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What is a Disability Claim?

A disability claim is a request for income assistance filed with the Social Security Administration. A claim is filed when a person believes that a mental or physical disability leads to his/her inability to lead a normal life or find a job. Depending on your medical and financial history, you can either file for Social Security Disability Insurance or Supplemental Security Income.

The disability claims process consists of five stages: initial, reconsideration, hearing, appeals council hearing and Federal District Court appeal. An initial claim involves filling out either an SSDI or SSI application. Your application will either be denied or approved by a Social Security claims representative within three to five months. Over 60% of applicants are denied during the initial stage. If denied, you have 60 days to file for reconsideration. Your reconsideration application will once again either be denied or approved by a Social Security claims representative. About 85% of reconsideration cases get denied. If denied again you can request a hearing, during which you or your representative can argue your case in front of an Administrative Law Judge. If you are unhappy with the judge’s decision, then you may file an appeal with the Social Security appeals council. The council can deny your appeal, send it back to the Administrative Law Judge for review or decide to award or deny benefits itself. If you are unsatisfied with the council’s decision, then you may file an appeal with the Federal District Court of Appeals.

What is a Disability Claim?

If you are unable to work due to medical condition that you are currently experiencing, you may be eligible for disability benefits from the Social Security Administration (SSA). The claims process can be challenging, and it is complex, with specific documents necessary to support your claim and to help you prove the severity of your condition. To have a successful claim, you need to provide hard medical evidence and other supporting documentation that verifies the severity of your condition, as well as any limitations and restrictions.

Without the proper supporting evidence, your disability claim will not be approved. You will need to show the severity of your condition and how it limits you and restricts your abilities to work and earn a living. You should always get your documentation in order before you get your disability claim underway, so you can improve your chances for a successful claim and being approved for disability benefits.

What Documents Are Needed For a Claim?

Documentation is the key to a successful claim. Before you apply for disability benefits, you should gather up some important documents that must be reviewed so your likelihood of a successful claim may increase greatly. To apply for disability benefits, you should have these documents ready:

  • Your work history – Include the names of employers, the contact details, your supervisor, your job responsibilities, and your job title.
  • Current earnings – You should provide a detailed history of your work earnings. This will help the SSA see how much you were earning from your job.
  • Household income/assets – To receive Supplemental Security Income (SSI), which is needs-based, you must show that you meet specific income and resource requirements. You will need to show proof of your household income along with any assets, which includes bank statements.
  • Bank Information – You will need to have your bank information available, such as a voided check or a direct deposit form from your bank so you can have any disability benefits direct deposited into your bank account.
  • List of any other benefits that you receive – If you receive food stamps, temporary aid for needy families (TANF), short-term disability from an employer plan or private plan, or workers’ compensation as well as any other benefits you should have an itemized list of these to provide to the SSA for review.
  • Citizenship status – You will need to demonstrate proof of your citizenship.
  • Medical records – You should provide a detailed list of everywhere you received medical care for your medical conditions that are disabling. Provide the names of the providers, clinics, hospitals, and so forth, their addresses and phone numbers, and the dates of service. If you have copies of the medical records, or if you acquire copies and can provide them directly for review, that can also help with the process but isn’t mandatory.

Appealing Disability Claims

It isn’t uncommon to have your disability claim denied. When your claim is denied, you will file a request for reconsideration, which is basically an appeal. When you do that, the SSA will once again review the details of your claim and see if anything was overlooked or if the wrong decision was made. To have a claim approved at this point, you must be able to provide additional details that they didn’t review the first time around.

When you receive your denial letter, it should detail why your claim was denied. You can take those details to try to come up with the needed information to have your claim approved.

Based on those details, you should have an idea as to what information your initial claim lacked that the SSA needed to see to approve your claim. You can then work to get those additional details. That means that if additional test results are needed, you can go to see your physician and talk with him or her about that. You will want to make sure your physician supports your disability claim because your medical records are what helps to determine if your claim is approved.

How to File a Disability Claim

A disability claim can either be filed yourself or through a disability advocate. Before filing a claim, an applicant should be able to prove that he/she is expected to be out of work for at least a year due to a permanent disability. One should also make sure that there are sufficient medical documents and physician’s opinions to confirm the existence and severity of the disabling condition. You must not be able to perform your previous job nor should you be able to get a different job that would pay you in excess of $1,000/month.

Gathering the necessary evidence can be a rather time consuming and complicated process. Thus, it is recommended that one hires a Social Security Disability attorney before beginning the application process. Usually, an attorney will not collect any fees unless you win your case. Typical attorney fees are about 25% of the claim that has been awarded to you. An attorney can receive no more $6,000 for winning a Social Security Disability case. To contact a disability attorney or advocate who can review your case at no charge, please fill out our Free Evaluation.

All disability claims can be filed by phone, at a local Social Security office or online. The hearing stage will be conducted in person in front of a judge.

Top Reasons For A Claim Being Denied

While there are dozens of reasons for a claim being denied, there are some reasons that are much more common than others. Usually it is because your claim and its evidence fail to establish the severity of a disability case. That means additional medical records are required. You need to provide tests and physician notes that clearly detail the severity of your medical issues.

Often, having a residual functional capacity (RFC) completed by your physician can help your claim. These forms will give your physician the opportunity to detail the severity of your condition. Your doctor will clearly and specifically indicate your condition and its symptoms and any side effects from treatments.

For example, the RFC may say you cannot stand more than two consecutive hours, that you must reposition every hour, that you cannot lift more than 10 pounds, that you cannot squat, bend, or reach. When the SSA reviews your RFC, they should get a better picture of your overall health and what you can and cannot do.

Filing A Disability Appeal

If your disability claim is denied, you will want to file an appeal. When you receive your denial notice, it will tell you how long you have to get your appeal filed.

If you miss that deadline, then you will not be able to appeal the decision and you will have to file a new claim all together. When you file an appeal, you should enlist the help of a disability lawyer if you haven’t gotten one to help you already.

A disability lawyer is familiar with the claims process and stays current on disability laws and procedures. With the help of an attorney, you are much more likely to end up having your claim approved.

When you retain a disability attorney, you will not have to pay anything up front. Instead, disability lawyers receive a percentage – which according to the SSA protocol – is 25 percent of your backpay, but the amount cannot exceed $6,000.