Applying for Disability in New York

Approval and Denial Statistics for Disability Claims in New York 


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 - Approximately 60 percent of all disability claims filed under the Social Security Disability and SSI disability programs in New York fail to meet the SSA disability qualifications and are denied. 

These statistics vary from year to year and denial rates of 70 percent are not uncommon. The majority of disability claimants will find it necessary to file an appeal in order to ultimately win their benefits. 

How does the disability evaluation process work? 

After a disability application has been completed in a Social Security field office--meaning that the claimant has undergone a disability interview, completed a disability report form, and supplied all necessary information regarding their condition and symptoms, history of medical treatment, and work history information (substitute school information for a child applicant)--the claim is transferred to a disability examiner in the state disability processing agency. 

In most states, this agency is referred to as DDS, or disability determination services. At DDS, the disability examiner who is assigned to the claim will immediately begin to gather the medical records from the treatment sources listed on the disability application. 

The examiner, of course, will not be able to obtain records from treatment sources that are not listed. And, in some cases, if the claimant fails to list the proper name of the medical facility, the examiner may have increased difficulty in obtaining the records in a timely manner, and perhaps not at all. 

This, of course, illustrates why a claimant should provide a detailed history of their treatment when the claim is filed. This should includes the names of treating physicians, dates of treatment, names of hospitals, clinics, and private practices, and also the addresses of treatment facilities. 

The medical history should go back at least as far as the alleged onset date for the claimant's disability. Social Security will not be able to approve benefits with a fully favorable onset date (which can have a direct impact on how much back pay is received) unless the disability examiner can obtain medical record documentation as far back as when the disability is claimed, or alleged, to have begun. 

Most claimants will benefit from writing down their full medical treatment history before going to the Social Security office for their disability application review. Writing down this information in advance will often improve the accuracy of the information and allow the disability examiner to A) obtain the medical records faster and B) not miss essential information from the claimant's treatment history. 

Note: The time used to obtain medical records constitutes the single largest delay in the processing of a disability claim. 

The Social Security definition of disability 

To satisfy the Social Security Administration definition of disability and qualify for disability in New York, a claimant will need to prove that their condition, or set of conditions (which may be physical, mental, or a combination of mental and physical conditions) will last at least one full year. 

Additionally, for adults, the SSA definition of disability requires a degree of severity in the claimant's overall condition that results in the inability to engage in work activity that earns at least the income limit for what SSA defines as substantial gainful activity. 

This includes jobs that have been performed in the claimant's history of past work, and also jobs the claimant has not done but for which their skills and training might otherwise qualify them. 

There are two ways of being approved for disability 

Once the medical records have been obtained by the examiner, they will be read and evaluated. The examiner will first look to see if the claimant has a condition that qualifies for approval in the listing manual, also known as the Social Security list of impairments. 

If the claimant does not have a listing-level condition (most claimants do not), the examiner will then look for evidence of physical and/or mental limitations that interfere with daily activities and the ability to perform basic work activities. 

The limitations that are noted by the disability examiner will be used to give the claimant what is known as an RFC, or residual functional capacity, assessment. This is essentially a rating of what the claimant can still do, despite their condition. 

The RFC rating--what the person can still do--is then compared to the demands of their past work. At this point, it becomes obvious that it is just as important to supply detailed work history information as it is medical treatment information. 

If the claimant is currently limited enough that they cannot go back to a past job, and are also found incapable of being able to switch to some type of other work they may be found disabled and awarded benefits. 

Filing for disability as a child 

For children who file for disability in New York, the SSA definition of disability stipulates that the condition or set of conditions possessed by the child must present limitations severe enough to prevent the ability to engage in age-appropriate activities. If the child is school-age, the focus of the claim will be largely on determining whether or not the child can perform academically at the same level as their same-age peers. 

The criteria and requirements involved in applying for disability benefits in New York are the same as for all other states since the Social Security system is federal and standardized. 

Meeting the definition of disability will require proving that the condition A) has lasted (or will last, according to a projection based on the medical evidence) for one full year and B) is severe enough to prevent the performance of work activity (or age-appropriate activities if the claimant is a child). 

Disability application denial rate: 62.3 percent.

Disability application approval rate: 37.7 percent.

What You Need To Know Before You Apply

The denial rate in New York is quite high at 62%, one big reason for this is that many people do not get representation until they have been denied. 

Many lawyers are partly to blame for this since it is very common for someone looking for a lawyer at application level for their SSDI or SSI claim to be told to "apply and call back when you are denied". Some lawyers(not all) do this because an attorney's fee is based on past due benefits and if the lawyer wins a case at application they feel the fee does not cover the work involved in handling a case at this level.

This approach should be avoided because it is very important that the case be handled properly from the beginning, not only to assure you have the best chance to win at application level, but also to ensure that an application that was not properly done does not come back to haunt you at a later stage in the process. Studies have shown approval rates are much higher at the initial application level.

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Applying for Disability in Texas

Approval and Denial Statistics for Disability Claims in Texas 


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 - More than 60 percent of all disability claims in Texas are denied in any given year. This is in line with most states: The average rate of denial at the disability application level tends to hover around 70 percent. 

Due to a variety of factors, the majority of claimants will not meet the qualifications for disability benefits until one or more appeals have been filed. And in most cases, winning disability benefits will require pursuing a claim to the second appeal level, the request for hearing before an administrative law judge. 

Qualifying for disability 

Qualifying for disability can be difficult. The Social Security Administration uses a unique definition of disability. It is not enough to have a percentage loss-of-function, or to lose the ability to return to a former job. An individual must have a severe medically determinable impairment (which may be mental, physical, or both) which must last for one full year or longer. 

However, if the condition has not lasted a full year by the time the application for disability is filed, this is not necessarily an issue as a disability claims examiner can review the medical evidence and make a projection as to whether the individual's state of disability will last a year or longer. 

In addition to the duration requirement, the condition must be severe enough that it impacts normal daily activities and interferes with the ability to perform basic work activities. 

Each Social Security Disability and SSI Disability claim decision is both medical and vocational in nature, meaning that the limitations posed by the claimant's condition, or conditions, are considered in the context of how it affects their ability to work. 

Applying for disability 

Filing for disability in Texas will involve initiating a claim with the Social Security Administration online, or by contacting a local Social Security office. 

Contacting a local office offers distinct advantages over the online process. While the online process is touted as saving time, an SSI application cannot actually be filed online. 

This means that an individual whose claim will involve SSI--either entirely or as part of a concurrent Social Security Disability and SSI application--will still have to be contacted by a Social Security Claims representative. Translation: the online process may not save any time at all. 

Additionally, the act of contacting a local Social Security office offers the advantage of being able to ask questions and receive answers about a) the process of filing for disability and b) the requirements for qualifying for disability benefits. This, by itself, can avoid confusion and eliminate mistakes. 

However the claim is initiated, each disability claim in Texas will eventually involve a claimant having to undergo a disability application interview with a CR, or claims representative, at a local Social Security office. The interview can be conducted in person. 

For individuals who have mobility or transportation issues, however, the interview can be conducted over the phone. This may also be requested for claimants who simply prefer a phone interview. 

Who makes the decision on the disability claim 

After the claim has been taken, it will be transferred to a case processing specialist known as a disability examiner. This is at a separate state-level disability agency known as DDS, or disability determination services. The examiner at the Texas DDS will be responsible obtaining the medical evidence that is needed to make a decision on the case. 

However, the examiner can only gather records from the sources indicated by the claimant on their disability report form at the time of filing for disability. For this reason, claimants should be sure to include all pertinent information regarding their medical treatment history, including their dates of treatment, the names of their treating physicians, and the names and addresses of all hospitals and clinics. 

The correct name for a medical facility is especially important since Social Security will use this information to send out letters requesting medical records. If a claimant supplies an incorrect name, the disability examiner may fail to obtain the needed records which can pose a significant disadvantage to the case. 

At the very least, it may cause a significant delay in receiving a decision on a Social Security case. The wait for medical records, in fact, constitutes the longest portion of the time needed to process a disability application. 

What is the actual process of evaluating a claim? 

The process is as follows: 

1. The claimant's medical records are gathered, read, and evaluated. If it becomes apparent from the analysis of the records that they have a condition that satisfies a listing in the Social Security Disability list of impairments, they may be approved on this basis. 

2. If the claimant does not have a listing-level impairment, the information from their medical records will be used to determine what their current mental limitations and/or physical limitations are. This is their RFC, or residual functional capacity. The RFC rating is then compared to the demands of the jobs that were performed in the 15 year time period prior to becoming disabled. 

Note: This is why it is extremely important for a claimant to supply a complete and detailed work history during the interview for the disability application -- in fact, this is why it is generally a good idea to write down both the work history, as well as the medical history, prior to the application appointment at the Social Security office so no important details will be omitted. 

3. If the claimant's limitations do not rule out the ability to return to their past work, meaning they can return to one of their former jobs, they will be denied on this basis. 

If their limitations are great enough to rule out their past work, the case will move on to the final step, which is to determine whether or not they have the education and skills needed to perform some type of other work (which they have never done), given consideration of their age and functional limitations. 

4. Individuals whose condition is severe enough to make it impossible to do their past work, as well as other work that relies on their education and job skills, will meet the requirements for disability. 

In other words, they will be found to be disabled and will qualify to receive disability benefits on an ongoing monthly basis, in addition to receiving whatever back pay they may be eligible for. 

As stated, the majority of claims are denied at the disability application level. Most claims, of course, are denied on the basis that the claimant can do some type of other work. 

How long does it take for a disability decision? 

Claims for disability are usually decided within 90-120 days. There are exceptions to this, of course. Claimants who are scheduled for consultative medical examinations by Social Security and do not keep their appointment will add unnecessary delay to their case. 

Also, claimants who have had recent heart or eye surgery, or who have suffered a stroke will usually have their case deferred for three months so that Social Security can evaluate the residual effects. 

Since the large majority of claims in Texas are denied by Social Security, claimants should be ready to file an appeal upon denial. The first appeal is the request for reconsideration. 

Disability application denial rate: 67 percent.

Disability application approval rate: 33 percent. 

What You Need To Know Before You Apply

The denial rate in Texas is quite high at 67%, one big reason for this is that many people do not get representation until they have been denied. 

Many lawyers are partly to blame for this since it is very common for someone looking for a lawyer at application level for their SSDI or SSI claim to be told to "apply and call back when you are denied". Some lawyers(not all) do this because an attorney's fee is based on past due benefits and if the lawyer wins a case at application they feel the fee does not cover the work involved in handling a case at this level.

This approach should be avoided because it is very important that the case be handled properly from the beginning, not only to assure you have the best chance to win at application level, but also to ensure that an application that was not properly done does not come back to haunt you at a later stage in the process. Studies have shown approval rates are much higher at the initial application level.

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Requirements for Long Term Disability

If your employer offers you long-term disability (LTD) coverage as part of a benefits package, or if you've purchased an individual policy on your own, you may be eligible to continue receiving most of your salary in the event you become unable to work.

A person filing an LTD claim has a number of hurdles to clear, however, before benefits will be approved. The most important is to prove, with medical evidence, that you meet your insurance policy's definition of disability. But there are also requirements related to waiting periods, premiums, and minimum number of hours worked that you must keep in mind when applying for LTD benefits.

How Do I Prove That I'm Disabled?

If you're thinking about filing an LTD claim, you should first consult the summary plan description in your long-term disability policy (or ask your employer's human resources department) for the policy's precise definition of "disability." Generally, you will be found "totally disabled" if you're unable, due to illness or injury, to substantially perform the duties of your occupation. If your LTD policy provides for "partial disability," you may qualify for benefits if you can no longer work full-time at your own occupation, even if you're capable of working full- or part-time at another job.

Many policies state that you cannot file an LTD claim if you are still on your employer's payroll.

As in Social Security disability cases, the most important factor in proving your disability in an LTD claim is the opinion of your treating doctor. As part of your application for LTD benefits, your doctor will be asked to complete a form or write a statement regarding his or her opinion on your condition. Your physician's opinion is critical, but the claims administrator will also want objective proof of your disability. Therefore, the administrator will also request all the medical records related to your disability, including relevant clinic notes, lab results, x-rays, MRIs, exam findings, and surgical reports.

To show that your disability is ongoing, you should continue to receive treatment from your doctor while your LTD claim is pending, and even after you are approved for benefits. Failure to continue treatment may be grounds for the insurance company to cut off your benefits.

Other Requirements for Receiving LTD Benefits

It perhaps goes without saying that, if you're required to pay premiums for your LTD coverage, failure to make timely payments could cause your insurance to lapse. However most people who are insured under LTD plans have free coverage through their employer.

Full-Time Work

Most employer-sponsored LTD plans require that you're a full-time employee at the time you become disabled. "Full-time" is usually defined as working at least 30 or 35 hours a week, but check your particular LTD policy to be sure.

Waiting Period

Virtually all LTD policies have an "elimination period" between the time your disability occurs and when you can begin receiving benefits. This is essentially a waiting period during which you're not yet eligible for LTD benefits. Waiting periods are often three months or six months, but often last the same length as your short-term disability policy (most employees who have LTD insurance also have a short-term policy from the same company). Note that you'll likely be required to use up all sick leave before filing for short-term disability, and exhaust all short-term disability before filing for LTD.

Pre-Existing Conditions

There are exclusions for pre-existing conditions in many LTD policies. In general, a pre-existing condition is classified as an illness or injury that was diagnosed and/or treated within a certain period (often 90 or 180 days) before your LTD coverage began. If such a condition is present, you will not be paid benefits for any long-term disability that arises from that pre-existing condition for the first twelve months of your LTD coverage.

Excluded Conditions

Before filing an LTD claim, make sure that your illness or injury is in fact covered by your LTD policy. Some policies have exclusions for particular diseases or workplace accidents. Also note that many LTD policies contain a 24-month limitation on disabilities caused in part by alcoholism, drug abuse, or mental or nervous conditions.

Will My Insurance Company Require Me to File for Social Security Disability?

If you've been approved for LTD benefits, almost all policies require you to file for Social Security Disability benefits as well. That's because your insurance company can offset the amount you receive from Social Security against your monthly LTD payment. Because of this offset, your insurance company has a significant interest in seeing you approved for Social Security disability. It's not uncommon for an insurance company to hire a disability attorney to represent you in your Social Security case.

Similarly, if you're receiving LTD benefits based on an injury that occurred on the job, you may also be required to file for workers' compensation. Like Social Security, any Workers' Compensation payments you receive will offset your LTD benefits. It is important that you follow through on your Social Security and Workers' Compensation claims if you wish to continue receiving LTD benefits.

  Do You Meet The Long Term Disability Requirements?

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What You Need To Know Before You Apply

The national denial is quite high at 65%, one big reason for this is that many people do not get representation until they have been denied. 

Many lawyers are partly to blame for this since it is very common for someone looking for a lawyer at application level for their SSDI or SSI claim to be told to "apply and call back when you are denied". Some lawyers(not all) do this because an attorney's fee is based on past due benefits and if the lawyer wins a case at application they feel the fee does not cover the work involved in handling a case at this level.

This approach should be avoided because it is very important that the case be handled properly from the beginning, not only to assure you have the best chance to win at application level, but also to ensure that an application that was not properly done does not come back to haunt you at a later stage in the process. Studies have shown approval rates are much higher at the initial application level.

Applying for Disability in Florida

Approval and Denial Statistics for Disability Claims in Florida 


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 - Approximately seven out of ten claims for disability in Florida are denied at the initial claim, or disability application, level in Florida. Because the prospect of being denied on a disability claim in Florida is so high, most claimants can expect to utilize the appeal process before they eventually receive disability benefits. 

Applying for disability in Florida will involve having to complete a disability application interview with a claims representative in a local office. 

The purpose of the interview is to provide the claims representative with all the information that may be necessary for properly evaluating the claim, and, potentially, meeting the qualifications necessary for receiving a Social Security Disability award or SSI disability award. 

Qualifying for disability in Florida 

Individuals filing for disability in Florida should keep in mind that while their cases will be decided primarily on the basis of information contained in their medical records, the decision will also be made using vocational information (i.e. information concerning one's job history) if they are an adult, and often academic information if they are a minor-age child on whose behalf the claim is being filed. 

For adults applying for disability benefits, the goal will be establish that one's current and projected functional limitations(physical limitations or mental limitations) are severe enough to prevent the individual from engaging in their past work activity, or in other types of work activity at a level that earns them a substantial and gainful income. 

Whether or not a claim for disability is considered to meet the qualications and requirements for disability will depend on the findings reached by a disability examiner. 

A disability examiner is not the same individual who take claims in Social Security offices. Examiners work at state disability agencies (usually, depending on the state, referred to as DDS, disability determination services, or DDD, the disability determination division. The examiner who handles the disability determination for a claim will have the claim forwarded to them after the initial intake phase has been completed at a Social Security field office. 

The examiner's chief goal is to gather records from the doctors and other sources of medical treatment listed on the disability application. The examiner then extracts the pertinent information from those records in order to determine if the claimant's case satisfies the SSA definition of disability, thereby qualifying the claimant to receive disability benefits under either the title II SSD or title 16 SSI program. 

As stated above, the majority of claims will be denied at the initial claim level and individuals wishing to pursue their claim should file their first appeal, which is a request for reconsideration. Claimants who follow the appeal process will, statistically, be likely to have benefits approved by the time the second appeal, a hearing before an administrative law judge, takes place. 

Filing for disability claim as a child 

For children applying for disability in Florida, the disability qualifications are a bit different. The requirements for disability for children are predicated on the inability to engage in activities that would be considered normal for one's age, i.e. age-appropriate activities. 

It is for this reason that on children's claims medical records are reviewed, but school records are also often reviewed when the child is of school age (including grade reports, IEPs, and reports of academic and intellectual testing). 

Disability application denial rate: 73.2 percent.

Disability application approval rate: 26.8 percent. 

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WHAT YOU NEED TO KNOW BEFORE YOU APPLY

The denial rate in Florida is quite high at 73%, one big reason for this is that many people do not get representation until they have been denied. 

Many lawyers are partly to blame for this since it is very common for someone looking for a lawyer at application level for their SSDI or SSI claim to be told to "apply and call back when you are denied". Some lawyers(not all) do this because an attorney's fee is based on past due benefits and if the lawyer wins a case at application they feel the fee does not cover the work involved in handling a case at this level.

This approach should be avoided because it is very important that the case be handled properly from the beginning, not only to assure you have the best chance to win at application, but also to ensure that an application that was not properly done does not come back to haunt you at a later stage in the process. Approval rates are much higher at the initial application level.

Applying for Disability in Pennsylvania

Approval and Denial Statistics for Disability Claims in Pennsylvania 


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 Pennsylvania, approximately 69 to 70 percent of all disability claims are denied in a typical year. For a majority of claimants, this will make the disability appeal process a necessity. 

Fortunately, claimants who have been denied and who appeal their case to the level of an ALJ (administrative law judge) hearing will have a statistical likelihood of winning benefits, assuming their case has been properly prepared for presentation to the judge. 

Why are disability claims denied? 

When a denial on a disability application happens, it may be the result of a technical issue, such as having too much earned income at the time of filing, or having assets that exceed the allowable limit (note: the assets limit of $2000 only applies to SSI while the Social Security Disability program does not take assets into consideration and has no limit). 

However, in most cases, the denial occurs because the claimant's case has failed to meet the medical requirements for disability under the guidelines used by SSA. 

The medical requirements of a case have to do with the most basic issue, which is the determination of whether or not a person is disabled. 

To arrive at that determination, Social Security uses the following definition of disability: A claimant must have a severe impairment that results in their inability to perform substantial and gainful work activity for a period of not less than one full year. 

Meeting the requirements for disability 

To satisfy this definition, a person applying for disability in Pennsylvania must prove, through their medical record documentation, that they have a medically determinable mental or physical impairment (in many cases, claimants have both physical and mental impairments) that affects their ability to engage in ADLs, or activities of daily living, and significantly interferes with their ability to perform basic work activities. 

Furthermore, a claimant's condition must be severe enough that it rules out their ability to perform their past work (potentially any job they have done in the fifteen year period prior to becoming disabled), and further rules out their ability to use their skills and education to perform some type of other work. 

How does the actual disability determination process work? 

After a disability application is taken at a local Social Security office in Pennsylvania, it is transferred to the state disability agency. In most states, this agency is known as DDS, or disability determination services. At DDS, the case is assigned to a disability examiner. 

The examiner's role is to render a disability determination on the case using both medical and vocational evidence, specifically medical records obtained from the claimant's treatment sources and information obtained from the claimant's work history. With regard to both types of information, the disability examiner will be entirely dependent on the information provided at the time of application. 

For this reason, compiling a list of treatment sources prior to the appointment for the disability application interview, with dates of treatment, names of doctors, and addresses of facilities is usually a practical idea. This can minimize the opportunity for important information to be omitted and can allow for more accurate information to be provided. 

For example, when the names of medical facilities are incorrectly listed, it can slow down the process of obtaining medical records. In certain instances, it can even make it impossible to obtain records. 

By the same token, a claimant may wish to record their work history, complete with job titles and descriptions of jobs and the duties they entailed, prior to going in for the interview (or having the interview conducted over the phone, which is an option for someone filing for disability). 

How is the evidence used on a disability case? 

The information obtained from the claimant's medical records is used to gauge in what ways, and to what extent, the claimant is functionally limited, either mentally, physically, or both mentally and physically. 

Physical limitations such as a reduced ability to stand, sit, walk, carry, reach, or grasp, and mental limitations such as a a reduced ability to remember, concentrate, or assimilate new information are used to render an assessment known as an RFC or residual functional capacity, rating. A person's RFC is a rating what they can still do despite their disabling condition. 

When a disability claimant's RFC rating shows that they no longer have the ability to return to their past work, and that they do not possess the ability to perform some type of other work that their skills and education might ordinarily suit them for, they may qualify for disability benefits. This is known as a medical vocational allowance. 

Some claims may be approved without regard to a claimant's vocational considerations. This occurs when a claimant has a medical condition that is listed in the Social Security Disability list of impairments, also referred to as the blue book (the blue book began as a desk reference source for disability examiners, judges, and disability attorneys and representatives). 

However, not all conditions are listed in the blue book and for those that are the qualifications criteria is very specific and difficult to meet. 

Qualifying for disability as a child 

For children to qualify for disability, the process of qualifying for disability is esentially the same. Children may be approved on the basis of satisfying the requirements of a listing. 

When a listing cannot be met, however, the effect of the child's condition on ADLs (activities of daily living) must be such that it prevent them from engaging in activities that are specific to their age and peers. 

For adults to qualify for disability, activities of daily living, of course, must be restricted to the extent that these functional limitations eliminate the ability of the claimant to work and earn a substantial and gainful living. 

Disability application denial rate: 69.1 percent.

Disability application approval rate: 30.9 percent. 

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WHAT YOU NEED TO KNOW BEFORE YOU APPLY

The denial rate is quite high at 69% in Pennsylvania, one big reason for this is that many people do not get representation until they have been denied. 

Many lawyers are partly to blame for this since it is very common for someone looking for a lawyer at application level for their SSDI or SSI claim to be told to "apply and call back when you are denied". Some lawyers(not all) do this because an attorney's fee is based on past due benefits and if the lawyer wins a case at application they feel the fee does not cover the work involved in handling a case at this level.

This approach should be avoided because it is very important that the case be handled properly from the beginning, not only to assure you have the best chance to win at application, but also to ensure that an application that was not properly done does not come back to haunt you at a later stage in the process. Approval rates are much higher at the initial application level.

Applying for Disability in California

Approval and Denial Statistics for Disability Claims in California 


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 vary from year to year, but, typically, individuals applying for disability in California will have approximately a 30 percent chance of being awarded benefits. Up to 70 percent of all claims may be denied in any given year making it necessary for the majority of claimants to pursue the Social Security appeal processbefore eventually becoming eligible to receive benefits. 

Claims at the initial level are typically decided in under 120 days, though decisions can take much longer due to a variety of factors, one of which may include any difficulty the examiner has in obtaining medical records from the listed medical treatment sources. 

Disability claims in California may be initiated online or through a local Social Security office. However, online filing will not allow an SSI claim to be taken; as claimants are unlikely to know in advance if their claim will involve the SSI program, the SSD program, or both programs in the form of a concurrent claim, claimants may wish to eschew the online process in favor of contacting a local office. 

Online filing, it should also be noted, does not allow for a face-to-face interview with a Social Security Claims Representative (CR) who may answer whatever questions the claimant has. This, in and of itself, may reduce confusion and minimize the potential for making mistakes with regard to the application and any subsequent appeals that may follow. 

Starting the disability claim 

After contacting a local field office, an appointment will be set for a disability application interview. The interview may be conducted in person at the Social Security office, or conducted over the phone for those individuals who have medical mobility or transportation issues. 

The purpose of the disability interview is for SSA to gather all the information that is needed to process the claim. However, the most fundamental information that will be acquired during the interview concerns a) the claimant's medical treatment history and b) the claimant's vocational work history. 

The Importance of the Medical history information 

The medical treatment history will be used by Social Security to determine whether or not the claimant qualifies for disability by having a condition that is listed in the blue book, also known as the Social Security Disability list of impairments. 

Note: The approval criteria for a listing tends to be fairly specific and detailed and the majority of claims are not approved on the basis of a listing. 

However, there is a second, more common route to being approved. The disability examiner assigned to the case will also review the medical evidence to determine a) what the claimant's physical and mental functional limitations are and b) the extent to which these limitations restrict their ability to engage in normal activities of daily living (ADLs), including basic work activities. The severity of the claimant's limitations is rated on an RFC, or residual functional capacity, assessment. 

Claimants who are found to have a listing-level condition, or are found to have limitations that are severe enough to rule out their ability to perform their past work activity, or other types of work (for which their age, work skills, and education might otherwise suit them) will be considered to have met the qualifications for disability. This is known as a medical vocational allowance. 

Individuals who are approved on the basis of a medical vocational allowance may be eligible to receive both ongoing monthly disability benefits, as well as some amount of disability back pay. 

The Importance of the Work history information 

The information obtained from a claimant's work history is as important as that which is obtained from the medical records. This is because, as stated, while some claims are approved on the basis of just the medical records (satisfying the requirments of a listing), most claims are granted through a medical vocational allowance. 

In this type of approval, Social Security must have enough information about the claimant's former jobs--their past work for the entire 15 year period prior to becoming disabled--to determine if they a) still retain the functional capacity to return to a past job, and b) have acquired skills that may allow them to switch to some type of other work if they cannot return to their past work. 

Be careful when submitting the medical treatment and work histories 

Because both the medical and vocational histories are crucial to making a determination on a disability claim, claimants may wish to write down both prior to the appointment time for their disability interview. This may allow for more completeness, but also avoid accidentally leaving out critical pieces of information. 

In supplying the medical history, claimants should be careful to provide the names of all diagnosed conditions, the names of all treating physicians (who may be asked at a later date to supply a statement in support of the case), and the full names and addresses of all medical treatment providers, including all doctor's offices, all clinics, and all hospitals. The latter is often crucial since the disability examiner who is assigned to the case will use the information submitted by the claimant at the time of application to send out medical record requests. 

Note: The single largest delay on any disability claim has to do with how long it takes Social Security to obtain the claimant's medical records. 

In supplying the vocational work history, claimants should be careful to supply all jobs worked during the past 15 years, including job titles, employers, and detailed descriptions of the duties associated with each job. Social Security will use this information to identify the claimant's individual's jobs in a reference source known as the DOT, or dictionary of occupational titles. 

The DOT allows Social Security to determine what the physical and mental demands of a claimant's past work might have been. This, in turn, may be compared to the current level of functioning possessed by the claimant, which may lead to two separate conclusions: Is the claimant capable of returning to their past work?; Is the claimant capable of performing some type of other work? 

Claimants who are incapable of doing either (returning to their past or doing other work) may meet the requirements for disability. However, it should be very clear that the outcome of a case may be influenced by the accuracy of the work history information provided by a claimant. 

Qualifications - There are two ways of being approved for disability 

A disability claim is approved by the Social Security Administration when the evidence of the case satisfies the SSA definition of disability. 

Under this definition, for an individual to be considered disabled, they must have one or more medically determinable impairments (corrobated by medical records provided by licensed medical sources). The impairment may be physical or mental in nature, or both. It must also be severe to the extent that it lasts for at least one full year and prevents the individual from engaging in substantial and gainful work activity. 

Individuals filing for disability in California will have the evidence of their case evaluated for three possible outcomes: 

1) Being approved on the basis of satisfying the requirements of a listing in the Social Security list of impairments; 

2) Being approved on the basis of a medical vocational allowance; 

3) Receiving a denial of their claim, in which case claimants should file an appeal prior to the expiration of the appeal deadline. 

Qualifying for disability as a child 

Children apply for disability benefits through the SSI program. As with adult claims, a child may qualify for disability based on having a medical condition (a physical problem or mental problem) that is included in the disability listings. This type of approval is made on the basis of medical records. 

Whereas adult claimants have a secondary route to approval through a medical vocational allowance that takes into account their vocational work history, a child may also be found disabled if they are unable to engage in what SSA refers to as age-appropriate activities. When the child is of school age, this will usually mean that medical records will be reviewed, as well as any academic records that are available, such as grade reports, IEPs, and the results of IQ and achievement testing. 

Social Security Disability versus SSI 

The Social Security Administration provides disability benefits through two separate programs: the title 16 Supplemental Security Income program, otherwise known as SSI, and the title II Social Security Disability program, referred to as SSD, and sometimes as SSDI (Social Security Disability Insurance). 

In terms of how disability claims are examined and decisions are made, there are no differences between title II and title 16 benefits. Whether or not a claim will be for SSI or SSD will be determined sometime during, or after, an initial claim has been filed with a Social Security office. Which program applies to a person's claim is dependent upon their insured status. 

SSD is for individuals who have worked long enough to acquire work credits which insure them. 

SSI is for a) individuals who have no work history (e.g. children), b) individuals who were once insured for SSD but have lost their insured status because they have not worked in a long time, and c) individuals who are currently insured for SSD but are only eligible to receive a small monthly benefit amount (in such instances, the claim may be concurrent and involve both programs). 

From a benefit standpoint, both SSD and SSI provide for monthly disability benefits. SSI beneficiaries receive an amount that is determined annually by the federal government, while SSD beneficiaries receive an amount based on their earnings history. 

SSI beneficiaries also receive medicaid benefits, while SSD beneficiaries will become eligible for medicare coverage. 

Denials on disability claims in California 

The high rate of denials on disability applications necessitates that the majority of claimants will need to file one or more appeals in order to qualify for disability benefits. Appeals must be filed within 60 days (plus an added 5 days for mailing time) of the date of the denial. This date is usually stamped in the upper right hand corner of the denial letter, or notice of disapproved claim. However, claimants should take note that the appeal must actually be received by Social Security by the 65th day, not simply postmarked by that date. 

Claimants who submit appeals are advised to do the following: 

1. Keep a copy of all appeal paperwork submitted. 

2. Within 10-14 days of submitting the appeal, make a followup status call to Social Security to verify that the appeal was received, to avoid the possibility of a late appeal situation. 

Note: Claimants in California who are represented by a disability lawyer or a non-attorney disability representative will have their appeal completed by the representative for them. Having said this, a claimant who receives a denial letter should contact their representative to ensure that both parties are aware of the denial. Again, this is to avoid the possibility of an late appeal. 

Disability application denial rate: 69 percent.

Disability application approval rate: 31 percent. 

                                     DO I QUALIFY FOR DISABILITY IN CALIFORNIA

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WHAT YOU NEED TO KNOW BEFORE YOU APPLY

The denial rate is quite high at 69% in California, one big reason for this is that many people do not get representation until they have been denied. 

Many lawyers are partly to blame for this since it is very common for someone looking for a lawyer at application level for their SSDI or SSI claim to be told to "apply and call back when you are denied". Some lawyers(not all) do this because an attorney's fee is based on past due benefits and if the lawyer wins a case at application they feel the fee does not cover the work involved in handling a case at this level.

This approach should be avoided because it is very important that the case be handled properly from the beginning, not only to assure you have the best chance to win at application, but also to ensure that an application that was not properly done does not come back to haunt you at a later stage in the process. Approval rates are much higher at the initial application level.