Successfully Applying for Disability Benefits in Rhode Island

Applying for Disability in Rhode Island

How to apply and qualify for SSD, SSI in Rhode Island (RI)

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 - An individual filing for disability for disability in Rhode Island will generally have a chance of approval that mirrors that of claimants in most states. The rate of approval generally averages 30 percent, while the rate of denial may be as high as 70 percent.

From a practical standpoint, this means that claimants A) should not be surprised if their disability claim is denied at the disability application level, and B) should immediately file an appeal if their initial claim is denied.

At the first appeal level--the request for reconsideration--the rate of denial is often higher, often exceeding 80 percent. However, by the second appeal level, the request for a disability hearing before an ALJ, or administrative law judge, the odds of meeting the requirements for disability most often tilt in the claimant's favor, provided the claimant has representation, their medical condition has not improved, and/or they have not returned to SGA, or substantial gainful work activity.

Why are claims more likely to be approved at the Social Security hearing level following an initial claim denial? In some cases, this will simply be due to the fact that the claimant's age has changed and that they now fall under more favorable medical-vocational rules.

However, in most cases this is likely due to a combination of certain factors:

1. At a hearing, the disability decision is made by a judge. Judges, unlike disability examiners, are not subject to immediate oversight by unit supervisors or quality assurance units, i.e. judges function autonomously and independently.

2. At a hearing, the claimant usually has representation from a disability attorney or non-attorney representative who has presented a well-supported basis for approval under the rules and regulations of the SSDI and SSI programs.

In more specific terms, this means additional medical record documentation, often a medical source statement obtained from a claimant's treating physician, and more scrutiny of a) the claimant's job history and b) the functional limitations that comprise their RFC, or residual functional capacity.

3. At a hearing, the claimant interacts with the decision-maker on their claim, the administrative law judge and is not reduced to simply being a name associated with a case number and set of medical records.

Applying for disability in Rhode Island

Disability claims are, for the most part, initiated through local Social Security offices. Claims can be filed online; however filing online will not allow for an SSI disability application to be taken. It will also not allow for direct initial interaction between the CR, or claims representative, at the Social Security office.

This interaction is important for multiple reasons. First, because the CR transfers the claim to the disability examiner who makes the decision at the disability application level. Second, because it allows the claimant to ask questions and have them answered. This fact alone may reduce confusion and help to avoid mistakes.

A person who wishes to apply for disability in Rhode Island should contact their local SSA field office. An appointment date will be set for a disability application interview. The purpose of the interview is for SSA to obtain all the information that is needed to process the claim. This information includes personal identifcation information.

However, the information that will be used by the disability adjudicator, i.e. the disability examiner, will focus on the claimant's medical treatment history and, if they are an adult, their vocational work history (if the claimant is a child filing for disability, the focus will typically be on the medical records and, if they are of school-age, their academic and testing records).

Because clarity and detail regarding the medical and work histories is so very important, claimants should write down this information before going to the appointment for the disability application.

Regarding the work history, this should include all jobs worked in the 15 year period prior to becoming disabled, including job titles, descriptions of work duties, and dates of employment.

Regarding the medical treatment history, this should include the names and addresses of all hospitals, clinics, and doctor's offices where treatment has been received, including dates of treatment. The names of all treating physicians should be included, as well as a list of all diagnosed conditions, symptoms, and their onset date.

Qualifying for disability in Rhode Island

The qualifications for disability in Rhode Island are the same as in all other states. This is because the title II Social Security Disability and title 16 SSI disability programs are federal and standardized. The primary differences between SSD and SSI are of a non-medical nature and involve the most basic eligibility criteria.

For example, SSI, which is a need-based program, has a countable asset limit of $2000 for individuals (countable assets include vehicles other than one's primary transportation, real estate other than the home a person lives in, and anything that is a cash equivalent or can readily be converted to cash such as money in a savings account).

SSD, on the other hand, which is not need-based, but is a benefit that a person becomes insured for as a result of work activity, does not even count assets.

A claimant's basic non-medical eligibility for Social Security Disability or SSI will be determined at the time of application by the Social Security office where the claim is filed. After the claim is successfully filed (this occurs after a disability interview has been conducted), however, the question of whether a person will qualify for disability benefits will be determined by the state disability processing agency. In most states, this agency is referred to as DDS, or disability determination services.

At DDS, the claim will be evaluated primarily on the basis of the medical evidence that is obtained by the disability examiner. In some cases, a decision will be made on the basis of the medical evidence alone. This is known as a medical vocational allowance, in which a determination is made that the claimant has one or more severe medical conditions that have lasted a year or longer and which have prevented a return to substantial and gainful work activity.

In the process that leads to qualifying for disability in this manner, the examiner will evaluate the medical evidence and then determine what physical and mental limitations the claimant has. Then these limitations will be measured against the work experience of the claimant to determine if they can either do their past work or some type of other work. If they can do neither, they will be approved to get SSD or SSI disability.

However, it is often the case that a claimant will be found capable of doing some type of other work even if they cannot do their past work. And this accounts for the high percentage of disability cases denied.

  • Disability application denial rate: 67.4 percent.
  • Disability application approval rate: 32.6 percent.

    Level II: Request for Reconsideration - If a an application for disability benefits is denied, a claimant may decide to discontinue their pursuit of the claim, file for disability on a new claim, or file the first appeal which is the request for reconsideration.

    For most claimants, giving up on the pursuit of the claim will be the wrong decision. A simple fact regarding the Social Security Disability and SSI system is that most initial claims, or disability applications, will be denied. Typically, in a given year, 70 percent of disability applications will be denied, and more than 80 percent of reconsideration appeals will be denied.

    Having said that, however, the majority of claimants who attend a Social Security hearing with able representation and a well-prepared case will receive a Social Security Disability award or SSI award. For most claimants, it will be worthwhile to pursue the claim after it has been denied.

    How should the claim be pursued? An alarming number of individuals will mistakenly assume that applying for disability on a new application will be the best course to take. However, this will usually result in another denial of the claim and a filing date that might result in a lower amount of Social Security back pay even if the claim were to be approved.

    The best option after being denied initially, almost without exception, will be to file a request for reconsideration, the first appeal. Reconsiderations have a very high rate of denial; however, the fundamental purpose of this appeal, for the majority of claimants, will simply be to move the case closer to the hearing level.

    That said, claimants who file a reconsideration request should still attempt to maximize their chances of winning at this level. Therefore, when submitting the appeal request and the disability report form that goes with it, the claimant should indicate any changes in their medical condition, any new treatment received, and certainly any new sources of treatment. This will allow the disability examiner who handles the appeal to obtain new evidence for consideration in the case.

    Notes on requesting a reconsideration:

    1) A represented claimant (representation is provided by a disability lawyer or non-attorney disability representative) should contact their representative after receiving the notice of denial. SSA is obligated to notify the representative of all case actions, but there are instances in which proper notification is not made. By contacting the representative, the claimant can ensure that all relevant parties are aware of the status of the claim and that an appeal deadline is not missed.

    2) A claimant who does not have disability representation should submit the appeal as quickly as possible to reduce unnecessary processing time. They should also make a copy of the appeal before submitting it and also make a followup status call to the Social Security office after submitting the appeal. Both actions will help to verify that the appeal deadline is not missed and the appeal submission is received and processed.

    Qualifying for disability on the reconsideration appeal

    Qualifying for disability at this appeal level is no different from qualifying at the application level. Once again, after the appeal request is made at a local Social Security office, the case will be sent to the state disability agency, known in most states as DDS, or disability determination services. At the state agency, the case will be assigned to a disability examiner, different from the first, who will examine the evidence of the case.

    The examiner will review the medical evidence to determine if the claimant meets the qualifications for disability under a listing (in the Social Security Disability list of impairments). Meeting the disability requirements of a listing only involves the medical evidence.

    However, being approved on the basis of a listing is difficult. The criteria is very specific and most claimant's medical records will not provide the necessary evidence to do this. Moreover, not all medical conditions, physical or mental, are contained in the listings.

    Claimants who clearly do not qualify for disability on the basis of a listing may be approved on the basis of a medical vocational allowance which uses a five step sequential evaluation system and which relies as much on medical evidence, i.e. medical records, as the claimant's work history information.

    Disability decisions at the reconsideration level tend to be made faster than at the disability application level since most of the development work has been done on the case. It is not unusual to receive a decision on a reconsideration in 4-8 weeks time.

    Claimants who are denied on this appeal should immediately file the next appeal, a request for a hearing. Statistically, the odds of approval at the hearing level lean in the claimant's favor if they have able disability representation that provides updated medical evidence and a compelling argument for approval, also known as a theory of the case.

    In most cases, a claimant's representative will also attempt to obtain a supporting statment from the claimant's treating physician, referred to as a medical source statement, the equivalent of an RFC, or residual functional capacity statement.

  • Reconsideration appeal denial rate: 87.1 percent.
  • Reconsideration appeal approval rate: 12.9 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: 56.8 percent
  • Disability Hearing approval rate: 43.2 percent

    Note: Rhode Island has a single Social Security Hearing office located in Providence RI. The disability award rate for the Providence hearing office is lower than the national average and lower than the award rate for Social Security Administration Region 1. Average Processing time for disability hearings in Rhode Island is 378 days.

    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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