Applying for Disability in New Jersey
How to apply and qualify for SSD, SSI in New Jersey (NJ)
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 - A claim for disability in New Jersey will typically have approximately a 30 percent chance of being approved. In an average year, the denial rate at the application level may border on 70 percent for all claims filed.
For this reason, claimants should prepare for the possibility of having to file at least one appeal before winning benefits, though in the majority of cases (since the denial rate is even higher on the first appeal), a claimant will need to file two separate disability appeals.
The first appeal is a request for reconsideration which employs the same process of evaluation as the disability application. The second appeal is a request for a disability hearing before an ALJ, or administrative law judge.
Filing the disability claim
Each application for disability will typically start in a field office, or Social Security office. Claimants do have the option of filing for disability online, or by calling the SSA toll free line to file a claim with the teleclaims center. However, the toll free line is not perceived to be the best choice because it is often a source of incorrect information. And the online process does not allow an SSI claim to be taken.
Applying for disability at a local office allows a claimant to interact with the CR, or claims representative. The CR essentially gets the claim started and then transfers it to the disability examiner at the state disability agency (DDS, or disability determination services) who handles the medical evaluation of the case.
Initiating the claim in a local office also allows questions to be asked and answered directly, which can eliminate confusion and avoid mistakes. Individuals who have difficulty getting to a field office may request that their disability application interview be conducted over the phone. This may also be requested for claimants who simply prefer a phone interview.
The disability application interview
At the field office level, each claimant is interviewed to determine if they meet the basic eligibility requirements, i.e. is the person working and earning more than the allowable limit for substantial and gainful income, or, if the application is for SSI, does the individual have countable assets that exceed the allowable limit?
If it becomes apparent that the claimant will be unable to satisfy the non-medical qualifying requirements, the claim will be quickly denied through the technical denial process in which no medical evaluation is conducted.
The disability decision process
During the interview, information will also be obtained from the claimant in order to determine if they meet the medical and vocational qualifications for disability.
For adult claimants, the disability decision will most often be both medical and vocational in nature, meaning that Social Security will consider the limitations an individual has a result of their residual functional capacity (what they can still do despite their impairment, or impairments) in conjunction with the types of work they may have done in the past.
The disability examiner, the processing specialist who actually makes a decision on the claim (after the application for disability has been taken at a Social Security office), will follow a five step sequential evaluation process in which the claimant's functional limitations are compared to the physical and mental demands of their past work.
If a) it is determined that they are unable to return to their past work (which potentially includes any work performed in the last 15 years, what SSA refers to as the relevant period) and b) it is further determined that they are unable to perform other work that their skills and education might ordinarily qualify them for, they will meet the standard for disability and be awarded benefits.
Note: Not all disability approvals will be based on a medical-vocational decision that takes into account the claimant's work history, as well as their history of medical treatment. Some cases will be approved on the basis of satisfying a listing in the Social Security Disability list of impairments.
Very few cases, however, are approved on the basis of a listing as the listing requirements are specific and require equally specific information from the medical record documentation.
Filing for disability for a child
An application for disability in New Jersey that is filed on behalf of a child will follow the same processing steps as an application for an adult. The difference will be that in place of evaluating the work history, a claim for a child will rely on medical documentation and, if the child is of school age, academic records as well. The goal for determining disability for children is to ascertain if the child is capable of engaging in age-appropriate activities.
Social Security appeals
For those individuals who are denied and decide to follow the appeal process, the chance of eventually receiving a disability award will be favorable.
Claimants who have their cases heard by an ALJ, or administrative law judge, for instance, will have approximately a 60 percent chance of being awarded. This is usually conditioned on presenting a well-developed claim that puts forward a theory of the case, i.e. a reasoned basis for approval, given the facts of the case.
However, before an appeal before a judge may be requested, a claimant must first go through the reconsideration appeal process.
Level II: Request for Reconsideration - Reconsideration is the first appeal that an individual who has been denied on an application for disability may file.
A reconsideration may be requested as soon as a notice of denial, or notice of disapproved claim, has been received. To request the reconsideration, a call should be made to the Social Security office where the initial claim was filed. The SSA field office will then mail out the appropriate paperwork to be completed, signed, and returned.
If the claimant has received an additional diagnosis, or their condition has worsened, or they have had additional medical treatment (particularly with a new treatment source), this should be indicated on the disability report form for the reconsideration appeal so the disability examiner will know to send out a request for this information.
SSA has a fairly generous appeal period. A claimant is given 60 days, plus 5 additional days to account for mailing of documents. Despite this, a person would be wise to get the appeal filed as soon as possible after learning they have been denied simply to reduce, as much as possible, the total time spent on their case.
Also, after submitting the appeal, it is generally a good idea to make a followup status call to the Social Security office 10-14 days after the appeal has been sent in to verify that it was received. This may help avoid a situation in which the appeal deadline is missed because SSA did not receive what was submitted. With this possibility in mind, a claimant may wish to make a copy of their appeal before submitting it.
Individuals who are already represented by a disability attorney or non-attorney disability representative will have their appeal submitted for them. Nonetheless, it is a good idea to contact the representative's office when the letter of denial is received to verify that both parties have received the notification.
The qualifications for disability are the same at the reconsideration appeal as at the disability application level. The process is essentially identical, meaning that a case can be approved on the basis of satisfying the requirements of a listing, or approved on the basis of a medical vocational allowance, a type of decision where the determination is made that the individual's physical and/or mental limitations no longer make it possible for them to engage in substantial and gainful work activity.
The rate of denial at the reconsideration appeal level tends to be higher than the application level. It is generally higher than 80 percent in most states. This is not surprising considering the fact that the evaluation process is the same at both levels. The only significant difference is that a different disability examiner is involved at each level.
Individuals who are denied on a reconsideration should immediately file a request for a hearing.
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.
Basic facts about disability hearings
1. There are two ways of being approved for disability at a hearing - The first is by the judge (administrative law judge or ALJ) awarding SSD or SSI benefits on the basis of a listing. This is achieved when a claimant's medical records indicate that they have a medical condition that satisfies a particular listing, such as the listing for asthma or for one of several musculoskeleletal conditions.
Being awarded disability benefits on the basis of a listing is somewhat difficult because A) most medical conditions are not included in the Social Security list of conditions and B) the approval criteria of a listing is fairly difficult to satisfy in most cases.
In most cases, if a case is to be approved by a judge at a disability hearing, it will be on the basis of a medical vocational allowance. This is when the judge reviews the medical evidence and the claimant's work history and determines that they no longer possess the ability to work at a level at which they can earn a substantial and gainful income.
This type of approval relies more heavily, of course, on a claimant's disability attorney proving their case. This is because there are a number of arguable elements of a case, such as the claimant's RFC, or residual functional capacity, and the skills involved in the claimant's past relevant work.
Note: past relevant work is defined as potentially any job that was done in the fifteen year period prior to becoming disabled, as long as the job was done long enough for the individual to learn the requirements of the job and the job provided a substantial and gainful income while it was done.
2. There are three types of decisions - When cases are approved by judges at disability hearings, the approval may be fully favorable or partially favorable. The difference between the two has to do with onset date.
When a person applies for disability benefits, they are asked to state an AOD, or alleged onset date, for their disability. This is basically when they claim their disability began. If the judge approving the case agrees with this date, the decision will be fully favorable. If the judge believes the claimant's disability does not go as far back as the claimant believes (based on the medical evidence), then the decision will be partially favorable.
What does it matter if the decision is partially or fully favorable? It actually matters quite a bit. The farther back the onset date is set, the more likely it is that the claimant will not have to wait very long (or at all) for their medicare coverage to begin. Also, the further back the onset date is set, the more in Social Security back pay the claimant may potentially collect.
Establishing the most favorable onset date is accomplished by pointing out relevant information in a claimant's medical records. And sometimes it is partially accomplished through an examination of the claimant's work history. But in all cases, the issue of onset (and how much back pay a person may be entitled to) becomes a clear reason for obtaining disability representation for a hearing.
3. You may submit evidence for your hearing - Not only is a claimant allowed to submit evidence for a hearing, they are practically guaranteed to lose their case in most instances if they do not. This is because while a disability examiner will gather a claimant's medical records at the disability application and reconsideration appeal levels, at the hearing level the Social Security Administration does none of this. Therefore, by the time a hearing takes place, the only records in the file are those that were gathered many months before, meaning that they are certainly out of date (anything older than 90 days is considered aged and not acceptable for proving that a person is currently disabled).
Claimants who show up at disability hearings alone and unrepresented are sometimes surprised to learn that they essentially have no evidence to support their claim. Again, this highlights the value of representation. One of the chief goals of a representative is to ensure that by the time the hearing comes to pass there is substantial evidence available to the judge to prove that the claimant's case meets the standards for disability. Representatives accomplish this by gathering recent medical records but also by obtaining statements from a claimant's own doctor, or treating physician. Which brings us to the final point.
4. A statement from your doctor can be helpful - A statement from a claimant's doctor can actually make the difference between winning or losing a case. At the earlier levels of the system, a doctor's statement may not have any effect at all on a case. This is because disability examiners rely on the input of medical consultants who work in their case processing units, but also because examiners have no training in basic Social Security law, such as the code of federal regulations and the various SSRs, or social security rulings. Judges, however, make decisions according to law. As such, the written opinion of a claimant's doctor, as long as it is not in conflict with the doctor's own medical records, can be considered as the chief evidentiary authority in the case. And this is why most disability lawyers and representatives will attempt to secure a medical source statement for a case, otherwise known as an RFC form (RFC stands for residual functional capacity)
Note: While New Jersey has an average disability hearing approval rate of 58.7 percent, the individual hearing offices in New Jersey vary widely in their award rates. The Jersey City NJ hearing office has a disability award rate of 47.1 percent, the Newark NJ hearing office has a disability award rate of 57 percent, and the South Jersey NJ hearing office has a disability award rate of 67 percent.
For the region to which New Jersey is attached (SSA Region 2) the rate of approval for cases at the hearing level is 55.5 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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