Applying for Disability in Utah
How to apply and qualify for SSD, SSI in Utah (UT)
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 - In any given year, 30-37 percent of disability claims in Utah may be approved at the application level. In the majority of cases, Filing a new disability application, however, after the denial of a claim is not advised for two reasons: 1) The disability claim is likely to be denied again and 2) Even if the subsequent new claim is approved, the claimant may be eligible for less disability back pay as a result of a less advantageous filing date.
Most claimants who are denied should file their first appeal, the request for reconsideration. If denied on this first appeal, they should file the second appeal, the request for hearing before an administrative law judge, or ALJ.
The approval rate for claims decided at the hearing level tends to go up markedly regardless of one's state of residence.
Applying for disability in Utah
To apply for disability in Utah, a claimant may attempt to file online or contact a local Social Security office. Filing online will not allow for a one-to-one personal interview with a Social Security Claims Representative (CR) at a Social Security office.
This is problematic because it prevents the claimant from asking questions about the application and appeal process which may reduce the likelihood of mistakes.
Additionally, an SSI disability claim cannot be filed online. Since claimants will not know in advance if their claim will involve SSI, SSD, or both SSD and SSI in the form of a concurrent claim, the online filing process may not be as productive as filing with a local office.
To initiate a claim with a local field office, a claimant should contact the office and arrange for a disability application interview to be conducted. For claimants who have mobility or transportation issues, this interview may be conducted over the phone. This may also be requested for claimants who simply prefer a phone interview.
The primary purpose of the disability interview is for the claimant to supply information that is necessary to process the disability claim. For the most part, the focus will be on the two areas of evidence upon which most disability decisions are made: the medical treatment history and the vocational work history.
To ensure that important details and information are not ommitted from either, claimants are advised to write down both their medical treatment history and work history prior to the appointment for the disability application interview.
Qualifying for disability in Utah
The qualifications for disability in Utah are the same in either the SSI or Social Security Disability program. The distinctions between the two programs have chiefly to do with funding sources (SSI is need-based while SSD is based on work credits earned as a result of work activity), health insurance (SSI recipients receive medicaid while SSD recipients receive medicare), and non-medical eligibility criteria (SSI has a cap of $2000 on the amount of assets an individual may possess while SSD has no asset limit).
From the perspective of evaluating a disability claim, there is no difference at all between the two disability programs.
In order to be eligible to receive disability benefits, a claim must satisfy the Social Security Administration's definition of disability. This definition requires that the evidence obtained from the claimant's medical records must verify that the claimant has one or more medical impairments. The impairment, or impairments, can be physical, mental, or a combination of both.
SSA is primarily concerned with the fact that the claimant's condition must be:
A) Medically determinable (meaning verified by testing and/or observations made by a qualified medical professional).
B) Severe to the extent that the condition interferes with the ability to engage in work activitity for adults, or, for children, interferes with the ability to engage in age-appropriate activities.
C) Must have a duration of not less than one full year.
Making the decision on the disability case
The actual process of making a decision on a disability claim goes as follows:
1. After the disability claim is initiated at a local office, it will be transferred to a disability examiner at a state-level agency known as disability determination services, or DDS. The examiner will obtain the medical records from the sources listed by the claimant on their disability application.
Obtaining the records may take a matter of weeks or months depending on how much difficulty the examiner experiences in requesting the records.
Once the records have been received, the examiner will read and evaluate them with two purposes in mind. The examiner will first check to see if the claimant has a condition that is contained in the Social Security Disability list of impairments.
Typically, most claims are not approved in this manner since the approval criteria for a listing tends to be more specific than a claimant's medical records will accomodate and also since many medical conditions are simply not included in the listings.
If the claimant cannot be approved on the basis of a listing, and this is usually the case, the examiner will review the medical records with the purpose of determining what functional limitations (mental or physical, or both) the claimant may possess, and to what extent. These limitations are drawn together in an assessment known as an RFC, or residual functional capacity, assessment.
The RFC assessment is compared to the demands of the claimant's past work to determine if the claimant has the ability to return to a former job. If the claimant does not have the capacity to do this, the claimant's age, level of functional capacity, education, and job skills are analyzed to determine if the claimant has the ability to perform some type of other work.
If the claimant cannot return to their past work, or perform any type of other work at a substantial and gainful earnings level, they will meet the requirements and qualifications for disability and may be approved to receive ongoing disability benefits in addition to some amount of Social Security back pay.
Receiving a decision on a disability claim in Utah
Qualifying for disability in Utah on the intial claim may take 90-120 days. Decisions can take longer, particularly if SSA finds it necessary to send a claimant to a consultative medical exam.
Claimants who receive a notice of denial on their application should file for an appeal immediately. SSA will allow a claimant an appeal period of at least 60 days from the date of their denial notice, but to avoid unnecessary processing time, denied claimants should immediately request an appeal by contacting their local Social Security office, or by having their representative do this, if they are, in fact, represented.
Level II: Request for Reconsideration - The request for reconsideration is the first appeal level and may be submitted after a disability application has been denied.
In many ways, the reconsideration and application levels are the same. The requirements and qualifications criteria do not change and the process for evaluating a claim, likewise, does not change.
As before, the claim will be decided by a disability examiner who will review the medical evidence in order to determine if the claimant satisfies the necessary criteria to qualify for ongoing disability benefits and/or disability back pay (which is usually the case due to the processing time required for most cases).
At every level of the Social Security and SSI disability system, the filing of appeals will work the same way.
1. To get an appeal started following the receipt of a denial notice, a claimant should immediately contact their local Social Security office. This will result in the appropriate paperwork (an appeal request, a disability report form, and medical release forms) being mailed out. This paperwork should be completed as quickly as possible and then returned to Social Security.
2. A copy of the appeal paperwork should be retained by the claimant. This is to safeguard against the possibility that the submitted appeal is not received by Social Security.
3. Very often, a Social Security office that has received an appeal from a claimant or their representative will send an acknowledgment letter. However, this is not always done. Therefore, within two weeks of submitting the appeal, the claimant should call Social Security and do a status check to verify that the appeal was actually received.
4. If the claimant has disability representation, meaning they are represented by a disability attorney or non-attorney disability representative, that individual will typically do the appeal, keep a copy for their own records, and mail a copy of the appeal to the claimant.
Nonetheless, however, a claimant who receives a denial notice should contact their representative immediately. This is to ensure that both parties have received the denial notice, potentially avoiding the possibility of a late appeal filing. A late appeal situation can easily mean having to start over with a new disability application, a new filing date, and the potential loss of disability back pay.
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: Utah has a single hearing office in Salt Lake City UT. The Utah hearing office approves claims at the hearing level at better than the national average ; however, with a processing time that is slower than the national average (380 days in Utah versus 342 days for the country-at-large).
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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