Applying for Disability in Louisiana
How to apply and qualify for SSD, SSI in Louisiana
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 filing for disability in Louisiana currently have a 32 percent chance of being approved on an application for disability benefits. Nearly 68 percent of claimants will be denied at this level of the process.
For those who are initially denied, the SSA disability system will allow for multiple appeals. Typically, most claimants who are denied on their application will also be denied on their first appeal, but, statistically, will have a much higher chance of receiving a Social Security Disability award or SSI award on the second appeal, the request for a disability hearing.
Qualifying for disability
Qualifying for disability benefits in Louisiana under either the SSD or SSI program will require demonstrating that an individual has, according to the evidence presented in their medical records, one or more medically determinable severe impairments.
Medically determinable simply means that the diagnosis of the condition and the characterization of its severity must be established by objective medical observation and testing.
The condition of the individual may be physical or mental in nature, and, often, claims are filed on the basis of both mental and physical conditions. With either type of impairment, the qualifications criteria is the same.
Under the SSA definition of disability, the condition must be severe enough that it has lasted one year and interferes with normal activities of daily living. If it has not lasted a full year at the time of applying for disability, a projection can be made as to whether or not it will last the minimum durational length required by the Social Security Administration.
In addition to this durational requirement, the condition, if the claimant is an adult, must be functionally limiting to the extent that the individual cannot perform work activity that earns a substantial and gainful income.
How does Social Security determine a person is disabled?
Each disability application in Louisiana is initiated at a Social Security office. However, the decision is not made there. After the claim is started, the case is transferred to a disability claim examiner at an agency known as DDS, or disability determination services.
At DDS, the examiner will begin to accumulate the claimant's evidence to determine if their case meets the Social Security definition of disability. There are two ways of being approved for disability:
1. Being approved for disability on the basis of a listing in the Social Security Disability list of impairments.
2. Being approved for disability on the basis of being unable to engage in work activity that earns a substantial and gainful income, including types of work that was performed in the past by the claimant, as well as other work for which the claimant might be suited based on their age, education, skills, and functional limitations. This type of disability approval is known as a medical vocational allowance.
Disability benefits for children
For a child filing for disability, there must be functional limitations that prevent the child from engaging in age-appropriate activities. Rendering a decision on a disability claim for a child normally involves a review of the child's medical evidence, but also often requires a review of the child's academic records (grade reports, IEPs, and IQ and achievement testing results), if they are of school age, to determine if they are on-pace with their peers.
How long does a disability decision in Louisiana take?
Decisions on disability claims filed in Louisiana are generally made within 90 to 120 days. When cases are approved, SSA will provide an award notice that details when benefits will commence as well as how much the claimant will receive in monthly benefits and back pay. When cases are denied, SSA will provide a notice of denial detailing the individual's appeal rights and the deadline for filing the disability appeal.
Level II: Request for Reconsideration - Reconsideration is an opportunity for a claimant who has been denied on a disability application in Louisiana to file an appeal and continue pursuing their claim.
The request for reconsideration is the first appeal in the SSA disability claim system and the procedures and qualifications used in the reconsideration process to determine a claim are the same as for the disability application.
Things to keep in mind regarding the reconsideration:
Who handles the reconsideration?
The reconsideration, like the disability application, is handled by a disability examiner at the Louisiana DDS, or disability determination services agency. Because this is the case and because the reconsideration process takes place just a few weeks after the processing of the initial claim, the rate of denial for reconsideration appeals is very high; in fact, reconsiderations usually have a higher rate of denial than disability applications--more than 80 percent.
Typically, only when the reconsideration-level examiner discovers a clear error on the part of the prior examiner, or when the claimant presents either a new diagnosis or new and compelling evidence, will a disability claim be approved at the reconsideration step.
How long does the reconsideration take?
Reconsiderations generally take far less time to process because most of the needed documentation has already been gathered.
That said, if a disability claimant has not returned to a doctor for treatment during the processing of the disability application, it will be likely that the reconsideration-level examiner will need to send the claimant to an appointment for a Social Security medical exam, otherwise known as a CE, or consultative examination. The purpose of a CE is only to acquire recent evidence so that a disablity decision can be made. Consultative exams do not provide treatment and are typically short and cursory.
How long do you have to file the reconsideration?
The request for reconsideration must be made within the alloted appeal time period. The appeal period is 60 days from the date of the denial of the disability application. Social Security offers an additional five days for mailing time; however, claimants should be mindful that the appeal must be received at a Social Security office by the end of this total time period, not simply postmarked by the final day.
Appeals that are not received in a timely manner by SSA will result in the claimant being forced to begin over with a new disability claim. The effect of this is a several month delay on the case and the potential loss of Social Security back pay.
Most requests for reconsideration will be denied and this is a given. However, claimants who are denied may then file the second appeal, the request for a disability hearing before an administrative law judge.
At the hearing level, the qualifications and criteria are the same. However, the odds of qualifying for disability are substantially higher due to the nature of the hearing process. At the hearing, both the claimant and their disability representative--who may be a non-attorney representative or a disability lawyer--may interact with the decision-maker, a federal adminstrative law judge, and present a theory and rationale for the approval of the claim, either through a medical vocational allowance, or by meeting the requirements of a Social Security listing in the SSA list of impairments.
Note: Reconsideration appeals are presently suspended in the state of Louisiana. Conjecture holds that the reconsideration appeal may return; however, currently, individuals who have been denied on a disability application may immediately file a request for a disability hearing.
Level III: Request for Hearing before an Administrative Law Judge - The disability hearing is the second Social Security appeal available to claimants in Louisiana 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
The request for a Social Security hearing will be sent by a claimant or their disability representative, or disability lawyer, to the Social Security office where their claim has, up to that point, been administered. After the Social Security office processes the hearing request appeal, however, the file is transferred to ODAR. Otherwise known as the office of disability adjudication and review, or simply the hearing office, this is where the claim will eventually be assigned to an ALJ or administrative law judge.
We say "eventually" because a case may wait a number of months at a hearing office before it is actually assigned to a particular judge. The wait is generally due to disability hearing backlogs, which may vary depending on which part of the country a claimant lives in and which hearing office has control of their case.
Once a case has been assigned to an ALJ, however, it can potentially take months longer for the hearing date to be established. During that interim period, many claimants will naturally wonder what is happening with their case. At the hearing office end of things, the simple answer is that probably not much or anything at all is happening.
The exhibit list
Many or most (but not all) Social Security hearing offices will compile an exhibit list for the hearing which is analogous to a book index. The exhibit list is a listing of everything that is currently in the claimant's file, including medical evidence, past decisions, reports of contact that have occurred between a claimant and a disability examiner (if the examiner, for example, spoke to the claimant about their work history, daily activities, or medical treatment sources), and residual functional capacity assessments that were made by a DDS physician or DDS psychologist.
The exhibit list is important because once the claimant's disability attorney or non-attorney disability representative receives a copy of the exhibit list, they can identify at a glance what medical evidence has been entered into the claimant's disability file, organized by specific medical provider (hospitals, clinics, doctors).
However, in terms of real case development, nothing is actually occurring at the hearing office. This is because once a case moves beyond the reconsideration appeal stage, the Social Security Administration ceases to perform any case development work, which is primarily gathering medical evidence.
This is exactly why, when a disability hearing does occur, the medical evidence in the file will usually be many months old. Disability approvals cannot be made without current evidence, of course, because the SSA position is that, to award ongoing monthly disability benefits, there must be evidence to prove that the claimant currently meets the qualifications for disability.
Preparing the disability case for a hearing
It is crucial that a claimant or their disability representative should obtain medical record updates (to cover any periods of treatment happening after the reconsideration-appeal stage of the claim) and submit them to the judge who hears the case. Most representatives will also endeavor to obtain a supporting statement from a claimant's treating physician.
This type of statement is known as a medical source statement and it is very similar to a residual functional capacity assessment that is made at DDS when the case is determined at the disability application and reconsideration appeal levels.
The primary difference between the two, however, is that an RFC rating is made by a doctor who works for Social Security (a unit medical consultant at disability determination services) while a medical source statement is provided by a claimant's own doctor.
With an RFC assessment, the DDS medical consultant, at the application and reconsideration levels, has provided an opinion on the claimant's functional capacity (which translates to ability to work) without ever having treated or seen the claimant. The medical source statement, on the other hand, represents the medical opinion of a doctor who is familiar with the claimant's condition, has provided treatment for the condition, and is qualified to issue a statement concerning the claimant's functional limitations.
It should be fairly obvious which of the two opinions should be accorded the greater weight. Unfortunately, disability examiners rely on the opinions of the doctors who work with them, while going so far as to disregard the opinion of a doctor who has actually treated the claimant.
At the hearing level, however, judges who follow the directives of rulings do give deference to the opinion of a claimant's own doctor. Which is why it is so very important for a medical source statement to be obtained for a hearing and why so many disability lawyers and disability representatives will work to obtain one for presentation to the administrative law judge.
Note: The hearing approval rates listed above are for the state of Louisiana at-wide. Louisiana has multiple disability hearing office locations with rates of approval ranging from 44.4 percent to 32.7 percent.
The Alexandria LA hearing office has a disability award rate of 43 percent; The Metairie LA hearing office has a disability award rate of 38.7 percent; the New Orleans LA hearing office has a disability award rate of 44.4 percent; the Shreveport LA hearing office has a disability award rate of 32.7 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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