While there are many different aspects involved in investigating a long-term disability claimant or individual disability insured, including IME’s, surveillances, database searches, etc., one of the most valuable tools at our disposal while working for a disability insurance company was the personal contact interview. Conducting a disability interview is both art and science, and takes a lot of training and experience to perfect. In the end it can make the difference between a claim for disability benefits being approved or denied. To our surprise, after jumping ship to the other side and representing SSDI applicants at Social Security disability hearings, we learned that the exact same questions asked during our previous disability interviews were, and continue to be, used by Administrative Law Judges. Thus, winning at the disability hearing level requires more than simply submitting medical documentation and arguing the law, but also in-depth knowledge of the correlation between activities of daily living and stated restrictions and limitations (residual functional capacity). If your disability attorney is not fully prepping you for a hearing by questioning you in great detail (for hours) about the same, taking into consideration your physical and mental impairments, you need to find a competent disability advocate fast. There are plenty of general practitioners out there who believe, as lawyers, they can take on virtually any case, but that is not reality. Think about it. If you have a sinus problem you go to an ENT, not a podiatrist who treats feet. The legal profession is no different folks. Find a disability specialist.

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Truth be told, through experience in representing clients before the Social Security Administration in disability appeals, we have learned how to successfully leverage certain aspects of the disability benefits hearing to a client’s advantage. However, that being said, prior preparation is paramount to winning Social Security disability benefits by way of an Administrative Law Judge (ALJ) decision. A few vital things to consider are noted hereinafter. Request to attend the hearing. Don’t go overboard though and consider this an acting job. Exaggerating your stated restrictions and limitations is fatal to a disability claim. Your testimony must be credible and reliable. However, consistently conveying relevant information alone is not enough. Your appearance also must serve to humanize your case and have the ALJ associate an actual face with your file, preferably a sympathetic one. Thus, it is imperative that you retain a disability lawyer well in advance of the hearing who knows how to prep a witness properly. And not just any disability attorney, but one who handles the majority of his or her cases in this area of specialization, and regularly appears before Social Security judges in your jurisdiction. Remember, a good attorney knows the law, but an excellent one knows the judge, meaning he or she understands the type of proof expected to win before the ALJ assigned to your case. Updated medicals from supporting physicians, to include questionnaires tailored for specific impairments and narratives are a must. Although a treating physician who has a longitudinal relationship with a patient carries the most evidentiary weight, if necessary, seek out a physician for an independent medical examination (IME) as well. When a claim is borderline a solid IME may help win you Social Security disability benefits. Favorable medical proof should be forwarded to the assigned ALJ and/or hearing office in advance of your disability hearing date, with a well-written summary by your disability advocate. Waiting until the date of your hearing and attempting to submit updated medicals to an already stressed out ALJ is not best practice.

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If you have filed an initial application for disability benefits with the Social Security Administration along with medical records and other supporting documentation, and received an unfavorable written decision, the next step is the reconsideration level. Keep in mind the Social Security Administration will deem you to have received the notice denying you disability benefits, within five days after the date on it, unless you can prove that you didn’t receive it within that period. There are similar time constraints during every step of a disability appeal, so it is important that you are aware of them and act accordingly. Don’t take chances. Check out SSA.gov, visit your local Social Security office, or contact a disability lawyer. For reconsideration you must complete a Appeal Disability Report and Request for Reconsideration and send them in to your local Social Security office. They will then forward them to the State Disability Determination Services office that originally reviewed your disability benefits case. Although it won’t be the same team that reviews your records the second time around, be realistic folks, because they usually just back up the original disability examiners’ decision. If you receive an unfavorable decision at the reconsideration level, the next step is to go to a hearing. Complete the Appeal Disability Report and Request for Hearing by Administrative Law Judge (ALJ) and send them into your local office. Meeting face-to-face with a judge takes a long time - in many cases years, before you actually appear at a hearing with your disability attorney. Although the ALJ is required to be neutral and detached, fair and impartial, and the hearing is supposed to be non-adversarial, many of these judges fathom themselves advocates for their agency rather than finders of fact, and are predisposed to denying you benefits (more on this in future posts). If you lose at the hearing level, the next step is the Appeals Council Review. Complete the Request for Review of Decision/Order of Administrative Law Judge and send it in to your local office. It will be forwarded to the Office Of Hearings and Appeals in Falls Church, VA. This review is on the papers. A well-reasoned brief citing statutory and case authority is essential (more later). The Appeals Council rarely grants disability benefits on it’s own. However, they will determine whether your hearing was fair, and if not, send your case back for a second hearing. Once again, this can take years, but at the very least, gives you another bite at the apple. If the Appeals Council either refuses to review your case or denies your disability appeal, the next and last step is to take your case to federal district court. There, a federal judge has the power to award you disability benefits, deny you benefits, or send the case back for another hearing.

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The Social Security Disability Income (SSDI) program is the largest involuntary insurance policy in the world. As soon as you are old enough to start working, FICA taxes are taken out of your paycheck, to provide benefits to you upon reaching retirement age, or if you become disabled. That’s in theory anyway. The truth of the matter is, if you become disabled and are unable to keep working, the very program you had no choice but to pay into for all those years will do just about everything in their power to deny you benefits. Had you been given the option of investing those FICA taxes yourself in an individual disability policy you might have been better off. That’s not to say that insurance companies issuing individual and group long-term disability benefit plans won’t give you a run for your money either. However, the big difference is, that with private disability insurance, depending on the policy, you may very well be covered for benefits if you are unable to work and perform your own occupation at the time you became disabled. With SSDI, in many instances, after considering your age, education, experience, residual functional capacity, and other factors, you can’t collect Social Security disability benefits if you could move across the country and work as a surveillance system monitor (a favorite of Social Security Administrative Law Judges and the medical and vocational “experts” that they consult), looking at a security screen all day. It really doesn’t matter that you used to be a mid-level manager in a Fortune 500 company either. The end result is, like most applicants, you will likely be denied disability benefits and have to fight for what your deserve every step of the way. That means understanding, navigating, and winning the Social Security Administration Disability Appeal Process. Here at DisabilityAppeal.com we think the way the system operates is despicable. So we are going to share a few things with you that we have learned over the years. It won’t be legal advice, but should give you a better understanding of how the disability appeals process works and help you win Social Security disability benefits.

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A new site dedicated to helping you understand the Social Security Administration Disability Appeal Process.

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