II. Simple Steps To Use When Fighting Your SSD Case
by Linda Fullerton
ljfullerton919@hotmail.com President/Co-Founder - Social Security Disability Coalition
A. Social Security pays only for total disability
Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability. You are disabled under Social Security rules if you cannot do work that you did before and if they decide that you cannot adjust to other work because of your medical condition(s). You have a valid claim if you have been disabled or are expected to be disabled for 12 consecutive months, or your condition will result in your death. You should file your claim within 12 months of the date you first became disabled - Social Security will only pay monetary benefits for a maximum of 12 months prior to the date of your application. This is true regardless of what date you became disabled. To decide whether you are disabled, SSD uses a step-by-step process involving five questions. Are you working? - If you are working and your earnings average more than $800 a month, you generally cannot be considered disabled. If you are not working is your condition "severe"?. Your condition must interfere with basic work-related activities for your claim to be considered. If it does not, they will find that you are not disabled. Is your condition found in the list of disabling conditions? For each of the major body systems, SSD maintains a list of medical conditions that are so severe they automatically mean that you are disabled (The "Bluebook of Listings and Impairments"). If your condition is not on the list, they have to decide if it is of equal severity to a medical condition that is on the list. If it is, they will find that you are disabled. Can you do the work you did previously? If your condition is severe but not at the same or equal level of severity as a medical condition on the list, then they must determine if it interferes with your ability to do the work you did previously. If it does not, your claim will be denied. Can you do any other type of work? If you cannot do the work you did in the past, SSD looks to see if you are able to adjust to other work. They consider your medical conditions and your age, education, past work experience and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied. If possible get a copy of your personnel file from your previous employer (contact the human resources dept - give them authorization to send it to you and tell them why you want it - for SSD reasons) documenting how many days you were absent from work (attendance records, sick days, doctor's excuses, leave of absence, warning letters etc) due to your illnesses before you could not work any longer. Keep a copy for yourself send one to SSD.
NOTE: Once you are approved there is no time limit on disability benefits. You will continue to receive a disability benefit as long as you continue to be disabled and otherwise meet work or other eligibility requirements. However, your case will be reviewed periodically to see if there has been any improvement in your condition and whether you are still eligible for benefits. If you are still eligible when you reach full retirement age, disability benefits will automatically be converted to retirement benefits.
B. Take as active a roll as possible in fighting your own case
If you cannot handle it get a family member to help you the less YOU do the longer it will take to process your claim. The actual time it takes to process your claim may be more or less based on the State you live in - disability determinations are made by a Disability Determination Service in the State where the disability applicant lives. These State agencies are required to comply with federally prescribed policies and procedures, which helps assure that the programs are administered consistently from State to State. The nature of your disability; how quickly SSD can obtain medical evidence from your doctor or other medical source; and whether it is necessary to send you for a medical examination. As further assurance of consistency, samples of the State agencies' determinations undergo an extensive quality assurance process performed by Federal reviewers (Currently 7 out of 10 applications get randomly selected by computer for this process). Unfortunately, this
additional review may cause delays in some cases.
NOTE: This data is what you are REALLY up against when fighting a claim - taken right off of SSA's own website. No matter what anyone (SSD workers, lawyers etc) tells you, these figures are the true facts. Also the GAO considers Social Security Disability to be a HIGH RISK area for 2003 so things are expected to be much worse when the 2003 reports come oud This information is important - not to scare or discourage you, but to show how bad the system is and how important it is that you do EVERYTHING possible
here to speed up your claim so it does not fall into those statistics. The current system as it stands is set up to discourage you so they can rob you of your money or in hopes that you will die in the process of trying to get your benefits - then they don't have to pay you! DON'T GIVE THEM THAT SATISFACTION - DON'T BE A VICTIM OF THE SYSTEM - TAKE ACTION NOW - DON'T BE SAD - GET MAD!!!!
C. Have Doctors are Supportive of Your Claim
If your primary care doctor or any other doctor is unsupportive of you/your diseases/SSD claim - get rid of them immediately and find a new one. You will almost surely be denied if your primary care
physician/specialists do not support your claim. Some tips on "How To Talk With Your Physician About
Supporting Your Disability Claim: can be found at:
www.immunesupport.com/lib...fm?ID=3022
SSR 96-2p: POLICY INTERPRETATION RULING TITLES II AND XVI: Giving Controlling Weight to Treating Source Medical Opinions
www.ssa.gov/OP_Home/rulin...di-01.html
SSR96-5p: POLICY INTERPRETATION RULING TITLES II AND XVI: Medical Source Opinions on Issues Reserved to the Commissioner
www.ssa.gov/OP_Home/rulin...di-01.html
D. Seeing Specialists
Make sure you see and get properly diagnosed by any specialists for your medical problems - make sure to mention/document all PHYSICAL and MENTAL problems you may have - ALL are important factors when filing for SSD. (EXAMPLE - Many people who are disabled suffer from depression in some form
as a result - so it is important that if you have that problem that is diagnosed properly/documented and included in your list of illnesses). Try all possible options to treat your disease before filing for a claim - SSD needs to see that you are trying to get better but that treatments have little or no affect on your condition.
SSR 96-4p: POLICY INTERPRETATION RULING TITLES II AND XVI: Symptoms, Medically Determinable Physical and Mental Impairments, and Exertional and Nonexertional limitations
www.ssa.gov/OP_Home/rulin...di-01.html
E Get Copies of ALL Your Medical Records
Get copies of ALL your medical records and tests - keep a set for yourself and send a set to SSD
F. Make Copies of All of Your Records
Anytime you fill out any paperwork for SSD make copies of it for yourself before sending it back to them
G. Filling Out Forms
When filling out SSD forms answer ALL questions as to how you would feel on your WORST day. NEVER downplay your symptoms or exaggerate them either Explain in detail the frequency, severity and duration of your symptoms and limitations and how they limit your ability to work and function on a daily basis. If you have problems filling out their forms (due to concentration, memory, pain) - make sure you mention that on the form and if it took you several days/weeks to fill them out, or if you had to have someone else do it for you - mention that too.
SSR 96-3p: POLICY INTERPRETATION RULING - TITLES II AND XVI: Considering Allegations of Pain and other Symptoms in Determining Whether a Medically Determinable Impairment is Severe.
www.ssa.gov/OP_Home/rulin...di-01.html
SSR 96-7p: POLICY INTERPRETATION RULING TITLES II AND XVI: EVALUATION OF SYMPTOMS IN DISABILITY CLAIMS: Assessing the Credibility of an Individual’s Statements.
www.ssa.gov/OP_Home/rulin...di-01.html
H. Make a List of ALL Medications/Supplements You Take
Make a list of ALL medications/supplements you take. Be sure to list anything that you are allergic to or other reason why you cannot take a medication/treatment that a doctor has recommended (do not use the reason that you cannot afford it). Always ask for and have your doctor give you SAMPLES whenever possible especially for new medicines that they may want you to try - they get tons of them from drug reps - you just need to ask for them. If for some reason they don't have samples - get a trial prescription
(a few days/one week) so you are not paying tons of money for something you may not be able to take because of allergies or nasty side effects. Keep a daily diary of the intensity and frequency of your symptoms, pain and how it limited your activities that day. Note the things/activities that may have made your symptoms worse. Make copies of all of this information - keep one for yourself, give one to each of your doctors and send one to SSD.
I. Go through the Doctor's Bluebook of Listings
Find all the listings you meet and copy and paste them into a document - keep a copy for yourself - send one to SSD
www.ssa.gov/disability/pr...s/bluebook
www.ssa.gov/disability/pr.../index.htm
NOTE: Fibromyalgia/CFS claimants - see these documents:
SSR 99-2p: POLICY INTERPRETATION RULING TITLES II AND XVI: Evaluating Cases Involving Chronic Fatigue Syndrome (CFS)
www.ssa.gov/OP_Home/rulin...di-01.html
Chronic Fatigue Syndrome and Fibromyalgia Patients: Should You File a
Disability Claim?
www.immunesupport.com/lib...fm/id/3900
Completing Disability Forms: Five Critical Tips to Keep in Mind for Chronic
Fatigue Syndrome and Fibromyalgia Patients
www.immunesupport.com/lib...fm/ID/3487
J. Get copy of Residual Functional Capacity Questionnaire
Make copies for ALL your doctors to fill out and in your own words make up a letter answering all the questions - make sure to include how these diseases affect your life. You may wish to revise this sample to better reflect your own limitations, then ask your doctor to fill out your own version instead of whatever DDS sends: pbcers.org/rfcq.htm. A guide for providers on what to include in a report on your disability - read this and write your own to give to your doctor so he knows the answers:
www.ssa.gov/disability/pr...-adult.htm
www.ssa.gov/disability/pr...idence.htm
www.ssa.gov/disability/pr...elines.htm
www.ssa.gov/disability/pr...eneral.htm
SSR 96-8p: POLICY INTERPRETATION RULING TITLES II AND XVI: Assessing Residual Functional Capacity in Initial Claims
www.ssa.gov/OP_Home/rulin...di-01.html
SSR 96-9p: POLICY INTERPRETATION RULING TITLES II AND XVI: Determining Capability To Do Other Work-Implications Of A Residual Functional Capacity For Less Than a Full Range of Sedentary Work
www.ssa.gov/OP_Home/rulin...di-01.html
SSR 85-16: TITLES II AND XVI: Residual Functional Capacity For Mental Impairments
www.ssa.gov/OP_Home/rulin...di-01.html
K Write All Your Elected Officials
Write all your elected officials and if you get any responses make copies - keep a set for yourself - send a set to SSD
www.congress.org
L. Helping Doctors Fill Out Paperwork
Offer to help your doctors fill out any paperwork that they may get from you or SSD.
M. Get Statements from Family, Friends, Co-Workers and Doctors
Ask your close family, friends, previous co-workers and doctors to write letters (on 8-1/2 x 11" paper) on your behalf stating how your illnesses affect your life and how they have changed you. Make sure they mention both physical and mental changes in your condition. The letters should include their background/relationship to you - how they know you, how long they have known you and your conditions. They should end with a statement as to why in their opinion you cannot work ANY type of job. Have them get the document notarized (many banks will do this for free) Up to four is sufficient. Make copies - keep a set for yourself and send one to SSD.
N. Keeping Doctors Appointments
If SSD asks you to see any doctors make sure you keep the appointment and audio/video tape record the visit - get copies of all that doctor's findings. Be very honest and specific about your condition. DO NOT wear make up or dress fancy - act, dress, look, function like you would on an average day. Make sure SSD doctors know that you have followed all medical recommendations you were given by your doctors and what affect they are having on your condition. If you have not been able to follow doctors recommendations due to side affects that have been problematic to your condition make sure you alert the SSD doctor to that as well. If possible have someone drive you to the appointment who knows about your medical conditions (family/close friend) and whom can also tell the doctor how these diseases affect your life.
SSR 96-6p: POLICY INTERPRETATION RULING TITLES II AND XVI: Consideration Of Administrative Findings of Fact By State Agency Medical and Psychological Consultants and Other Program Physicians and Psychologists At The Administrative Law Judge and Appeals Coucil Levels of Administrative Review; Medical Equivalence
www.ssa.gov/OP_Home/rulin...di-01.html
O. If Your Case Has Been Denied
If your case has been denied - file your appeal IMMEDIATELY in person if possible (no longer than 60 days). VERY IMPORTANT: get copies of all the records in your SSD file including ALL claim examiners notes and any doctors reports from doctors that SSD had you see - it is your right to have them.
Note: federal law allows you to reopen the prior claim within one year of the date of the initial denial for any reason. You can reopen a previous claim within four years of the initial denial if SSD finds good cause to do so. Even if you cannot reopen a previous claim you should be able to file a new SSD application if it has been five years or less since you last worked full time.
SSR 92-1p: POLICY INTERPRETATION RULING: Request Under the Privacy Act or The Freedom of Information Act for Access to Records and For Disclosure Of Material Maintained by the Office of Hearings and Appeals
www.ssa.gov/OP_Home/rulin...di-08.html
P. Use the SSD Website
Use the SSD website - it has lots of useful info and never be afraid to contact them by phone to ask questions as to the status of your claim: Website:
www.ssa.gov or Phone: 1-800-772-1213
You can conduct your Social Security business 24 hours a day, including weekends and holidays. You can ask to speak to a representative from 7 AM to 7 PM on business days. Some of the services available include scheduling an appointment, changing your address, and signing up to send your Social Security check directly to your bank. You can also use their automated services 24 hours a day to request services such as a replacement Medicare card or Social Security Statement, and a variety of other forms and
publications. Their phone lines are busiest early in the week and early in the month, so if your business can wait, it's best to call at other times.
Q. SSA IG
If you feel that you are being treated improperly report it immediately to the SSD Office of Inspector General and Office of Public Inquiry:
Inspector General's Office
Allegation Management Division
PO Box 17768
Baltimore MD 21235
Phone: 1-800-269-0271/410-965-8882
Rene Johns - Phone: 410-966-9158
Danny Johnson - Phone: 410-966-9158
Fax: 410-966-9201/410-597-0118
E-mail:
oig.hotline@ssa.gov
Social Security Administration Office of Public Inquiries
Phone: 410-966-3000
Contact: Mary Ann
R. Utility Shutoff
If you are facing utility shutoff, foreclosure on your house or bankruptcy due to waiting for your claim to be processed - make copies of any letters/notices and send them to SSD/elected officials and your lawyer
if you have one requesting a dire needs review of your case
S. Pre-Hearing Review
If you have been denied and have been waiting too long to get a hearing - look into getting what is called a Pre-Hearing review of your case.
SSR 97-2p: POLICY INTERPRETATION RULING TITLE II AND TITLE XVI: Prehearing Case Review by Disability Determination Services
www.ssa.gov/cgi-bin/cqcgi...C_TEXT=YES
T. Taping Testimony
If you have a hearing scheduled bring any new medical evidence, family, friends, doctors to speak on your behalf and ask to record it on audio/video tape. Be very honest and specific about your condition. DO NOT wear make up or dress fancy - act, dress, look, function like you would on an average day. If possible have someone drive you to the hearing who knows about your medical conditions (family/close friend) and can also tell the judge how these diseases affect/have changed your life. Make sure judge knows you have followed all medical recommendations you were given by your doctors and what affect they are having on your condition. If you have not been able to follow doctors recommendations due to side affects that have been problematic to your condition make sure you alert the judge to that as well.
U. Representation
You may chose to fight your case alone (it is NOT mandatory to have a lawyer) or seek legal/advocate representation. You can hire a lawyer - very important to actively keep after a lawyer if you hire one. Since they get paid 25% of your retro pay or current cap of $5300 it is in their best interest for your case to drag on - the longer it takes to process the more they get. You may be able to take advantage of legal-aid or pro-bono services. You can get a paralegal or in some cases free
advocacy from the Centers for Independent Living in your area:
www.abledata.com/Site_2/ind_lvng.htm
Disability Legal and Advocacy Resources:
www.makoa.org/legal.htm
III. Social Security Programs and Web Resources
Applications for this program can be obtained through this website:
www.ssa.gov/applyforbenefits/
For more information on this program and how to apply, call Social Security's toll-free number: 800-772-1213. People who are deaf or hard of hearing may call Social Security's toll-free TTY number: 800-325-0778
Social Security Disability Coalition: FREE knowledge and support with a focus on reform of the Social Security Disability System groups.msn.com/SocialSecu...yCoalition