Applying for Disability in Iowa
How to apply and qualify for SSD, SSI in Iowa (IA)
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 - Individuals seeking disability benefits in the state of Iowa may stand a 25-30 percent chance of being approved for benefits at the initial claim, or disability application, level. Typically, on a nationwide basis, approximately 70 percent of all claims for SSDI and SSI are denied at this level, making it necessary for claimants to file one or more appeals in order to ultimately qualify for disability benefits.
To file for disability in Iowa, you must prove that you have a severe medical impairment. This impairment (or impairments if you have several conditions and this is usually the case) may be physical or mental in nature. To be considered severe, it must affect your ability to perform one or more basic work activities.
Beyond the severity requirement for qualifying for disability, there is also a duration requirement meaning that, to receive a disability award, a person's state of disability must be shown to either A) have lasted for at least one full year or B) be projected to last for at least one full year.
The severity and duration requirements for disability are proven through the information contained in one's medical records which should contain evidence of a claimant's diagnosis (or diagnoses if there are multiple conditions), their history of treatment, and their response to treatment. All sources of medical evidence are given consideration; however, the opinion of a claimant's treating physician will carry the greatest significance in terms of evaluating the evidence.
Two ways of qualifying for disability
There are two separate mechanisms for satisfying the criteria and qualifications for disability. The first is by demonstrating, via the medical evidence, that the claimant has one or more conditions that adhere to the criteria of a listing. A listing is a specific mental or physical condition that is contained in the SSA impairment manual, or blue book, also known as the Social Security list of impairments.
The listings include dozens of impairments and the approval criteria that must be satisfied in order to be approved on the basis of a listing.
Getting approved on the basis of a listing means that a case will be decided on the basis of only the medical evidence and that it will be unnecessary to review the claimant's work history. However, because the Social Security listings are extremely specific in terms of the approval criteria, the majority of cases cannot be approved this way.
The second mechanism by which a claimant may qualify for disability is a medical vocational allowance. This is how most claims are approved. A medical vocational allowance also involves a review of the available medical evidence. Following this review, the decision-maker on the case (a disability examiner or a disability judge, depending on the level of the claim) will complete a rating of the claimant's functional capabilities (i.e. how long they can walk, sit, stand, reach, lift, carry, etc). This rating is known as an RFC, or residual functional capacity, assessment.
The RFC assessment (an assessment of what a person can still do despite their disabling condition, or conditions) is compared to the jobs performed by the claimant in the past 15 years. If the claimant's current abilities are less than the requirements of their former jobs, they may potentially be awarded disability benefits. However, this will only be the case if the decision-maker also finds that they are functionally incapable of switching to some type of other work as well.
This fact alone makes it more difficult to attain eligibility for the Social Security Disability or SSI disability program than certain other programs, such as long term disability insurance or veterans benefits.
Most Filing a Social Security Disability Application - How to File
and the Information needed by SSA
Level II: Request for Reconsideration - Reconsideration is the first level of appeal. Reconsideration involves the same criteria and qualifications; nothing, in fact, is different in the handling of this appeal from the way a disability application is processed. A reconsideration must be request in a timely manner, meaning within 60 days of the date of the denial of the disability application. SSA also adds to this timeframe an added 5 days for mailing time.
To lessen the chance of missing the appeal deadline, a claimant should contact their Social Security office within several days of sending their appeal paperwork to verify that it was received. Keeping a photocopy of the paperwork is also a good idea in the event that the paperwork was not received. In most cases, Social Security will send out a verification notice informing the claimant that the appeal was received, but this does not always occur, so a followup call is advised.
Reconsideration appeals are processed by the same state agency that handles the initial claim, meaning the claim is evaluated by a disability examiner who reviews the medical evidence to determine the claimant's functional limitations and assess the claimant's ability to engage in work activity.
The reconsideration examiner will generally have all the information that is needed to decide the claim since most of the medical and vocational information was gathered at the disability application level. However, in certain cases, the examiner will need to obtain additional records for any treatment that was obtained by the claimant in the interim period between the denial of the application and the filing of the first appeal. In other cases, there may be no new medical evidence and the evidence that is in the file may have "aged out", meaning that none of it is recent enough to allow a decision to be made.
When medical examinations are necessary
Social Security considers recent medical information to be no older than 60 days. To make a decision on a disability claim, there must be at least some recent information in the file. When there is no recent information in the file and none to obtain from the claimant's treating physician or other sources of treatment, it may be necessary to request a CE, or consultative examination.
These exams are typically short and provide only a basic snapshot of a claimant's condition. They do not entail any medical treatment, nor are cases generally won on the basis of information provided in a CE report received from an examining consultative physician (though, it should be said, that the results of a mental consultative exam are typically more likely to establish that a claimant has met the requirements for disability).
Nonetheless, claimants are required to attend any appointments set for a CE and the failure to do so may result in a denial of the disability claim on the basis of non-cooperation.
Because the reconsideration is subject to the same process as the initial claim, a claimant is less likely to qualify for disability at this level. In most states, a reconsideration appeal is likely to be denied. Claimants who are denied at this level should file a request for a disability hearing immediately.
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.
Like all appeals, the 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.
Although representation on a disability claim is optional at all levels of the system, at the hearing level claimants are strongly advised not to forgo being represented by a competent and qualified disability lawyer or non-attorney disability representative.
In addition to providing a winnable "theory of the case" that conforms to Social Security regulations and court rulings, a representative can often help a claimant achieve the most favorable onset date (when the disability began) which can directly impact how much the claimant may receive in disability back pay.
Basic facts about disability hearings
Note: The Social Security Hearing office in Iowa, officially known as ODAR, the office of Disability Adjudication and Review, has a disability award rate that is lower than the SSA region (region 7) that Iowa is a part of (43.1 percent). Iowa's hearing award rate is also lower than the national average which approximates 50 percent each year, a figure which is usually somewhat higher when representation is involved.
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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