People claiming Social Security Disability benefits often must appeal at least one unfavorable decision from the Social Security Administration. According to one SSA report, over half of claims were initially denied during the most recent year with data available. As any Chicago injury attorney knows, claim denial can add significantly to an applicant’s wait for benefits. This makes proper preparation for the SSD appeals process crucial.
There are four levels of appeal: reconsideration, hearing, SSA Appeals Council review and federal court review. Many people must go through at least the first two levels before receiving a favorable decision.
During reconsideration, a new claims examiner reviews the existing claim and makes a new decision. When requesting reconsideration, applicants can submit any new medical evidence that may impact the claims examiner’s decision. However, applicants can do little else to prepare for reconsideration. Many claims are denied at this level because the primary facts in the case have not changed.
During the next level of appeal, an administrative law judge holds a formal hearing. After questioning the claimant and a vocational expert, the judge makes a new determination. The hearing is independent from the previous decision the claims examiner made. Therefore, applicants may benefit from spending more time preparing for this stage of appeal.
Before the hearing, applicants should review the SSA’s case file. Doing this offers several benefits:
- Applicants can check for missing or inaccurate information that may have negatively affected the initial claim decision. Applicants can then secure relevant documentation to remedy the issue.
- Applicants can learn why the claim was denied. Initial claim decisions are not reviewed in appeals hearings, as any Chicago injury attorney can explain. However, by understanding the rationale behind the denial, applicants can present a stronger case during the appeal.
- Applicants can see when the collected medical records leave off. After a claim is denied, the SSA usually stops gathering medical evidence. Given the typical delay between claim denial and the hearing, several months of records may be missing. This can be problematic, since an administrative law judge cannot make a decision without current medical information.
Applicants should request missing or updated medical records as soon as they receive notice of the hearing date. Applicants can submit new records to the Office of Disability Adjudication and Review. Applicants may also want to keep a personal copy to help prepare for the hearing.
Applicants should also seek out secondary documentation to support objective medical evidence. Statements from medical professionals and personal sources can help establish the severity and impacts of the disabling condition.
Any statements from physicians should be detailed and descriptive. A doctor may write a letter or use a Residual Functional Capacity form to describe the applicant’s functional limitations. The RFC form specifically asks for information about the applicant’s ability to do necessary work-related activities. These include sitting, standing, lifting weight and carefully handling objects.
Personal sources, such as co-workers, relatives or personal acquaintances, can also provide supporting statements. These statements carry less weight than medical evidence or a professional medical opinion. However, the SSA recognizes that personal sources may offer unique insights into an applicant’s daily symptoms and limitations. As a Chicago injury attorney can attest, this documentation can add valuable support to a claim.
Besides gathering medical evidence and supporting statements, applicants should be prepared for the hearing itself. During the hearing, an administrative law judge asks detailed questions about the disabling condition. Applicants should be ready to provide specific, descriptive answers, since vague answers may undermine credibility.
Applicants should think carefully about the nature of their symptoms and limitations. Applicants should be able to describe the location, intensity and frequency of symptoms, along with any precipitating factors. Applicants should also consider the specific functional impacts the disabling condition causes. For example, applicants could discuss activities they can no longer perform independently or activities that require special accommodations.
Applicants should be as accurate and honest as possible. Understatement and over-exaggeration can both hurt a claim, as any Chicago injury attorney knows. Considering likely questions and answers before the hearing is the best way for applicants to be ready with credible answers.
An applicant’s ability to work gainfully is another crucial focus during the disability hearing. The administrative law judge closely reviews the applicant’s work history to determine whether the applicant could resume past work. The applicant’s previous work also serves as an indication of the applicant’s work-related skills. Based on work history, a vocational expert testifies whether the applicant could reasonably pursue new work.
Applicants should be ready to discuss prior jobs in detail. Aside from the job title and duties, applicants must describe relevant training, typical hours and use of special equipment. Unique duties, such as supervising others or interacting with the public, are also considered relevant. If any past jobs and related duties are represented inaccurately during the hearing, applicants should correct the misunderstanding.
An administrative law judge can only consider “past relevant work” when making a disability determination. Any work the applicant performed over 15 years ago is not relevant. Part time or short duration work is typically not given weight. A failed work attempt or a job that ended before the applicant mastered it is not material either. Applicants should inform the judge if they believe work has been classified as past relevant work in error.
Finally, applicants may benefit from working with an attorney when appealing denied claims. A Chicago injury attorney can provide advice on properly documenting the claim and preparing for the hearing. An attorney can also assist during the hearing by correcting errors that might otherwise lead to an unfavorable decision.