Successfully Applying for Disability Benefits in Tennessee

Applying for Disability in Tennessee

How to apply and qualify for SSD, SSI in Tennessee (TN)

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 - As in most states, the process of filing for disability benefits in Tennessee will typically involve three separate stages.

It will, in most instances, begin with an initial claim, or disability application, followed by the filing of the first appeal, the request for reconsideration, followed by the filing of the second appeal, the request for hearing before an ALJ, or administrative law judge.

Some claims will be approved at the first level of the system. Statistically speaking, an application for disability in Tennessee is likely to be approved roughly 25 percent of the time and denied three-quarters of the time.

The odds of approval at the application level are obviously not favorable. However, for those who pursue the process, at least as far as having their claim brought before a federal judge, the chances of meeting the disability qualifications for either the SSI or SSD program, will be in the claimant's favor.

Requirements for disability

Qualifying for disability in Tennessee or any other state will require proving that one's medical condition (physical, mental, or both physical and mental) is severe enough to eliminate the ability to work and earn a substantial and gainful income.

The definition of disability used by the Social Security Administration states that this level of severity must exist for at least one full year in order to meet the requirements for disability.

Note: it is not necessary to have been disabled for an entire year prior to filing for disability; a review of the medical evidence can be used to make a projection as to whether or not an individual's condition will be disabling for at least one full year.

Applying for disability in Tennessee

To initiate a disability claim, a person may file online or in person using the Social Security Administration website. The second option may seem more convenient; however, applying in person at a local Social Security office will be the preferred method. This will allow a claimant the opportunity to directly interact with the CR, or claims representative, who will do the intake for the claim.

The disability application interview that is conducted by the CR will focus on obtaining information that is necessary for processing the claim, and which will be given to the disability examiner who is assigned to the case. This includes the claimant's work history, medical treatment history, and the date they claim as the beginning of their disability (the AOD, or alleged onset date).

Providing the evidence for the case

With regard to the work history, Social Security will need a listing of all jobs held by the claimant for the 15 year period prior to becoming disabled. It will be important to include job titles, the dates worked for each job, and the duties performed for each job. This information will be used by the disability examiner to determine the physical and mental requirements of the claimant's past work.

With regard to the medical treatment history, Social Security will need a listing of all diagnosed conditions, all sources of medical treatment, including the names and addresses of all hospitals, clinics, and doctor's offices, and the names of all treating physicians.

This will allow the disability examiner to request all relevant medical records for the purpose of determining A) whether or not the claimant is currently disabled and B) if the claimant is currently disabled, how far back their disability actually begins (which is vital for calculating how much in back pay the claimant may be owed).

Note: For most claimants, it will be very practical to write down both the medical treatment history and work history prior to the appointment for the disability application interview. This will allow more thought to be given to the information, and, typically, will result in more detailed and accurate information, aspects which may be critical to the outcome of the disability claim.

For example, if the medical sources are not listed correctly (such as an incorrect name or address), the disability examiner may experience difficulty in gathering the records. This can add weeks or months of processing time to a case. If the claimant completely leaves out a medical source, this may result in an absence of crucial information that might have resulted in an approval of the claim.

How is the disability decision made?

The disability examiner will obtain the medical records (this is usually the examiner's first task after receiving the case from the Social Security office) and use them to determine what types of physical and mental limitations are possessed by the claimant. These limitations in functional capability will be used to produce an assessment of what the claimant can still do, despite their condition, or conditions.

This assessment is known as an RFC, or residual functional capacity, rating and is made on an RFC form. Qualifying for disability benefits will, in most cases, depend on how limiting the individual's RFC is.

When an RFC rating is so limiting (examples of limitations include reduced ability to lift, sit, stand, hear, see, reach, concentrate, remember, function with supervisors and co-workers, etc) that it effectively rules out the ability to go back to one's past work, or perform some type of other work for which the individual's skills and education would ordinarily qualify them, they will generally meet the qualifications for disability.

Note: There are cases in which claimants are approved on the basis of medical evidence alone, without the need to consider their past work, or work skills. This is when the claimant has a condition that satisfies the disability requirements of a listing. Listings may be thought of as the approval criteria needed to win for certain specific conditions.

The listings are sometimes referred to as the blue book, or the Social Security Disability list of impairments.

Most cases are not approved in this manner as the listing criteria is fairly specific and most claimant's medical records will not provide the necessary evidence. Also, many common impairments are simply not given a listing.

For most claimants, the route to approval will be a medical vocational allowance, which will involve reviewing the medical evidence and the work history to determine if the claimant has the ability to return to substantial and gainful work activity.

Children filing for disability in Tennessee

Parents filing for disability in Tennessee on behalf of minor-age children will follow the same process of application, meaning that:

A) The Social Security Administration will be contacted, usually through a local field office.

B) A disability application interview will be conducted by a CR, or claims representative (a Social Security employee who is responsible for doing the initial intake on the claim).

C) The claim will be sent to the state disability agency where it will be assigned to a disability examiner who will obtain the necessary medical information--and, often, in the case of children, academic records, as well--needed to render a decision on the claim.

Why do most initial claims fail to qualify for disability benefits?

At the disability application level, decisions on cases are made by disability examiners, case-processing specialists who work in state disability agencies (usually named DDS, or disability determination services).

Disability examiners are not entirely autonomous and work in conjunction with medical consultants, psychological consultants, and unit supervisors. Their decisions are also subject to various levels of quality control.

As a result of these factors, disability examiners tend to make far fewer approvals on Social Security Disability and SSI claims than administrative law judges who function autonomously and independently. This accounts for why claims that are denied at the application and reconsideration appeal levels are typically approved by judges at hearings (the second appeal available to claimants).

  • Disability application denial rate: 75.7 percent.
  • Disability application approval rate: 24.3 percent.

    Level II: Request for Reconsideration - In the event that an application for disability is denied, a claimant will have the option of starting over with a new claim, or filing an appeal.

    Starting over, except in the case of a technical denial (where the basis for denial has nothing to do with the medical aspects of the case, but, rather, a technical issue such as a claimant working and having too much earned income at the time they file for SSD or SSI disability) will typically offer little advantage to a case.

    In fact, the opposite is usually true. A new claim will nearly always be denied again for the same reasons as the prior claim, amounting to a huge expenditure of wasted, valuable time. Also, beginning over has the potential for the claimant to potentially lose significant amounts of disablity back pay.

    The first appeal is a reconsideration request.

    The reconsideration is identical to a disability application in several ways. The disability examiner--this time a higher-level examiner--will review the medical evidence looking for signs that the claimant has a medical condition that satisfies a listing in the Social Security Disability list of impairments, or signs of functional limitations (physical and mental) that might restrict the ability of the person to engage in substantial and gainful work activity.

    Most claimants will not have a condition that meets or equals a listing. However, for claimants whose functional limitations are severe enough to rule out the ability to engage in both their past work, and any other type of work that relies on their education, skills, age, and functional capacity, the result will be a disability approval.

    To request a reconsideration, a claimant should contact the Social Security office where their original claim was started. Upon receiving the necessary appeal paperwork, they should complete, sign, and return it as soon as possible. SSA allows a deadline of 60 days, plus an added 5 days for mailing time.

    However, to avoid additional delays, the paperwork should be returned immmediately. This is to avoid the possbility of a late appeal, but also to avoid the "aging out" of medical evidence, i.e. evidence becoming older than 90 days.

    When a Social Security Disability or SSI case is reviewed at any level of the system (disability application, reconsideration appeal, disability hearing, etc) and there is no current medical evidence in the file, the adjudicator or judge, depending on the level the claim is at, will not be able to render a favorable decision on the claim.

    In such situations, the claimant will be scheduled for a Social Security medical exam, also known as a CE, or consultative examination. The scheduling of the exam, and the wait for the exam report, can easily add 1-2 months of extra processing time to a case.

    When consultative examinations are not required, reconsideration decisions can easily be made within 30-60 days. Most decisions on reconsideration appeals are denials. And, in fact, the rate of denial at this level of the system significantly exceeds the rate of denial at the application level.

    This is not surprising when one considers that the process of evaluation at both levels is identical. Only at the hearing level does the process substantially change, as the claimant and their disability representative (who may be a disability attorney, or a non-attorney disability representative) will both interact with the decision-maker, who is a federal judge.

    Also, while at the lower levels of the system the disability examiner reviews the case without much involvement from the claimant, at the hearing level the judge relies primarily on medical record updates obtained from the claimant's representative, in addition to a reasoned argument for approval presented by the representative.

    Note: After requesting the reconsideration appeal, a claimant should a) make a copy of the appeal and b) do a followup status call to the Social Security office within 2 weeks of mailing the appeal. This is to verify that the appeal is actually received, thus avoiding the potential for an untimely appeal which may result in having to start over with a new claim.

    As mentioned above, starting over with a new claim can have a negative effect on the amount of back pay that a claimant may be eligible to receive.

    Claimants who are represented at the time they are denied for disability on their application will have their appeal completed and submitted by their representative.

    However, a call should be made to the representative's office to verify that they have received their copy of the denial letter. Again, this will help to ensure that the appeal is submitted in a timely fashion.

  • Reconsideration appeal denial rate: 91.5 percent.
  • Reconsideration appeal approval rate: 8.5 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

    1. Where will my disability hearing be held? - Hearings are held at local Social Security hearings offices, which are called ODAR, or office of disability adjudication and review. Local, however, is subject to interpretation. For some individuals, depending on the state and city in which they live, the hearing office may only be twenty minutes away. However, it may entail a drive of several hours. For example, in the state of North Carolina which has multiple hearings offices, a hearing office may be several hours away.

    Because getting to a disability hearing can sometimes be difficult for a claimant who has a problem with access to transportation, or who has a medical issue that affects their ability to withstand long trips, SSA sometimes provides satellite hearing locations. This may simply be a conference room at a bank which is sufficiently large enough. SSA also provides hearings by video which allows the claimant to see the judge on a tv monitor and vice-versa.

    Are video hearings beneficial? The answer depends. They may certainly make it easier for a hearing to be held. However, one of the great advantages of a disability hearing is the fact that, for the very first time, the person who is applying for disability will get to meet the person who is making the decision on their disability claim. This makes the claimant more than simply a file, or a collection of medical records. Some would theorize that it actually helps to humanize the disability determination process.

    There can be no doubt, of course, that disability casese are much more likely to be won at the hearing level versus the disability application and reconsideration appeal levels.

    Very often this is attributed to several other characteristics of hearings such as the following: by the time a hearing takes place, a claimant's condition may have worsened; at the hearing, a claimant will usually have a disability representative or disability lawyer who is experienced in handling Social Security Disability and SSI claims; at hearings, an ALJ or or administrative law judge will actually give credence and weight to the opinion of a claimant's own doctor (called in SSA terms the treating physician).

    However, despite all this, one should never dismiss the influence of the factor of which we speak, namely that at a hearing it helps the case that the judge can actually see and speak to the person filing a claim. Judges will ask claimants about their medical condition, their work, and the effect that their condition has on their ability to engage in normal activities of daily living.

    The judge is obviously looking for an answer to each question. But without a doubt the judge is also gauging the manner in which the claimant responds. Which cannot be done when there is no interaction between the person filing and the person making the decision.

    2. Will the disability judge use the same requirements for disability at a hearing? Yes, the administrative law judge is bound by the same rules and guidelines for making decisions on cases. In fact, some would argue that judges do a better job of this than disability examiners.

    While disability examiners use the DOT (the dictionary of occupational titles), the adult and childhood listing, and the medical vocational rules (the grid), they know practically nothing about SSRs (social security rulings) and title 20 of the code of federal regulations. Judges are intimately familiar with every aspect of disability law. They also, as I previously stated, give condideration, sometimes deference, and sometimes "controlling weight" in a disability case to the opinion of a treating physician.

    3. What are the qualifications that will be used to make a decision on my disability claim at the hearing? You have to meet the Social Security definition of disability. This definition states that your medical condition (which may be a single physical condition, mental condition, or a combination of various conditions) must be disabling for a full year at a minimum?

    What is disabling in the eyes of SSA? To consider you fully disabled, your condition must be severe enough that you either meet the requirements of a listed impairment in the Social Security list of impairments, or the condition must be severe enough that it prevents you from working and earning at least the SGA amount (SGA stands for substantial gainful activity).

  • Disability Hearing denial rate: 39.9 percent
  • Disability Hearing approval rate: 60.1 percent

    Note: The Tennessee hearing award rate listed above is the average for the state. The separate Social Security Hearing offices in the state award disability claims from a low of 48.5 percent to a high of 69 percent.

    Processing times vary widely as well. The hearing office with the slowest processing time for hearings is Nashville TN (429 days). The hearing office with the fastest processing time for cases is the Chattanooga hearing office (223 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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    Rates of Approval for Individual Social Security Hearing Offices in Tennessee

    Chattanooga TN hearing office - disability award rate of 65.4 percent

    Franklin TN hearing office - disability award rate of 68 percent

    Kingsport TN hearing office - disability award rate of 69 percent

    Knoxville TN hearing office - disability award rate of 58.4 percent

    Memphis TN hearing office - disability award rate of 48.5 percent

    Nashville TN hearing office - disability award rate of 58.7 percent