that the judge will review the medical evidence and the claimant's work history (in the case of children filing for disability, the focus will not be on work, of course, but often on school information), and determine if the claimant's current limitations are great enough to result in an awarding of disability benefits.

    As with the first two levels, the judge may deny the disability claim. The judge may also approve the claim on the basis of satisfying a listing (in the blue book, or Social Security Disability List of Impairments) or on the basis of granting a medical vocational allowance, a type of approval in which it is decided that the individual's limitations rule out the ability to engage in work activity.

    Approvals made by disability judges may also be a partially favorable hearing approval or fully favorable hearing approval. A partially favorable decision means that the original onset date alleged by the claimant has not been granted, meaning potentially that the claimant may not receive as much back pay as would be hoped.

    A fully favorable approval grants disability in accordance with the onset date alleged by the claimant and may mean substantially more in back pay received. Getting the most favorable onset date, of course, is a primary benefit of having representation at the hearing level. Representatives will work to establish the earliest possible onset date and investigate options for documenting this via the Social Security case file, or via additional records that may be sought.

  • Disability Hearing denial rate: 51.7 percent
  • Disability Hearing approval rate: 48.3 percent

    Note: Disability hearing award rates in Florida average 48.3 percent, a figure that is marginally below the national average for Social Security hearing decisions. On a national basis, claimants who go to a hearing are given an award 50 percent of the time. Hearing offices in Florida have approval rates that range from a low of 37.2 percent to a high of 57.5 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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