Although the Social Security Administration (SSA) doesn’t require you to hire an attorney, statistics show that you are much more likely to be approved if you are represented. However, if you decide to represent yourself there are some important things to keep in mind throughout the process.
Don’t Miss Filing Deadlines
Make sure that you meet all deadlines for filing your request for reconsideration or request for a hearing. Usually the SSA will give you 60 days to file from the time you receive a denial notice. If you miss the deadline, you will have to show “good cause” for why it was missed. If the SSA decides there wasn’t “good cause,” you will likely have to start the process all over again.
Provide the SSA With Complete Medical Records
One of the primary reasons claimants are denied is because they fail to provide all the medical records necessary to prove their claim. Although the SSA is supposed to get these records for you, you cannot rely on the SSA to ensure its own file is complete. This means that you will have to review the SSA's file in your case to make sure they have all the relevant evidence.
The medical providers who treated you should give the medical records to you upon your request, but you may have to sign a release. Also, there are often copying charges related to getting your records. Some state have laws regarding how much you can be charged to get copies of your records, or forbid a doctor from charging for records for disability purposes.
Make sure you only submit relevant medical records. For example, if your claim is based on back problems, don’t submit records from your oral surgeon or your ophthalmologist. Here are examples of the types of records you may need to provide depending on the reason for your disability claim:
- discharge summaries from hospitalizations
- emergency room records
- lab reports
- xray, CT scan, and MRI reports
- biopsy results
- surgical reports
- records from visits to your doctor
- medication list with dosages, prescribing doctor, and side effects (these lists can be requested from your pharmacy)
- treatment notes from your therapist or psychiatrist
- physical or occupational therapy records, and
- school records and I.Q. tests.
It's important to make sure that the SSA has all of the contact information for the medical providers who treated you for your disability. The more information the SSA has, the more likely it is to make a correct decision in your case.
One of the most important pieces to winning your claim is your doctor’s supportive opinion; without it, you are unlikely to be approved. Therefore, it is important to speak with your doctors to make sure that they are willing to help.
You will also need to provide your doctor(s) with residual functional capacity (RFC) forms to complete. There are RFC forms for physical and mental assessments (or both), depending on the basis of your claim.
Physical RFC. A physical RFC form assesses how your medical condition affects your ability to do certain work-related activities like sitting, standing, lifting, and walking. If your RFC shows you can’t do a sedentary (sit-down) job (or more), you will be approved for benefits. You can get a physical RFC form here.
Mental RFC. If your disability claim is based on a mental condition such as depression or anxiety, you will need to have your treating psychiatrist or psychologist complete a mental RFC form. The mental RFC will assess your ability to do the mental or emotional aspects of a job like remembering simple instructions, getting along with others, and being reliable. You can get a mental RFC form here.
Understand the Listings
The SSA has a collection of medical conditions that it has concluded are so severe that they warrant an automatic approval of benefits. These conditions are called “listings.” However, it is not enough to simply be diagnosed with a listing, you must also meet all of the specific criteria the SSA has established for that listing. DisabilitySecrets.com, a part of Nolo's legal network, has an article for every major and minor disease or injury, with the listing requirements fully explained.
Many of the listings have complicated criteria. You may want to take a copy of the listing requirements to your doctor to see if your condition meets them. If it does, you will need to provide the SSA with the medical evidence that shows how you meet each requirement. For example, if your claim is based on chronic obstructive pulmonary disease, you will need to provide the results from your breathing test. You will also have to make sure that any testing you have done meets the specific requirements of your listing.
Understand Other Ways to Get Approved
There are other ways to win your claim even if you can’t get approved under a listing. Here are some examples:
The grids. The grids are a series of tables that direct Social Security to find an applicant disabled or not-disabled depending on the applicant's age, education, the skill level of their past work, and the person’s physical residual functional capacity. The grids are only used if Social Security finds that an applicant can't do their past work, but they are often helpful for getting older claimants approved for benefits.
Combination of impairments. Many people have more than one disability that prevents them from working. If this is true for you, the SSA must consider the combined effects of all of your medical conditions on your ability to work. To do this, the SSA will use the medical evidence in your file to prepare your RFC (either mental, physical, or both) and will then use your RFC to decide if you can still work.
Combination of exertional and non-exertional limitations. An exertional limitation is one that affects your ability to do the physical requirements of a job like sitting, standing, walking, lifting, and carrying. Non-exertional limitations are those that affect your ability to do the mental and emotional requirements of a job such as following directions and getting along with your boss and co-workers. If your medical condition(s) result in both exertional and non-exertional impairments, the SSA must consider their combined effect on your ability to work. Usually, the more limitations a claimant has the more likely he or she is to get approved.
Here is more information on these and other advanced theories of disability that lawyers use. Keep in mind that regardless of the theory you use, you must provide the SSA with as much relevant medical evidence as possible.
Prepare for the Disability Hearing
Most disability claims are approved at the hearing level. A hearing is conducted in front of administrative law judge (ALJ) who will listen to your argument and review the medical evidence you have submitted.
An ALJ will also have the opportunity to question you about your condition and to ask clarifying questions about your records. The ALJ will also usually have a vocational expert (VE) at the hearing. A VE is a person who is trained to give an opinion about the types of jobs you can and cannot do based on your physical and mental limitations. The ALJ will generally follow the VE’s opinion about whether or not you can work.
When you go to the hearing, you must be ready to explain any inconsistencies that may exist in your medical records. You must also be able to cross-examine the VE if he or she testifies that you can still work.
Here are some tips for what to say and not say at your disability hearing.
The Appeals Council and Federal Appeals
If the ALJ denies your claim by mistake, you can ask the Appeals Council (AC) to review the ALJ’s decision, but the AC doesn’t have to review the decision if it doesn’t think its necessary. If your claim is denied by the AC, or if the AC refuses to review the ALJ’s decision, you can appeal to the federal district court. The SSA will not assist you with a federal appeal and you must make sure that you follow the court rules carefully otherwise your complaint will be dismissed. It makes sense to hire a disability lawyer to appeal to the AC or federal court (and in most cases, the ALJ hearing as well).