The Disability Process
OverviewWhen a person has a severe medical problem, or several medical problems combined, so bad that they can no longer work, they may be entitled to disability benefits paid by the Social Security Administration. If they apply for Social Security disability benefits, the Administration will look at different factors. The Social Security Administration does not just look at any particular diagnosis you may have, and it does not just consider whether or not you can continue to do you regular work.
Under the Social Security Act, the law of the land, whether or not you qualify for benefits is NOT just a medical determination. It is also based on your skills and education, and transferability of skills, and degree of restriction.
Social Security benefits come ONLY from the law passed by Congress. It is not the same as a private insurance policy which either you or your employer may have purchased; it is not the same as a state worker’s compensation law; it is not the same as a state disability statute (like TDI). The Social Security Act sets out a fairly complicated and very difficult procedure and standard for becoming qualified for disability benefits.
The Social Security Act is a law passed by Congress. That means that it is a political compromise between those Senators and Congressmen who thought that one of the purposes of government is to provide for the well being of workers who become ill, and can not continue to earn a living, by creating a plan of social insurance contributed to by all workers and to provide such insurance, and, on the other hand, those Senators and Congressmen who felt that everyone is responsible to provide for themselves and if they did not or could not they could either beg for charity or starve. It’s that simple.
All it takes to pass a law is a quorum to vote on it. The law does not have to be a shining example of brevity, clarity, or logic; it does not even have to make sense. What we have in the Social Security Act is a political compromise which creates a difficult process and a hard standard for the definition of what it means to be “disabled” and “entitled to benefits.” Moreover, through the years Congress has changed the law to even further limit eligibility for benefits, and in the present difficult financial circumstances of the United States (record budget deficits), it is looking for even more ways to limit the amounts paid out to disabled persons.
We have been effectively navigating these waters, in behalf of our clients, for almost 40 years.
We have organized strategies for obtaining your complete records as held by Social Security and reviewing those records with you to ensure that there are no obvious errors and mistakes; for requesting special medical opinion evidence from your doctors and suggesting possible special medical testing and opinions; for submitting records into evidence which Social Security will have to consider and building a complete medical file to fully present your situation.
Our office will directly communicate with you, your family and other witnesses you may suggest, and with your physicians, to ensure the file includes all evidence of your disability.
Dealing with Social Security, through application, delays, denial, and appeals and uncertainty, will cause stress and worry. When we represent a client we take responsibility for dealing with Social Security and for handling all necessary paperwork with you and for filing appeals. If a hearing before an Administrative Law Judge becomes necessary you may take comfort in knowing that you will have an attorney who is familiar with you, and with your record, and who has met with you and your witnesses and prepared you and will be with you at the hearing to present your case, and submit a memorandum to the judge, and to cross-examine any medical or vocational experts called by Social Security. You will have an attorney who has been there before and who works for YOU.
What is Disability?What it means to be “disabled” for Social Security benefits is controlled by the
- Social Security Act passed by Congress,
- Regulations of the Commissioner of Social Security,
- Rulings of the Commissioner,
- Program and Office Manual System (POMS) of the Commissioner,
- Hearings Office Manual (HALLEX) of the Commissioner,
- Decisions of the U.S. Court for the District of Rhode Island,
- Decisions of the U.S. Court of Appeals for the FIRST Judicial Circuit, and
- Decisions of the Supreme Court of the United States of America.
The concept of “disability” under Social Security Practice is not based on a having a particular diagnosis. It is based upon the degree of restriction and limitation caused by your medically determinable impairments: That is, by the LOSS OF WORK RELATED FUNCTIONAL ABILITY.
Under Social Security law “disability” means that you have medical problems so significant as to cause such difficulty, restrictions, and limitations that you LACK THE RESIDUAL FUNCTIONAL CAPACITY to engage in SUBSTANTIAL GAINFUL WORK ACTIVITY, meaning that you CAN NOT do:
- not only your regular job,
- but any other occupation for which you are qualified,
- or for which you could become qualified based upon your age, education, work experience, and any special training you may have had,
- which exists in significant numbers in the national economy,
- on a full time basis of 40 hours a week,
-on a routine, scheduled, ordinary, regular, day-in and day-out work day basis,
-with full attendance, punctuality, quantity standards, and quality standards,
- without special consideration, accommodation, or assistance,
- on a continuous and continuing basis.
To determine whether you meet the definition of disabled the Social Security Administration considers all of the things you cannot do because of your condition and after writing-off these limitations what is left is called “Residual Functional Capacity” or RFC. If you lack the RFC for Substantial Gainful Work Activity (SGA) you are disabled pursuant to the Social Security Administration’s definition. SGA is any occupation existing in the region of country you live in or several regions of the country. It means work for which you are qualified based on the “vocational factors” of age, education, experience, and any special training. The evaluation is done in a “Five Step Sequential Analysis” located at Volume 20 Code of Federal Regulations section 404.1520 (20 CFR §404.1520).
The Social Security ProcessThe Social Security process may involve several levels. At each level a determination of disability will be made. Below is a brief explanation of what may be expected at each level
Initial: At the initial level an examiner from Disability Determination Services (DDS) compiles the medical evidence and a physician reviews the medical evidence and makes a disability determination. If disability is denied that the initial level the Claimant may file a Request for Reconsideration.
Reconsideration: The file is sent back to the same DDS office, but a different examiner. This examiner will update the record and another determination will be made. If a denial is issued at this level the Claimant has a right to Request a Hearing before an Administrative Law Jude at the Office of Hearings and Appeals.
Hearing: Hearings are in front of an Administrative Law Judge (ALJ) and often include testimony from a Medical and/or Vocational expert paid for by the Social Security Administration. A medical expert would be there to provide an opinion as to the Claimant’s medical conditions and RFC. A vocational expert would provide statistical data regarding the existence of jobs that could be performed with the given RFC. Generally a decision is not made at the hearing, but will be mailed.
Post Hearing: If a Favorable Decision is issued a notice of award will be forthcoming detailing what payments to expect. If there is any confusion at this level our office is always available to help our clients understand the notices and we will work with you to be sure Social Security is sending you any and all money you are entitled to. The ALJ’s decision is final, however if the ALJ issues an Unfavorable decision a Claimant has the option to file a Request for Review with the Appeals Council (AC). If the AC affirms the Unfavorable Decision the Claimant has the right to file a civil complaint in the appropriate United States District Court.
Let our decades of experience help you navigate this difficult process.
Contact us today for a free telephone consultation 401-737-6800. IF WE ACCEPT YOUR CASE you do not have to be alone.
We do not represent you, and no attorney-client relationship exists, unless and until we meet, agree, and execute appropriate documents and authorizations.