What Is Important in Winning Your Social Security Disability Case?

Lawyer defending his client

One of the first questions we are always asked is “how do I know if I qualify for disability?”

The standard that the Social Security Administration looks at to find someone disabled is 1) you must have a severe mental or physical impairment, 2) that impairment must last or will last at least 12 months, and 3) those problems must prevent you from full-time work. How we prove those things to SSA is through medical records.

Tips for Winning Your Disability Case

While there are many important things in a disability case, perhaps the most critical to winning your case is your medical treatment. Getting in and staying in regular medical treatment is key. Your medical records are the evidence of your disability and how severe it is. It is very difficult to win your disability case without sufficient documentation in your medical records. This is often challenging for people that are unable to work and have lost their income or insurance. The Social Security Administration will not consider lack of income or insurance as a valid reason not to have regular medical treatment since there are free and sliding scale clinics available. This can be very challenging and stressful for people to navigate when they are already struggling. Hiring an Attorney to help guide you though this process early on can ensure you are developing the evidence you need to win your case, and getting the proper medical care you need as well.

The second area the Social Security Administration focuses on is how your physical or mental impairments keep you from returning to your past work, or other less strenuous work. The rules are less restrictive once you turn 50 years old. To accomplish this critical step in the disability process, you must have limitations or restrictions from your Doctor to show how your impairments prevent you from working full time. This can be a complicated process because doctors do not tend to put their medical notes in the vocational terms that the Social Security Administration is looking for. SSA is looking for specific restrictions and limitations and if those are not there, or not adequately supported by your records, you will most likely be denied.

This complex step of the process can be very confusing where the medical and legal issues cross and can take a while to develop. Having an attorney with experience in handling Social Security Disability cases can make a difference in whether or not you win your case.

How a Social Security Attorney in Morristown Can Help You

Having experienced representation can significantly increase your chances of winning your disability case. While the medical treatment is important there are many other important aspects to your case that can be complicated such as completing appeals and forms for examiners at DDS, meeting deadlines, gathering and submitting evidence and preparing your case for a hearing, or even appealing to the Appeals Council or Federal District Court. Even after you win your case, many need assistance in verifying you are receiving the correct and full benefit for you and your family, or in handling reviews of claims later.

Social Security Disability

Am I eligible for Social Security Disability benefits?

Social Security will pay you benefits if you cannot work because you have a medical condition that is expected to last at least one year or result in your death. This description is the federal government’s definition for disability and will be used to determine whether your situation qualifies you for disability benefits. The definition limits the disability payments to long-term only and does not give money to people with partial disability or short-term disability. Primarily, if you have paid enough in Social Security taxes – at least half of the working quarters since you turned 21 years of age – you are eligible to file a claim for Social Security Disability if you become disabled.

To get disability benefits, in addition to meeting the disabled definition, you must also meet two different earnings criteria:

  1. A “recent work” test based on your age at the time you became disabled; and
  2. A “duration of work” test to show that you worked long enough under Social Security.

Who decides if my disability entitles me to SSDI?

The Social Security office will review your application to determine whether you worked enough years to qualify and to assess the level of your current work activities. If you meet these criteria, your application will be passed on to the Disability Determination Services office in your state which completes the disability decision for the Social Security office.

The state agency will ask your doctors and specialists for information about your condition and will consider all the facts in your case. They will use the medical evidence from your doctors and hospitals, clinics or institutions where you have been treated and all other information.

Specifically, they will ask the medical team for the following information:

  • What your medical condition is
  • When your medical condition began
  • How your medical condition limits your activities
  • What the medical tests have shown
  • What treatment you have received

In addition to the above, they also will ask the doctors for information about your ability to do work-related activities, such as walking, sitting, lifting, carrying and remembering instructions. Your doctors are not asked to decide if you are disabled. Additional medical information may be needed before a final decision can be made. It is possible that the state agency will ask you to go for a special examination. Although the preference is to use your current doctor, the exam may be conducted by another qualified physician.

How long will my application process take?

According to the Social Security Administration the length of time it takes to receive a decision on your disability claim can take from three to five months.

It can vary depending on several factors, but primarily on:

  • The nature of your disability;
  • How quickly medical evidence is obtained from your doctor or other medical source;
  • Whether it is necessary to send you for a medical examination in order to obtain evidence to support your claim; and
  • If your claim is randomly selected for quality assurance review of the decision.

Is there an alternative to the full application process?

Yes. The Social Security Disability Insurance has an initiative called Compassionate Allowances (CAL). This is a process whereby the Social Security office can provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously meet disability standards. There are 88 qualifying rare diseases and cancers on the list. Compassionate allowances allow the office to quickly identify diseases and other medical conditions that qualify under the Listing of Impairments, based on minimal objective medical information. Compassionate allowances allow Social Security to quickly target the most obviously disabled individuals and get their benefits to them.

Is my family eligible to receive benefits?

It is possible that certain members of your family qualify for benefits based on your condition and your previous work.

Those family members include:

  • Your spouse, if he or she is 62 or older
  • Your spouse, at any age if he or she is caring for a child of yours who is younger than age 16 or disabled
  • Your unmarried child, including an adopted child, or, in some cases, a stepchild or grandchild. The child must be under age 18 or under age 19 if in elementary or secondary school full time
  • Your unmarried child, age 18 or older, if he or she has a disability that started before age 22. (The child’s disability also must meet the definition of disability for adults.)
  • Your divorced spouse may qualify for benefits based on your earnings if he or she was married to you for at least 10 years, is not currently married and is at least age 62. The money paid to a divorced spouse does not reduce your benefit or any benefits due to your current spouse or children.