Will I Qualify For Disability Benefits in Washington?

To qualify for disability benefits under the title II Social Security Disability (SSD) program, or under the title 16 Supplemental Security Income (SSI) program, or both programs as is often the case, a person must meet the definition of disability used by the Social Security Administration.

The SSA definition of disability is unique to SSA and differs considerably from the criteria for VA disability, long term disability, or workman's compensation. It stipulates that a person must have one or more medical conditions (physical or mental, or a combination of both) that are severe in nature.

The severity level must exist to the extent that either the person has not been able to work and earn a substantial income for at least one full year due to their condition, or--based on a review of the evidence--will be determined to be unable to work and earn a substantial income for a period of not less than one full year as a result of their condition.

Qualifying for disability in Washington

Disability examiners and disability judges who render determinations and decisions on claims employ a five step sequential evaluation process:

1) Is the claimant working and earning a substantial and gainful income as measured by SSA? If the answer is yes, the claim is denied. If the answer is no, the process moves on to step 2.

2) Does the claimant have a severe impairment? If the answer is no, meaning that the claimant's conditions are non-severe (such as a sprained ankle), the claim is denied. If the answer is yes, the process moves to step 3.

3) Does the claimant have a condition that satisfies the approval criteria of a medical condition contained in the Social Security list of impairments?

If the answer is yes, the case will most likely be approved and the process stops here. If the answer is no (and it usually is--most claims are not approved on the basis of a listing as the approval criteria is fairly demanding in most cases and very many medical conditions are not even included in the listings), the case moves to step 4.

4) Is the claimant capable of performing their past work? At this level, it becomes apparent that Social Security is not only concerned with a person's medical history, but their work history as well. Which is why applicants are asked to provide information about their work history.

If a claimant is found to be capable of returning to their past work (potentially any job performed in the 15 year period prior to becoming disabled), the case will be denied.

In most cases, though, a claimant will be found to be unable to return to their past work. If so, the case will move on to the fifth and final step.

5) Is the claimant capable of performing some type of other work, even if they cannot do their past work?

This is the step at which disability claims gain most of their complexity. Because aside from simply determining what a claimant's functional limitations are (that result from their various conditions), their limitations will also need to be considered in a greater context that takes into account their age, level of education, and level of work skills.

Disability examiners and disability judges refer to a set of medical vocational rules (the grid) that directs decisions on claims. However, the process is not entirely cut-and-dried. At disability hearings, for example, a judge may elect to have a medical expert appear to lend expert opinion to the process of determining in what ways, and to what extent, the claimant is physically or mentally limited.

By the same token, the judge may have a vocational expert appear to give expert testimony regarding the claimant's chances of switching to some type of other work, given their age, education, skills, and limitations. At the hearing level, of course, a disability lawyer or representative will be utilized to not only prepare and present the case, but also cross-examine expert witnesses who appear at the judge's discretion.

How many disability cases are approved in Washington?

Currently, about 36% of all initial disability claims filed in Washington are approved for disability benefits. In some years, the approval rate is substantailly lower. This, of course, means that between 60%-70% of all disability applicants are denied disability.

This makes it necessary for the great majority of claimants to continue pursing their claim through the appeal system before ultimately being given a disability award.

Filing for disability in Washington

You can file an application for disability with Social Security at any one of 24 Social Security offices throughout the state, or you can file your Social Security Disability application online.

The trick to completing an online Social Security Disability application is to complete all parts of the disability application process. This means that you need to complete the application, disability report form, and medical release online.

However, if you think you might also qualify for the need-based SSI (Supplemental Security Income) disability program, you will not be able to complete an application online. Because an SSI application involves an evaluation of a claimant's income and resources, a disability interview must be conducted through a Social Security office; thus, online filing is not available.

The complicating factors, of course, are 1) the fact that a significant percentage of cases will involve both Social Security Disability (SSD) and SSI simultaneously, in the form of a concurrent claim and 2) the fact that it will be impossible to know in advance whether or not a person's case will be for SSD, SSI, or both programs.

For this reason, it is probably a better expenditure of a claimant's time to simply complete a disability application with a local Washington Social Security field office. This can be done in person, or by phone, which makes the process just as convenient as the online process (and less confusing since there will be an actual individual to speak with and ask questions of).

The disability claim decision process

Once you file your disability application with Social Security, your disability claim is sent to Disability Determination Services. DDS is a state agency that is responsible for making disability determinations for the Social Security Administration. Washington has three regional DDS offices located in Olympia, Seattle, and Spokane.

Once your disability claim reaches a Washington DDS regional office, disability examiners, staff physicians, and psychologists determine if you qualify for any of three disability programs: Social Security Disability insurance (SSDI), Supplemental Security Income disability (SSI), and in the state of Washington, Non-Grant Medical Assistance (NGMA).

The Washington DDS locations receive about 1700 new disability claims each week; these disability claims are processed by 250 employees. In fact, DDS processes all initial disability claims, reconsideration appeals, and continuing disability reviews (all disability beneficiaries have their disability claim reviewed periodically).

At DDS, your disability claim is assigned to a disability examiner or specialist, who is responsible for getting medical treatment records, work information, and for making a disability determination. They may request additional information from you or they may schedule a consultative medical examination to get all the information they need to make their disability determination.

If the case is denied: filing the first appeal

If your initial disability claim is denied, you have two choices. You can give up or file an appeal of your initial disability claim denial with a reconsideration appeal. As stated above, reconsideration appeals go back to DDS for a disability determination, the only difference being that your disability claim is assigned to a different disability examiner.

As you might guess, the approval rate for reconsideration appeals is very low. The only reasons for an approval at this level of the Social Security Disability process are: an error on the part of the disability examiner who made the initial disability determination, or that there is new and compelling evidence to support a finding of disability.

In Washington, as in all other states, reconsideration appeals are just a necessary step to the next level of the Social Security Disability process. The approval rate for reconsideration appeals in in Washington is about 13%.

Disability hearings in Washington

So what should you do if your reconsideration appeal is denied? You should appeal the denial by requesting a hearing before an administrative law judge. Unlike initial disability claims and reconsideration appeals, disability hearing decisions are not made by DDS or disability examiners. They are made by administrative law judges at a Social Security hearing offices.

Washington has hearing offices in Tacoma, Spokane, and Seattle. The disability hearing appeal is the most winning level of the Social Security Disability process. This means more people are likely to qualify for Social Security Disability at this level than any other level.

Administrative law judges in Washington have an average approval rate of about 61%. This means that approximately 40 percent of claims are still denied by judges. However, if a case is properly prepared with objective evidence that proves a claimant has severe functional limitations, and if it is likewise properly presented with an understanding of Social Security regulations and SSRs (social security court rulings), the chances of approval are within the claimant's favor.

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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