Our Approach to SSA Disability Claims

Our Approach to SSA Disability Claims

Our approach involves working with you to get your “initial application” for benefits approved.

Qualifying for disability benefits

Qualifying for disability can be more complex that suffering from a disability and meeting the basic requirements listed above. In fact, there is not a specific rule or book one can look at and determine that they should qualify although there is a “Blue Book” that set out the “Listing of Impairments” and is discussed below. On the other hand, if you suffer from a condition that makes it very hard or difficult to work for extended time, YOU SHOULD CONSIDER APPLYING FOR DISABILITY BENEFITS.

It is important to understand that qualifying for disability if not just about having a medical diagnosis; it is about being able to prove that your condition or impairment prevents you from completely being able to work— — —at any job. A disability attorney can work with you to develop your case under these strict standards.

As stated above, SSA publishes its “Blue Book” that contains the full listing of impairments that are most likely to qualify you for disability benefits. The Blue Book is not an exhaustive list. In fact, if you have a disability that is not in the Blue Book, contact Dan Wimmer because in recent years, the SSA has approved disability benefits if your lawyer can show that your condition is “functionally equivalent” to a listed impairment.

Even so, the process to obtain SSDI and SSI benefits has become so difficult and complicated that over the past few years, a large body of law has evolved. These rules, laws and statutes govern who is disable based on certain conditions and interpretations. Although it is recommended that you obtain representation with a Social Security disability attorney, an attorney is not required to file your application or to win an appeal. A person can mail their application to SSA, use SSA’s online process or visit the local SSA office.

Even if you choose to pursue your claim without legal representation, we strongly suggest you personally visit your local Social Security Office rather than relying on the mail or filing online. You will be better served by having a person you will consider a good contact to discuss the process. Still, However, because the SSA is one of the largest U.S. government agencies, it is possible that some documents could get lost.

Keep copies of everything you provide to SSA. Remember, how time consuming and aggravating it was to gather all your records and documents the first time; it is worse if forced to do it a second time. Also, most Disability attorneys use sophisticated case management systems designed to track all case activities, including submitted documents, case notes, and calendar dates when certain things must be done.

Initial application

If your “initial application” is complete and accompanied with relevant medical records and non-medical evidence to support the SSA standards, the application is probably ready to be filed.
Statistics show that a properly prepared initial application has the best chance of being approved.

Our approach is to focus on working with our clients to achieve these results the first time— — —at the initial application stage.

Our approach involves carefully reviewing a claimant’s application before filing the claim. We examine and analyze all medical and non-medical evidence and apply SSA’s five-step evaluation process.

If you did file an initial application that was denied because it was incomplete or lacked sufficient information or was denied for any other reason, contact the Law Offices of Dan Wimmer.

The SSDI/SSI initial application process:

Once the “initial application” is submitted and SSA determines you qualify for benefits, your claim file is sent to a DDS (Disability Determination Service) office. A typical DDS office is staffed with disability examiners, medical consultants, vocational experts, and other employees experienced with disability claims.

The DDS will request your medical records from the health professionals you have provided. The DDS office is responsible for analyzing your medical records and making the initial decision on whether you are disable under SSA standards.

If the DDS office does not have sufficient information to render a decision about your disability, it can require you to obtain a consultative examination. Also, the DDS pays for those examinations. If you were represented by a disability attorney from the beginning of your disability, he/she would have prepared you about the “consultative examination.”

Being prepared means there are certain things that should not be said and there are certain things that should always be said during an examination. However, always be truthful when asked a question. Never lie or fabricate statements — —your statement is a declaration made to a federal agency under penalty of perjury if the statement is untrue.

If you do not agree with a decision made by SSA or DDS regarding your initial application, you have four opportunities to appeal those decisions.

Reconsideration

If your initial application is denied, your first official appeal is a request for “reconsideration.” A “reconsideration” appeal is exactly what it means; you are asking the SSA/DDS to “reconsider your initial application,” but with new and different examiners, meaning examiners that did not participate with the initial decision.

The Law office of Dan Wimmer handles these types of appeals. As your legal representative we will file all necessary documents. While “reconsideration” is an official appeal, it is also an opportunity to include new evidence and to evaluate all previously submitted documents. For example, your attorney could analyze whether the medical records provided to SSA/DDS were complete. Compete medical records are records that provide a detailed description of your medical condition and fully explains how your disability affects your ability to work and carry on with your normal daily activities.

Before filing any appeal, our firm will analyze every word in your medical records to determine if your symptoms were fully discussed and properly recorded in your medical records. Moreover, if we represented you from the beginning, we would have given you suggestions about how to explain your symptoms to your doctor at each visit, ensuring those statements become part of your medical records.

The most important records your attorney will need to win your disability case is your medical records.

Medical records also include all current and past medical visits and any new treatments occurring after filing your initial application. If your case is denied at the reconsideration appeal level, you should file an appeal for a hearing before an Administrative Law Judge (ALJ). At the Law Office of Dan Wimmer, we can represent you at ALJ appeals hearings.

Like the “reconsideration” appeal, at the ALJ hearing you can present new evidence. This is an excellent opportunity to strengthen your case. Because about 50% of the cases appearing before an ALJ receive approval, you should almost always consider this level of appeal. Also, the Law Office of Dan Wimmer offers free case analysis and evaluations if your case was denied.

Request For An Administration Law Judge (ALJ) Hearing

ALJs are independent federal judges that preside over SSA legal hearings. During the hearings, ALJs can ask questions of you and all testifying witness including SSA vocational and medical experts. Your attorney may also question those experts including their findings, conclusions, and statements. However, an ALJ hearing is not an adversarial trial setting like you might see on TV. In fact, the ALJs are not against you, but it is their job to analyze the evidence and make a decision whether you qualify for SSDI benefits.

Most of the time, appearing before an ALJ is the first opportunity for the disable person to appear before a government official and explain how their medical condition keeps them from working. Also, ALJ hearings could last one-hour and on some occasions a little longer. Many ALJ hearings are now handled telephonically or with Video Teleconference like Zoom. Claimants also have a legal right to appear before the ALJ in person.

If your case is denied at the Administrative Law Judge level, it can be appealed to the Social Security Appeals Council

Social Security Appeals Council

In rare cases, the Social Security Appeals Council will grant a review of a case file that has been heard by an ALJ. The chance of getting before this judicial body is very low, but on occasions ALJs have applied an incorrect rule, law, or standard of review. This is rare because ALJs are generally very experienced and knowledgeable. Even so, ALJs can make mistakes. If the Appeals Council denies your claim, the next appellate level is a Federal District Court.

Federal Court Review

If the Appeals Council declines to review your case, you can file a civil law suit in the appropriate federal district court. However, this form of appeal has a very low chance of success. This is why we strongly encourage injured persons to hire a disability attorney at the beginning of their cases. Disability attorneys can guide a claimant about the federal court process. Our approach is to work with disabled claimants early in the process and by encourage them to file their claims immediately upon the onset of a qualifying disability.

Do you need a SSA Disability attorney? No.

There are two situations when a SSA Disability Attorney should be considered:

Before a claim is filed, and;
After a claim has been denied.

Here is how an SSA disability attorney can assist you

In addition to the initial application SSA Form 16, it is quite common the SSA/DDS will require additional forms. One of the most important is the Function Report—Adult Form SSA-3373. This form is sent by SSA to the person who is disabled. Also, it can be requested at either the “initial application” stage or at “reconsideration.”

Download the Function Report—Adult Form SSA-3373 and look at Question 20 a, under Section D. You will see various boxes to check. If in checking any of these boxes your explanations are not consistent with other prior oral, written statements or answers, you may fall into a trap. Consistency helps initial applications.

Follow along with these examples and hints

The SSA receives over 1, 500,000 disability claim applications every year. This large number of applications suggest that the many SSA rules, federal statutes, and case law decisions must be interpreted and applied to each claim. Because every initial application involves numerous forms and questions, our legal training enables us to work with clients about how to fully understand what a question is asking and how frame and present truthful and accurate answers. Above all, NEVER mislead or misstate your medical injury status.

Back to SSA-Form 3373 and Question 20, (a)

Example: If you checked the Lifting box, indicating that lifting affects your daily life activities, in essence you are saying that your injury prevents you from the “lifting” of items over certain pounds, say, 10-15 pounds and your job requires lifting 25–50-pound boxes. This is often very true. In fact, it was probably the constant lifting of heavy boxes for many years that contributed or caused your painful, disjointed, and degenerative back condition you are experiencing.

However, if in any other SSA document you said that you are not working because of “back pain,” and are staying home to provide care for two small children between the ages of 2-5, we may have a problem. Under this fact pattern, and absent a properly worded explanation, the SSA would likely construe that caring for two young children requires you to occasionally lift the children and/or do household work or lift heavy loads of laundry. Because your activities are not properly explained, a disability claim examiner could conclude that your stated limitations are not accurate. Meaning, your disability is NOT TRUE. WORDS MATTER.

On the other hand, a disability attorney would ask you if someone else was in the house doing the heavy lifting of laundry, or able to give assistance with the children, or a relative or an older child that stayed with you most days. You might easily skip over this small detail because you know what is happening in your home. However, a disability attorney would know how important it is to frame your answer so that it honestly reflects your actual day-to-day disability pains and limitations. WORDS MATTER.

Another example:If you stated in your ‘initial application’ that you cannot work because your condition seriously restricts arm motion or movement. This means that you cannot lift your arms above your shoulders, because there is excruciating pain. However, when interviewed you indicate that while at home you spend time working in your garden or cleaning your home, doing heavy laundry, or playing with a child. Statements or answers like this are red flags and suggest to the SSA/DDS and ALJs that you are not really disabled if you can do these types of activities. What words you use and where you place them in sentences matters. Be careful because words mean different things to different people. WORDS MATTER.

***** You have a right to be represented by an attorney during every interview, hearing, or interaction with any SSA personnel. *****

Because WORDS MATTER so much with the approval of a social security disability cases and the risk of being denied is high without representation, we strongly encourage you to call for a free consultation with the Law Office of Dan Wimmer. Remember, we also give free case evaluations. Contact use today.