Applying for Disability in Hawaii
How to apply and qualify for SSD, SSI in Hawaii (HI)
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 - In a typical year, a disability claim that is filed in the state of Hawaii will stand between a 25 and 35 percent chance of being approved.
The corollary to this is that between 65 and 75 percent of all claims filed under the Social Security Disability or SSI disability program will be denied.
Qualifying for disability in Hawaii is the same as in all states since the SSD and SSI system is federal in nature (though, despite this fact, state-level DDS, or disability determination services, agencies are responsible for rendering decisions on claims after they are taken in local Social Security offices).
Requirements for disability
The qualifications can be broken down into two separate categories: non-medical requirements and medical qualifications.
Non-medical criteria are, for the most part, settled during the time of application. Non-medical criteria, as one might guess, have little to do with the actual merits of a case and, instead, deal with basic program eligibility such as one's citizenship status, marital status, income levels if they are working and receiving at least a substantial and gainful income, and asset levels (only SSI claims concern assets, not SSD claims).
Medical requirements for disability can best be understood by explaining the definition of disability used by the Social Security Administration. To be considered under the Social Security Act, a person must satisfy five separate criteria.
First, they must not be working and earning more than the allowable limit for earned income, known as SGA, or substantial gainful income. If they are working when they apply for disability and are earning as much or more than the limit, they will be given a quick technical denial on that basis.
The second qualifying factor is that the claimant must have a severe impairment. This is important because not all medical impairments are considered severe and potentially disabling. The initial rule of thumb used by SSA, however, is that, at the very least, the condition must interfere with basic work activities in order to be considered severe.
Social Security Disability list of impairments
The third qualifying factor has to do with whether the claimant has a condition for which their medical records clearly indicate that they satisfy the approval criteria in the SSA impairment manual, also known as the blue book.
The blue book is the Social Security Disability list of impairments. This is essentially a listing of individual conditions (such as depression and attention deficit disorder) and the very specific criteria that needs to be shown in the medical evidence in order to be approved for benefits.
Most claimants would be surprised to learn that the majority of medical conditions are not listed in the listing of impairments. For example, carpal tunnel syndrome, a fairly common impairment possessed by individuals whose work requires them to engage in stressful, repetitive finger and hand movements, is not in the listings.
Not surprisingly, most claimants are not approved at step 3 on the basis of meeting or equaling the requirements of a listing. For the majority of claims that are not approved at step 3, the evaluation process moves onto the fourth step.
How is the ability to engage in work activity considered?
The fourth qualifying factor is whether or not the claimant can engage in their past work. Past work can include nearly any job done in the prior 15 years as long as the claimant earned sufficient wages for the job to be counted and as long as the job was held long enough for the claimant to actually learn the job (therefore, a job held for 3 weeks would likely not be considered).
How is past work considered? If the claimant's current physical and/or mental limitations are greater than their ability to perform the functions of their past work, they may possibly be approved. However, just because a claimant cannot return to their past work does not mean that they will be approved for disability. They must still be evaluated at the fifth step.
The fifth aspect of qualifying for disability is whether or not the claimant can do other work, assuming that they have been found to also be unable to do their past work. This is where the Social Security Disability and SSI programs can be seen as significantly more stringent than other programs as a person who qualifies for disability must not only prove that they cannot return to a past job, but must also prove that their limitations rule out the ability to switch to a new form of work.
The majority of claims are generally denied on this basis at the disability application level. Fortunately, most claimants who utilize the appeal process will have, statistically, a much higher chance of receiving a disability award, particularly if their case is presented to an administrative law judge at a hearing.
Hearings provide a better chance of winning disability benefits for a number of reasons; one of those reasons is that this is the first step at which a claimant can actually speak with the decision-maker on their claim and may also have a designated disability representative present a theory of the case, or rationale for approval.
Before a claimant can go to a hearing, however, they must first go through the first appeal level, the request for reconsideration.
Level II: Request for Reconsideration - The reconsideration appeal in Hawaii must be requested within 60 days of the disability application denial. The appeal is handled in precisely the same manner as the application, meaning that the same criteria and qualifications apply.
As with the application, a disability examiner (this time a different one) will review the available medical evidence. Since the appeal happens fairly quickly after the initial disability claim decision, there may no new medical evidence to gather.
In many cases, however, because Social Security requires that at least some recent medical evidence is in the file for the decision to be made (recent is defined as not older than 60 days), a claimant who is undergoing a reconsideration may be sent to a consultative medical examination or CE. A CE can be physical in nature, or mental, meaning the exam could entail a psychological or psychiatric evaluation.
Qualifying at the reconsideration level
Statistically, qualifying for disability at this level is difficult as this appeal has a fairly low rate of approval. A decision on the reconsideration appeal tends to occur faster than at the first level (again, because much of the case development has already been done).
Because reconsiderations are overwhelmingly denied by SSA, claimants who file this appeal should probably prepare for the strong possibility of being denied and look at the reconsideration as the stepping stone to a hearing.
Level III: Request for Hearing before an Administrative Law Judge - The disability hearing in Hawaii, like the reconsideration, must be requested within 60 days of the last denial.
Unlike the reconsideration, the hearing is conducted by an administrative law judge, or ALJ. The ALJ performs the same functions as a disability examiner in the sense that the medical and vocational evidence is reviewed and the claimant may be approved on the basis of a listed impairment or a medical vocational allowance.
Whereas a disability examiner renders a determination without meeting, and in many cases without speaking with, a claimant, the purpose of the disability hearing is that the claimant may meet the decision-maker and have the opportunity to present their case.
Presenting the case means that the claimant and/or their representative (a disability attorney or non-attorney disability representative) will obtain whatever medical record updates are required and enter them into the case file. This is critical, of course, because once the case is concluded at the reconsideration appeal level, the Social Security Administration will cease all development on the case. From that point forward, this becomes the responsibility of the claimant.
Another primary difference between the hearing level and the lower levels of the system is that a claimant's representative will generally make an attempt to obtain a medical source statement from a claimant's treating physician. This does not occur at the first two levels (disability application and reconsideration).
However, when a medical source statement from a doctor who has a history of rendering treatment is presented to an ALJ and when the statement is fully corroborated by the rest of the medical evidence, it can have a very strong impact on the outcome of the case. Judges, in fact, will often give controlling weight to the opinion of such a doctor.
Hearings, from the time they are requested may take several months, even as long as one full year to schedule, depending in which part of the country the claimant resides. Social Security hearing decisions tend to be substantially more in favor of claimants, particularly when a case has been fully prepared and properly presented.
Note: There is a single Social Security Hearing office in Hawaii, located in Honolulu. Its disability award rate is above both the national average and the disability award rate for SSA region 9.
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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