Thousands of people with disabilities are waiting months to get through a Social Security appeal of their denied disability case. If you are one of them or are in disbelief that you were denied in the first place, you may think that the Social Security Administration (SSA) disability approval system is unfair. It is not the intent of SSA to be unfair. However, close to two-thirds of initial disability applications are denied. Why?
SSA must be absolutely certain that a medical condition has impaired a person’s functionality to such an extent that they are unable to work at any job. The Social Security disability insurance (SSDI) program is a financial safety net available to workers who have paid into Social Security long enough and recently enough. Should they find themselves unable to continue working because of a severe medical condition, they are entitled to benefits. However, SSA follows very strict rules to prove that entitlement.
Key Parts of a Disability Application
Your initial disability application is comprised of a packet of forms and reports that tells SSA how your medical condition has made it impossible for you to physically work to earn no more than $1,000 a month, or “substantial gainful activity.” This is an SSA term and is a measure of a person’s work ability to earn income.
The key parts of an application packet are the:
- Disability Technical Application – Information about you, your family, your jobs and earnings to determine entitlement to Social Security disability benefits
- Adult Disability Report (ADR) – very specific information detailing your medical condition, medications and treatments; work history and the physical demands of past work; and your work skills and education
- Function Report – information on how your medical impairment impacts activities associated with daily living such as preparing meals, paying bills or interacting socially with others
The Evaluation Process – Medical
Once your application is sent to Social Security, disability examiners at your state’s Disability Determination Services (DDS) office begin a very strict step-by-step evaluation process to determine if your medical condition meets, or is equal to, it’s qualifying list of impairments. They may send you additional questionnaires specifically about your medical impairment. These supplemental forms ask the same questions in a different way. They may also require that you undergo a consultative examination (CE) with an SSA-contracted medical professional to further evaluate your medical history and condition.
The Evaluation Process – Functionality
DDS must understand just how capable you are at doing work, so they evaluate how your condition impacts what you do throughout your day. They will identify what things you can still do in spite of your physical or mental impairment. This is your “residual capacity.” If they think you cannot return to your past work, they will factor in your age, education and capabilities to decide if you can train for different work.
A Road Map Decision
SSA’s disability examiners must decide, without a doubt, that your medical condition is expected to keep you from working at any job for a year or longer, or may result in death. They follow a very black-and-white, letter-of –the-law, road map of rules to make that determination. If there is any room for doubt, DDS will deny your application at this point in the process. It usually takes three to four months for DDS to make a decision on an initial disability case.
The Judge has the Power
However, if your claim is denied, you can get approved through the Appeals process. In fact, approval rates improve greatly by the time a case reaches the hearing level of an appeal when the final decision is made by an Administrative Law Judge (ALJ). The judge is not strictly held to the bureaucratic process at DDS and has the ultimate power to decide a case. Also, more time has passed and more medical evidence has been added to support your case. The ALJ does a new review and meets with you face-to-face to ask questions. The judge can make a far more subjective decision about your condition and capacity to work.
Build a Disability Case that Wins with Freedom Disability
Think of the disability approval process as if it were a tower of building blocks. There are so many factors that can shake the tower. Your medical records may not be complete enough. The answers to questions about your daily activities may not be convincing enough. Working with an expert Freedom Disability Advocate will help you avoid making these mistakes from the start. One thing is definite about the process – it is long, complicated and very difficult to get through on your own.
If you are one of the thousands of people with disabilities who have been initially denied disability benefits, you can succeed. But you must follow the necessary steps to get approved. If you started the process with Freedom Disability, or need help appealing your case, our Freedom Disability Advocates are the experts you need to help you build a strong disability case that wins.