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.
DO I QUALIFY FOR DISABILITY IN CALIFORNIA
FREE CASE EVALUATION, GET BENEFITS FASTER
AVOID MISTAKES W/FREE HELP!
WHAT YOU NEED TO KNOW BEFORE YOU APPLY
AVOID MISTAKES W/FREE HELP!
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.
No comments:
Post a Comment