Applying for Disability in Ohio
How to apply and qualify for SSD, SSI in Ohio (OH)
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 applying for SSD and SSI disability benefits in Ohio are denied at the disability application level at a rate higher than 70 percent, making it a necessity, in most cases, for claimants to file at least one appeal.
In actuality, the majority of claimants who do not qualify for disability on their claim will find it necessary to file two appeals, the first being a request for reconsideration, and the second being a hearing request which will take their case before a federal judge at a disability hearing.
Medical and non-medical requirements
For adults filing for disability benefits in Ohio, receiving a Social Security Disability award or SSI disability award will be dependent upon satisfying medical disability requirements and non-medical disability requirements.
The medical disability requirements of a claim come into play once the case has been assigned to a disability claims examiner who will review the medical and vocational evidence. The non-medical requirements are usually addressed while the claimant is undergoing the process of applying for disability.
The Non-medical requirements for both SSD and SSI dictate that a claimant must not be working and earning what the Social Security Administration considers to be a substantial and gainful income, otherwise known as SGA. Individuals may work and file for disability, and may even work and receive disability benefits, but only as long as their gross monthly income is under the SGA limit.
Additionally, for individuals filing under the title 16 SSI disability program, there is also the non-medical requirement of being under the asset-resource limit of $2000, in countable assets, in order to maintain eligibility as well. The asset limit does not apply to the title 2 SSD, or Social Security Disability, program.
Concerning medical requirements of SSD and SSI, the qualifications for disability are mandated under the Social Security Administration definition of disability. The definition is fairly specific and establishes a five step disability evaluation system that is used by disability examiners and judges alike.
The two methods of being approved for disability
Under the sequential evaluation system, to receive a disability award, a claimant must either be approved on the basis of satisying a listing--in the bluebook, or Social Security Disability list of impairments--or be approved on the basis of a medical vocational allowance.
Satisfying the requirements of a condition in the listings can be fairly difficult for a number of reasons. The listings are very precise and require highly specific information from a claimant's medical records. In most cases, a claimant's records will not provide the necessary substantiation. Also, however, is the fact that most medical conditions are not listed in the blue book. Carpal tunnel syndrome is one such example.
The majority of claims will not be approved on the basis of a listing, but, instead via a medical vocational allowance. This type of determination involves an analysis of the claimant's work history (going back at least 15 years prior to the time of disability) as well as their history of treatment.
Therefore, for this reason, it is critical that a claimant provide a detailed work history and a detailed medical treatment history when the disability application interview is conducted at a local Social Security office. The interview will be conducted by a CR, or claims representative, who will be responsible for the intake portion of the claim.
However, the CR will not medically process the case. That is the function of the disability examiner at the state disability agency (referred to, in most states as DDS, or disability determination services). The CR transfers the case to the examiner after the disability application and disability report form have been completed. The examiner will gather all the necessary medical records for the case but will depend entirely on the information that has been provided to the CR--by the claimant--during the application process.
Providing medical treatment and work history information
Note: For most individuals filing for disability, it is practical and efficient to write down the medical treatment history and work history prior to the appointment for the disability application interview. This will allow for greater detail and leave less room for the omission of important information.
With regard to the medical history, a claimant should be careful to provide all dates of treatment, the names of treating physicians, all diagnosed conditions, and the names and addresses of treatment facilities (without this information, the disability examiner may experience difficulty sending out requests for medical records.
With regard to the vocational work history, a claimant should list all jobs performed within the last 15 years, what SSA refers to as the relevant period. Job titles should be provided, but also dates worked for each job, and, most importantly, the duties performed for each job, since the examiner will refer to a jobs database to look up each job and their mental and physical requirements.
How is the disability claim evaluated?
According to the Social Security definition of disability, a claimant must have a severe physical impairment, or mental impairment. The impairment, or impairments, must interfere with the ability to engage in normal daily activities, and, in particular, the ability to perform work duties.
This level of severity can be demonstrating by satisfying the requirements of a disability listing. However, if the impairment is severe enough that it prevents the ability to work and earn a substantial and gainful income for a period of at least one year, preventing the claimant from engaging in past work and further preventing them from switching to some type of other work, they can expect to be approved for disability benefits under the SSD or SSI program, or both programs if the case is for concurrrent benefits.
Children and filing for disability
A child filing for disability in Ohio will need to prove that their mental condition or physical condition is medically determinable, meaning supported by objective medical evidence. Beyond that, it must be shown that their condition is severe enough to prevent the child from engaging in age-appropriate activities. This will necessitate a review of medical record documentation, and, usually, academic records if the child is of school-age.
Level II: Request for Reconsideration - Disability claims that have been denied may be appealed. All appeals, at all levels, must be filed within 60 days of the date of the denial letter, or notice of disapproved claim. This date is generally stamped in the upper right hand corner of the notice.
For claimants who have been denied on a disability application in Ohio, the appeal to be filed will be a request for reconsideration. The reconsideration is essentially a repeat of the disability application.
Once again, the claim is sent by the Social Security office to a disability examiner at DDS (this time a different examiner) who will review the medical records for evidence of functional limitations that are great enough to rule out the claimant's ability to perform basic daily activities and engage in work activity.
In this sense, the evaluation and qualifications process is unchanged. Reconsideration decisions typically occur much faster than decisions on initial claims. This is because most of the development work has already occurred.
In some cases, enough time may have elapsed that the claimant's file no longer has recent medical record documentation (recent is defined as not older than 90 days). In such cases, the claimant will be sent to a Social Security medical exam, otherwise known as a CE, or consultative examination.
In addition to being made faster, reconsideration decisions also have a higher rate of denial. This is also because the process is largely unchanged between the first two levels. Claimants will not usually be awarded benefits at this level unless the reconsideration examiner can find fault with the decision of the initial claim examiner, or unless new and strong medical evidence comes to light during the reconsideration process.
Requesting the reconsideration
To ask for a reconsideration, a claimant who has been denied on a disability application should contact their local Social Security office. The appeal request and a disability report form will be mailed out, which should be completed, signed, and returned to SSA as soon as possible.
Note: Before mailing the appeal paperwork back to Social Security, a copy should be made in case the appeal forms are not received. Also, within two weeks of mailing the appeal forms, the claimant should make a followup status call to verify that the appeal has been received so that a late appeal situation can be avoided.
Claimants who are already represented by a disability attorney or non-attorney disability representative will have their appeal submitted by the representative.
Nonetheless, upon receiving the denial notification, a claimant should contact their representative to make sure that the representative received their copy of the notice as well. This, again, will help to avoid a situation where the appeal is not filed timely.
As stated, reconsideration appeals have a high denial rate. Individuals who are denied disability at this stage should immediately file the second appeal, the 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 Ohio claimants 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
1. Where is the disability hearing held? - Disability hearings are typically held at an office of disability adjudication and review, or ODAR. From this point forward, we will simply refer to it as the hearing office. We say "typically" because there are occasions when, due to distance considerations (where the hearing office is in relation to where the claimant lives), it may be necessary to hold a Social Security hearing in an alternate location. It is not uncommon for a satellite hearing location to be nothing more than a conference room at a local bank.
SSA also makes video hearings available and a claimant may receive notification that their hearing will be conducted in this manner.
Opinions differ with regard to video hearings; however, it has always been maintained that one of the primary advantages of in-person disability hearings is that the claimant may be both seen and heard by the decision-maker for their disability claim; in this case an administrative law judge. Video hearings, though they may be more convenient for judges and the Social Security Administration, would seem to give away this advantage.
Note: Claimants are not required to attend video hearings and have the right to refuse them in place of a traditional in-person hearing.
2. Who makes the decision at a disability hearing? - Disability hearings are decided by ALJs, or administrative law judges. Disability judges make decisions much the same way that disability examiners do. They evaluate the medical evidence looking for signs that the claimant may have a condition that meets or equals a disability listing and, if not, they review the medical evidence to determine in what ways, and to what extent, the claimant may be functionally by their medical condition, or conditions. Claimants who are sufficiently limited by their condition may be determined to be unable to return to work activity and, thus, be awarded disability benefits.
Social Security judges decide the outcome of claims according to the same requirements and qualifications for disability. For a judge to approve a claim, it must be evident that the claimant has at least one severe medically determinable impairment that has lasted (or will last based on projections) for at least one year and which will either satisfy the requirement of a listing, or prevent the claimant from engaging substantial and gainful work activity.
3. Will the judge rely on a medical expert the way a disability examiner will? - Judges make disability decisions independently and do not require a medical expert to sign off on the case, as is generally true at a DDS, or disability determination services.
That said, judges will often request that a medical expert appear at the hearing to provide expert testimony on the case. This occurs when the judge determines that input from a licensed medical physician would be helpful in clarifying aspects of the case. However, the appearance of a medical expert at a hearing does not impair the authority of the judge to make his or her ruling.
4. How long will it take to get a disability hearing scheduled? - The answer to this question can be open-ended at best. The time it takes to schedule a hearing will be subject to whatever backlogs exist at a particular hearing office, as well as the caseload for the judge that the case is assigned to. Ordinarily, it will take at least several months for a hearing to be scheduled and waits of a year or longer are not unusual. And once the hearing has been held, it may take months longer for a notice of decision to be received.
Because the hearing process is very long, claimants should approach the hearing stage as a "one shot" proposition and do the utmost to prepare for the hearing. In reality, a claimant who is denied at a disability hearing may file a new claim and eventually get their case heard again by a judge at a second hearing. But in most instances this may take up to two more years. Therefore, the best approach will be to treat the hearing as an all-important opportunity for presenting one's case.
To adequately prepare a disability case for a hearing, a claimant will need to ensure that, by the time of the hearing, the administrative law judge has access to recent medical records.
This is crucial for three reasons: 1) Without recent medical record documentation, a case cannot be approved for disability, 2) Social Security does not obtain medical records for the case as it moves beyond the reconsideration appeal level and 3) By the time a hearing takes place, the medical records in the claimant's file will ordinarily be many months old.
5. Should I be represented at a disability hearing? - Individuals filing for disability are not required to have Social Security representation. In fact, this is true at all levels of the SSA system, even including federal court.
However, it is generally widely agreed upon that appearing at a Social Security hearing without representation is unwise. Disability claimants will be unaware of core concepts regarding SSI claims and SSD claims, such as unsuccessful work attempts, SGA, duration, the application of grid rules, how to judge past work as relevant, etc. Furthermore, claimants will be unfamiliar with how to dissect the contents of a case file which is necessary to understand on what basis a person's application for disability was denied, and on what basis their reconsideration appeal was denied.
Judges, in fact, will routinely advise claimants who appear unrepresented that the hearing may be rescheduled if the claimant would like additional time to seek a disability representative or disability lawyer.
6. Is a person more likely to qualify for disability at a hearing? - The answer to this question is definitively yes. SSD and SSI claims are denied at the disability application level at a rate that averages 70 percent regardless of one's state of residence. At the first appeal level, the request for reconsideration, the rate of denial exceeds 80 percent. At the disability hearing level, however, roughly half of all claims are awarded benefits. That percentage rises when a claimant is represented.
Why is there a disconnect between the rate of approvals at the first two levels of the system versus the disability hearing level? There are numerous reasons, however two stand out:
1. Social Security judges are independent and autonomous in their decision-making, i.e. they do not answer to supervisors who can easily overturn their decisions.
2. Disability judges give consideration and weight, sometimes controlling weight, to the opinion of a claimant's own doctor, which SSA refers to as a treating physician. When a claimant's doctor provides a medical source statement and the doctor statement is substantiated by the medical records (meaning the doctor's opinion is in-line with what his records have historically indicated), the medical source statement will often serve to provide a firm foundation to meet the SSA requirements for disability.
Note: There are multiple hearing offices in Ohio and the statistic given above is an average for the state. The state-wide average for Ohio is less favorable than the nation as a whole and the individual disability hearing offices in Ohio have rates of approval as high as 51.2 percent and as low as 44.1 percent. (Disability award rates for the various hearing offices in Ohio are listed near the bottom of the page).
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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Rates of Approval for Individual Social Security Hearing Offices in Ohio
Akron OH hearing office - disability award rate of 51.2 percent
Cincinnatti OH hearing office - disability award rate of 45.6 percent
Cleveland OH hearing office - disability award rate of 48.7 percent
Columbus OH hearing office - disability award rate of 44.1 percent
Dayton OH hearing office - disability award rate of 44.5 percent
Toledo OH hearing office - disability award rate of 49.2 percent