SS Disability – Help in Applying

Those of you who have tried to apply for Social Security Disability for your spouses know what a bureaucratic nightmare of phone calls, in person appoinments, reams of forms to fill out, attorney fees, and denials, it can be. This section has been set up to help ease and streamline the process for you.

JANUARY 2011 UPDATE - LATEST WEBSITE FOR SS DISABILITY ASSISTANCE - CLICK HERE

I have included three different ways of obtaining the information you need based upon your own unique computer skills or lack thereof.

#1. For those of you who can easily navigate websites and links, Disability Secrets is a comprehensive website that should provide you with all the information you need.

#2.For those of you who are adventurous and do not mind navigating through a lot of posts, there are two message board topics that provide extensive information, a lot of it from our resident expert Jane:

• Social Security Disability
• Drawing Disability Insurance and Pension

#3.For those of you who prefer straight reading, see below:

Social Security Disability Benefits: Why Are There So Many Denials? by Jennifer Gaudet, April 2007

We have all heard the comment that no one gets Social Security Disability Benefits the first time around; that people are denied first and need to seek the assistance of a lawyer to get their case approved. How wrong we are! With a little more knowledge as to how the process works, a truly disabled person can get approved the first time.

The first thing a disabled person needs to know is the Social Security Administration is not trying to find every way possible to deny a person their benefits. In fact, Social Security does not even make the decisions as to whether or not a person is disabled; rather, that is the job of a third party Evaluation Team from their state’s Determinations Office.

To get approved for disability benefits with the least amount of hassle and time, an applicant would first need to understand what the definition of disability is and prove how their medical condition meets the requirements of this definition:

“A disabled adult is defined as an individual age 18 or older who is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

Sometimes, this definition can be hard to meet…especially if a person has just had an accident and the doctor’s are unsure if their patient will be unable to recover satisfactorily in a 12 month timeframe. Many people resort to applying for disability benefits because they have limited knowledge of what the program is actually designed for. They do not know of the definition they must meet to get accepted for monthly benefits. Please understand that the Social Security program is not a program for people who are disabled for the “short term” even though they may be facing great financial difficulties. This program was designed for people who will be disabled for at least 12 months are more.

If a person’s medical condition meets the above definition of disablement, then he/she should consider filing an application for Social Security benefits. A good understanding of the application process is needed to ensure that benefits are approved the first time the applicant applies:

1. To apply for Social Security Disability Benefits, the applicant should call the Social Security Office to get an appointment so that an employee can help them fill out the application.
2. During the appointment, the Social Security employee will ask a series of questions in order to complete the application. Because some of the questions can be very detailed, it is best that the applicant gather the following items to bring with them to the appointment:
   • Birth Certificate
   • Copies of all medical records since the disability began
   • Last Tax Return if self employed
   • List of medications, what strength, who prescribed it, and how often it is taken
   • Voter Registration Card
   • Marriage Certificate
   • Medical Records (see more information on this item further in this newsletter)
   • Letter from Doctor detailing the disability and how it keeps the applicant from working (see more information on this item further in this newsletter)
   • Names, addresses, and phone numbers of all doctors that have treated the disabling condition
   • Filled out Social Security Form 3368 (this form can be obtained from the social security website…having this form filled out ahead of your appointment is highly recommended since the questions that are asked can be very thought provoking and could be answered wrong if not thought about beforehand.)
   • Narrative on the person’s life: The applicant should ask that this narrative be attached to their application, along with the medical records and forwarded on to the Determinations Office for review. The narrative needs to include the following information:
     1. Education (schools attended, year completed, degrees obtained)
     2. Previous work history (include specific duties performed, years worked there)
     3. Description of how the current medical condition affects the applicant from being able to continue working at their job
     4. Description of normal daily living activities the applicant can no longer do like he/she used to (eat, bathe, dress, do housework, etc)
     This narrative accomplishes two things:
     1. It allows the applicant to answer all of the questions the Social Security interviewer will ask him/her with greater accuracy. (Accuracy of all information is crucial to obtaining a favorable decision in the least amount of time.)
     2. It allows the Determinations Office to obtain a good mental picture of what the applicant is going through, which can be helpful due to the fact that they do not get to speak with the applicant face to face.
     3. NOTE: When answering the questions the Social Security employee asks, the applicant should be VERY SPECIFIC with their answers. They should not give brief descriptions of the disabling condition. The applicant should describe his/her condition in as much detail as he/she can. Remember, medical conditions affect each person in different ways…general answers can be looked at in different ways too…BE SPECIFIC.
     4. NOTE: It is when the Social Security employee begins to question the tasks the applicant is able to do on a daily basis that the letter from the doctor should be shown. What should this letter include?
   • The statement from the doctor must say more than "my patient is 100% disabled and unable to work." In other words, if a doctor states that an individual cannot return to work or cannot reasonably be expected to find "other work", then the doctor must state why a claimant is unable to work.
   • The letter must state to what extent the patient can: sit, stand, bend, walk, balance, crouch, stoop, perform dexterous hand movements, reach overhead, lift a certain amount of weight, perform tasks that are classified as simple, routine, and repetitive. It should also describe patient’s general strength levels (typically measured on a 5 point scale): grip strength in either hand, range of motion in all major joints, and reflexes.
   • NOTE: The answers the doctor gives to the above items is how the Social Security Office determines if the applicant is still able to do the job he/she used to do or if there is another type of job that has the same type of skills the applicant can do, but at a lesser type of exertion level.
3. After the application is completed, the Social Security employee sends it to the State Determinations Office for review.
4. The first thing the Determinations Office does is mail letters to the doctor’s offices listed on the application, asking them to supply them with the applicant’s medical records. The doctors have an approximate 30 day time frame in which they are to respond and send these records to the Determinations Office. If records have not been received in 15 days, the Determinations Office will send the doctors a second request for records.
   • NOTE: Earlier, I stated that copies of the medical records should be gathered ahead of time and brought with the applicant to the interview. The reason for this is although the Social Security office tells applicants not to worry…that they will request the medical records needed to make their decision, things can go wrong in the process of obtaining them. Although the Determinations Office does make every effort to obtain doctor’s records, THEY DON’T ALWAYS SUCCEED IN GETTING THEM. The medical offices may be so bogged down with work that they don’t take the time to make the requested copies. Some medical offices also claim that they have never received the letter(s) of request. By having gathered and submitted the medical records themselves, the applicant is better assured of the following:
     1. They can be sure that the state Determinations Office has all of the records necessary for them to make an informed decision on their behalf
     2. The disabled person can read what is written in their medical files before submitting them to Social Security to determine if the doctor’s notes are correct, if anything needs to be added and if there is sufficient documentation to support their claim
     3. The workers at the Determinations Office get graded as to how fast they process the applications that appear on their desk. For this reason, applications that have all of the medical records attached to the application are looked at immediately so that a decision can be made and the case closed as quickly as possible
   • NOTE: It is very important for the applicant to read these medical files before going in to apply for benefits. I have heard of instances where the doctor wrote down the symptoms on a patient’s chart along with his diagnosis/medications prescribed only to have the transcriptionist make mistakes in typing his notes. The mistakes were enough to make the medical record reflect a different disease altogether, which caused the applicant’s case to get denied. If any part of the medical record is not correct, THE APPLICANT MUST NOT MAKE THE CHANGES THEMSELVES BY WRITING ON THE RECORDS THEY HAVE OBTAINED. Instead, they must go back to their doctor’s office and speak to him/her about the problem, ask that he/she correct the record, and provide another copy for the applicant to submit.
   • NOTE: Continue to get copies of all doctor appointments/tests run and continue to submit them to the Determinations Office until they have made a decision on your claim. This is very important to do since the more information the Determinations Office has on the applicant’s disability, the better decision they will be able to make as to whether or not the medical records meet their definition of disablement.
   • NOTE: The Social Security employee may tell the applicant they will not accept the records that have been copied to give to them. The applicant must at that point insist that their records be included as part of their application packet. There are a number of reasons as to why the Social Security Office prefers to obtain the records themselves, but the employee should honor an applicants request to have their copies attached to the application. However, should the applicant decide not to submit his/her records at the time of the application and choose to allow the Determinations Office to gather the records themselves, the applicant needs to stay in constant contact with their doctor’s office manager to see if the office has received the letter from Social Security requesting the records, if the doctor’s office copied the records requested and if the doctor’s office mailed the requested records off. Staying on top of the doctor’s office is the only way the applicant will know if the Determinations Office has all the evidence they need to make a decision on his/her claim.
5. After approximately 30 days of waiting for records to arrive from doctor’s offices, the Determinations Office uses all of the “evidence” they have obtained from the doctors that responded to make their decision. If a doctor has not sent in the disabled person’s records by this time, there is nothing the Determinations Office can do to make them comply. They will have to make their decision based on what information they have on hand. Doctors’ failure to send in medical records requested is the reason behind 90% of all denied Social Security claims. Remember, the Determinations Office is not blessed with a face to face interview with the disabled applicant. They only have a folder of documentation to review in order to make a decision. If the pile of medical records does not provide an accurate view of the person’s condition, there is no way the Determinations Office can know otherwise. They can only base their decision on what is written in the records they have in front of them.
   • NOTE: In situations where the Social Security application has been denied and is in the appeals process, it is imperative that the person collect his/her medical records on his/her own and submit them to the Determinations Office themselves. This should continue to happen as long as the applicant is seeing a doctor and has not yet received a decision from the Social Security Office. Many of the applications are denied due to a lack of medical information because the doctor’s office did not submit the records the Determinations Office requested. The applicant should make sure the Determinations Office has what they need to make their decision by hand delivering the medical records themselves!
6. After reviewing the information at hand, the Determinations Office will decide if there is enough evidence written in the medical records to explain why the disability keeps the person from being able to remain employed at their job. If the worker determines there is not enough evidence, an appointment will be made for the disabled person to meet with a doctor Social Security has hired for the purpose of obtaining additional medical information. The Social Security doctor will document whether or not the disabled person can sit, stand, walk, talk, etc. He may or may not speak with the disabled person about his/her particular disability.
   • NOTE: Understand that not much will come out of this visit unless the applicant has a very OBVIOUS and SEVERE disability. It is after visits with the Social Security doctor that we have heard comments from the public that the doctor did not address the applicant’s disablement with them – all he/she did was his/her own set of questions/tests. This is because the Social Security doctor is paid to only perform certain tests and gather that information in a 15 minute period. VERY OFTEN, an appointment with the Social Security Doctor is a sure indication that your case will be denied. Thus, the importance of the applicant gathering the medical records themselves and ensuring that the Determinations Office has everything they need to make their decision.
7. Once the Social Security Doctor’s report is submitted to the Determinations Office, all of the medical evidence on hand is reviewed and a decision is made. A letter of approval or denial is sent to the disabled person at this time.
8. Social Security’s decision is based on the person’s disability, education and work history, as well as the employment availability NATIONWIDE for people with that disability. They may determine that the disabled person could work at a job, even though that job is not available where that person lives. Is this fair? No, but it is something that we all have to deal with since that is written into the law that Social Security must follow.

In the United States, there is currently a 60% denial rate for people applying for Disability Benefits the first time they apply. The number one reason why this is occurring is there is a lack of medical evidence in the medical charts to support the applicant’s claim of disablement.

What can a disabled person do to ensure that their medical record reflects all that is needed to get accepted?

1. The applicant should make sure their doctor knows of their intentions to file for Social Security Disability Benefits. Ask him/her if they are willing to assist with the application. If not, the applicant should find a doctor who will.
   • A doctor's statements on the medical records should:
     • Be detailed regarding a patient's symptomology, restriction in range of motion, muscular strength, and the ability to sit, stand, walk, crouch, bend, and reach. It should also state the frequency, severity and the duration of the symptoms the patient reports as being disabling.
     • Should specify the medical reasons as to why a Claimant is unable to work; that is, the physician should indicate the diagnosis, prognosis, and the functional restrictions that result from a patient's impairment(s), i.e. why the patient is unable to return to work. Although there may be multiple symptoms, how does each symptom (combined or viewed separately) prevent the person from holding a job at any given time of the day?
2. When going to the doctor’s office, the patient should specifically state all of the symptoms they are feeling. They shouldn’t waste time carrying on a casual conversation with their doctor. South Louisiana culture teaches us not to complain to others about our problems. The irony with this is that patients take this cultural behavior with them to the doctor’s office. When the doctor asks how a patient is doing, the patient shouldn’t respond that they feel great and then forget to mention all of the symptoms that got them to the doctor’s office in the first place! Proper documentation of all symptoms and how the doctor assists the patient with those symptoms is what helps the Determinations Office make their decision as to whether or not the applicant should receive benefits. One way for a patient to prevent forgetting to tell the doctor everything is to write a journal of their symptoms on a daily basis before seeing the doctor and bringing this journal with them to their appointment. All of the symptoms can then be recorded and addressed in the medical record. The patient can even request that their journal become part of the medical record if they feel their doctor isn’t taking the time to read and document all of their symptoms. If the patient’s disability application has already been denied and is in the appeals process, I cannot stress enough the importance of taking the time to journal the symptoms on a daily basis and requesting that it be placed in the medical records.
3. Request copies of medical records at each doctor’s visit. By requesting copies of the visit each time, it will allow the applicant to read what was documented in the chart during the visit. If the applicant discovers that something is not correct, he/she will then need to speak with the doctor about any necessary changes or mistakes that were noticed. Transcriptionists often make mistakes when typing up patient records, which is why it is very important to check the medical records to see if everything is accurate. Once obtaining a copy of the visit, the applicant should place it in a file at home. When it is time to apply for disability, the applicant will already have copies of the medical records ready to submit.
   • NOTE: If the patient requests copies of their medical record for that day’s visit while at the doctor’s office, there is no charge. Otherwise, if a patient asks for a copy of all of the records that are in their chart, there will be a charge for every page they need to copy.
   • NOTE: A chiropractor's records are not considered evidence by the Social Security Disability program since chiropractors are not considered to be medical doctors. However, the X-RAYS taken by a chiropractor are admissible as evidence.
4. The Determination Office is looking for three things:
   • the frequency/duration of the symptoms that prevent the applicant from working
   • the intensity of the symptoms that prevent a disabled person from working
   • Proof that ongoing treatment is being received for the disability. (The applicant should have seen a doctor at least every two months for help with the disabling condition and should still be under doctor’s care during the application process).
     • NOTE: If an applicant is applying for the first time, it is not necessary to get the assistance of a lawyer to help them. If the medical records fully show the applicant is disabled ACCORDING TO THE GUIDELINES ESTABLISHED BY SOCIAL SECURITY FOR THEIR PARTICULAR DISABLEMENT, then benefits should be awarded.
     • NOTE: Getting a lawyer to help an applicant with their case is not going to insure that the applicant will be granted monthly cash benefits, nor will it make the process go any faster. The lawyer simply has more knowledge of the way the system works than the average person. It is only during a denial stage where an applicant will have their case heard by an administrative law judge at a disability hearing that the services of an attorney are crucial.

One last thing a disabled person should be aware of is that a person applying for Social Security Disability need not be totally unemployed. The person is allowed to make under $900 a month (as of 2007) and can still be considered for disability benefits. This is because any amount less than $900 is not considered “Substantial Gainful Activity”.

As you can see, the process of applying for Social Security Disability is not that hard, but it does require some work to be done ahead of the application. They are not trying to make it harder for people by denying requests left and right as the public seems to think they do. No, their office is much like any other office where people go to ask for assistance. All offices will deny people what they are asking for if they haven’t provided the documentation requested to prove their need.