Will I Qualify For Disability Benefits in New York?

In a recent period, 37.8 percent of disability applicants in New York were approved for benefits on their initial claim (i.e. disability application) as compared to a national average approval rate of 31.7 percent.

A person filing in New York may have a slightly better-than-average chance of being awarded benefits. That said, up to 60 percent of claimants will still face the prospect of being denied and having to pursue their claim through the Social Security appeals process.

Filing a disability claim in New York

To qualify for Social Security Disability or SSI disability benefits in New York, a person must first file an application. In New York, like other states, you can file a Social Security Disability application online, or by phone or in person at a local Social Security office.

At this point in time, the disability application process can be handled more thoroughly by your local Social Security office. This is because the online process does not allow for a face-to-face disability interview to be conducted between conducted between a claimant and a Social Security CR, or claims representative, which allows for the opportunity to ask and receive answers to specific questions about the filing process during the disability interview.

However, this is particularly true for claims involving the title 16 SSI disability program. The reason for this is that A) a large percentage of claims will involve both SSD and SSI concurrently, B) claimants will have no way of knowing in advance if their claim is for SSD, SSI, or if it will be filed in both programs, and C) the Social Security Administration does not offer a way to file an SSI application online.

If you have reason to believe your claim will not involve SSI and will involve Social Security Disability only, you may wish to file online, but you will need to be careful to complete all the necessary online forms. Many disability applicants manage to file their application online but, more often than not, fail to complete the necessary disability report form, or medical release form. This, unfortunately, sets the stage for a quick denial of a claim.

If Social Security does not receive these forms within thirty days of your online application date, they may deny it for failure to cooperate or pursue, and send a closeout letter. Note: this happens routinely when the claims process has been started online.

The disability claim evaluation process in New York

The Social Security Disability process is the same for every state in that you file an application that provides medical and work information. Once your disability file is complete, your disability claim is sent to a state disability processing agency for a medical determination. Social Security uses federally funded state disability agencies to make their disability determinations.

Some states have one centralized disability agency while other states are decentralized and have multiple disability agencies. New York has a decentralized system. There are four disability determination services agencies. They are located in Albany, Bowling Green Station, Buffalo, and Endicott, New York. It really does not matter other than knowing where your disability file has been sent for a decision (for example, if you choose to contact your disability examiner to discuss some aspect of the case, provide additional material that is pertinent to your case, or simply to obtain the status of the case).

Disability examiners gather medical information from the treatment sources you provided at your disability application interview. If they feel they do not have enough current medical information to make their disability determination you will have to attend a consultative examination.

Most likely they will also send out a work report form for you to more thoroughly address your work activity for the fifteen years prior to your becoming disabled and other questionnaires designed to provide a better picture of how your disabling condition prevents you from performing substantial, self-supporting work activity. After the disability examiner gets the necessary information, they will approve or deny your disability claim.

If your disability claim is denied in New York, you can appeal the decision with a reconsideration appeal, if your reconsideration appeal is denied you can appeal that decision through an administrative law judge disability hearing appeal. Reconsideration appeals have a decidedly low approval rate while disability hearings have the highest approval rates of the entire disability process.

Only 14.0 percent of the disability applicants who file reconsideration appeals qualify for disability in New York. However, that is still above a national reconsideration approval rate that averages 11.0 percent.

About 53.2 percent of disability applicants who attend disability hearings in New York qualify for disability compared to a national average of about 50.0 percent. However, these statistics are derived from both represented and unrepresented claimants. Claimants who appear at hearings unrepresented tend to win approximately 40 percent of the time while represented claimants tend to be awarded up to 60 percent of the time.

Note: The request for reconsideration appeal step is currently suspended in the state of New York as New York is one of 10 prototype states testing a system in which denied claims move immediately to the hearing level upon appeal. Reconsideration may be reinstated at some point and many consider this likely. In the meantime, a claimant who is denied on a disability application should request, and prepare, for a hearing before a federal administrative law judge.

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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