Successfully Applying for Disability Benefits in New Mexico

Applying for Disability in New Mexico

How to apply and qualify for SSD, SSI in New Mexico (NM)

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 benefits in New Mexico will meet the requirements of the Social Security Disability or SSI program approximately 30 percent of the time on their initial claim. This is in line with the national average, though it will mean that as much as 70 percent of claimants will find it necessary to enter the appeal process before finally receiving a disability award from SSA.

The disability adjudication process in New Mexico is administered by the Social Security Administration and is regulated by the various rules, regulations, and court rulings that enforce the federal Social Security Act.

Each SSI disability application to be taken; therefore, since most claimants will not know in advance if their claim will be for title II benefits (Social Security Disability), title 16 benefits (SSI), or a combination of both benefits (known as a concurrent claim), it is generally advisable for an individual to locate their nearest Social Security office and make arrangements to file a claim.

Applying in person

Applying for disability in person will allow a claimant to directly ask questions to the claims representative who takes the application. Additionally, local Social Security offices will allow claimants the option of having their application interview conducted over the phone for those who have mobility or transportation issues. This may also be requested for claimants who simply prefer a phone interview.

The process of qualifying for disability benefits in New Mexico involves multiple offices of the SSA system. While the initial claim, or disability application is taken at a local Social Security office, the claim is not medically processed there, nor is the decision made by the claims representative, or CR, doing the intake for the application.

After a claim is started, it is transferred to a disability examiner who will do the following:

A) Gather the medical evidence from the treatment sources listed on the disability report form completed at the time of application.

B) Evaluate these records to determine the claimant's current level of physical and mental limitations, or restrictions (known as RFC, or residual functional capacity).

C) Compare the claimant's limitations to the demands of their previous work history (if they are an adult) or to the activities that are considered to be appropriate to their age (if they are a child filing for disability).

The criteria for disability stipulates that each claimant must possess a severe impairment that interferes with the ability engage in normal daily activities. For adults, this will mean difficulty engaging in work activity and for children filing for disability this will mean difficulty performing age-appropriate activities.

Approval Scenarios

An approval for disability, for an adult applicant, will be made when one of the following scenarios applies:

Scenario 1: When a review of the medical evidence reveals that the claimant has a medical condition, mental or physical, that satisfies the requirements of a listing in the Social Security Disability list of impairments, otherwise known as the impairment listing manual or blue book. When a case is approved via a listing, the decision is medical only, not medical-vocational. Translation: being approved on the basis of a listing only involves the claimant's medical records; there is no need for the claimant's relevant work history to be reviewed.

Most conditions are not included in the listings. And satisfying the disability requirements of a listing, either by meeting or equaling them, can be difficult given the nature of the listings, i.e. the listing qualifications tend to be very specific and, thus, require fairly specific medical record documentation.

Most disability claims that are approved are not approved on the basis of a listing, but, rather through a process of considering the claimant's functional limitations, their past work demands, and their job skills.

Scenario 2: When a review of the medical evidence and the claimant's relevant work history (potentially any job they have worked in the 15 year period prior to becoming disabled) reveals that an adult is incapable of returning to their past work, and is further incapable of doing some type of other work--for which they might otherwise be suited based on their age, level of functional limitations, education, and skills.

Note: It is crucial to provide very detailed information regarding both the medical and work histories when a claimant is filing for disability and being interviewed by a CR, or claims representative.

Providing medical and work history information

With regard to the history of medical treatment, claimants should provide a list of all hospitals, clinics, and doctor's offices. This information should go back at least as far when the claimant's condition or conditions began as proving the earliest possible onset date can have a substantial effect on how much disability back pay a person is determined to be eligible to receive.

The names of all treating physicians should be included since, prior to a disability hearing (should a hearing be necessary), a disability attorney or disability representative will likely attempt to obtain a supporting statement from a treating physician, i.e. a medical source statement.

Also, the correct names and full addresses of all medical facilities should be included since this will assist the disability claims examiner in their efforts to obtain all the needed medical records. Providing incomplete contact information for sources of medical treatment can add significant delays to the processing of a case. In fact, the time used to request and receive medical records tends to account for the largest delays on a disability case.

With regard to the vocational work history, claimants should provide not only the titles of all past jobs and the date ranges for all past jobs, but detailed descriptions of the duties and responsibilities for each job.

This information will be used to identify each job in a reference source known as the DOT, or dictionary of occupational titles, which will be used to assess the skill levels possessed by the claimant. Incorrectly identifying the claimant's past jobs may lead to a faulty conclusion regarding the skills possessed by the claimant, and may influence the outcome of the claim.

Children filing for disability in New Mexico

Children may be approved on the basis of a childhood listing in the Social Security Disability list of impairments. The medical-vocational process, which includes consideration of a claimant's work history, of course, does not apply to a child filing for disability.

Instead, children who meet the qualifications for disability (under the SSI program) will typically be approved when a review of medical records, school records, testing scores, and, possibly, teacher questionaires indicate that they are limited in their ability to stay on pace with their approximate-age peers.

The inability to perform "age-appropriate activities" is the standard for determining whether or not children qualify for disability benefits.

  • Disability application denial rate: 69.9 percent.
  • Disability application approval rate: 30.1 percent.

    Level II: Request for Reconsideration - The request for reconsideration is the first appeal that is available to a person who has been denied on their application for disability. The reconsideration does not offer the highest chance of success on a claim. In fact, the rate of denial is higher than for the preceding disability application.

    However, though a small percentage of reconsiderations (usually 10-15 percent) are approved, for those who are once again denied at this level, the next level of the system--the request for a disability hearing presided over by an administrative law judge, or ALJ--offers a substantially higher chance of receiving a Social Security Disability award or SSI disability award.

    What a claimant should know about the reconsideration process

    1. A request for reconsideration may be made after a disability application has been denied. It must be requested within 60 days of the date of the denial of the disability application. Social Security will allow an extra five days to account for mailing time so the total appeal period is actually 65 days.

    2. A reconsideration appeal must be submitted by the 65th day from the date of the denial not simply mailed and post-marked by the 65th day. Do not make this mistake since it will result in a late appeal.

    3. If an appeal arrives late at a Social Security office and there is no good cause (an acceptable reason for being late), the claimant will be forced to begin again with a new claim. This will result, most likely, in several months of additional case processing time. It will also probably mean a reduction in the amount of disability back pay that the claimant is eligible to receive.

    4. The qualifications for disability are the same at the reconsideration level. In fact, the process does not change at all. It is for this reason that claims are unlikely to be approved at this level.

    Nationally, more than 80 percent of reconsideration appeals are denied, a much higher rate of denial than the disability application stage.

    Individuals who are denied on a reconsideration and request a hearing appeal, however, are statistically likely to win disability benefits if they are represented by a disability attorney or non-attorney disability representative and the case is well-supported by a) medical evidence, b) a thorough evaluation of the claimant's vocational work history, and c) a logical theory of the case that is advanced by the representative to the judge.

    5. The decision on a disability reconsideration will usually be made faster than the decision on a disablity application. Most claimants should expect to receive a decision in 4-8 weeks.

    6. After a reconsideration appeal has been submitted, a claimant should make a followup call to the Social Security office to verify that it was received. This will help avoid situations involving late appeals and missed deadines.

    In this same vein, even claimants who are represented and will have their representation submit their appeal for them should still contact their disability representative once they receive their letter of denial. This will verify that both parties have received the notification and that the appeal will be submitted in a timely manner.

  • Reconsideration appeal denial rate: 90 percent.
  • Reconsideration appeal approval rate: 10 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.

    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

  • Disability Hearing denial rate: 33.8 percent
  • Disability Hearing approval rate: 66.2 percent

    Note: There is at present a single Social Security Hearing office in New Mexico (officially, known as ODAR, the office of disability adjudication and review).

    The hearing office in Albuquerque NM has a disability award rate that is moderately higher than the national average for hearing-level approvals. That said, however, approximately one-third of claimants who go to hearings in New Mexico will be denied, though this number will be higher for unrepresented claimants.

    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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