Part I: Sources

Medical evidence is the cornerstone for Social Security’s determination of your disability. A qualified Social Security Disability lawyer can explain how the benefits process works and save you time and effort.

Each person who files a disability claim is responsible for providing medical evidence showing that he or she has an impairment and how severe that impairment is. It is always best for your doctor to provide detailed records of your condition, along with an explanation of how it limits your ability to work or perform everyday tasks.

The medical evidence can also come from other “acceptable medical sources” depending on what condition has caused your impairment.

Acceptable Medical Sources

The Social Security Administration (SSA) defines “acceptable medical sources” as medical professionals including:

• licensed physicians (doctors)
• licensed or certified psychologists. Included are school psychologists or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, for purposes of establishing mental retardation, learning disabilities and borderline intellectual functioning only.
• licensed optometrists, for purposes of establishing visual disorders only (except, in the U.S. Virgin Islands, licensed optometrists, for the measurement of visual acuity and visual fields only)
• licensed podiatrists, for purposes of establishing impairments of the foot, or foot and ankle, depending on whether the state in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and ankle
• qualified speech-language pathologists, for purposes of establishing speech or language impairments only. For this source, “qualified” means that the speech-language pathologist must be licensed by the state professional licensing agency, or be fully certified by the state education agency in the state in which he or she practices, or hold a Certificate of Clinical Competence from the American Speech-Language-Hearing Association.

Evidence from Treating Sources

SSA regulations place special emphasis on evidence from treating sources because they are likely to be the medical professionals most able to provide a detailed assessment of the claimant’s impairment and may bring a unique perspective to the medical evidence. Timely and accurate reports from treating sources are essential for accelerating the claims process.

Medical Evidence From Health Facilities

Social Security will also request copies of medical evidence from hospitals, clinics or other health facilities where you have been treated. All medical reports received are considered during the disability determination process.

Other Evidence

Information from other sources may also help show the extent to which a person’s impairment affects his or her ability to function in a work setting; or in the case of a child, the ability to function compared to that of children the same age who do not have impairments. Other sources can include: public and private agencies; non‑medical sources such as schools, parents and caregivers, social workers and employers; and other practitioners such as naturopaths, chiropractors and audiologists.

US Representative Kathy Castor, a Tampa Democrat, has introduced legislation in Congress which she hopes will help thousands of families who are waiting for Social Security Disability benefits, but are currently trapped in a multi-year backlog as the Social Security Administration processes their Social Security Disability claim. Castor’s bill would require the Social Security Administration to schedule a Social Security Disability hearing within 75 days and require an administrative law judge ruling within 15 days of the hearing date.

Each year thousands of applicants must wait up to a year and a half before they receive their Social Security Disability benefits. Currently, the average waiting time is 510 days for individuals seeking a hearing. In certain areas of the United States, the waiting period can be even longer.

Over the past decade Social Security Disability cases have doubled, and there are currently 750,000 Social Security Disability Cases that are awaiting a hearing. These delays have occurred due to staff cutbacks, private insurers requiring claimants to file for Social Security Disability prior to receiving an insurance settlement, and a general increase in Social Security disability applications. This excessive delay can spell economic disaster for many families. Some individuals find they are unable to pay their bills. Others face foreclosure on their homes, or are forced to consider filing bankruptcy.

The Social Security Administration announced they will begin hiring up to 175 new administrative law judges and open an additional processing center in Virginia to increase their ability to process Social Security Disability claims. In addition, the Social Security Administration is improving their disability determination process through a nationwide Quick Disability Determination system. The Social Security Administration hopes these efforts will allow them to process claims more efficiently.

Hopefully, this new legislation and the increased efforts of the Social Security Administration will begin to eliminate the backlog of Social Security Disability cases and help individuals who are currently caught in the Social Security Disability waiting game.

Suffering from an illness or any other disorder can be difficult, stressful, and disruptive to your life. You may be unable to work, or perform daily tasks - such as paying bills, shopping, or maintaining your home.

The Social Security Administration maintains a list of impairments which it uses to determine disabilities. To receive Social Security disability benefits your condition must be on their list or as severe as a listed condition. Your disability must last at least 12 months, and you have worked and contributed enough in employment taxes to qualify. Unfortunately, many don’t understand what information you need to support your claim.

The Social Security Administration needs the following documentation or evidence to determine a disability:

Medical Evidence - physical descriptions or symptoms of the illness or condition including abnormalities of behavior, memory loss, or disorientation.

The severity of your condition - the extent the condition affects your daily living, social functioning, concentration, and persistence.  Evidence of declining health may manifest in the inability to groom oneself, complete tasks, live independently, or maintain a job. Mental health decline can also increase social isolation, altercations, hostilities and job firings. Any episodes of hospitalizations or treatment programs will also evidence a severe medical condition.

Documentation - outlines the duration and limitations of your disorder and includes examinations, records of hospitalizations, the results of tests, and individual statements.

Understanding the Social Security Administration’s medical determination process is the first step to receiving Social Security disability benefits. If you have been denied Social Security Disability benefits a Social Security Disability attorney can help. A Social Security Disability lawyer is an expert at gathering medical evidence and determining the documentation you will need to get the Social Security Disability benefits you deserve. You can have your case evaluated for free by most disability attorneys.

Why is the Social Security Administration overwhelmed by questionable claims? Recent lawsuits against insurance companies claim they are partly to blame.

Each year insurance companies require an estimated 2.5 million applicants to apply for Social Security Disability benefits before paying insurance claims. This practice increases insurance company’s profits by decreasing claim reserves or refusing to pay a claim altogether. Many policies also allow benefit payments to be reduced if the claimant receives disability benefits from another source including Social Security Disability benefits or worker’s compensation.

The Arguments

The insurance agencies argue that advising a claimant to apply for Social Security Disability benefits is standard procedure, and their goal is to make sure that claimants receive the benefits in which they are entitled. Plaintiffs said insurers are abusing the system by routing individuals who clearly will not qualify for Social Security Disability benefits through the application process. They argue the Social Security Administration has more stringent disability requirements than many insurance companies which include requiring a disability to last at least 12 months and the applicant be unable to work.

Unfortunately, this has increased the claim process time for individuals whose claims are valid. The wait time to see an Administrative Law Judge has doubled since 2000. The issues will only increase as the population ages and more individuals are unable to work.

What can you do?

Social Security Disability lawyers have specialized knowledge of how the benefits process works and can save you time and effort. Don’t let the insurance companies pressure you. Your disability is stressful enough without having the added burden of filing your claim alone. Get Social Security Disability help today.

The Council for Disability Awareness (CDA) is a non-profit organization which tracks the trends of disabilities. The CDA reviewed information from 2007 long-term disability claims and the Social Security Disability Insurance 2007 Statistical Supplement to develop a comprehensive overview of current long-term disability trends.

The CDA determined that in the last 10 years, the number of workers who have long-term disabilities grew four times faster than the United State’s workforce. The CDA also determined that women are at the greatest risk of suffering a long-term disability with a growth rate 2 times the rate of working men.

In 2007, the Social Security Administration also had their lowest approval rates for Social Security Disability claims, approving only 37.6% of Social Security Disability Insurance claims. Social Security Disability Insurance applications continued to rise to approximately 2.2 million. Cancer is currently the second leading cause of new claims behind accident and injury claims, which are the fastest growing type of Social Security Disability Insurance Claims.

According to the CDA 2007 survey, 152 million workers were covered for disability insurance under the SSDI program in 2007; this is a 13% increase over the 134 million workers covered a decade ago. Given the increase in disability claims and the decrease in Social Security Disability Insurance benefits awarded, Americans need to prepare for long-term disability. Social Security Disability lawyers have specialized knowledge of how the benefits process works and can save you time and effort. Your disability is stressful enough without having the added burden of filing your claim alone. Get Social Security Disability help today.

You’ve been injured or diagnosed with a condition which qualifies you for Social Security disability benefits. It’s imperative that you begin the process as soon as you’re eligible to file a claim, and to plan ahead financially, since claims can be a lengthy process.

If you’re just beginning your Social Security Disability Insurance or Supplemental Security Income claim and haven’t spoken to a disability attorney, have your disability case evaluated today. A qualified lawyer can advise you on how to make the process go more smoothly and perhaps more quickly.

When filing a claim, realize the process could take more than a year. Though the Social Security Administration estimates initial claims filings to take 90-120 days, it’s not unheard of for the initial claim to take 6-8 months to complete . Even then, most of those initial claims - around 70% or more - are denied. The appeal process alone can take as little as 90 days to more than 1 year to get to the hearing stage, depending on the case load of the claims Examiner assigned to your case. Even then there is no guarantee your appeal will go through and your claim approved.

It’s important to have an attorney by your side to make the most of your disability claim process. Social Security Disability lawyers have specialized knowledge of how the benefits process works and can save you time and effort. Your disability is stressful enough without having the added burden of filing your claim alone. Get Social Security Disability help today.

When determining whether or not a case will be a good social security disability claim based on a mental impairment case, it is important to keep several requirements outlined in the Social Security Listing of Impairments in mind. The following outline describes the basic components of a viable psych case, which are taken directly from the Listing of Impairments. For more information on this topic you can visit the SSA’s website at www.ssa.gov/bluebook/AdultListings.htm.

Remember that for a claimant to be awarded benefits based on a mental disorder, the disorder must be considered to be “severe” by the SSA. By “severe,” they mean that the functional limitations caused by the disability, must show marked impairment in several areas of functioning. These areas of functioning are listed below.

 Activities of Daily Living
• Cleaning, shopping, cooking, taking public transportation, paying bills, maintaining a residence, caring appropriately for one’s grooming and hygiene, using telephones and directories, using a post office, etc.

 Social Functioning
• Capacity to act independently, appropriately, effectively, and on a sustained basis with other individuals
• Ability to get along with others
• Examples of impaired social functioning: Altercations, evictions, firings, fear of strangers, avoidance of interpersonal relationships, isolation, cooperative behaviors, consideration for others, awareness of others’ feelings, social maturity.

 Concentration, persistence, or pace
• Ability to sustain focused attention and concentration sufficiently long enough to permit timely and appropriate completion of tasks commonly found in work settings

 Repeated Episodes of decompensation
• Exacerbations or temporary increases in signs or symptoms accompanied by loss of adaptive functioning
• Episodes can be seen in records that show:
• Increases in medication
• Change of medication
• Need for more structured psychological support system
• Hospitalizations, placement in halfway house
• When they say “repeated episodes,” they mean one of two things:
• 3 episodes in one year
• Average of once every 4 months, each lasting at least two weeks

So in general, remember that it is not the actual diagnosis that will get a claimant awarded, but the functional impairments caused by the diagnosed mental impairment. For example, Social Security will not award a claim simply because the claimant has been diagnosed with bipolar syndrome. However, a claimant with Bipolar Syndrome who has marked deficits in social functioning, concentration, persistence or pace, and has had repeated episodes of decompensation, may be awarded.

If you would like more information on applying for Social Security Disablity (SSDI) or Supplemental Security Income (SSI), click here for a free consultation.

People get denied Social Security Benefits for many reasons. The following is a list of only a few examples of ways to get denied.

1. You make too much money. If you earn more than $940 a month, you will be denied SSDI outright. $940 is the limit to the amount of Substantial Gainful Activity (SGA) that can be performed.

2. Your disability will not last at least 12 months. If Social Security determines that your disability is not severe enough to last at least 12 months or result in your death, you will be denied.

3. You do not follow treatment prescribed by your doctor. If your doctor has prescribed treatment or therapy that is expected to improve your condition, you must follow it, or you will most likely be denied. A few exceptions to this rule do exist. A few of them are listed below.

You can not pay for treatment.
It is against your religious beliefs.
The doctor prescribes treatment that is not effective.
You have a mental illness that prevents you from following the prescribed treatment.

4. You do not comply with the SSA or DDS’s requests for information or medical records. Social Security will send you numerous forms and questionnaires to fill out that are meant to help them get a better idea of how your limitations affect your ability to work. DDS will also send you questionnaire’s and may even send you to a consultative exam (CE) to be evaluated by a doctor that they choose. If you are not forthcoming with requested information, or you fail to attend a CE, you can be denied.

5. Social Security is unable to locate you. If the SSA can not find you, they will be unable to assess the severity of your condition, and consequently, will deny your case.

As you can see, there are many potholes along the road to receiving disability benefits. A qualified attorney can help you navigate the tretcherous path to a successful claim. If you need assistance attaining the benefits you desreve, click here for a Free Social Security Disability Case Evaluation.

If a claim is denied at the reconsideration level, there is another opportunity to appeal the unfavorable decision. This appeal is called a request for a hearing before an administrative law judge (ALJ), and an individual has 60 days from the date on the denial letter (Notice of Reconsideration) to file it. After the 60-day statute, a claimant must submit “good cause” for filing late. The ALJ has the right to either reject or accept such a claim.

In order to file, one must submit the following forms to the SSA:

1. Request for Hearing by Administrative Law Judge (HA-501-U5)
2. Disability Report-Appeal (SSA-3441-BK)
3. Authorization for Source to Release Information to the Social Security Administration (SSA-827)

After the appeal is processed by the SSA, it will be forwarded to the Office of Disability Adjudication and Review, where it may undergo a pre-hearing case review to decide if a favorable decision can be made before a hearing is scheduled. If a favorable decision is made at this point, it is called a “Decision on the Record.” Generally however, the claim does proceed to the Hearing, which is scheduled many months later.

In the disability determination process, there are a series of steps that must be considered by DDS, the SSA, an ALJ, or the Federal Court, whichever is applicable at any particular stage. These steps, which make up the Sequential Evaluation Process, are used to determine whether or not an individual is entitled to Social Security Disability benefits. If at any point in the process, a person meets the criteria of one of the steps he is either awarded or adjudication moves to the next step, depending on which one he is currently at. Conversly, if he does not meet the criteria of even one of the steps, he is denied. The Sequential Evaluation Process proceeds in the following order:

Step 1: Is the claimant engaged in SGA (Substantial Gainful Activity)?

SGA refers to a certain amount of money that a person makes from working. In 2008, the SGA threshold is $940 per month for a non-blind individual and $1,570 per month for a blind individual. If one makes over $940 per month, then that individual will be denied at Step 1. However, if he makes $940 or less, the adjudicator will move on to Step 2.

Step 2: Is the impairment or combination of impairments severe?

The SSA considers an impairment or combination of impairments to be severe if it significantly affects an individual’s ability to work. That is, does it cause such severe physical or mental limitations that one is unable to work on a sustained basis. If your impairments are determined to be not severe, the SSA will deny your claim. If they are severe, then they proceed to Step 3.

Step 3: Does the claimant meet or equal a listing in the Listing of Impairments?

The Listing of Impairments contains impairments from every body system. If a person meets the criteria established in a particular listing, or if the impairments are equivalent in severity to one of the listings, than that individual is awarded. If a person does not meet or equal a listing, he is denied at Step 3.

Step 4: Can a claimant do his prior work?

If an individual can do his prior job the claim is denied, because the SSA assumes that the impairment must not be severe (as defined in Step 2). If he is unable to perform his prior work, adjudication continues to Step 5.

Step 5: Can a claimant do any other kind of work?

If an individual possesses skills that can be transferred to another job, possibly one that is less physically or mentally demanding, then he is denied. If it is deemed that the claimant does not possess transferable skills that would allow him to perform another job, he is awarded.