Elder Law

Advice for Claimants for Social Security and SSI Disability Benefits

By dvanar

1. Claims for Social Security Disability (SSD) benefits, or Supplemental Security Income (SSI) claims based on disability, usually take a long time to process. The decision on an initial claim will usually take months. If you get denied on your initial claim, and you usually will, the next step in the appeals process, called a reconsideration, sometimes takes seven or eight months to process. If you get denied on a reconsideration request, the next appeals level, a hearing, usually takes up to a year or longer. Therefore, if you are disabled and unable to work, file a claim for benefits immediately. Claimants often experience severe financial hardship because, having no idea how long it takes to process a disability claim, they waited before filing an application for benefits. And if you are denied, don?t give up; continue to appeal.

2. Most claimants for SSD and SSI disability benefits will be denied at the initial claim level. As a result, most SSD and SSI disability claimants will have to appeal of their claims at least as far as a hearing before an administrative law judge (ALJ). Initial claims are denied 60 to 70 percent of the time. Reconsiderations, the initial step in the appeals process, usually have a much higher rate of denial than initial claims ? 80 to 85 percent. Although there are exceptions, a reconsideration, in most cases, amounts to no more than a medical examiner?s rubber stamp of the initial claim denial. As a result, most claimants will have to appeal to the next level, a hearing before an ALJ, if they hope to be approved. Generally, the approval chances on at the hearing level are good; nationally, more than half of all ALJ hearings are won by disability claimants.

3. An large number of claimants for benefits, or those who file an appeal following a denial, fail to properly complete their paperwork, or fail to submit the Social Security forms in a timely manner. All appeals for disability must be filed within 60 days of the date of the last denial. Therefore, if you had problems doing the paperwork for your initial SSD or SSI disability claim, you should seek qualified assistance immediately.

4.  The decisions made by the Social Security Administration on claims for disability benefits are based solely on medical evidence. Simply stated, you cannot win a social security disability case without current medical evidence which substantiates your claim. Therefore, claimants should provide medical reports based upon regular, ongoing medical treatment. As a general rule, you will not be approved for SSD or SSI benefits if you are not being seen currently by a medical provider. Also, when a claimant does not properly list every treatment source on a disability application or request for appeal, the case can be delayed for months or, worse, be decided without crucial evidence being properly reviewed. Typically, this results in a denial.

5. Detailed statements from a claimant’s treating physician will carry great weight on an Initial SSD or SSI disability claim, or subsequent appeal. In fact, under the “treating physician” rule, ALJs must give substantial weight to the opinions of treating physicians, particularly when those opinions are documented and are consistent with a claimant’s medical evidence. However, the opinion of a treating physician will be given little weigh if that opinion is not supported by objective medical findings.

6. A statement from a treating doctor should mirror the Residual Functional Capacity (RFC) form used by physicians and examiners at the state agency which makes medical decisions on Social Security cases. The purpose of an RFC form is to rate the residual (i.e. leftover) functional capacity of a claimant, or a claimant’s ability to engage in normal daily activities, after taking into account the individual’s condition. The RFC form is used by the examiners at the state agency making the medical decisions. To the extent possible, the same form and analysis should by used by a claimant’s treting physician and medical experts.

7. Claimants who appeal their denied claims with attorneys win more often than claimants who appeal without attorneys. It’s a fact. Attorneys know how to structure the case and present the claim, and can identify critical medical evidence. This skill is often the difference between winning and losing on appeal. Attorneys fees are limited in SSD and SSI disability appeals. Unless the agency or a Court rules otherwise, attorneys fees are capped at 25% of past due benefits, subject to a maximum of $5300.

8. The disability cases that win tend to be the cases with better medical documentation. Disability claimants must realize this: social security bases its decisions on medical evidence. Statements from employers, relatives, and other non-medical sources are worthless in most cases. Therefore, claimants interested in winning should spend the bulk of their time making sure the proper medical evidence is in place.

Full post as published by Law Office of Donald D. Vanarelli Blog on December 31, 2008 (boomark / email).