Successfully Applying for Disability Benefits in Indiana

Applying for Disability in Indiana
How to apply, meet filing requirements, and the criteria to qualify for Benefits in IN

Approval and Denial Statistics for Disability Claims in Indiana

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 - At the disability application level in Indiana, approximately 29 percent of all
Filing for disability in Indiana

Applying for disability in Indiana begins with the initial claim, or disability application. The application may be filed online or through a local Social Security office. Filing online poses disadvantages, however.

The first is that it does not allow an opportunity for a face-to-face meeting with a CR, or claims representative. The CR is responsible for the intake portion of the claim and the disability interview is valuable because it allows a claimant to directly ask questions concerning the application and appeal process.

Secondly, the online process does not allow an application for SSI to be taken. This is problematic since many cases are concurrent, meaning they involve both Social Security Disability and SSI, yet it will be impossible for a claimant to know in advance if their claim will be for SSI, for SSD, or both programs in the form of a concurrent claim.

It will typically be to the claimant's advantage to contact a local Social Security office and request an appointment to
file for disability. The disability application interview may be conducted at the Social Security office, or it may be conducted over the phone which may simply be a preference for some claimants and a convenience for those who have medical mobility issues.

A person's medical and work history

The purpose of the disability interview will be for the Social Security Administration to obtain all the information that is needed to process the claim. The primary emphasis, however, will be the claimant's medical treatment history and work history.

Because this information is instrumental to how a disability decision is made, claimants should consider writing down both their medical treatment and work histories prior to the disability interview so that important details will not be omitted.

With regard to the work history, claimants should provide a list of all jobs worked in the 15 year period prior to becoming disabled (what SSA refers to as the relevant work period) and should include job titles and descriptions of the duties required of each job. This information will be used by a disability examiner to identify the claimant's jobs in the DOT, or dictionary of occupational titles.

With regard to the medical history, the claimant should provide a listing of sources of treatment, both current and going back to the time their disability began. The full names of hospitals, clinics, and doctor's offices should be included so that the examiner is able to identify the medical practice in a database and then send requests for medical records.

Providing incomplete information may actually contribute to delays in the decision of the claim. Typically, the biggest delay on any disability claim concerns how long it takes SSA to gather the claimant's medical records.

Who makes the disability decision and how long does it take?

After the disability claim is filed in a local Social Security field office, it is transferred to a disability examiner at Disability Determination Services (DDS) for evaluation and processing.

All told, the disability process at this level may take as long as four months on average, though claims can sometimes be decided in 60 days or less. In nearly all cases, the amount of time necessary to process a case will be dependent on how long it takes to acquire the medical evidence for the case as well as whether or not there is a need to send the claimant to an independent medical exam, also referred to as a CE, or consultative examination.

Note: a CE may be physical (such as a general physical exam, a neurological exam, or even an appointment for xray imaging) or mental (e.g., a mental status exam, a full psychiatric evaluation, a psychological exam i.e. IQ testing, or memory scale testing) in nature.

The purpose of a CE is to provide recent medical evidence, not treatment of any kind. The exam is scheduled by the disability examiner who is evaluating the claim and is paid for by the Social Security Administration. Under no circumstances should a consultative examination appointment be missed as this can form the basis for a denial of a claim. That said, an appointment can be rescheduled if it is missed for a valid reason.

Qualifying for disability

The qualifications for disability in Indiana are based upon a claimant demonstrating the following:

A) That they have a severe, medically determinable mental or physical impairment--or a combination of one or both types of impairments. "Medically determinable" simply refers to the fact that any condition that is alleged to be a medical disability must be corroborated by objective medical evidence obtained from a valid, acceptable medical source.

Generally speaking, this means medical records obtained from a licensed medical physician, at a hospital, clinic, or physician's practice.

B) That this impairment or impairments will last--or will have already lasted--not less than one year. One year is the durational threshold for disability claims. Even in cases where it is apparent that an individual is completed incapacitated, a claim for disability may be denied on the basis of duration if the condition improves before the one-year mark, or if Social Security determines that it is likely that the claimant's condition will medically improve.

C) That this impairment or combination of impairments will prevent the individual from being able to engage in substantial and gainful work activity. When Social Security considers work activity, consideration is given to past jobs that the person has done and might potentially return to, as well as other types of work that they might be able to switch to.

However, the primary consideration is whether or not the claimant's condition is severe enough to prevent them from being able to do any work at a level that earns what SSA considers SGA, or substantial gainful activity.

In the actual processing of a disability claim, a disability examiner will obtain the medical records from the various sources of treatment listed on the disability application at the time of filing.

This, of course, highlights why it is very important to provide detailed information regarding the medical treatment history, particularly since the examiner will rely completely on the information provided by the claimant.

In other words, the examiner will not be able to obtain all the needed information if the claimant leaves out one or more treatment sources, or does not provide an accurate name for a medical facilility so that the examiner may identify the facility when sending out requests for medical records.

How the disability decision is made

After receiving the records--which very often takes weeks, and sometimes months, the examiner will evaluate the information contained in the records in order to determine the following:

1) Does the claimant have a medical condition, of a physical or mental nature, that satisfies the qualifications and criteria of a listing in the Social Security list of impairments?

In most instances, the claimant will not have a listing-level impairment. The criteria for a listing tends to be fairly specific and precise, making it difficult for claims to be approved in this manner.

2) If it is apparent that the case cannot be approved on the basis of a listing, the examiner will review the medical evidence of the case to determine in what ways and to what extent, the individual is functionally limited. Functional limitations include a reduced ability to lift, carry, sit, stand, crouch, stoop, reach, grasp, maintain attention and concentration, remember, and interact with coworkers and supervisors in a work setting.

Physical and mental functional limitations are assessed so that a claimant's RFC, or residual functional capacity can be determined. The RFC is simply a rating of what a person can still do despite their condition. The RFC rating is compared against the demands of the claimant's past work (this highlights why it is very important to provide accurate job titles and detailed descriptions of the work performed for each job).

If the determination is made that the claimant can no longer do their past work and would be prevented from doing other types of work, they will generally be awarded disability benefits.

In most instances, however, the determination will be made that that claimant, even if they are judged incapable of going back to their past work, has the ability to engage in some type of other work.

This fact typically makes it critical to file one or more appeals in order to ultimately meet the qualifications for disability. By the second appeal level, the administrative law judge hearing, the majority of claimants will have a favorable chance of winning benefits assuming that their case has been properly prepared for presentation to a judge.

  • Disability application denial rate: 70.1 percent.
  • Disability application approval rate: 29.9 percent.

    Level II: Request for Reconsideration - An individual who has been denied for disability may file an appeal. The request for reconsideration is the first appeal and is handled, once again, by a disability claims examiner at the agency responsible for disability determinations. In most states, the agency is known as DDS, or disability determination services.

    The reconsideration must be filed within the allowable time limit (60 days from the date of the first denial plus an additional five days for mailing time). To ensure that the appeal is received in a timely manner, claimants should do the following: keep a copy of all submitted forms and make a followup status call to the Social Security office several days after the appeal has been sent to guarantee that it was received.

    How the reconsideration appeal decision is made

    The qualifications for disability at this level of the SSD and SSI system are the same. And, in fact, the process is identical in practically every way to the disability application level. The reconsideration level examiner will examine the medical evidence to see if the claimant has a medical condition that satisfies the requirements of a disability listing.

    If this is not the case, the examiner will continue to look for signs of functional limitations, both physical and mental, and rate these limitations on an RFC form.

    The residual functional capacity assessment will compare the claimant's current level of fucntioning to the demands of their past work. The RFC assessment will also be used, in conjunction with the information obtained from the claimant's work history to determine if the capacity to switch to some type of other work exists.

    As with the application for disability, if the claimant's limitations outweigh their ability to do their past work or switch to some form of other work, they will qualify for disability benefits.

    The majority of reconsiderations are also denied

    Reconsideration appeals are denied at an even higher rate than initial claims. Generally, more than 80 percent of these appeals are denied. This stands to reason since A) the case is again being decided by a disability examiner and B) only a few weeks of time separate the application from the reconsideration. Is it possible to win the claim at this first appeal level? Yes, and a small percentage do win at reconsideration.

    To maximize one's chances, any medical information that was not considered by the first disability examiner should be obtained and brought to the attention of the reconsideration examiner. Disability attorneys and non-attorney representatives who are proactive about winning at this level will often attempt to obtain additional supporting documentation and take the additional step of contacting the examiner to discuss the case and check its status.

    Individual's who are denied at this level should immediately file the second appeal, the request for hearing before an administrative law judge.

  • Reconsideration appeal denial rate: 95.3 percent.
  • Reconsideration appeal approval rate: 4.7 percent.

    Level III: Request for Hearing before an Administrative Law Judge - The disability hearing is the second Social Security appeal available to claimants 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

    Where will my hearing be held?

    All Social Security Disability and SSI disability hearings are held at regional hearings offices. Each office is known as an ODAR, or office of disability adjudication and review. Depending on the size of the state in question, there may one or several hearings offices. However, even in larger states such as North Carolina (tenth most populous) where there are multiple hearing offices, getting to a hearing location may involve a fair amount of travel.

    Because this can impose a hardship on claimants, particularly those with transportation or medical issues that restrict their movements, SSA will sometimes hold hearings in satellite locations. A satellite location may simply be a conference room at a bank.

    In principle, this is not dissimilar from the setting at a Social Security hearing office. Contrary to what some might assume, though the hearing is conducted by a federally appointed judge, it is somewhat informal. Satellite locations can make it much easier for some claimants to attend their disability hearing. In other instances, Social Security may schedule a claimant for a video hearing. Video hearings are exactly what the name implies. Both the claimant and the judge interact through video conferencing.

    Are video hearings to the benefit of the claimant? This is debatable, though it bears mentioning that one of the advantages of going to a disability hearing is that, unlike the disability application and reconsideration levels, a claimant can actually be seen by, and speak with, the individual rendering the decision on their claim.

    This certainly makes the claimant more than just a collection of records and forms in an electronic file and, psychlogically, this may be part of the reason why disability judges have a much higher rate of approval on claims than disability examiners at the first two steps of the system.

    Claimants who do not wish to give up the advantages of an in-person hearing may refuse to have their hearing conducted by video and subsequently have a live hearing scheduled.

    Who will make the decision on my disability hearing?

    Disablity examiners make the decision on the application and reconsideration. At the hearing level, the decision is made by a federal administrative law judge. The decisions of judges fall under the same disability requirements used by SSD, SSI examiners.

    That is to say, the judge will review the medical evidence of record to determine if the claimant has a severe medical impairment that meets the Social Security definition of disability.

    The definition requires that the claimant have a condition that is severe enough to satisfy the requirements of a disability listing, or prevent the performance of work activity that earns a substantial and gainful income.

    Two things to keep in mind:

    A) Judges are not subject to supervision the way disability examiners are

    An examiner works in a case processing unit and the decision they make on an SSD or SSI claim is subject to manipulation and revision by their immediate supervisor, by the doctor in their unit who provides consultation on claims (i.e. signs off on the decision made by the examiner), and even by quality control units that may render their disability decision null and void. Social Security judges, on the other hand, do not have supervisors and do not have their cases "signed off on".

    They may decide to have either a medical expert or a vocational expert appear at a hearing, but this is to provide illumination on substantive issues of the case. And an expert only appears at their discretion. In no way, shape, or form does the expert have any intrinsic authority over the decision made by the judge. If the judge decides that the claimant satisfies the medical qualifications and qualifies to receive disability benefits, that is the judge's perogative.

    The independent nature of the judge at a disability hearing is advantageous to claimants. If the judge in a case decides that the claimant should be awarded benefits, that will be the outcome. Very often, however, a disability examiner will attempt to approve a claim and find their decision overriden or reversed by others in the disability bureacracy.

    B) Social Security judges do not usually perform case development

    This is simply another way of saying that if the claimant, or their disability attorney or disability representative, does not obtain and submit additional (and recent) medical evidence for the hearing (hopefully including a statement from the claimant's physician), the judge's decision will be based on what was already in the file at the time of the last disability denial, at the reconsideration.

    Translation: the case will most likely be denied again.

    Evidence gathering, prior to a hearing, is absolutely essential. Claimants who do not do this to support their case, or have disability lawyer or representative do this on their behalf, almost guarantee for themselves a third denial (the first being the disability application and the second being the reconsideration appeal).

  • Disability Hearing denial rate: 53.4 percent
  • Disability Hearing approval rate: 46.6 percent

    Note: The award rates quoted above are averages for the state of Indiana. Individual Social Security Hearing offices in Indiana range approve as few as 42.7 percent of cases heard to 53.2 percent of cases heard.

    The Evansville IN hearing office has a disability award of 48.3%; the Fort Wayne IN hearing office has a disability award rate of 53.2%; the Indianapolis IN hearing office has a disability award rate of 45.9%; the Valparaiso IN hearing office has a disability award rate of 42.7%.

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