Individuals applying for Social Security benefits may presume the only requirement is to file an application with the Social Security Administration (SSA), and SSA will take care of the rest. The reality is, filing for Social Security disability benefits is a complex process. Consequently, most of the initial claims are denied. Most often it is because the claimants are unprepared or they are unaware of the filing process. Knowing how SSA works will spare you many unwelcome surprises along the way. For example, you must know and understand the definition of disability as defined by SSA which is “the inability to engage in any substantial gainful activity because of medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than twelve months.”
Before you begin the initial application form 3368, [assuming your filing for an adult] let us review some important issues. First, the claimant must not be working when they file their application. Second, gainful activity does not mean only your current employment it also includes all work history, work you have done in the past fifteen years as you will see on form 3369 “Work History Report”. For instance, you have a documented back injury and your current employment is plumbing which can be rigorous work. However, several years before you worked as a bus driver which is not considered rigorous work. SSA will compare the disability [your injured back] with your ability to work as plumber to transferring your skills to a bus driver. The SSA examiner will review the levels of exertion such as sedentary, light, medium, heavy and very heavy work you are able to do. What you must prove to SSA is you cannot do either with an injured back. A word of caution about listing your work history on form 3369, always start with your last job and the dates you worked. Listing them incorrectly could have a negative effect of proving one skill cannot be transferred to another.
The second part of the disability definition is medical, physical and mental impairment. You will be required to complete form 3370 “Adult Pain Questionnaire and form 3373 “Function Report.” Continuing with the scenario above, telling SSA on a form that you have an injured back is not enough it must be a documented diagnosis by your physician. Even with documentation your injury it must have lasted or expected to last continuously of not less than 12 months. Before your physician completes form 4734 “Physical Residual Functional Capacity Assessment” or (RFC) ask for your medical records in advance review these records, often your physician may not have recorded what you need to prove your injury. For example, if your physician states in your medical file “the patient complains of lower back pain” this not a physician diagnosis; they are the patients claims or statements to the physician, which will not prove your back injury to SSA. You should discuss your diagnosis with your physician and perhaps he can help you with the documentation you need to prove your disability. A word of advice about seeing a physician; if at all possible, see your own treating physician; being referred to a physician by SSA is most likely a denial to your application.
Once you have filed all the initial forms, SSA requires a 5 month waiting period before initial claims are processed. The theory to this is to allow the claimant heal from their injury and return to work. In addition, if your claim is approved you will be paid “back-due benefits” commencing after the five month waiting period to the time of the favorable decision. After the 5 month waiting period, you should receive an answer within 3 to 5 months. More often than not, a SSA examiner will need additional information thus denying your initial application. If you have been denied you will receive a letter of denial after which you have sixty days to file form 561 “Request for Reconsideration”. Once your request for reconsideration has been approved you will receive form 3441 “Disability Report Appeal”. The worst thing you can do is to file using the same evidence you used on your initial application. You need to supply new evidence to do this use form 4631 “Claimant’s Recent Medical Treatment” and form 4632 “Claimant’s Medications” supported by your updated medical records. Remember your initial application was most likely denied for lack of evidence.
As mentioned in the beginning, filing for social security disability is a very complex and stressful process some of which are not addressed in this article. Filing for social security disability is important to your lively-hood and should not be taken lightly. The best thing a claimant can do to be successful is to hire an attorney or a certified social security disability representative. If you are worried about the cost, fear not because according to SSA it is unlawful to collect unapproved fees from claimants filing for social security disability. Meaning, social security disabilty cases are on contingency bases; that is, the person you hire to represent you cannot charge a fee if they do not win a favorable decision on your behalf. Further, the amount allowable is twenty-five percent (25%) of the back-due benefits or $6,000.00 which ever is less.
To recap, before you file for social security disability be prepared. Review your work history, obtain your medical records and consult with your treating physician. Lastly, remember you do not have to go through this process alone hire an attorney or social security representative. For more information on how to file for social security disability visit www.ssa.gov