Social Security Disability
We have represented hundred of clients successfully over the years with their social security disability and SSI claims. Our firm has experience in all levels of the application process and can even assist with appeals in the Federal District Courts.
If you have questions about applying for social security disability or SSI then please review the question and answer section below. If you cannot find the information you need, or if you would like clarification then please call our office and speak to an attorney or staff member. We can be reached at (859) 624-3380 (Richmond) or (606) 726-9991 (Irvine)
QUESTIONS AND ANSWERS
1. What is the difference between Social Security Disability and SSI (supplemental security income)?
Social Security Disability is available to those persons that have contributed to social security during their working years by paying the F.I.C.A. tax to the Social Security Trust Fund. SSI is a needs based disability program that is not based on amounts paid into the fund, but is instead based on financial need if a person is first considered disabled.
2. Why should I consider applying for either Social Security Disability or SSI?
Most people apply for these programs if they are unable to work due to a physical or mental impairment and the impairment is expected to last for at least twelve months or result in death.
It is important to understand that if you have paid into the insurance program that you are only applying for those benefits that you are legally entitled to. We always encourage clients, if they meet the requirements, to exercise their rights under the system for which they have otherwise paid.
3. What does the Social Security Administration (hereinafter SSA) consider a disability?
A disability is an inability to engage in any substantial gainful activity (SGA) by reason of a medically determinable physical or mental impairment which is either expected to result in death or which has lasted for twelve months, or is expected to last for twelve months.
In addition to having a medically determinable physical or mental impairment we will also have to prove that you cannot return to your previous employment or engage in a different type of employment in the national economy.
It is important to understand that SSA does not consider whether you like a certain type of job or even whether or not those types of jobs are available in your hometown.
4. What is substantial gainful activity (SGA)?
SGA is work that is done for pay and involves significant mental or physical activity. For more information on SGA go to www.ssa.gov for details.
5. How do I prove to the SSA that I have an impairment that prevents me from engaging in substantial gainful activity.
A physical or mental impairment must be proven by clinical evidence from an acceptable medical source, such as a physician, that shows by objective medical evidence in the form of signs, symptoms and laboratory findings that shows you cannot work.
Objective evidence such an MRI, CT scan, x-ray, cardiac stress testing, EKG, pulmonary function studies or EMG/NCV studies are the types of tests that help to prove impairments. Most times it will be critical for an applicant to have these types of tests to support their medical provider’s findings.
Mental impairments need to be proven by showing that you have received treatment and testing that shows you lack the basic ability to make reasonable decisions in a competitive work environment. It is often helpful to obtain independent testing from a certified psychologist or psychiatrist to prove the extent of your limitations. However, it is critical in every case to seek treatment for your mental impairment and to maintain treatment during the time your claim is pending.
Our office can provide assistance in obtaining this testing for you.
6. Will the SSA assist me in obtaining medical evidence?
Yes the SSA is under a legal duty to develop the administrative case record with medical evidence to support its decision. Typically you will be sent to an independent medical exam for assessment. These findings will then be reviewed by SSA doctors to assess the level of impairment.
In most instances the SSA independent medical exams are not helpful or fail to provide good insight into your problems.
7. What is the best way to obtain evidence to prove my impairment.
It cannot be stressed enough to clients that their treating physicians are the best source of medical information about them. Your primary physician will have the medical history for you and will be in the best position to discuss your physical or mental condition. It is also extremely important to obtain information from any specialists you have seen for treatment.
Our office can assist you in this regard by requesting narrative reports from these physicians and by providing your physicians with forms that are impairment specific. These forms are medical reports, or residual functional capacity reports, that are specific to the type of impairment that you have. For instance, if you have advanced coronary artery disease, our office can provide your cardiologist with a form that is specific to the SSA’s requirements for cardiac impairments. This is often very helpful to physicians because they usually are not familiar with the requirements of the SSA disability process.
It is very important to get these forms completed early in your application process.
8. Will the fact that I have been declared disabled by another agency such as the Veterans Administration or Workers Compensation mean that I will my social security disability case?
No it will not. These other agencies’ findings may be helpful but they are not binding on the SSA. This is because those agencies definitions of “disability” may be very different from the SSA definition. Additionally, most private disability insurers define disability based on job specific definitions, whereas the SSA uses a much broader definition.
9. Can I object to taking a medical examination provided by the SSA based on religious or personal reasons?
No. You must attend your medical appointments with their doctors or you will be denied benefits.
10. Is a medical report from my primary physician more helpful than one from the SSA’s consultative physician.
Yes, by regulation it is entitled more evidentiary value than a non-treating physician. However, you doctor’s opinions must be supported by objective medical evidence and must be consistent with other evidence in the file.
11. How does the actual disability process work?
There are several levels of review and appeal in the disability process. After you make your initial application you will receive a initial decision in your case. In our experience the vast majority of these decisions are denials. At that stage you have the right to file an “application for reconsideration” which is an internal appeal. You typically will not get a face to face hearing with an officer from SSA, but instead will go through another “paper” review of your medical records.
You will then receive a reconsideration determination which again, by our experience, usually results in another denial for the vast majority of cases. At that point you have the option of filing a request for an hearing before an Administrative Law Judge. This will be your first, and usually last, opportunity to come face to face with the person making the decision in your case. In our experience, the majority of cases are either won or lost at this level and it is extremely important that you have representation by a lawyer at this hearing.
After the hearing you will receive either a favorable or unfavorable written decision from the Judge. You can request a review of his decision from an arm of the SSA called the Appeals Council. The Appeals Council is an extremely slow process and usually results in an unfavorable decision, or a decision upholding the Judge’s findings.
At this juncture you are entitled to appeal the SSA decision by filing an original action in the Federal District Court where you reside.
It is very important that you obtain representation the earliest possible level in your claim so that your evidence can be properly developed prior to your hearing.
2. How is disability evaluated under the SSA rules?
All applications are evaluated using a five step sequential process. If you fail to meet any of the steps in the process your claim will be denied at that step. The five steps, or questions, considered by SSA are as follows:
- 1. Is the claimant presently engaged in substantial gainful activity?
- 2. Does the Claimant have a severe impairment?
- 3. Does the claimed severe impairment meet or equal any of the Listing of Impairments.
- 4. Can the claimant perform their past relevant work if they do not meet a Listing?
- 5. Can the claimant perform other work in the national economy?
13. Can impairment have been considered severe in the past even though the Claimant has now recovered?
Yes, a person with a severe impairment that has recovered but the full recover took longer than twelve months might be entitled to a closed end period of disability benefits.
14. What is a Listing of Impairment?
Listing of Impairments, otherwise know as the “listings”, is a description of each major body part (heart, back etc.) and the types of the conditions for each body part that SSA considers disabling. To meet a listing of impairment the impairment must have lasted longer than twelve months.
The Listing of Impairments are broken down into two separate parts. One part for evaluation of adults and the second for the evaluation of children.
15. What if I have more than one impairment?
SSA is required by regulation to consider all of the Claimant’s impairments in combination. Therefore, it is possible that multiple impairments may work to make someone disabled even though when considered individually they otherwise would not.
16. How does SSA evaluate the pain I have?
By regulation SSA must consider a Claimant’s allegations of disabling pain. In order to evaluate pain SSA will look at the Claimant’s testimony and determine whether it is credible based on laboratory findings and objective medical testing. For instance, if you claim disabling back pain but do not have an MRI showing a severe back condition, you testimony would have less weight.
In evaluating pain SSA will consider the Claimant’s credibility, therefore, it is always important to be accurate and truthful with the information you provide to SSA.
17. How does SSA evaluate my physical or mental capacity to work?
Typically SSA will evaluate both a person’s physical and mental capacity by determining their “residual functional capacity.” In other words, considering a person’s impairments what type of activity can they continue to engage in. For physical impairments this deals with the weight a person might lift, the amount of time they can be standing on their feet and the time they can remain seated in a chair. In making this determination SSA may consider the types of medicines a person is taking and its effect on them. For mental impairments SSA will consider a person’s ability to interact social with the public and co-workers and with the person’s ability to remember and carry out instructions and make work related decisions.
If you have other questions not answered herein please do not hesitate to contact our office for further assistance.
