Applying for Disability in Maine
How to apply and qualify for SSD, SSI in Maine (ME)
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 - Statisically, an application for disability in Maine may be approved between one-third and one-quarter of the time, making it necessary for up to two-thirds of claimants to follow the appeal process before they may qualify for disability benefits.
For the majority of claimants, seeking disability benefits through the Social Security Administration will generally involve multiple stages. The process begins with an initial claim, followed by, in the event of a denial of a disability application, a request for reconsideration appeal.
Reconsiderations tend to have a lower rate of approval than initial claims (disability applications). Therefore, for many claimants, the process will end with the request for a disability hearing before an administrative law judge, or ALJ.
Applying for disability in Maine
Starting an application for disability in Maine should, ideally, begin with contacting a local Social Security office. Claims may be filed online. However, this can only be done for title II Social Security Disability claims.
At present, it is not possible to file a title 16 SSI disability claim online. The majority of claimants, of course, will have no way of knowing if their claim for disability will involve only SSD, only SSI, or both SSD and SSI in the form of a concurrent claim.
disability interview will be for the claimant to provide all the information that is necessary to process the claim.
However, of particular importance will be information regarding the claimant's history of medical treatment and, in most cases, their work history as well. For this reason, it will be practical for most claimants, prior to their interview appointment, to write down this information. This will allow for more detailed information and quite possibly prevent the omission of important details.
The medical treatment and work history
With regard to the medical treatment history, the claimant should be careful to provide a list of all diagnosed conditions, symptoms, and complaints, the names of all treating physicians, and the names and addresses of all medical treatment providers (hospitals, clinics, doctor's offices).
This information will be used by Social Security--specifically by the disability examiner--in requesting medical records. The more complete the information is, the greater the probability of obtaining records that document the existence of functional limitations that substantiate the claimant's limited ability to work, as well as the onset date of the claimant's disability.
The onset date is important for:
A) Establishing how much disability back pay the claimant may be eligible to receive and
B) Determing when a claimant who is eligible for medicare coverage may have their coverage activated.
Note: the time required to obtain medical records typically constitutes the single largest delay on a claim for disability benefits.
With regard to the work history information, the claimant should provide a list of all jobs held within the 15 year period prior to becoming disabled. This is known as the relevant work period and jobs held before this period are not considered.
The work history should include job titles, detailed descriptions of all work duties associated with each job, and the date ranges for all jobs. This information will allow Social Security to determine which of the claimant's jobs were relevant to their disability claim, what the physical and mental demands of the claimant's past work might have been (in relation to their current functional capabilities), and the skill levels possessed by the claimant.
Qualifying for disability in Maine
Qualifying for disability in Maine or any other state will mean substantiating that one's physical or mental condition is of a severity level that effectively eliminates their ability to engage in work activity that earns a substantial and gainful income (known as SGA, or substantial gainful activity).
The Social Security definition of disability also mandates that to meet the qualifications of SSD or SSI, a claimant's state of disability must exist for a year or longer. Cases in which disabling conditions do not last this long will be denied on the basis of duration.
However, it should be pointed out that in meeting the requirements for disability, this one year minimum duration length can be projected at the time of application, meaning that a person does not have to wait 12 months after becoming disabled before filing a claim. The claim may be filed at any time.
How is the disability decision made?
After an initial claim is taken at a local Social Security field office, the claim is transferred to a state disability processing agency. In most states, this agency is referred to as DDS, or disability determination services. At DDS, the claim is given to a claims processing specialist known as a disability examiner.
The disability examiner will be responsible for obtaining the claimant's medical records based on the information provided at the time of application. Once this information has been received, though, the examiner will review it to determine whether or not the claimant has a medical condition (mental, or both physical and mental) that meets the criteria of a listed impairment in the Social Security list of impairments.
Most claims will not be approved on the basis of a listing, however. The bulk of claims that are approved will meet the requirements for disability after a five step sequential evaluation process has been conducted that results in a medical vocational allowance.
In this process, both the medical evidence and the claimant's work history will have been reviewed to determine whether or not the claimant has the ability to return to their past work, or the ability to engage in some type of other work. If the claimant cannot go back to a former job, and cannot transition to a new job doing some type of other work, they will meet the qualifications for disability.
Assuming that they also meet whatever non-medical requirements apply to their case (e.g. consideration of assets will apply to SSI, though not to SSD), they will be approved to receive ongoing monthly disability benefits and usually some amount of Social Security back pay as well.
Level II: Request for Reconsideration - A person who has been denied for disability in Maine may file an appeal known as a request for reconsideration.
Note: This request should be made immediately following the denial of the application. Social Security will allow 60 days for the filing of this, or any, appeal. However, it will be in the claimant's best interests to get the appeal filed as soon as possible to minimize case processing time.
Individuals who are represented by a disability lawyer or non-attorney disability representative will have their appeal submitted by this individual. Note: Disability representatives receive copies of all correspondence sent to claimants, including notices of denial and examination appointment letters.
Even so, a represented person should contact their representative to verify that both parties have received the denial notice (to avoid the undesirable situation of a missed appeal deadline which could result in a less favorable filing date and potentially less money in disability back pay).
Individuals who do not have disability representation should contact SSA and request that the appeal forms be mailed out to them (the appeal request, the appeal disability report form, and the medical release forms).
After completing, signing, and returning them to Social Security, the claimant should keep a copy of the forms (in case the submitted forms are not received by SSA) and should also make a note to perform a followup status call to the Social Security office within 2 weeks of submitting the paperwork.
The Reconsideration decision process
A reconsideration appeal is nearly indistinguishable from a disability application in terms of how it is processed. As with an initial claim, the case is processed at the state disability agency usually referred to as DDS.
At this agency, a disability examiner will, once again, review the claimant's medical records to determine whether or not they can be approved on:
1) The basis of satisfying the disability requirements of a listing (in the Social Security list of impairments, also known as the blue book) or
2) Via a medical vocational allowance, a type of decision in which consideration is given to whether the claimant can return to their past work as well as whether or not they can perform some type of other work.
The chances of approval at the reconsideration level
The evaluation process and the qualifications for disability at this appeal level are the same as at the initial claim level. For this reason, it should come as no surprise that reconsideration apeals are unlikely to be approved. In fact, the chances of receiving a Social Security Disability award or SSI award at this level are significantly lower than on a disability application.
In the majority of claims, an approval on a reconsideration request, effectively a reversal of the disability application decision, will only occur if:
A) The claimant's condition significantly worsens between the time the application is denied and the reconsideration request is filed or
B) New evidence is brought into the case that was previously not available to Social Security, or
C) The reconsideration examiner discovers a clear error on the part of the prior examiner.
Reconsideration appeal decisions are typically made faster than disability application decisions. It is not unusual to receive a reconsideration decision in under 4-8 weeks.
Individuals who are denied on a reconsideration--and this is usually the case--should, once again, immediately file an appeal. The second appeal is a request for a Social Security hearing.
Level III: Request for Hearing before an Administrative Law Judge - As the previously mentioned statistics indicate, the chances of approval are not exceptionally high.
Individuals who file for disability benefits in Maine should consider this at the outset; that and the fact that the appeal process is usually a necessity. Most claimants, though, who appeal their cases, will be approved at the hearing stage.
Why is a claim more likely to be approved at a hearing?
In some cases, the claimant's medical condition may have worsened by the time they get to a hearing.
However, the nature of the hearing appeal probably has more to do with the higher rate of approval. Hearings allow claimants to appear before the decision-maker on their case. And more often than not, claimants at hearings have disability representatives who advocate for their case.
Good advocacy, of course, means having established a rationale for approval based on the strength of medical evidence which may include supplemental records that have been gathered, as well as a qualified statement from a claimant's doctor.
Additionally, a primary benefit of using an experienced representative is that the individual aspects of the case may be parsed and analyzed, such as the significance of the claimant's relevant work history, in addition to the information provided in the medical treatment history.
Why do claims often fail to qualify for disability at the application stage? At this level, decisions on cases are made by disability examiners working in state disability agencies (usually, known as DDS, or disability determination services).
Technically, examiners render decisions on initial claims, but disability examiners also work with medical consultants, psychological consultants, and supervisors. Thus, the decisions they make are subject to outside interpretation, modification, and are also subject to different levels of quality control.
The result of this working environment is that examiners tend to make fewer approvals on SSD and SSI claims than judges at disability hearings.
Note: The Social Security hearing office in Portland ME has a disability award rate that is higher than the national average and also higher than SSA region 1 (50 percent, 51.9 percent respectively).
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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