How to Win a Social Security Disability Insurance Case

If you are thinking of applying for Social Security Disability benefits, it is extremely important to educate yourself on the entire process before you apply.

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are federal programs that provide assistance to people with disabilities. Applying for benefits can be a daunting task involving many steps and can often take months or even a year to complete. However, there are things one can do to speed up the process and avoid pitfalls that can delay or even deny assistance.

Below are tips, as well as common mistakes to avoid when applying, to increase your chances of getting your Social Security benefits quickly.

First Steps - Consider Hiring a Licensed Disability Attorney or Advocate

Filing for Social Security disability benefits can be a frustrating and confusing process. Most applicants don’t know how to complete the necessary paperwork and submit accurate and complete medical records from doctors, clinics, and hospitals. Statistics released by the Social Security Administration in June 2013 show that 65 percent of initial applications are declined.

While the Social Security Administration (SSA) doesn’t require an applicant to be represented by an attorney or disability advocate, seeking qualified legal assistance will safeguard the best chance of winning disability benefits. In fact, statistics have shown that the Social Security Administration (SSA) is more likely to approve someone who is represented by an attorney or advocate.

The single most important factor to winning a claim is having the right medical evidence. Represented applicants are more likely to win because disability attorneys and advocates know how to develop the evidence needed for an approval for a particular medical condition.

A disability attorney or advocate also has experience working with medical professionals and may be more effective at asking the correct questions, often making the doctors more willing to help.

Lastly, if a claim is denied, an attorney has extensive experience with the appeal hearing process. This includes knowledge of the local administrative law judge (ALJ), who rules on the case, the ability to confront and explain any potentially harmful information in the applicant’s medical records, as well as the expertise to know which argument will most likely win the case.

What's the Difference Between a Disability Attorney and a Disability Advocate?

The term Social Security disability advocate is used by both attorneys and non-attorneys who help people with disability cases. However, most individuals who advertise their services as "disability advocates" are not attorneys.

Non-attorney disability advocates must have a college degree, but do not have to have a law degree or legal training. They do have to pass a Social Security exam on disability procedures and have a criminal background check.

Disability attorneys have graduated from law school and passed the bar exam. They have extensive legal training. Additionally, they are bound by the “attorney-client privilege,” which prevents them from divulging a client’s sensitive information. They are also bound by professional conduct rules requiring them to respond to your requests for information in reasonable amount of time, and keep you up to date on the status of your claim.

Also, only a licensed attorney can appeal your Social Security disability claim to federal court, should you lose your Appeals Council step with Social Security.

Differences in Cost - None

Both non-attorney and attorney advocates are limited to the same percentage of your disability award. Federal law generally limits the fees charged by Social Security disability attorneys to 25% of your backpay, or $6,000, whichever is lower.

Make Sure You Apply for the Correct Benefits

The Difference Between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)

One of the easiest mistakes to make when applying for Social Security Disability benefits is to apply for the wrong type of benefit.

Social Security Disability Insurance (SSDI) pays benefits to you and certain members of your family if you are "insured," meaning that you worked long enough and paid Social Security taxes. It allows workers who become disabled to receive their Social Security retirement benefits early.

Supplemental Security Income (SSI) pays benefits based on financial need. When you file an SSI disability claim, make sure you can show that you have very few financial assets and a low income.

Medical Records Are Key

Medical evidence can make or break your disability claim. It is not enough to say you have a disability or even enough for your doctor to say you are disabled. One must prove that a medical condition, or combination of conditions, prohibits employment. The SSA relies on authoritative and accurate medical records from doctors, clinics, and hospitals to determine the severity of a physical or mental condition.

It is important to be extremely thorough and do your homework when applying for disability benefits. Some of the information that is requested by the SSA includes but is not limited to:

  • List of medical conditions
  • Information about doctors, healthcare professionals, hospitals and clinics including names, addresses, phone numbers, dates of examinations and treatments
  • Names and dates of medical tests you have had
  • Names of medications and who prescribed them
  • Date your medical condition began to affect your ability to work

It is important to complete your application and medical forms in their entirety and as accurately as possible. Getting documents together in a timely matter is important, but be aware that poor grammar, typos, incorrect codes or numbers will have a negative impact on your application.

Best Practices for Curating Medical Evidence

  • Document everything, even unconventional methods you have done for the condition, – chiropractic visits, pain management, acupuncture, physical therapy, counseling or rehab.
  • Ask for copies of your doctor’s visit notes.
  • Request copies of test and lab results.
  • Make copies of everything.
  • If you have a condition like fibromyalgia that does not lend itself to testing, your doctor’s diagnosis, treatment and notes will be extremely important.
  • Make sure everything your doctor says is written down. The Social Security Administration will deny your application without adequate written evidence.
  • Consider asking your specialist to write a letter acknowledging your inability work due to your disability.
  • Be mindful of how your disability impacts your everyday life. If you drive, acquire a handicapped hang tag for your car. If you use ability aids such as canes, walkers, oxygen, etc. use them always and make them visible to neighbors and friends.

What To Do if Your Initial Application is Denied

If your initial claim for Social Security Disability benefits is denied, you have 60 days to file an appeal with the SSA. This is the first step of the appeal process and is called a request for reconsideration. Your application is sent back to the SSA for a second review. This process can take three to five months to complete and less than fifteen percent of appeals will be approved during this stage of appeals process.

The Social Security Disability hearing is the second step of the appeal process. You have sixty days from the date of your denied reconsideration request a hearing. At this time your case will be examined by an administrative law judge (ALJ). This judge will review your case and can either approve your claim, send your case back for review, or deny your claim. Even though this stage can take up to two year to complete, the good news is that 63 percent of hearing cases are decided in favor of the applicant.

Hire a Qualified Disability Attorney

If you applied for benefits on your own the first time, were denied, and are currently at the appeal stage, make sure you have a qualified disability attorney representing you at the hearing stage of your appeal. While the SSA does allow you to represent yourself, it's not in your best interest to do so.

Statistics show that applicants who have legal representation at a disability hearing are more likely to be awarded benefits than those who do not. Your attorney can help prepare you for your hearing and will ensure that your case is presented properly before the administrative law judge (ALJ).

Do Whatever It Takes to Attend the Hearing

It is absolutely necessary to make sure you do everything within your power to show up for your disability hearing and are on time.

If you fail to attend and do not have a good reason for your no-show, you may lose your opportunity to reverse the SSA's decision to deny your disability benefits.

Make a Good Impression

Show respect to the administrative law judge (ALJ) by being well groomed and in clean, business casual clothing. In addition to your physical appearance, you will need to show civility and respect to the ALJ who is reviewing your appeal.

Know Your Case and Your Medical Records

Even when working with a disability attorney, it is important to be familiar with the information included in your disability claim. Ask to review the records that have been provided to the SSA and the medical evidence being provided to the administrative law judge (ALJ). Your attorney is there to represent you legally in regards to your claim but you are the best advocate in regards to your medical condition. Make sure nothing is accidentally left off of your disability application file.

Stay in Regular Contact with Your Attorney

Your attorney may be handling multiple cases at once - it is wise to check in with your attorney on a regular basis to make sure he or she has everything needed to represent your case.

Communicate the Effects of Your Disability Honestly

Always be honest when describing how your disability prevents you from performing work related activities. If your disability involves chronic pain that comes and goes – be specific about how often you do have it and how debilitating it is. You should never over-exaggerate your disability, nor you should not downplay it either. It is better to be honest instead of saying you can never get out of bed due to pain when in fact the pain is worse at some times, or better at another. If you feel unsure about how to describe your condition, talk to your attorney.

Remember, it is not uncommon for an applicant to wait as long as two years to receive be hear in court. Your chances of being awarded disability benefits are highest during the hearing stage of the appeal process.

Make sure you follow the above advice in order to increase your chances of a favorable hearing outcome.

Common Mistakes When applying for Social Security Disability

  • Assuming you don’t need or can not afford a disability attorney or advocate
  • Applying for disability benefits too soon
  • Applying for disability while receiving unemployment benefits
  • Not seeing a doctor for your medical or emotional disability
  • Applying for the wrong type of disability benefits (SSDI or SSI)
  • Filing a new disability claim, instead of appealing a denial
  • Discontinuing treatment with your physician
  • Not taking your medications as prescribed
  • Not submitting accurate and complete medical records and evidence
  • Continuing to work after applying for SSDI or SSI
  • Listing incomplete job history
  • Grammar, typos, incorrect coding or ID numbers
  • Not checking your status after filing
  • Waiting too long to apply for disability benefits
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