Demystifying

Once you have applied for Social Security disability and the Social Security Administration (SSA) has determined you meet requirements for one of its disability programs, either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), a medical decision must be made to determine if you are disabled. There are many different pieces of information that Disability Determination Services (DDS), a state agency that determines whether an SSA applicant is disabled, considers in its determination. Many times an SSDI or SSI applicant will be asked to complete a Function Report to help DDS representatives make a disability determination. A Function Report is a multi-page questionnaire about an applicant’s activities and how their disabilities impact their daily lives. Although a multi-page questionnaire may seem like a daunting task for someone who is disabled to complete, it is important for an applicant to fill-out this form and return it do DDS by the time prescribed by the disability determination agency. Failure to do so almost certainly will result in a denied disability claim. The refusal to complete the Function Report is interpreted by DDS as a failure to cooperate. The Function Report examines a variety of topics including how an applicant’s disabilities impact the ability to work, in-depth detail about an applicant’s daily activities and an explanation about how an applicant takes care of basic personal needs like showering, dressing and preparing meals. Here are some tips to make sure your Function Report has a valuable impact on your disability case: 1) Answer every question. 2) Answer every question completely and don’t limit yourself to the space provided on the form. If you feel you need more space to adequately answer the questions, please include an additional piece of paper to fully respond. 3) Make sure you print the forms. A legible answer to a question will diminish the possibility of having your answers misunderstood. If an applicant feels too overwhelmed to complete the Function Report on their own, they are free to ask a friend or relative to help complete it, but it is important to understand that DDS is trying to understand the capabilities of the applicant. This includes the applicant’s ability to complete this type of questionnaire. If the applicant has someone else complete the Function Report DDS may not have a full understanding about the applicant’s physical and or mental health limitations. If it is necessary to seek assistance with completing the Function Report, the person helping must also indicate that they assisted the applicant on the form. If you receive a Function Report while you have a Social Security disability claim pending remember to complete it to the best of your ability and return it to DDS within 10 days of receiving it.

There are two types of partially favorable decisions. One is for a closed period of disability. The other is for an alternative disability onset date. A closed period of disability means the Administrative Law Judge finds that you are disabled for only a certain period of time. You will be paid benefits for this period, but you will not receive any ongoing benefits. A closed period is beneficial for claimants whose conditions have medically improved to resume working.  A Judge may also award a claimant benefits for a closed period of disability if something in their medical evidence refers to medical improvement. An alternate onset partially favorable decision indicates the Administrative Law Judge does find you disabled but does not think you were disabled as early as you originally alleged. The onset date of your disability will be related to evidence or fact(s) in your record, for example: when you stopped working, were diagnosed with a condition, or received medical treatment. In both cases after the decision is issued, the next step is the payment process. It takes up to 120 days from the date of the decision to receive the Notice of Award. The Notice of Award describes what backpay you will receive, as well as the attorney’s fees that your attorney is authorized to receive for his work on you case. It may take up to 90 days from the date of the award letter to receive your backpay. In the case of an alternate onset date decision, the Notice of Award will also indicate what your monthly ongoing benefits will be and when you can expect to receive them. If you are awarded for a closed period or alternate onset date and disagree with the decision, you do have the option to appeal; but there are some risks. Appeals go to the SSA Appeals Council. The Appeals Council could rule in your favor, but they can also put the whole issue of disability back on the table and potentially reverse the Administrative Law Judge’s favorable decision. At Greeman Toomey, we typically do not file appeals of these decisions or recommend that our client’s appeal. If you are awarded a closed period of disability and believe that you are still disabled, it may be in your best interest to forgo the appeal and instead file a new claim. If you choose not to appeal the Administrative Law Judge’s decision, it will be finalized. As a result, when you file a new claim there will be no risk of Social Security reversing the prior decision. If you have received a Notice of Decision – Partially Favorable and have any questions, please do not act until you contact our office at (612) 332-3252.

When a Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) claim is filed and Social Security confirms that the applicant meets the technical requirements for at least one of the disability programs, Social Security will send the file to a state agency for disability determination purposes. The agency that determines whether an applicant is disabled is known as Disability Determination Services (DDS). This agency considers a number of different factors in determining if an applicant is disabled. One tool DDS sometimes uses in determining disability is a Consultative Exam (CE). A CE can be either a physical or mental health examination performed by medical professionals, often times a medical doctor, psychiatrist or psychologist. This type of exam is scheduled when DDS concludes that there’s not enough medical evidence available about an applicant to determine whether or not the applicant is disabled. The exam is provided at no cost to the applicant, but it is the applicant’s responsibility to provide their own transportation to a CE. If you attend a CE you want to make sure you provide the medical professional conducting the exam with all the necessary information about your disabilities. You MUST inform the medical professional of ALL problems, both mental and physical, you are dealing with associated with your disabilities and how those disabilities limit your ability to work. Make sure to bring all of your prescribed medications, in their prescribed containers, to the CE and it’s especially important that you are on time or even a little early for your CE. At completion of the exam the medical professional will issue a report and send the findings to DDS, it could take several weeks before this report is sent to DDS. This report, along with an applicant’s medical records, past work experience, detailed information about how impairments impact an applicant’s ability to manage daily activities and the opinions of the applicant’s own medical treating sources are all considered in determining disability. It is important to know that when a CE is ordered YOU MUST ATTEND. It is very important for an applicant to show-up on time for the CE and to cooperate with the medical professional. Failure to attend an ordered CE will certainly result in the DENIAL of a Social Security disability claim. Keep in mind, the medical professional conducting the CE is not your own doctor, but an INDEPENDENT MEDICAL SOURCE THAT HAS HIS OR HER FEES PAID BY SOCIAL SECURITY. Your behavior and actions will be observed by this medical professional from the moment you arrive at your CE appointment until the minute you leave. For more information about CEs visit: http://www.socialsecurity.gov/OP_Home/hallex/I-02/I-2-5-20.html

Sometimes a family can receive Disability Insurance Benefits (DIB) beyond the impaired person’s benefits. The unmarried children of a successful claimant can receive children’s benefits or auxiliary benefits.” There are three types of unmarried children who qualify for auxiliary benefits under 20 C.F.R. § 404.350: a child under the age of 18, an adult child who is disabled prior to age 22, and a child who is a full time student and is under 19. Eligible children include natural children, legally adopted children, and certain stepchildren, grandchildren, and equitably adopted children per 20 C.F.R. § 404.354. These auxiliary benefits are available when DIB payments are available – five months from the date of disability. Auxiliary benefits are subject to back payments in the same fashion as DIB back payments; you can receive back payments for benefits up to 12 months prior to the date o f the parent’s application for benefits per POMS GN 00204.030. Thus, even if the child does not meet the requirements to be an auxiliary beneficiary when benefits are awarded, the child can receive back payments to which they would have been entitled. At Greeman Toomey, we always remind and encourage our clients to file for auxiliary benefits when they are eligible so that our clients’ families receive all of the support to which they are entitled.

There are two portions to the Social Security Disability Initial Application. The first portion is called the Adult Disability Report (ADR) and the second portion is the Benefit Application. The ADR asks questions regarding your medical conditions, medical treatment, work background and education level. It is important to have a list prepared of all of your physical and mental health conditions that limit your ability to work. It is also helpful to prepare a list of the hospitals and clinics where you have been treated for these conditions. Social Security is most interested in your recent medical treatment. At Greeman Toomey, we ask our clients to prepare a list of places where they have received treatment in the past 12 months. We need the name and contact information of the facility, dates of treatment, and the name of the doctor that treated you. The ADR will also ask if you have had any medical tests performed at these facilities, and if you are being prescribed any medications. There may be other places that have additional medical records. These include public welfare offices, prisons or jails, other attorney’s offices, vocational rehabilitation centers, workers compensation, etc. If any of these sources are applicable to you, please collect the relevant contact information. The ADR asks for information regarding the applicant’s work background. The report asks about the jobs held in the past 15 years, or the five most recent jobs. Please prepare a list of your past employment. For each job, the reports asks for your job title, the type of business, start/end date, hours worked per week, and rate of pay. The ADR does not ask for much detail regarding each job, but you will later receive a Work History Report from the SSA Disability Determination Services office. The final questions on the ADR ask about your education history. Specifically, the highest level of schooling you’ve completed, along with any job or vocational training. Dates of completion for each level of education will also be requested. The ADR also asks if you have ever attended special education classes. The Benefit Application is typically the easier portion to complete and requires less advanced preparation. It goes into detail regarding your personal information. It asks what city and state you were born in, in addition to information about your children and spouses. The Benefit Application also asks about earnings in the current and previous year. This includes the names of employers and any self-employment income. Your case manager will be contacting you to complete the initial application either over the phone or in our office. To make the appointment go smoothly please prepare the required information. If you have any questions please do no hesitate to call our office at (612) 332-3252 or toll-free at (877) 332-3252.

The day you’ve been waiting two years for is finally here. It’s time for your Social Security hearing before an Administrative Law Judge (ALJ). You are happy the day has finally arrived, but also nervous because you don’t know what to expect. At Greeman Toomey we ask that our clients arrive at our office 90 minutes prior to their hearing’s scheduled time. Our office is conveniently located in the same building as the Office of Disability Adjudication and Review (ODAR), the location of hearings for Twin Cities’ metro area residents. When you show-up to our office you can be confident that your hearing attorney has reviewed your file and is prepared. The first step is to discuss what will happen at the hearing with a Greeman Toomey attorney. During this time the attorney will go over any questions he or she has about your medical conditions and treatment, as well as answer any questions you may have a bout the process. After the preparation is complete it will be time to go to ODAR for the hearing. You will then wait in the ODAR lobby until your case is called before the assigned ALJ. Once this happens you will proceed to the hearing with your attorney. At the hearing there many be a few other people in the room with you besides your attorney and the ALJ. Almost every hearing includes the presence of a vocational expert. This independent expert will testify about what types of jobs you may or may not be able to perform. The ALJ might also appoint an independent medical expert to testify about your disabilities and how they might affect your ability to work and a court reporter is assigned to document the hearing. After testimony from the experts your attorney does a thorough job of proving the facts of your case to the ALJ. The entire process takes about 45 minutes and is a lot more informal than a typical hearing you might see in a different type of courtroom. Typically you will not know the decision the judge is going to make the day of the hearing and have to wait until the presiding judge writes the official decision, which can take up to 90 days to receive.

In a previous post on this blog entitled “The Initial Level” we discussed the first of the four main levels of an application for Social Security disability benefits and/or Supplemental Security Income. This entry discusses the second level which is commonly referred to as the “Reconsideration Level.” If an individual’s application was denied at the initial level, then the process will continue to the reconsideration level. The reconsideration level is very similar to the initial level in that the Social Security Administration (SSA) will conduct a complete review of your claim and the medical evidence which has been collected from your health care providers. However, at this level the evidence will be reviewed by individuals who did not take part in the decision made at the initial level. The SSA will again review all of the evidence that was considered at the initial stage, as well as any new material that has been submitted. Although a new evaluation is being conducted at the reconsideration level, unfortunately, the denial rate at this level is very high. For example in 2009 only 8.2% of medical decisions made at the reconsideration level resulted in approval. (See Outcomes of Applications for Disability Benefits here) If it is determined that an individual is not disabled at the reconsideration level, the individual may request a hearing in front of an Administrative Law Judge, which is the third stage an application for disability benefits can progress to. The Hearing Level will be addressed in a future post.

An RFC is important at several stages of the 5 step sequential evaluation process, but let’s start with a definition. RFC stands for residual functional capacity, and is an individual’s maximum remaining ability to perform sustained work on a regular and continuing basis. In other words, what can the person do 8 hours a day, for 5 days a week? An RFC is assessed based on all the medical records in a case and is supposed to represent the most a claimant can do, both physically and mentally. A person’s RFC considers both exertional and non-exertional limitations. Exertional limitations have to do with physical strength and fall into one of seven categories: sitting, standing, walking, lifting, carrying, pushing, and pulling. Non-exertional limitations include any work-related limitation that is not covered by one of the exertional categories. Non-exertional limitations include: mental abilities, vision, hearing, speech, climbing, balancing, stooping, kneeling, crouching, crawling, reaching, handling, fingering, feeling, and environmental restrictions. If any exertional limitations are involved in a disability claim, then the RFC assessment must include an exertional classification of sedentary, light, medium, heavy, or very heavy work. As a person moves down the list of exertional classifications (for example, from heavy to medium) fewer jobs are available that fall within the person’s RFC. As a result, the lower the exertional classification, the better the claimant’s chances of being found disabled. Non-exertional limitations can also decrease the number of jobs that fall within a claimant’s RFC. For example, limitations in fingering and handling could exclude assembly jobs, while limitations in interacting with the public could exclude customer service jobs. In future blog posts we will look at RFCs in several different scenarios and examine how they might affect the outcome of case.