What Evidence is Used to Evaluate a Disability Claim?

Posted on August 13, 2010 by Editorial Board

The most important evidence used to decide your disability benefits claim is medical evidence.  You must be prepared to inform the Social Security Administration (SSA) of all the treatment you have received and all of the doctors you have seen so that it may gather evidence to make a decision in your case.

The medical evidence must be from a valid and reliable source.  That’s not to say that evidence in other forms is not considered.  The SSA also relies on forms with information about your work history, your activities of daily living, and your ability to do physical activities provided by you, a family member, a friend, or even a doctor or counselor you have seen.

Another source of medical evidence that may be used to decide your claim comes from doctors that the SSA sends you to see.  Occasionally, people applying for disability benefits do not have enough medical evidence regarding an alleged physical or mental impairment to determine the severity and consequences of that condition.  As such, you may request that the SSA send you to see a doctor at no cost to you.

In some instances the SSA, in an attempt to fully and fairly decide each claim, will schedule an appointment for you to see a doctor. The doctor will provide the SSA with a report detailing his or her findings.  Those reports are also used to decide your claim.

Another important source of evidence used to decide your claim is medical opinion statements regarding your physical and/or mental abilities to do work.  Your doctor can fill these forms out and you can use them as evidence to help win your benefits.

Posted in Basics of SSD, Medical Evidence, Questions & Answers, Winning Disability Benefits | Comments Off on What Evidence is Used to Evaluate a Disability Claim?

When is the Best Time to Apply for Social Security Benefits?

Posted on August 12, 2010 by Editorial Board

You should apply for Social Security Disability or Supplemental Security Income (SSI) benefits when your health no longer allows you to work at the level of Substantial Gainful Activity.  Substantial Gainful Activity (SGA) is defined as work that is both “substantial” and “gainful.”  “Substantial” means work that involves significant physical or mental activities and “gainful” means work done for pay or profit, whether or not you actually realize a profit.

Usually, if you are working and earning more than a certain amount, you are not going to be found disabled.  However, that is not always the case.  In some instances, you may be able to work and earn some pay, yet still be found disabled.

In 2010, the SGA amount is $1,000.  The amount you are allowed to earn without being disqualified for benefits is set out in the regulations and changes yearly so it’s important to inform your lawyer or representative that you’re working, how many hours you’re working, and how much income you’re making.

You do not have to file for benefits immediately after becoming unable to work.  However, it’s important not to wait too long to file your application since you may become ineligible for Social Security Disability Benefits once your Date Last Insured (DLI) expires.  Many people are surprised to learn that Social Security Disability Benefits have a shelf life.

Once you quit working, you are only insured for disability benefits for a certain amount of time.  That time is determined by your earnings record and how much you paid in taxes while you worked.  It’s important to be aware of the date of your DLI since its expiration may prevent you from being able to receive benefits.

Supplemental Security Income does not have an expiration date, but many people, due to excess assets, may not qualify for SSI.

Posted in Basics of SSD, Filing Initial Application, Questions & Answers | Comments Off on When is the Best Time to Apply for Social Security Benefits?

Consultative Exams (CEs): What Are They?

Posted on August 12, 2010 by Editorial Board

After you’ve filed your application for Social Security benefits, you’ve received a letter in the mail notifying you that the Social Security Administration (SSA) is sending you out to a disability examination with a doctor.  The letter states it is to obtain medical information for a disability determination.  The examination has been arranged at SSA’s expense to obtain “needed information.”  It is very important you attend this exam, as failure to attend could result in a denial of benefits.

Some people believe this exam’s purpose is to provide medical treatment.  This is wrong.  The exam is not intended to treat you for any physical or mental condition.  SSA needs specific medical evidence to determine whether you are disabled.  The consultative examination (CE) is simply an evaluation to see what your current medical conditions are, and to have a doctor determine how severe these conditions may be at the present time.  The CE is usually conducted in less than thirty minutes.  The doctor may use his staff, nurse, or other assistant to help complete forms and take your vital signs.   The doctor is not required to report to you his findings, diagnoses, or evaluation of your disabilities.  He will send a written report to SSA of his findings.

A CE is not a substitute for medical treatment.  It is crucial for you to be in treatment with your own doctor or health care professional.  SSA requests the consultative examination when your medical sources cannot or will not give SSA sufficient medical evidence about your impairment for them to determine if you are disabled or blind.

Things to remember about a CE:

  • It’s not meant to be the same as a treating relationship with your own doctor, it’s a medical expert Social Security has hired to give them a report on how you are doing.
  • Be friendly and honest with the doctor, like in a disability hearing exaggeration can hurt your chances.
  • If anything really unprofessional happens in a CE be sure to tell your representative (or lawyer) about it as there are ways to object to a CE.
Posted in Basics of SSD, Medical Evidence, Questions & Answers, The Listings (Step 3) | Comments Off on Consultative Exams (CEs): What Are They?

How to get Social Security Disability or SSI Benefits?

Posted on August 9, 2010 by Editorial Board

You are considered disabled once you have proved your inability to work.  This can be proved either by establishing, through valid and reliable medical evidence, that you have been diagnosed with a medical condition or a combination of medical conditions that the Social Security Administration (SSA) has found to be per se disabling or by establishing that you suffer from a condition or a combination of conditions that prevent you from being able to sustain full-time employment.

Establishing disability can be done when you first file your initial application for social security with the state agency.  You must be sure to give the agency thorough information regarding all of your health problems and all of the doctors that you have seen.  If you have hired someone to help you with the initial application process, make sure you give him or her all of the information so that he or she can submit it to the state agency processing your application.

If you are not awarded your benefits at the initial application level, you should file an appeal, or request for reconsideration, in writing, within 60 days.  You will be given an explanation regarding why you were denied.  Make sure that the state agency that reviewed your case received medical records from all of your treating sources.  When you file your request for reconsideration, make sure that you, or the individual representing you, submits medical records from any treating sources that the state agency may have overlooked in your initial application.

If you are not awarded benefits at the reconsideration level, you must file your request for a hearing within the allotted time.  Proving disability at the hearing level is a little different than at the other levels.

You must still make sure that all of your medical evidence has been submitted, but you also get the opportunity to go before an Administrative Law Judge to explain how your medical conditions affect your ability to work on a full-time basis.  Many times, there is also a medical expert and a vocational expert present at the hearings to help explain to the judge what kind of medical conditions you have, how those medical conditions may affect your ability to work, and what kind of work you’ve done in the past and whether or not physical limitations that judge finds you to have will impede your ability to do your past relevant work, or any other work in the national or regional economy.

At the hearing level, you may also be allowed to have witnesses to testify on your behalf regarding your medical conditions and your activities of daily living.  Although in most hearings witnesses are not called.

After you file for Social Security Disability you can win either in the initial application (or reconsidered application) levels while your file is being reviewed by your state agency, or you can win later on at the hearing level when the file passes over back to Social Security.

Posted in Basics of SSD, Questions & Answers, Winning Disability Benefits | Comments Off on How to get Social Security Disability or SSI Benefits?