Filing an Initial Application

Why a State Agency Doctor’s Opinion Can Make or Break Your Social Security Disability Claim

When you apply for Social Security Disability benefits, your application is initially processed at the Social Security Administration (SSA) field office which verifies non-medical eligibility requirements. Once that is done, the field office then sends your case to your state’s Disability Determination Services office (DDS).

DDS is responsible for developing medical evidence, and making the initial determination regarding whether you are disabled under Social Security regulations.

DDS will normally obtain your medical records and, if the evidence is unavailable or insufficient for a decision, will consult with state agency doctors. These doctors, who are not specialists, will render an opinion about the medical or psychological issues in your claim. For example, they will address issues such as:

1. The existence and severity of your impairment.
2. The existence and severity of your symptoms.
3. Whether your impairment meets, or is the medical equivalent of, an impairment in the SSA’s Listing of Impairments.
4. Your residual functional capacity and capabilities, notwithstanding your disability.
5. Whether your impairment(s) meets the twelve-month duration requirement.
6. Whether you have failed to follow prescribed treatment, and, if so, the impact that has had on your disability. And,
7. In the case of drug or alcohol addiction, whether that addiction is material.

This is important, because for claims filed on or after March 27, 2017, there is no longer a treating physician rule. While the SSA is not supposed to give deference to a state agency doctor’s opinion, as a practical matter, DDS does seem to defer to state agency doctor’s opinion at the initial and reconsideration stages of the application process.

While the issue is supposed to be whether the medical opinions and medical findings are supportable and consistent, state agency paper review doctors don’t have the opportunity to examine you. Often, they rely on diagnostic studies found in your records, such as an MRI or CT scans, rather than the examination findings of your doctor.

Under the regulations, the DDS claims examiner is supposed to provide a written analysis of the persuasiveness of the medical opinions they relied on in denying the claim. They are also supposed to consider supportability and consistency in addressing the treating physician and state agency consultative opinions. They rarely do that, or do it correctly.

They are not required to explain how they considered other factors, including:

• the relationship with the claimant,
• specialization,
• familiarity with all the evidence in the claim, or
• whether new evidence received after the date of the medical source opinion, or prior administrative medical finding, makes the treating physician’s medical opinion more persuasive.

What Do Social Security Attorneys Do?

Two of the first things we want to review when we get electronic access to your SSA file, and your medical records, is any state agency physician opinion, as well as the DDS analysis. That helps you understand why your claim got denied, and helps us determine what evidence we need to overcome the state agency physician’s opinion.

These are just some of the reasons that a DDS state medical consultant opinion can make or break your Social Security Disability claim.

What Does It Cost to File a Social Security Disability Application?

Nothing! Unlike filing a lawsuit in state or federal court, there is no filing fee to file an application for Social Security Disability benefits. If your initial application is denied, you’ll have to file an appeal, called a request reconsideration, within sixty days of the date of the denial. There isn’t a filing fee to file a request for reconsideration either. If your claim is denied a second time, you’ll have sixty days in which to file a request for hearing, which will put your case in front of an administrative law judge. There isn’t a filing fee to request a hearing in front of the judge either.

Are There Any Upfront Costs or Attorney Fees to Filing a Social Security Disability Application?

It costs nothing to file a Social Security Disability claim, and there should be no upfront attorney fee or retainer. A Social Security Disability attorney only gets paid if they win your case. The attorney’s fee amount is calculated by the Social Security Administration, and is paid from your back due Social Security Disability benefits.

How Much Will My Social Security Disability Attorney Be Paid?

The payment of and the amount of an attorney fee is regulated by Social Security. At the initial application stage, request for reconsideration stage, and hearing stage, the amount of your fee is 25% of your back pay, with a maximum of $7200. Your back pay is the amount of benefits that are due to you from the date you were found to be disabled, through the date of the decision finding you disabled, less five months. The amount of your Social Security Disability benefits can be found at www.ssa.gov. Multiply the number of months of benefits by the amount of your benefits, and multiply that number by 25%.

For example, if you are awarded $10,000 in back benefits, an attorney’s fee would be 25%, or $2500. Your attorney can file a fee petition if they feel that they have spent more time on your case that would justify a fee more than the $2500.

If your case is lost before the administrative law judge and you must take an appeal to the appeals council, there is no longer a cap of $7200.

Your attorney may also charge you the cost for securing things like medical records, which is in addition to an attorney’s fee.

You Have Nothing to Lose by Hiring Cavey Law

It’s simple. If we don’t win your case, we don’t get paid. Your only responsibility whether you win or lose is to reimburse us for the cost of any medical records charged by your physicians or medical providers. We only win if you win.

Why Giving Your Social Security Attorney Your Medical Records Can Help Your Social Security Disability Claim

One of the keys to winning a Social Security Disability case is to have complete and accurate medical records that are provided to the Social Security Administration (SSA). While the SSA is generally not interested in medical records from two years prior to the date you claim you’re disabled, sometimes those medical records can be helpful.

If, for example, you’ve been diagnosed with a rheumatological condition or Epstein Barr virus, and you have lab work the documents positive studies, you should supply those records to your Social Security Disability attorney, or the SSA. The SSA always wants to see documentation that substantiates those types of diagnoses, so it is important that you tell your attorney and the SSA about those records.

Additionally, we always ask our clients for their medical records, because we don’t always get the complete chart from the treating provider. We ask our clients to provide us with copies of medical records they have in their possession so that we can compare what we’re given by the treating provider, and what our client has.

You would be surprised at what we find is and isn’t in medical records.

If you have a Workers’ Compensation, or Short- or Long-Term Disability claim, you probably have completed forms by the medical provider that address your restrictions and limitations. We don’t always get those when the medical provider sends us your chart. That’s why it’s important for you to give us any and all documentation you have.

It takes teamwork to make sure that your medical records are both accurate and complete.

The Duplicate Copy Rule and Your Social Security Disability Hearing File

Your social security claim file is kept by Social Security in the form of an electronic file. It is sorted into different sections. You can imagine that not only does junk make its way into your file, but also bad copies of medical records and other material.

The SSA’s best practices tell Social Security attorneys not to submit duplicate copies under any circumstances.

We, at Cavey Law, review the electronic file and remove duplicates. This is challenging because the Social Security Administration doesn’t do a great job in setting up the electronic file, or providing us with an accurate hearing exhibit file and table of contents. Many times, there are overlapping records, and when we remove records, we try to note that in the hearing exhibit file. No one wants to get yelled at by the judge for having duplicate copies of file material but, at least, if you are yelled at, you know that the judge has reviewed the file in its entirety.