What Social Security Disability Claim’s Examiners Want to See in Social Security Disability File Before They Will Grant Your Claim
In a recent report commissioned by the Social Security Administration, documents that the Office of Disability Determinations, who reviews the initial and request for reconsideration of every Social Security Disability claim routinely denies claims at this stage. In fact, statistics show that almost 2/3rd of initial applications are denied.
Why does this happen? To answer that question, you first must understand the five step sequential evaluation that is used in every Social Security Disability case. The Social Security rules require that:
- You have not engaged in substantial gainful activity;
- You have a severe impairment;
- You meet a medical listing;
- That you cannot return to your past relevant work;
- That you can’t engage in any work based on your age, education, or transferable skills.
The starting point for evaluating every Social Security Disability claim is your disability application. Why? That disability claims application has material information.
It includes a list of all your medical providers and one of the first things that the disability claims examiner will do is to write a letter to all your medical providers asking for a copy of your medical chart. If you haven’t listed all your medical providers, you are short changing yourself because, ultimately, the disability claims examiners will be reviewing your medical records and determining whether or not you have:
- A severe impairment
- Whether you meet a listing
- And if not, determining whether you can return to your past relevant work or return to other work based on your age, education, work exertional level and your prior skill level.
This analysis requires that the disability claims examiner understand medical conditions, their diagnosis, restrictions and limitations and also to be a bit of a vocational rehabilitation counselor to determine whether you meet the criteria at step four and five.
The reality is that examiners simply aren’t trained to understand this documentation and, worse yet, if your doctors’ don’t fully explain what your restrictions and limitations are, the claims examiner is going to pass your case off to a medical consultant.
DDS also have medical consultants on their staff who review the medical records to try to determine what your physical abilities are, more often than not they will determine that you are capable of doing at least light work based on their review of your medical records and that will result in the denial of your claim.
It’s important that every Social Security Disability applicant obtain and review their medical records so that they have a full understanding of whether their physician supports the claim, whether there is documentation that would help the DDS examiner make the right decision.
If your initial claim has been denied, you need to file a request for reconsideration within 60 days. Having attorney representation at the request for reconsideration stage can make the difference between getting your Social Security Disability benefits or being denied yet a second time. That means if you are denied at the request for reconsideration stage you get to get in line once again- this time a line for a hearing in front of the Administrative Law Judge.
Developing the medical evidence in your claim at the initial and request for reconsideration stage is crucial to support your Social Security Disability claim.
The five step sequential evaluation is hard to understand and, even worse yet, it is hard for a Social Security Disability applicant to develop the necessary medical and vocational evidence to win their claim.