Applying for Disability in Washington
How to apply and qualify for SSD, SSI in Washington (WA)
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 - Statistics on a national level, and in individual states, will vary from year to year. However, in a typical year, approximately one out of three claims for disability will be approved. The corollary to this, of course, is that two-thirds of all disability applications filed are likely to be denied.
In a recent period in the state of Washington, approximately 35 percent of initial claims, i.e. disability applications, were approved while approximately 65 percent of initial claims were denied.
When a claim is denied
Individuals who ared winning benefits will present itself at the hearing level. This is true for several reasons, but the most prominent and obvious is that the first appeal available to claimants, the request for reconsideration, is essentially a repeat of the disability application process.
In fact, there is practically no difference in how the decision is made aside from the fact that a different disability examiner will be responsible for making the reconsideration appeal decision.
For this reason, unless new and compelling evidence (medical or vocational) is brought into the case at the reconsideration stage, or unless an error on the part of the initial disability examiner is discovered by the second disability examiner, it is highly unlikely that a claim will be approved on the reconsideration appeal. Judges at hearings, however, are historically and statistically more likely to award benefits.
Again, this is for several reasons, but chief among may be the fact that the administrative law judge makes an independent decision. Disability examiners, by contrast, routinely have their decisions altered by their unit supervisors.
Also, there is the fact that both the claimant and/or their disability representative are permitted to present evidence and a rationale for approval based on Social Security regulations and rulings, whereas at the lower levels, the claimant does not ordinarily have any invovlement in the development of the case.
Applying for disability in Washington
Initiating a disability application in Washington will usually involve contacting a local Social Security field office.
Claims can be started online by using the SSA website. However, the online process does not allow an SSI claim to be taken at this time.
Since many applicants will have an SSI claim or a concurrent claim taken (meaning the claim is for both Social Security Disability and SSI), and, additionally, since a claimant will not know in advance which program or programs will apply to their case, it is usually more productive to contact a local office from the beginning.
Filing with the local office will also allow a claimant to pose questions to the field office CR, or claims representative, who is responsible for conducting the intake portion of the claim. The online process offers no person-to-person contact.
Contacting a local office for a disability claim will result in an appointment being set for a disability application interview. The purpose of the interview is for the claimant to supply all the information necessary for the claim to be medically processed.
Note: for individuals with physical mobility or transportation issues, the disability interview may be conducted over the phone. This may also be requested for claimants who simply prefer a phone interview.
Providing information at the disability application interview
The most important areas of information addressed during the interview will concern the claimant's medical treatment history and work history. This is the information that will allow the disablity examiner (at the state-level disability agency, usually referred to as DDS, or disability determination services) who receives the claim from the Social Security office to 1) conduct an evaluation of the claim and 2) render a decision.
Because the medical and vocational information usually serves as the basis for a decision on the claim, a person filing for disability may wish to write down both the work history and the medical treatment history before the appointment for the application interview. This will typically allow for more accurate information and greater detail, also ensuring that important pieces of information are not accidentally omitted.
Supplying medical history information
In supplying the medical treatment history, the claimant should be sure to include the names and addresses of all hospitals, clinics, and doctor's offices. This will enable the disability examiner to send out medical evidence request letters to the correct treatment sources and obtain the records as quickly as possible.
The importance of doing this cannot be understated: in most cases, the single largest delay on a disability claim is the time required to obtain medical records.
The medical treatment history should also include all diagnosed conditions, all date ranges for treatment, and the names of all treating physicians.
Note: if a disability hearing is later required, a disability attorney or disability representative will likely attempt to secure a medical source statement from a treating physician.
Supplying work history information
The vocational work history is at least as important as the medical treatment history in most cases. This is because while some claims may be approved on the basis of the medical evidence alone, meaning on the basis of a disability listing in the Social Security Disability list of impairments, most cases that are approved will not involve just the medical evidence.
The majority of approvals will occur after the decision has been made that the claimant has severe functional limitations (physical, mental, or both) that make it impossible for the claimant to return to substantial and gainful work activity. This is known as a medical vocational allowance.
In submitting the work history, a claimant should be careful to include a listing of all jobs worked for the entire 15 year period prior to becoming disabled. Not only should accurate job titles be included but also a detailed description of all work duties performed.
Submitting this information will enable the disability examiner to more accurately identify the jobs that are part of the claimant's past relevant work, and also the functional demands of these jobs and the skill levels they entail, all of which go into the making of a medical vocational allowance.
Why are disability claims denied in Washington?
Claims are sometimes denied on the basis of a non-disability issue (such as an individual filing for SSI who has too much in countable assets), or an individual filing for SSD who is still working and earning more than the allowable income limit (known as SGA, or subtantial gainful activity).
In such instances, a disability claim may be given a technical denial, meaning that the case is quickly denied at the Social Security office where the claim was filed--meaning, essentially, that the case will not follow the normal procedure of being sent to a disability claims examiner who reviews the claimant's medical evidence and then decides the outcome of the case.
However, in most cases, a denial will be issued because the claimant's case has failed to establish that it satisfies the Social Security Administration's definition of disability.
To satisfactorily meet this definition, it must be shown that the individual has a medical condition--which may be physical, mental, or both--that is severe enough to persist for at least one full year.
If the claimant is an adult, the condition must result in an inability to engage in work activity that earns a substantial and gainful income.
If the claimant is a child, the condition must be severe enough to prevent the child from engaging in activities that would be considered normal for their age, what SSA refers to as "age-appropriate activities".
Level II: Request for Reconsideration - When a claim for disability has been denied, a claimant will have the following options:
1) They may choose to discontinue all efforts to pursue disability benefits.
2) They may choose to file a new disability application.
3) They may choose to file a disability appeal.
An appeal is nearly always better than filing a new claim
There are very few cases in which it will make sense to discontinue efforts to win the claim. This is because while the rate of denial for Social Security Disability and SSI claims is high at the first two levels of the system, the odds shift in favor of the claimant at the disability hearing level--provided, of course, that the case is adequately prepared and presented.
Starting over with a new disability application will not be helpful for most claimants since a second disability application will likely be denied for the same reasons as the first application. Also, starting over with a new filing date may potentially result in the claimant being eligible for less back pay.
In nearly all cases, the claimant who has been denied on a disability application should file the first appeal, the request for reconsideration.
Requesting the reconsideration
To request a reconsideration, a claimant should contact the same Social Security office where their initial claim was started. After requesting the appeal, the field office will mail out the appropriate paperwork for the claimant to complete, sign, and return.
Social Security will allow the claimant 60 days, plus an added 5 days for mailing time, to return the appeal in a timely manner. However, the paperwork should be returned as soon as possible to avoid unnecessary processing delays.
Note: If the claimant has had recent medical treatment, or a change in their medical condition, this should be indicated on the disability report form for the appeal. This will alert the reconsideration-level examiner and prompt them to request updated medical records before making a decision on the case.
Also, claimants who send in an appeal should keep one copy of the forms in the event that the paperwork is not received by SSA. In line with doing this, the claimant should make a followup status call to the Social Security office within 10-14 days to verify that the appeal was actually received.
Denial rates on reconsiderations
Reconsideration appeals are processed in an identical manner to disability applications. For this reason, it should come as no surprise that the majority of reconsiderations are denied.
In most states, the denial rate on reconsiderations exceeds the rate of denial at the disability application level. Typically the reconsideration denial rate exceeds 80 percent.
Fortunately, by the second appeal level, the ALJ hearing level, the chances of approval are significantly higher, particularly when claimants provide a medical source statement from a treating physician and a well-documented "theory of the case" is advanced to the judge by the claimant's representative.
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.
Some basic facts about disability hearings in Washington
1. You may submit evidence for your Social Security hearing. You can submit evidence and, in fact, you should submit current medical evidence to support your disability claim. Social Security can only make a disability determination with evidence that is no more than 90 days old.
Having medical evidence from your treating medical sources will improve your chance of being approved for disability. This is one of the primary functions of a Social Security Disability representative and one of the most valued services they provide.
Whether you have a representative or not, the administrative law judge needs current medical evidence to make a disability determination.
2. There are three types of disability decisions at hearings - An administrative law judge makes three types of disability determinations: denial, partially favorable, and fully favorable.
If a decision is partially favorable, this means it was approved but benefits were not paid back to the date of onset of disability that was alleged by the claimant. In other words, the judge decided the claimant was disabled but not as far back as the claimant stated. If the decision is fully favorable, the judge agreed with the onset date indicated by the claimant when they filed their application for disability.
3. If the administrative law judge denies your disability claim, you can appeal their decision to the Appeal Council and wait for that decision or you can file a new disability claim.
For some, filing a new disability claim may cause them to lose the chance for Social Security Disability. Social Security Disability is based upon insured status and this insured status is lost after a few years. If your hearing was held after the date you were last insured, you will lose your eligibility for Social Security Disability benefits. It is not a bad idea for someone in this situation to file an Appeals Council Review appeal, or even a Federal Court case.
However, if you are still insured for Social Security Disability you may wish to begin the process again, because it most likely will save time. Most Appeals Council Review appeals are dismissed or denied.
A Social Security attorney or non-attorney representative will be able to advise a claimant of their best options following a denial on a case.
4. If the administrative law judge makes a partially favorable decision, this could mean they have awarded you a "period of disability" or they have changed the onset date of your disability.
A period of disability award usually defines a specific period of time for which the judge determined that the severity of your disabling condition or conditions met the requirements for Social Security Disability benefits. Generally, your payment for your period of disability will be paid in a lump sum and you will not receive continuing monthly benefits.
If the administrative law judge changes the onset date of your disabling condition, they have determined that your allegation of when your disability began cannot be supported by the medical and vocational evidence in your disability claim.
However, they also determined that that evidence supports a finding of disabled at a later date than you alleged. This is why the decision is only partially favorable to you.
Lastly, if the administrative law judge makes a fully favorable decision in your case, you may be eligible to receive disability benefits.
This means the judge agreed with the date you alleged you became disabled. They have determined that the medical and vocational evidence in your file support a finding of disabled.
With a fully favorable decision, you will receive the maximum amount of back pay benefits along with continuing disability monthly benefits provided you meet the non-disability criteria of the disability program you have been approved for (SSDI or SSI).
5. If you have a hearing appeal pending in Washington you will more than likely be approved for disability provided your file has evidence to support a finding of disabled.
Washington has a very favorable hearing approval rate that is just over 50 percent. Since you are likely to be approved for disability at your hearing, you should improve your chances of being approved by arriving for your hearing on time, making sure your case file has current supporting medical evidence, and that you are prepared to answer any questions the judge might have with regard to your disabling conditions and how they are limiting your ability to perform routine daily activities including work activates.
And, if you have not considered the services of a Social Security Disability representative, you should consider obtaining their services.
If you were not approved at your initial disability claim or your reconsideration appeal, it would stand to reason that your disability claim is not a straightforward Social Security Disability approval case. Meaning, you do not meet or equal the criteria of a Social Security Disability impairment listing and that your case if approved will most likely be approved through a medical vocational allowance. Medical vocational allowance determinations involve a consideration of your age, education, functional limitations, work history, and the transferability of your job skills.
6. Why does a disability attorney or representative improve the chances of winning?
As I mentioned above, most Social Security Disability hearing approvals are based upon medical vocational allowances. You as an average person would have no idea what medical information is needed to support your disability claim. Nor will you likely know the medical or vocational guidelines that might improve your chances of winning your disability benefits.
A disability attorney or representative will get necessary medical records, statements from your treating physicians, or functional reports that support your disability claim. They may even hire medical or vocational experts to help substantiate facts of your disability case.
Lastly, they will come to your disability hearing to present your disability case to the administrative law judge. Naturally, they present the facts of your disability claim using vocational and medical guidelines that are favorable to you being found disabled.
There is no concrete answer as to why a representative actually improves your chance of winning at an administrative law judge hearing, perhaps they win more because the administrative law judge is dealing with another legal professional or it may be that the representative is able to prepare your disability case in the most favorable way, or it could be that the representative is just able to present your case in a more objective, less emotional way.
Whatever the reason, having a representative improves your chance of winning your disability claim by at least 21%, according to statistical data gathered by Congress on the subject.
Note: There are multiple hearing offices in Washington and the approval and denial rates listed here are averages supplied by the DIODS extract prepared by the Office of Disability Programs.
The individual Social Security Hearing offices award disability benefits at the following levels: The Seattle WA hearing office approves 44.6 percent of cases; The Spokane WA hearing office approves 59.4 percent of cases; The Tacoma WA hearing office awards 54.7 percent of cases.
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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