Will I Qualify For Disability Benefits in Tennessee?

In the state of Tennessee, approximately 25 percent of all disability claims are approved at the initial claim, or disability application, level. This is in line with the national average. Nationally, roughly 30 percent of initial claims are approved in a given year.

As in other states, it will be necessary for the majority of claimants in Tennesee--up to 75 percent--to file at least one appeal before being awarded disability benefits. In most instances, two appeals will be required, the first being a request for reconsideration, and the second being a request for a disability hearing before a federal ALJ, or administrative law judge.

Qualifying for disability in Tennessee

A claimant in Tennessee may qualify for disability benefits through either the title II Social Security Disability (SSD) program or the title 16 Supplemental Security Income (SSI) program. Both programs handled in exactly the same way with regard to medical qualifications. The differences between SSD and SSI have to do with non-medical criteria, primarily concerning the asset and resource requirements for SSI.

To qualify medically through the SSD or SSI program (and keep in mind that, very often, claims are concurrent, meaning that they will involve an application taken in both programs simultaneously), a claimant must prove that they have a severe mental or physical condition.

To satisfy the SSA definition of disability, the condition must be severe enough that it does the following:

1. It must last for at least one full year.

2. It must interfere with normal activities of daily living and the ability to perform basic work activities.

3. It must present a level of severity that prevents the claimant from being able to engage in work activity that earns what Social Security considers to be a substantial and gainful income.

In satisfying the definition of disability, a claimant may be approved in one of two different ways. First, their medical records may be reviewed and it may be determined that they have a medical condition that meets the criteria for a listing in the Social Security list of impairments.

Most cases are not approved this way as the listing criteria for an impairment is fairly detailed and requires significant and specific medical documentation.

Second, in cases where a case cannot be approved on the basis of a listing, an individual's medical records and work history information will be reviewed to determine what their functional limitations are as a result of their condition, or conditions, and how these limitations reduce their ability to engage in work activity.

Individuals who are found to be limited to the extent that they cannot return to one of their past jobs, or switch to some type of other work, will generally be found to be disabled.

Filing for disability in Tennessee

The first step to qualifying for SSI or Social Security Disability is to file a disability application. You can file for disability (both SSI and Social Security) in person, or by phone, with your local Social Security office. Currently, there are thirty Social Security offices in Tennessee. If you are having a hard time locating the Social Security office nearest to you, there is an office locator on the Social Security website.

If you do not wish to file in person or by phone, you can file for Social Security Disability online. Be sure to complete the application, the disability medical report form, and a medical release form before submitting the application to Social Security.

Keep in mind that there is no online SSI disability application. For this reason, you may find it more productive to begin your claim by contacting a Social Security office. A claims representative will review your eligibility for both Social Security and SSI (Supplemental Security Income) disability during your disability application interview.

Disability decisions in Tennessee

Once your disability application is complete, your disability claim is sent to the Tennessee DDS (Disability Determination Services) located at 400 Deaderick ST, Nashville, TN 37202, for a medical disability determination. At DDS, your disability claim is assigned to a disability examiner who is responsible for gathering your medical records, scheduling consultative examinations, and finally making a medical disability determination.

If your disability claim is denied and you disagree with the decision, you should file a reconsideration appeal. Reconsideration appeals are sent back to Disability Determination Services. Very few reconsideration appeals result in an approval for disability benefits.

The second disability examiner is bound by the same disability rules and guidelines as the disability examiner who denied your initial disability claim; consequently the decision will most likely be the same unless there was an error, or you provided new and convincing evidence that you are disabled with your reconsideration appeal.

Reconsideration appeals are most often just a step toward getting to an Administrative law judge disability hearing where the chances of approval are much higher. The approval rate for reconsideration appeals in Tennessee is 16.2 percent.

Statistical data indicates that the approval rates for both reconsiderations and initial disability claims are lower in Tennessee than the national average.

Disability hearings in Tennessee

If your reconsideration appeal is denied, you can appeal the decision by filing a request for an administrative law judge hearing. This appeal allows you to appear before an administrative law judge who has far greater discretion when making disability decisions versus a disability examiner.

This fact may help explain why in Tennessee, like all other states, more disability applicants qualify for disability benefits at the disability hearing appeal level than any other level of the process.

The average approval rate for disability hearings in Tennessee is about 66.7 percent compared to a national disability hearing approval rate of 58.0 percent.

However, it is important to keep in mind that disability benefits are awarded by judges only when a case has been properly prepared and presented, meaning that the rationale for approval must conform to Social Security rules, regulations, and applicable court rulings, and it must be supported by objective medical evidence which validates that the claimant has at least one medical condition that satisfies the Social Security Administration's definition of disability.

Claimants whose cases are not properly prepared for a hearing (specifically, the accumulation and interpretation of medical and vocational evidence), nor properly presented, will face a much more difficult challenge in being approved.

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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