Applying for Disability in Oregon
How to apply and qualify for SSD, SSI in Oregon (OR)
Note: If you have already filed a claim and been filing for disability in Oregon were likely to be approved 33 percent of the time, and, conversely, denied 67 percent of the time.
This means that, while a significant percentage of individuals will be approved on an initial claim, the majority will need to follow the appeal process before being approved for disability benefits.
Note: Some individuals who are denied for disability file a new claim as their next course of action. In most instances, this will be a mistake and will disadvantage the claimant in several ways. In filing a new claim, a claimant will essentially give up their appeal rights, eliminating the option of requesting a reconsideration appeal.
Additionally, starting over with a new claim will result in a less advantageous filing date, which may have a negative effect on the amount of back pay a claimant may potentially be eligible for.
Applying for disability in Oregon
Claims for disability benefits are taken through the title II SSD program (Social Security Disability) as well as the title 16 SSI disability program. Both programs use the same standards, rules, and regulations.
Note: The substantial differences between the SSD and SSI programs have to do with non-medical eligibility criteria, such as how assets are considered (SSD does not consider assets at all, while SSI has an asset limit of $2000 for individuals), and which types of health coverage are provided; SSD provides medicare benefits while SSI provides medicaid benefits.
However, in terms of how claims are decided (i.e. how the disability determination is made after a review of the evidence), there is no difference between the two programs at all.
Whether or not an individual will have their claim taken in the Social Security Disability program, the SSI disability program, or in both programs as a concurrent claim will be determined by the Social Security Administration at some point during the application process. Typically, this information will not be known prior to the disability interview which is conducted by a CR, or claims representative, at a local Social Security office.
While each application for disability in Oregon is taken at a local Social Security field office, the qualifications for disability are met as a result of the claim being evaluated by a disability examiner at a separate state agency.
At DDS, or disability determination services, the claim is reviewed to see if it meets the necessary criteria for an approval. This involves an examination of the claimant's medical records, any statements submitted by physicians, as well as the results of any independent consultative examinations that have been scheduled and paid for by the Social Security Administration.
Disability applications in Oregon are typically decided within 90-120 days.
Qualifying for disability in Oregon
To qualify for disability in Oregon as an adult, you must prove that you have a medically determinable impairment that is both severe and which limits your ability to engage in substantial and gainful work activity. This level of severity must last for at least one full year. If the individual's condition has not lasted this long by the time of application, a projection can be made as to whether or not the condition will ulimately meet the duration requirement.
The severity of an individual's condition is typically proven through an examination of their medical records, as well as through information that is obtained regarding their history of work.
In some cases, a claimant will be approved to receive disability benefits on the basis of the information that is obtained from their medical records alone. This is when the claimant has a physical or mental condition that meets the requirements of a listed impairment in the Social Security Disability list of impairments.
More commonly, however, a claimant will be approved via a medical vocational allowance, a type of approval in which the determination is made that the claimant no longer has the ability to return to substantial and gainful work activity, either in the performance of their past work, or in the performance of some type of other work for which their education and work skills might otherwise suit them.
Qualifying for disability as a child
Children filing for disability in Oregon have their claims taken under the SSI disability program. These claims are decided on the basis of whether or not the child can engage in age-appropriate activities. For this reason both medical and academic records are often evaluated in order to determine if the child claimant is on-pace with his or her peers.
Filing an appeal in the event of a denial
Individuals receiving a notice of denial are informed of their right to file an appeal within 60 days of the denial (this date is usually stamped in the upper right hand corner of the notice of disapproved claim). The Social Security Administration, however, allows cliamants an additional five days for mailing time. Therefore, the actual appeal deadline is 65 days from the date of the denial.
Note: To successfully submit an appeal prior to the deadline, the appeal forms must be received by a Social Security office before the 65th day, not simply mailed and postmarked by the 65th day.
Level II: Request for Reconsideration - If you are denied on your disability application in Oregon, you may file an appeal. The first appeal available to claimants is the request for reconsideration.
A reconsideration, like all appeals, must be requested within 60 days of the date of the prior denial, in this case the denial of the application for disability. The denial date is usually stamped in the upper right hand corner of the denial letter.
Claimants should keep in mind that getting the appeal submitted timely does not mean simply mailing the appeal forms within the 60 day appeal period (actually, this appeal period is 60 days plus an additional 5 days for mailing time). For the appeal to be considered on-time, it must actually be received at a Social Security office before the end of the appeal period. Translation: it must be received by the 65th day following the date of the denial.
To request a reconsideration, a claimant need only contact their local Social Security office. Once this is done, the appeal forms (the appeal request, the disability report form on which the claimant may indicate recent medical treatment, and medical release forms) will be sent out to be completed, signed, and returned.
Claimants who are represented by a disability attorney or non-attorney disability representative will have their appeal done by their representative. However, to ensure that the representative has received their copy of the appeal, a claimant should contact the representative's office after the denial letter is received.
Note: Claimants who are not represented should make a followup status call to the Social Security office after the appeal is submitted to verify that the appeal is actually received and to guard against the possibility of a missed appeal deadline. Furthermore, for this same purpose, a copy of the appeal paperwork should be kept by the claimant in the event that the appeal is not received.
How is the disability reconsideration decision made?
The disability qualifications are the same at this level of the system as they are at the disability application level. The process is, in fact, identical. As with the disability application process, the reconsideration-level disability examiner will examine the available medical evidence to determine if the claim for disability can be approved on the basis of the medical evidence alone. This means satisfying the disability requirements of a listing in the Social Security Disability list of impairments, a.k.a. the listings, or the blue book.
If the claimant does not have a medical condition that qualifies for disability on the basis of a listing, then the examiner will review both the medical records and the vocational history (the work history) to see if the claimant can qualify on the basis of a medical vocational approval.
This is a decision made by determining the claimant's functional limitations (i.e. their RFC, or residual functional capacity) and comparing those limitations to the demands of their past work and the skills they possess (which or may not be transferrable to other work. When the disability determination is made that a claimant cannot engage in substantial and gainful work activity in the performance of either their past work or in the performance of some type of other work that they might otherwise be able to switch to, they will be considered disabled and will qualify to receive monthly disability benefits and/or disability back pay.
Disability reconsiderations in Oregon have a very high rate of denial and the chance of being denied on a reconsideration is much higher than on a disability application. Claimants who are denied at this appeal level will, statistically speaking, have a favorable chance of approval at the hearing level, provided that they or their representative present a solid and well-supported rationale for approval, i.e. a strong theory of the case.
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
Note: The majority of Social Security hearings are denied in Oregon. In Oregon, disability hearings are approved at lower than the national average. This is true for both hearing offices. The Eugene OR hearing office has a disability award rate of 46.5 percent and the Portland OR hearing office has a disability award rate of 45 percent. Hearing approval rates in Oregon are also lower than the SSA region which Oregon is part of, SSA Region 10.
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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