Overview of Disability
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Applying for Disability in Idaho
How to apply, meet filing requirements, and the criteria to qualify for Benefits in ID
Approval and Denial Statistics for Disability Claims in Idaho
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 - An individual applying for disability in Idaho stands, in most years a 30-34 percent chance of approval. The majority of claims will not meet the qualifications for disability at this level of the system; therefore, claimants who wish to receive benefits will typically need to file one or more appeals.
A prospective claimant who decides to file for disability can expect to receive a decision on their disability claim within 120 days. Very often, the decision can be received in 90 days or less.
That said, a claimant should not be surprised if the case at the initial claim, or SSD or SSI disability application, level, takes up to a year or longer. These situations do occasionally occur and when they do it is usually the result of the disability examiner's inability to obtain the medical records that are needed to reach a decision on the Social Security Disability or SSI case.
Qualifying for disability
Qualifying for disability benefits in Idaho is the same as in all states since the Social Security system that oversees the title II (Social Security Disability Insurance, or SSDI) and title 16 (supplemental security income, or SSI) programs is federal.
To meet the requirements for SSI and SSDI disability, a claimant must show that their condition, or conditions, are severe enough to prevent work activity that earns a substantial and gainful income.
For adult claimants, the qualifications for disability are proven as a result of the information contained in the claimant's medical records and work history. This information is used to ascertain what the individual's functional capabilities and limitations are, as well as the requirements of their past work.
If the individual is no longer capable of performing their past work, and not capable of using their acquired skill levels and education to do some type of other work, they will qualify to receive disability benefits.
Note: in a minority of cases, the decision on an SSD or SSI disability claim will be made based on only the medical records without any consideration of the claimant's work history. This occurs when the person filing for disability has a medical condition, a physical condition or a mental condition, that satisifes the approval criteria of a listing. Listings are contained in the SSA blue book, otherwise known as the Social Security list of impairments.
Receiving a disability award on the basis of a listing is substantially more difficult than being approved for benefits on the basis of a medical vocational allowance, in which it is determined that the individual can no longer engage in work activity while earning a substantial and gainful income, what SSA refers to as SGA, or substantial gainful activity.
How is the disability decision made?
Specifically, how is this determination made? After a claim is taken at a local Social Security office, it is sent to a Disability Determination Services agency within the respective state. There, the claim is assigned to a disability examiner. The examiner will use the information provided by the claimant at the time of filing for disability to obtain medical records from all the sources listed by the claimant.
Once the records arrive, the claimant will read and evaluate them, looking for evidence of specific functional limitations of a physical or mental nature. Examples of limitations include a reduced ability sit, stand, or walk for longer than a certain amount of time, or an inability to lift more than a certain amount of weight. Other types of non-exertional limitations might involve a person's ability to crouch or stoop, reach overhead, maintain attention and concentration, remember, tolerate heights or fumes, or interact with supervisors or co-workers.
These limitations in total will comprise an RFC, or residual functional capacity, assessment. The RFC rating essentially states what the claimant can still do despite their impaiment.
The RFC rating assesses what the claimant can still do, but it does not by itself state whether the claimant can still work. To make this decision, the examiner must compare the RFC rating to the types of work the person did in the past. It may be that their current limitations are great enough that they cannot return to their past work. This is very often the case. However, to be awarded disability, it must also be shown that they cannot do other work as well.
Generally, when a disability case is denied, it is because the decision has been made that the claimant can do some type of other work.
As stated, the majority of claims are denied. However, for those who appeal, at least as far as to the level of a hearing before an administrative law judge, the chances of winning benefits are typically in the claimant's favor.
Disability application denial rate: 65.3 percent.
Disability application approval rate: 34.7 percent.
Level II: Request for Reconsideration - Reconsideration is the first step in the Social Security Administration's appeal system. Under the reconsideration process, the qualifications for disability remain the same. The case goes through a process of evaluation that is identical to the disability application, which accounts for why a high percentage of these appeals are typically denied in most states.
The Request for Reconsideration must be asked for within the appeal deadline listed by SSA. A claimant who has been denied at the initial claim, or disability application, level, has 60 days from the date of the denial to file their appeal. After the appeal has been submitted, the Social Security office will often send out a confirmation letter indicating the appeal has been received.
However, this does not always happen; therefore it is wise to make a followup call for status within a few days to be sure that the appeal paperwork was, in fact, received.
Reconsiderations are also conducted by the same state disability determination services agency. The only major differences at this level are that the appeal will be handled by a different examiner and that the disability claim decision will typically not take as long.
How many reconsiderations are approved and how long does it take?
In most cases, the decision may made in half the time, assuming that the claimant's medical records are not considered aged (to be considered recent, at least some of the medical evidence in the file should not be any older than 60 days).
If there is no recent evidence, of course, the claimant may need to be sent to a CE, or consultative medical exam, the purpose of which is usually to provide recent medical observations, but little more.
Reconsideration appeals in Idaho have a high rate of denial. In Idaho, this is generally in excess of 80 percent. It is possible to increase the probability of winning at this level; however, this often requires a proactive disability representative who will attempt to obtain and submit compelling medical record documentation to the reconsideration-level examiner.
For most claimants, a denial on a reconsideration, as a practical matter, should simply be assumed. If a reconsideration is denied, the next step should be to file a request for hearing.
Reconsideration appeal denial rate: 86.5 percent.
Reconsideration appeal approval rate: 13.5percent.
Level III: Request for Hearing before an Administrative Law Judge - The disability hearing is the second Social Security appeal available to claimants filing for disability in Idaho and may be requested only after a reconsideration appeal has been denied.
A hearing must be requested within 60 days of the date of the prior denial, but, ideally, should be requested immediately after receiving notification of the denial of the reconsideration appeal to avoid unnecessary case processing delays, as well as the possibility of a missed appeal deadline.
Basic facts about disability hearings
1. The hearing will take place at an ODAR - ODAR stands for office of disability adjudication and review. After a claimant or their disability attorney or non-attorney disability representative has submitted a request for a hearing to a Social Security office, that office will transfer the file to the hearing office where it will wait to be scheduled for a hearing date.
While the case is pending at the hearing office, a claimant may be curious as to the status of the hearing request. However, it will generally not be productive to contact the Social Security office to obain the status. It will be best to contact the hearing office directly for this. And if a claimant is represented, the representative should call for the claim status and then report the information back to the claimant, keeping all parties fully informed as to what is happening with the case.
Having said this, though, since it is commonly known that a wait for a disability hearing may be very long, typically one of the only reasons to contact the hearing office at all is simply to verify that the hearing office did, in fact, receive the case after the hearing appeal was sent to the Social Security office.
2. The hearing decision will be made by an ALJ - ALJ stands for administrative law judge. Judges make decisions at the hearing level. While disability judges are subject to the same rules and criteria that guide the decisions of disability examiners (at the disability application and reconsideration appeal levels), judges also tend to approve a higher percentage of claims.
The higher rate of approval at hearings may be due to a number of factors. One important factor is that Social Security judges will accord deference and weight to the opinion of a claimant's own doctor, while a disability examiner may completely disregard the doctor's opinion. However, the higher rate of approval by judges is also often dependent on whether or not a claimant or their disability lawyer--
A. Has obtained and submitted to the hearing office additional medical evidence (which is necessary because after the reconsideration appeal stage has ended, SSA no longer gathers medical evidence for the case).
B. Has obtained a supporting statement from a claimant's treating physician (known as a medical source statement).
C. Has presented a logical argument for approval based on the claimant meeting the qualifications for disability via a listing (in the Social Security list of impairments) or on the basis of a medical vocational allowance.
A medical vocational allowance is a type of decision that is reached after the case has been subjected to a five step sequential evaluation disability system which determines that an individual filing for disability is unable to perform either their past work or engage in any other type of work for which their age, education, skills, and functional capabilities would ordinarily allow them to perform.
3. The judge may have expert witnesses present - This is often the case. If a witness is present at the hearing, the witness may be a vocational expert who can comment on the claimant's ability to return to their past work, or perform other work. Or the witness may be a licensed physician serving as a medical expert.
4. The judge may send you to a medical examination - Consultative medical exams, referred to by the acronym CE, are usually scheduled by a disability examiner at disability determination services. However, judges do sometimes send claimants to consultative examinations. As at the lower levels, a CE is ordered when the claimant is unable to present recent medical record documentation or has been uanable to present any evidence for a condition that they alleging (such as listing depression on the disability report form for the applicaion, but not having had formal treatment for depression).
5. There are three types of disability decisions at hearings - Disability examiners approve and deny Social Security Disability and SSI claims. However, judges issue denials, partially favorable decisions, and fully favorable decisions. The difference between a partially favorable or fully favorable decision is whether or not the judge has agreed to set the established onset date for a person's disability as the date that they originally alleged, or claimed.
6. You may submit evidence for your Social Security hearing - Not only do you have the right to do this, but it would be unwise not to. By the time a case is heard by an administrative law judge, the medical evidence that was gathered by the disability examiner working on the application for disability and by the disability examiner working on the reconsideration appeal will be fairly old. A Social Security Disability award or a SSI disability award cannot be granted if the decision-maker (in this case, a judge) does not have recent medical records to assert that the claimant is currently disabled.
Obtaining recent medical records and submitting them to the hearing office prior to a hearing is one of the chief functions of a disability representative or disability lawyer. Typically, a representative will delay sending out requests for medical record updates until just shortly before the hearing is scheduled. This is to avoid situations in which records are obtained, added to the file, and then become out-of-date because they were requested too soon in the process. Timing record requests is also a function that disability representatives are familiar with.
Disability Hearing denial rate: 51.1 percent
Disability Hearing approval rate: 48.9 percent
Note: The chance of receiving a Social Security Disability award or SSI disability award at the hearing appeal level tends to hover in the range of 48-52 percent for most cases; in cases where the claimant has representation, the award rate is typically higher by a number of percentage points.
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