SSDI - WHAT YOU MUST KNOW ABOUT SOCIAL SECURITY DISABILITY

Much of what you see on TV and read in the papers about Social Security disability is myth.  The same goes for the internet.  Separating truth from fiction can be a daunting chore.  As a disability advocate who has appeared before judges and argued on behalf of claimants, I've condensed some vital information into this article.  It isn't everything, but it does include vital and accurate information.  I'd almost call it "SSDI 101."

Your initial application must be correct and complete.  You wouldn't believe how many applications I've seen where only half the forms were completed.  Doctors addresses and telephone numbers omitted.  Dates of service were not given.  Job details are often omitted or improperly stated.  Take your time and complete these forms fully and accurately.

Be prepared to appeal to the next stage.  7 out of 10--yes a full 70 percent of initial applications are denied for one reason or another.  Instead of giving up, appeal all unfavorable decisions.  Awards come to the persistent.  "Don't delay.  Appeal today."  Sadly, only one-half of claimants who are denied will appeal.  Yet, a majority of those who do appeal will be awarded benefits, most of them will get paid all the way back to their alleged onset date.

Be sure you have enough solid medical evidence.  Individuals who have not seen a doctor for their alleged disabling condition are not likely to ever get Social Security disability benefits.  Even if you are not working and have no insurance, SSA expects you to be receiving medical treatment if you have a serious impairment.  The Act requires that you have a serious "medically determinable impairment" before you can be awarded benefits. If you cannot afford a doctor, check into a community free clinic, health department or similar provider.  Get on the Internet and Google "free health clinics in (your hometown)."

Try to get more documentation about your impairment.  Often, medical records alone are not sufficient.  Try to get your doctor to provide specific written testimony about the duration and severity of your symptoms.  Social Security provides two forms for this purpose.  If you have a physical impairment, use form HA-1151.  If you have an emotional/mental impairment, use form HA-1152.  Both of these forms can be downloaded at www.socialsecurity.gov/forms.  The doctor who completes and signs these forms should be a doctor who has treated you for a period of time, otherwise, Social Security won't give the form very much weight.

You must give Social Security a picture of your functional limitations.  You will not be found disabled because you have a particular illness or injury.  For example, having Multiple Sclerosis will not automatically qualify you for disability.  You must show severe functional limitations that make it impossible for you to perform any work on a full time, persistent basis.  What they want to know, for example, are things like:  how long can you sit, stand, walk?  Are you able to stoop, bend, crouch, kneel?  Are you able to meet the mental demands of work, such as remembering and carrying out simple instructions?  Adjusting to usual work situations?  Responding appropriately to supervision, coworkers and others?  Maintaining concentration, persistence and pace for up to 2 hours at a time?  

Document any unusual limitations that prevent working full time.  Some examples would be:  You must keep your feet elevated when sitting for longer than 30 minutes.  You have a medical condition that requires breaks more often than once every 2 hours or breaks that last longer than 15 minutes at a time.  You take medication that makes it dangerous for you to be around machinery.  Your condition would require you to be absent from work more than about 1 to 2 days per month on a persistent basis.  These are the types of things that could make you unable to perform full-time work activity.  They must be documented by your doctor.

Find someone local who can help you at your hearing.  You need someone who is learned and experienced in Social Security law and procedures.  He or she should have handled hundreds of Social Security disability cases.  This would be a professional person.  When I say local, it helps if you can walk in and speak face-to-face with this individual as your prepare for your hearing.  As to the fee, you cannot be charged a fee unless you win your case AND you collect retroactive pay or "back pay" in a lump sum--in addition to future monthly benefits.  The representative's pay will be a small percentage of your back pay.  If you do not collect back pay, the representative is prohibited from charging you any fees.  This is  called a "contingent fee agreement."  The fee is contingent upon winning and collecting money.

Finally, here are the levels of appeal available to you:

1. Initial claim - a decision will be made by your state disability determination agency within 90 to 120 days.  In Alabama, almost 71 percent are denied.
2. Reconsideration - is required in 40 states.  In the other 10 states, including Alabama, you may skip this step and go directly to step 3, a hearing.
3. Hearing before an administrative law judge.  It typically takes 12 months to complete this step.  This is the stage at which most cases are awarded.  The national approval rate for ALJ decisions in 2012 was 52 percent.  Alabama was slightly higher.
4. Step 4 is an appeal to the Appeals Council, a special agency inside the Social Security Administration.  You do not appear at this review; another administrative law judge will review the findings of the hearing judge and take one of 3 actions:
• Refuse to review - allowing the original hearing decision to stand.  This happens in about 75 percent of cases.
• Remand the case for another hearing before an administrative law judge.  This happens in about 22 percent of cases before the Appeals Council.
• Make a direct award.  This happens in only about 3 percent of cases.

     5. If your appeal before the Appeals Council is unfavorable, you may then file a lawsuit  against the Commissioner of Social Security in A US District Court.  This will require the help of an attorney.  Fewer than one percent of all Social Security cases are settled in federal district courts, however. 

Where am I most likely to win my Social Security disability claim?  Statistically, more people win their claims at the hearing before an administrative law judge than at any other step.  It is critical that you have adequate representation at this hearing because this is your best chance to obtain both your past due benefits and future benefits.
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This article was prepared by:
Charles W. Forsythe, MS
The Forsythe Firm
Huntsville, AL 35806
(256) 799-0297

This article is intended for general information only and is not to be considered legal advice for any particular claim or situation.  The Forsythe Firm does not retain any client for representation except by written contract and nothing herein may be construed to be representation in any form.  The Forsythe Firm is not affiliated with the US Social Security Administration.