Should you appeal your initial application denial or reapply if you are denied disability benefits? If the Social Security Administration (SSA) states your disability is not severe enough to receive benefits, appealing the decision is usually the right move. Many individuals believe that by simply reapplying the SSA may approve their new application, but statistically this is not accurate. In my experience, it is in your best interest to appeal the initial denial.
After your initial application is denied you have sixty (60) days to file a Request for Reconsideration. Many individuals refer to this as an appeal. The Request for Reconsideration is basically saying to the SSA that they made a mistake and need to take another look at your claim. When you file your reconsideration, the SSA should also gather any new evidence for your claim as well. If you submit the appeal on your own, you should include the updated information when prompted. If an attorney or representative completes your appeal for you, they should be in touch with you for updated information.
Unfortunately, the majority of these requests are also denied. Once again you will have sixty (60) days to file an appeal and request a hearing in front of an Administrative Law Judge (ALJ). Some statistics have shown you odds of winning your claim will increase at this stage.
The majority of successful disability claims ultimately end up in front of an ALJ. An administrative Law Judge is not bound by prior decisions by the SSA and is supposed to take a fresh look at your Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) claim.
In my experience as a Social Security Disability attorney it is very important to appeal your denied claim within the time limits set forth by the SSA. It is also my experience that simply reapplying time after time with an initial application is usually not the best course of action to receive a favorable outcome in your disability claim.
Many Social Security disability claimants are under the impression that hiring an attorney will speed up the processing of their case with the Social Security Administration (SSA). While hiring an attorney does not directly translate into a claim being processed more quickly by the SSA, there are many benefits of having an attorney on your case.
Benefits at the Initial Application Stage
Getting an attorney representative to help you with your initial application for benefits may help your chances of being found disabled. As most disability claimants and attorneys know, the majority of people are denied on their initial application. However, some benefits of our office helping a claimant complete an initial application may include:
- Helping you obtain a medical source statement from your doctor by providing questionnaires designed to get your doctor’s opinions on specific issues Social Security addresses: Social Security is supposed to give great weight to the opinions of your treating medical providers.
- Updating Social Security about changes in your condition and treatment: the more complete the medical records Social Security has, the more likely it will have enough evidence to make a favorable decision.
- Ensuring your application is complete: the application can be overwhelming to someone who has never done it before, but we are able to walk you through and ensure you provide complete and accurate information.
- Submitting medical records in support of your claim: while Social Security typically requests all of your medical records at the initial application stage, we are able to help follow up with providers Social Security cannot reach.
- Keeping track of your claim to make sure it is processed in a timely manner: we regularly follow up on each claim to make sure Social Security has everything it needs and to make sure the case is moving forward.
While Social Security does not give special treatment to cases handled by an attorney or qualified representative, having an experienced advocate working on your behalf can make your case stronger.
On The Record Request
If your application is denied at the initial stages, the next step is to request a hearing before an Administrative Law Judge (ALJ). Currently in Indiana, we have to wait for 12-15 months to get a hearing. This is a long time for claimants who are dealing with serious and painful conditions. One way an attorney can try to speed up the process is to file a Request for a Decision on the Record (an OTR request). When I file an OTR request, I attempt to make sure Social Security has completely updated medical records, and I write a brief that explains why the ALJ should be able to find the claimant disabled without holding a hearing. If the ALJ agrees with my argument, we can get a favorable decision without having to wait for a hearing. If not, we simply have to wait to argue the case in front of the judge.
Critical Case Request
If your financial situation is dire or your medical condition is terminal, you may be eligible for a critical case designation. The SSA breaks down critical case requests into six different categories: terminal illness, veteran with 100% permanent and total disability rating, military casualty/wounded warrior, compassionate allowances, dire need, and potentially violent/suicidal. If your attorney thinks you meet one of these requirements, he or she can submit a critical case request on your behalf. It is then up to Social Security to determine whether your case fits their criteria for a critical case designation. If so, the SSA will expedite the processing of your claim.
Follow this link for the complete rules on critical case requests.
Your Medical Records
At the initial application and the reconsideration stages, the Social Security Administration will request all medical records of which they are aware in order to make the most informed decision possible on your claim. Unfortunately, the SSA does not always have a complete record when it makes its decision. Sometimes a medical provider does not comply with the request in a timely manner; other times Social Security does not follow up on a request and the records fall through the cracks. Once Social Security has scheduled your ALJ hearing, our office requests your missing medical records as well as updated medical records from your current providers. Many times, when a claimant does not have representation, the judge and/or claimant may be unaware that the file is missing medical records. I feel that one of my office’s most important jobs as your representative is to ensure your medical record is complete for your best chances to win at your hearing.
In my experience, although hiring an attorney or claimant representative to help with your Social Security disability claim might not directly speed up your claim with Social Security, there are many things that an experienced attorney can do to make sure your claim gets processed as quickly and efficiently as possible.
A large number of my clients suffer from back pain, and there are many possible causes: degenerative disease, injury, or years of overexertion. The Social Security Administration (SSA) recognizes that severe back pain can be disabling, but you must have adequate documentation to prove you have a severe medical impairment. In other words, you must be able to provide medical evidence to show that your pain is the result of a medical diagnosis and that it has more than a minimal effect on your ability to work. Then you must show that your condition either meets or equals Social Security’s Listing of Impairments §1.04 for disorders of the spine, or that it keeps you from working at your past occupation or any other occupation. Your age, education level, and work experience can also figure into a finding of disability.
What does the SSA mean when they say you must “meet or equal a listing” to be found disabled? When it comes to your back, the SSA will look at the criteria in §1.00: Musculoskeletal System. In particular, Listing 1.04: Disorders of the Spine usually comes into play. To meet Listing 1.04, you must have medical imaging showing that you have nerve root compression, arachnoiditis, or lumbar stenosis in your spine. You must also have clinical evidence (treatment notes, for example) indicating specific corresponding physical symptoms.
If you do not meet or equal a listing, you may be found disabled due to your limited residual function capacity (RFC). If the SSA finds that your ability to stand, walk, sit, and lift is so decreased by your back pain that you are unable to work, you might be found disabled. In this scenario, the SSA may also take into consideration your age, education, and prior work experience to determine if you are disabled per Social security’s guidelines. An RFC assessment from your treating physician, sometimes referred to as a medical source statement, may persuade an Administrative Law Judge (ALJ) that you are disabled. It is the ALJ’s job to review the evidence to determine your RFC, and a statement from your treating doctor about your abilities and limitations in those functional areas can be very helpful.
In any claim for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI), it is important to have good and thorough medical documentation. As stated earlier, objective testing (such as MRIs, x-rays, or nerve conduction studies) is very beneficial. It is also important to have doctors’ treatment notes that indicate that you are compliant with doctor’s orders and taking your medication as prescribed.
My office is dedicated to helping Indiana residents get the benefits they deserve. It seems the SSA has an ever increasing workload, and my office strives to make sure your claims file is complete to make it as easy as possible for an ALJ to find you disabled. During the extensive waiting time for your hearing it is important to continue to receive the medical treatment you need, not only to improve your health, but to enhance your chances of winning at a Social Security disability hearing.
I talk to hundreds of people each year about Social Security disability. My clients have a vast array of diagnoses, and all of them are suffering in some way. Many of them have the added pain of feeling guilty that they have to apply for disability benefits.
If you keep up with the news and the opinion pages, you probably know that Social Security disability benefit recipients are being vilified across the media. Pundits claim that disability beneficiaries don’t want to work; journalists are quick to investigate and expose people who are “scamming the system.”
My experience with disability claimants, though, is very different. One of the most-repeated phrases I hear when I talk to my clients is, “If I was able to work, I’d be working.” They have tried, but their physical or mental limitations have kept them from finding work. If they do find work, they often are not able to keep up their attendance or their work pace and end up getting fired. Many of my clients have work records dating back decades – they have worked all their lives, but now they cannot keep it up. They have contributed to “the system” by having Social Security taxes taken out of their paychecks every week for years, but now they feel guilty for trying to use the disability insurance for which they paid. Some of them have bodies that have just worn down after long years of heavy labor; others are suffering the long-term effects of an accident or sudden illness.
Another misconception weaving its way through the media circuit is that it is easy to “get disability.” From reading some articles, you’d think that a person can wake up one morning with some aches and pains, head down to the Social Security office to sign up, and walk out with a disability check. Every one of my clients knows that this is not so. The application process alone takes several months of answering questions, gathering medical records, and attending consultative examinations. It was difficult for many of my clients to finally admit their conditions were bad enough that they had no choice but to give up working. It took humility for them to ask for help. Unfortunately, for many of my clients, the long bureaucratic process devastates their dignity. To show that they are disabled, they must share private details of their lives. Strangers peruse their medical records; examiners, attorneys, and judges require them to recount in excruciating detail their pain and their limitations.
To make matters worse, the long wait times for decisions bring additional stress and hardship to people who are already suffering due to their medical conditions. They are unable to work, so their families are struggling to put food on the table and keep a roof over their heads. Too many of my clients lose their cars, their homes, and sometimes their relationships while they wait in limbo for their appeals to be processed. Too many of my clients see their conditions worsen because they can’t afford the medical care they need. Many of my clients receive public benefits and Medicaid, but they are still left having to choose which of their medications they will be able to afford to refill this month and which they will have to go without. Too many of my clients die before a decision is made on their claim.
As a Social Security disability attorney, I know that the Social Security Administration is overwhelmed by more disability claims than it is able to efficiently process. I also know that there are many good, honest people who have run out of options and need Social Security disability to survive. My office staff and I strive to provide empathetic, passionate representation for our clients. It’s about more than winning claims; it’s about helping people who deserve to receive benefits because they cannot work.
Whenever I talk about the keys to a Social Security disability claim, I emphasize the importance of medical records. Medical records are important because the Social Security Administration (SSA) cannot find you disabled under its rules without finding that you have a “medically determinable impairment.” In other words, you must be able to provide acceptable medical evidence, such as objective test results or treatment notes showing diagnoses from acceptable medical sources, that proves that you have a medical condition that prevents you from being able to work.
Why are Medical Records Important?
While the SSA will most likely send you for an independent consultative examination to determine your diagnoses and symptoms, it is important to have medical records showing that you have been diagnosed and treated on your own. I have often seen decisions in which an Administrative Law Judge (ALJ) has concluded that a claimant’s impairment must not be as severe as he or she is alleging because the claimant did not receive significant medical treatment for it.
Medical records are helpful in proving that you are disabled because they contain the diagnoses and clinical findings of medical providers who have treated you on a regular basis. If those diagnoses and findings come from a doctor who specializes in treating your condition, Social Security will likely give them significant weight in determining whether your condition prevents you from working.
What Kinds of Medical Records are Important?
The most valuable records I can submit on behalf of my clients are objective test results. X-rays, MRIs, nerve conduction studies, pulmonary function tests, and other tests give hard data showing the severity of certain conditions. In fact, with appropriate test results it may be possible to show that you are disabled without even having to talk about whether you can perform work-like activities. If Social Security has a section in its Listing of Impairments that addresses your condition, it may include provisions that allow you to show you are disabled by showing that your results on certain tests fall above or below a cutoff number.
Of course, some conditions cannot be diagnosed using objective testing. Migraine headaches, fibromyalgia, and most mental disorders fall into this category. For other conditions, such as diabetes, some immune system disorders, and epilepsy, Social Security requires more than just objective test findings; you must also show that your symptoms occur at a particular level of severity or frequency in order to qualify as disabling conditions. In these cases, it is vital to have treatment notes, preferably from specialists, showing consistent treatment and compliance with doctors’ orders.
How Are Medical Records Obtained for the Hearing?
When I represent someone who is appealing the denial of a claim for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, one of my most important jobs is to make sure that all of my client’s medical records are submitted to Social Security. In the initial stages of a claim (on the initial application and at the request for reconsideration level), Social Security requests and pays for medical records associated with your claim. At the hearing level, though, if you have representation, your attorney or representative is responsible for ensuring that all of your records have been submitted.
The process of requesting medical records sounds simple, but it is something of an art. The average wait time for a hearing in Indiana right now is about fifteen months. After the Office of Disability Adjudication and Review (ODAR) receives your hearing request, it prepares your file for the ALJ by sorting and labelling the existing evidence in exhibits. However, the bulk of the waiting time is spent, well, waiting. Therefore, my office typically waits until the hearing is scheduled before we request updated medical records for your file. We have to balance several factors. First, every time we request records, we typically have to pay a $20 copying fee in addition to a per-page fee, so we do not want to request medical records multiple times. Second, if we request and submit your records too early, we might miss out on important information from records that are created within the few months prior to your hearing. Third, if we request your records too late, we will not receive them in time to submit them prior to the hearing; we want the ALJ to have all of the records available with plenty of time to review them prior to your hearing. Since some medical providers can take a month to respond to our request for records, we typically begin requesting records about six to eight weeks prior to your hearing. We then follow up on a regular basis to ensure that our request has been received and is being processed.
Many of my clients half-jokingly tell me that they can’t work, in part, because they spend so much time going to all of their doctors’ appointments. It is my duty as their attorney to ensure that all of that time they spend in treatment is documented for the ALJ at their hearing. Ensuring a complete hearing record is a meticulous, time-consuming effort, but it is one of the most important things I do for my clients.
Often, my blog topics reflect certain disabling conditions or Social Security disability issues that seem to be becoming more prevalent in my practice. Asperger’s Syndrome is definitely one of these conditions; I represent many children and adults who have been given this diagnosis.
Of course, the most recent DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, which was released in May of 2013) no longer contains a diagnosis of “Asperger’s Syndrome”; the disorder, along with other disorders such Pervasive Development Disorder NOS, is now included under the diagnosis of “Autism Spectrum Disorder.” As people with Asperger’s and their families know, it doesn’t matter what it’s called; the symptoms and limitations remain.
People with a diagnosis of autism spectrum disorder typically have social communication and interaction deficits and restrictive, repetitive patterns of behavior. These symptoms often interfere with an adult’s ability to work or with a child’s ability to function at an age-appropriate developmental level. If you or your child have these symptoms, you could be eligible for benefits under Social Security’s Disability Insurance (SSDI) program or Supplemental Security Income (SSI) program.
Whether you are an adult or a child on the autism spectrum, the first way the Social Security Administration (SSA) assesses whether your impairment is disabling under its rules is by referring to the entry for “autistic disorder and other pervasive developmental disorders” in its Listing of Impairments. The relevant listing for adults is Listing 12.10; the relevant listing for children is Listing 112.10. First, Social Security will determine whether you meet the diagnostic criteria for an autism spectrum diagnosis. Next, it will evaluate how severely your symptoms affect your ability to function. For adults, this means an adjudicator will determine how markedly your symptoms impair your activities of daily living, your social functioning, and your ability to maintain your concentration. The adjudicator will also review your record to determine whether you have repeated episodes of decompensation due to exacerbations in your symptoms.
For children, the adjudicator will evaluate functioning in six domains: acquiring and using information, attending and completing tasks, interacting and relating with others, moving about and manipulating objects, caring for yourself, and health and physical well-being.
Thorough medical records from a qualified professional can be key to a successful outcome in a Social Security disability appeal. Observations from a psychiatrist or therapist can go a long way in proving this type of disability. Children’s school records showing additional help they are receiving can also greatly enhance the chances of receiving a favorable decision from the SSA. Current treatments for patients on the autism spectrum can include, but are not limited to:
- Training in social skills
- Therapy, including cognitive, physical, occupational, and speech
With the ever-increasing number of these cases being brought before the SSA, it is important to have a well-documented medical record to help an Administrative Law Judge (ALJ) understand how disabling Asperger’s Syndrome can be. Securing medical source statements from physicians can help an ALJ understand the restrictions an individual may have in a school or work setting. If you have questions concerning Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI) benefits for Asperger’s Syndrome or any other impairment, it may be in your best interest to talk to an attorney or qualified representative to discuss your options.
Many of the clients I serve in my Indianapolis disability practice suffer from some type of depressive disorder. Sometimes their symptoms of depression are caused by or exacerbated by physical impairments, but often depression is a disabling condition all by itself.
Depression raises some unique obstacles in pursuing a Social Security disability claim. Deadlines must be met, appointments must be kept, and paperwork must be completed in a timely and thorough manner. If you have depression, though, you may lack the energy to keep track of your paperwork or even open your mail. You might be so socially and emotionally isolated that you do not attend appointments or return telephone calls. You may have difficulty maintaining attention long enough to complete questionnaires about your symptoms and work history. If you aren’t able to fulfill these obligations, it is likely your claim will be dismissed. It can be really helpful if you allow a family member or friend to help you make sure everything gets finished completely and on time.
The Social Security Administration (SSA) addresses the disability nature of depression and other affective disorders in its Listing of Impairments at Listing 12.04. To meet the requirements of this listing, you first much be able to show that you have medically documented symptoms such as:
- “Anhedonia,” or a persistent, all-encompassing loss of interest in your daily activities, even things you used to like to do
- Disturbance in your appetite causing weight gain or loss
- Sleep disturbance
- Psychomotor agitation (unintentional, purposeless movement) or retardation (listlessness, inability to physically carry out everyday activities)
- Lack of energy
- Guilt or feelings of worthlessness
- Problems concentrating or thinking
- Suicidal thoughts
- Hallucinations, delusions, or paranoia
It is not enough for you to explain to Social Security what your symptoms are and how they affect you. You must be able to provide documentation from a medical provider supporting your description of your symptoms. You must also be able to show that your symptoms have lasted or are expected to last at least twelve months. Records from a mental health professional carry the most weight, especially if you are treated by a psychiatrist or a psychologist.
The next thing you must show is that your symptoms from depression cause at least two of the following:
- “Marked” impairment (which is defined by Social Security as interfering seriously with your ability to function independently, appropriately, and on a sustained basis) in carrying out your activities of daily living, including maintaining your home, paying your bills, and running errands
- Marked impairment in social functioning, or your ability to interact and communicate with family members, friends, and strangers
- Marked impairment in maintaining concentration, persistence, or pace enough to complete tasks, especially in a work setting
- “Repeated” (which is defined by Social Security as occurring at least three times within a year and lasting at least two weeks at a time) episodes of decompensation, or times when your symptoms increase and result in a loss of your adaptive functioning
If your symptoms are currently under control due to medication and therapy to the extent that you do not typically have “marked” impairments as described above, Social Security might still find you disabled under certain circumstances. These situations occur if you have had chronic symptoms for at least two years and one of the following applies:
- You are unable to live outside of a highly supportive living environment
- Your symptoms are so tenuously controlled that even a slight change in your environment would cause you to decompensate
Probably the most disabling functional limitations for most of my clients with depression is the inability to work consistently on a full-time basis. Their symptoms prevent them from being able to focus and concentrate consistently enough to work an eight-hour day. Further, the lack of energy and sleep disturbances prevent them from being able to make it to work on time, or even at all, often enough to be able to hold a job.
Depression might be one of the most misunderstood disabling conditions in that many people do not realize how severely it can limit a person’s ability to function and how difficult it can be to overcome. However, with medical records that support the severity of your symptoms and reflect consistent treatment and medication compliance, it is possible to receive disability benefits for depressive disorders.
If you suffer from diabetes and your symptoms keep you from being able to work, you may be eligible for either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) payments.
The prevalence of diabetes among my clients seems to be ever increasing. Some of my clients suffer from Type I diabetes, which typically starts in childhood. However, most of my clients with diabetes have Type II diabetes, or adult-onset diabetes. Unfortunately, many of my clients have medical impairments that greatly increase their risk of developing diabetes, such as cardiovascular disease, high blood pressure, or high cholesterol. Others develop risk factors such as obesity, poor diet, and physical inactivity due to the physical limitations caused by their other medical impairments. If you suffer from diabetes, even if you do not consider it to be the most disabling condition you have, its effects on your ability to work may be substantial. When talking to Social Security about your disabling conditions, it is always important to discuss all of your impairments, even if you don’t think a particular condition like diabetes would be disabling to you all by itself. Social Security determines your limitations based on the combination of all of your functional limitations that result from any and all medically determinable impairments you have.
While the Social Security Administration (SSA) addresses diabetes in Section 9.00 of its Listing of Impairments, diabetes is no longer a listed impairment. (Social Security removed the listing for diabetes in 2011.) Instead, Social Security notes that the effects of diabetes on different body systems might allow you to meet or equal other sections of the Listings. In Social Security Ruling 14-2p, the SSA identifies some examples of the effects of diabetes, including:
- Diabetic neuropathy (evaluated under Listing 11.14 for peripheral neuropathies)
- Diabetic retinopathy (evaluated under Listings 2.02, 2.03, and 2.04, which deal with vision impairments)
- Amputation (evaluated under Listing 1.05 in the musculoskeletal section)
- Hypertension, cardiac arrhythmias, heart failure, or chronic venous insufficiency (evaluated under the cardiovascular system, which is section 4 of the Listings)
- Gastroparesis or ischemic bowel disease (evaluated under the Listings in section 5, which addresses gastrointestinal impairments)
- Slow-healing bacterial and fungal infections of the skin (evaluated under the Listings in section 8)
- Diabetic nephropathy (evaluated under Listing 6.06 in the genitourinary system section)
- Mental health issues such as cognitive problems, depression, anxiety, or eating disorders (evaluated under the Listings in Section 12 for mental disorders)
Symptoms vary among individuals, but many of my clients complain of similar restrictions on their work-like activities. For example, they are unable to sit or stand for even short periods; they have trouble using their hands on a frequent basis; and they would have difficulty completing an eight hour workday due to fatigue, pain, and the inability to control their blood sugar levels.
Most of my clients suffering from severe diabetes have plenty of medical records to support their claims, because symptoms of diabetes require so much monitoring and treatment. The fact is, the fight against the symptoms of diabetes is a constant and life-long struggle. If diabetes or any other medical condition is preventing you from working to support yourself or your family, it may be in your best interest to file an initial application with the SSA and then follow through with any appeals that are necessary to receive the benefits you deserve.
Proving you are disabled to the Social Security Administration (SSA) is not always easy. Before the SSA will even consider how your symptoms affect your ability to work, you must show that you have a “medically determinable impairment.” Telling Social Security that you have pain or fatigue or memory loss is not enough, by itself, to establish a medically determinable impairment. You must also be able to provide objective evidence that explains why you have those symptoms.
The most direct evidence you can provide is objective test results. These tests might include:
- Magnetic Resonance Imaging (MRI) and X-rays: these tests show the location and severity of physical damage to your musculoskeletal system that might cause symptoms such as pain.
- Electromyography (EMG) and nerve conduction studies: this type of test shows whether you have nerve damage that might cause symptoms such as pain, numbness, or weakness.
- Electroencephalography (EEG): this test helps to show abnormal activity in your brain that might cause symptoms from seizures or sleep disorders.
- CT Scans: these tests show damage to your organs that might cause symptoms such as pain, shortness of breath, or fatigue.
- Blood tests: these tests can show the presence or absence of different substances in your blood, which in turn can help prove that you have certain anti-immune disorders or other diseases.
- Stress tests: these tests measure the effects of exertion on your heart and can help quantify the severity of your cardiovascular symptoms.
- Echocardiograms: the results of these tests can show abnormalities in your heart that might cause symptoms such as chest pain, shortness of breath, weakness, or fatigue.
Not all medical conditions can be proven using objective testing, though. Mental health disorders, migraines, fibromyalgia, and pain disorders are notoriously difficult to prove because there are no reliable tests available to confirm them or rule them out. This does not mean, of course, that these conditions do not qualify as “medically determinable impairments.” If your medical records show that you have been appropriately diagnosed with an impairment, that impairment can be found to be a disabling condition. In those cases, Social Security reviews the “signs” of your impairment that have been observed by your medical providers. Medical “signs” are anatomical, physical, or psychological abnormalities that can be observed using medically acceptable clinical diagnostic techniques. (See Social Security Ruling 96-4p.) “Symptoms,” on the other hand, are your subjective descriptions of your impairments.
Many of my Indiana neighbors tell me they are in extreme pain, but they cannot afford to pay for appropriate medical testing. While Social Security occasionally will pay for some diagnostic tests like x-rays or pulmonary function tests, there is no guarantee that Social Security will order the tests best suited for proving the severity of your impairments. If you have adequate health insurance coverage and your medical provider agrees that objective testing is appropriate, those test results can help to show the SSA that you are disabled under its rules.
Another type of evidence that should carry a lot of weight with the SSA’s decision makers is a “medical source statement,” which is a statement from your treating doctor about the limitations caused by your conditions. If your physician records the specific mental and physical work-related limitations you experience, and the rest of the evidence supports your physician’s opinion, such a medical source statement may greatly enhance the likelihood that you will receive a favorable outcome in your Social Security disability appeal.
This article is not intended to discourage you from applying for Social Security disability benefits; if you are unable to work due to a disabling mental or physical condition I encourage you to apply for benefits. Social Security cannot simply deny your application for benefits for the sole reason that you are not receiving adequate medical treatment, especially if you are unable to receive treatment because you are unable to afford it. When you do apply, make sure you attend all of the examinations Social Security schedules, provide all of the information they request, and carefully comply with all of the deadlines.
My staff and I understand how frustrating it is to be unable to work and to get the level of medical care you need. We make sure that Social Security has all of the evidence available so they can make a good decision on your claim, and we help our clients obtain medical source statements and medical records from their medical providers. Please remember, this blog is not intended as legal advice.
In my Social Security disability practice, I meet many parents of children with special needs. They have heard that Social Security has a program for children with disabilities, but they do not know how to find out more about it. Here are some answers to some of the most common questions I hear from parents of disabled children.
How do I know if my child meets the requirements for SSI?
Qualifying for SSI is a two-step process. SSI, or Supplemental Security Income, is a needs-based program; therefore, your household must fall below a certain amount of income and resources to qualify at the first step. Unfortunately, there is no hard-and-fast number that I can say, “If you make XX amount of money, you are over the limit” because Social Security’s formula is more complex than that – it depends on the size of your household, your expenses, and the like. Similarly, there is a limit (currently $2,000 for a single person; $3,000 for a couple) on household resources (the value of the things you own), but there are exemptions for some things like your home and sometimes your vehicle. Really, the only way you can definitely determine whether you meet the income and resources limits is to talk directly to Social Security.
Once you qualify financially, Social Security determines whether your child meets the medical requirements. This determination is much less black-and-white than the resources test. They look at your child’s medical records and determine how her impairments limit her ability to function in six different “domains”: Acquiring and Using Information, Attending and Completing Tasks, Interacting and Relating with Others, Moving About and Manipulating Objects, Caring for Yourself, and Health and Physical Well-Being.
Is it best to work with a lawyer in the process?
In theory, Social Security’s process is designed so you don’t need an attorney. In fact, for SSI, you typically must complete the initial application by making an appointment directly with Social Security because they have to ask you those income and resource questions. You can contact Social Security by calling 1-800-772-1213.
The majority of people who apply receive denials of their initial applications, and there is an appeals process. That point in the process is where I believe an attorney does help quite a bit. We help you to make sure paperwork gets filed by the deadlines, we follow up with Social Security to make sure that everything is getting processed appropriately, and we prepare you for the administrative hearing. We request updated medical records, we write a brief to the judge, and we prepare you to appear and testify at the hearing. I find that many people feel much more comfortable going into the administrative hearing if they have an attorney with them.
What are some common mistakes made in the process?
Probably the biggest mistake I see people make in SSI cases is giving up too soon. Many people receive the denial of their initial claim and assume there is nothing else they can do, or they think the best thing to do is start a new application. Even though the appeals process is long and sometimes frustrating, the hearing level statistically gives the best chance of a favorable decision.
My other recommendations – not so much mistakes to avoid as things to do to help your case go as smoothly as possible – include:
- Provide information to Social Security about all of your child’s medical providers, including therapists and early childhood developmental programs.
- Make sure to go to all appointments that Social Security schedules for you.
- Keep Social Security updated about changes to your address or telephone number.
- Ask your child’s doctors to provide letters stating their opinions of your child’s limitations and prognosis.
- Make sure you give Social Security a realistic picture of your child’s limitations. In treatment and day-to-day life, the goal is typically to focus on your child’s strengths, emphasize the positive, and make your child feel like a “normal” kid. However, Social Security’s rules are based on what keeps your child from being able to do age-appropriate activities. It can be hard, but be brutally honest about the limitations your child faces every day.
Please remember that my answers are general, and you should not rely on them as legal advice. We do not have an attorney-client relationship. However, if you would like to ask more specific questions, or if your child’s claim has been denied, I encourage you to contact an attorney or claimant representative. Most offer a free consultation and may be able to answer questions you may have.