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Initial Claim for Disability Benefits

Filing an initial claim for disability benefits is a watershed moment in most workers’ lives.  By the point filing disability has been considered, a Claimant has almost certainly experienced such significant mental or physical health issues at to prevent or remarkably reduce the ability to work.  As such all communications with the Social Security Administration should be geared toward openly and honestly sharing all evidence of the limitations that the medically determinable impairments are causing.

What is Your Goal?

Not everyone who files an initial claim for disability benefits has to prove the same things.  Most individuals who are younger than 50 years old must essentially prove that there is no work of any kind that can be performed either due to physical limitations or due to an erosion of the occupational base due to non-exertional limitations.  For Claimants over the age of 50, the analysis shifts toward establishing that past work cannot be performed, and then further refining the analysis to determine how much exertion that the disabled person may be expected to sustain.  Educated Claimants who engaged in highly skilled work, especially sedentary work, may have a greater challenge in proving disability because of skills that they may have developed which could be transferred to other work.  For more insight into this analysis, we recommend that Claimants familiarize themselves with the Grid Rules.

Know your Chances When Filing an Initial Claim for Disability Benefits

When filing an initial claim for disability benefits, it is important to note that the odds are long initially.  At the initial level of application for disability benefits, Claimants are approved at a rate of approximately 30%.  This low approval rate may be due to a number of factors.  These factors include length of the illness, future prospects for recovery, failure to secure substantiating medical evidence, alleging an onset date that is too remote, or simply supplying answers that do not establish that the ability to work is impaired.  For this reason, the preparation of the initial claim for disability benefits should be undertaken with care and thought.

Identifying a Disability Date

The selection of the proper disability date (or Alleged Onset Date in SSA terms) is crucial.  I have written about the implications that this date holds, and OBF TV features a video on the subject.  Set the date too far back, and work history or lighter medical documentation from earlier times might hurt your chances.  Set the date too late, and you may miss your Date Last Insured or inadvertently forego benefits.  As a general rule, it is wise to claim an alleged onset date that occurs after work has ended, or at a minimum, during a time when work can no longer be identified as Substantial Gainful Activity.

Seeking Medical Care

Medical evidence is the currency of the kingdom when proving disability.  Medical records including x-ray, MRI, and CT interpretations, treatment records, hospital records, therapy records, and even chiropractic records are vital.  For this reason, Claimants need to be seeking medical care as directed by their physicians.  This is not always easy because financial strain is often a component of disability due to income being curtailed.  As such, seeking care at a free or sliding scale clinic may be necessary.  Additionally, it is important to note that for emergency conditions, hospitals must offer stabilization under the EMTALA rules.  All of this medical care is going to provide the foundation upon which the disability claim is built.

Talking With Your Doctor

Seeking treatment is a great start, but additional effort may be of value.  Claimants should discuss their limitations in detail with their treating physicians, and should explore whether or not their doctors would support a claim for benefits.  Supportive records can make a case, especially where the physician adds functional insight to the accompanying records, or prepares a supportive statement.  Supportive letters and well drafted records will make the path to claim disability benefits substantially easier.

Visiting the SSA Doctor

At some point in most claims, the SSA will make an appointment for the Claimant to visit an SSA doctor who will examine them and provide their opinion regarding limitations.  The records generated by these visits are often significantly less favorable than treating physician records, but in the absence of records from a treating physician these records will be used.  If they are unfavorable records, or if they do not clearly establish the presence of a disabling condition, these records will be used to deny a claim, especially if there is not treatment evidence to provide an opposing viewpoint.  Despite the frequently unfavorable evidence that is generated, it is advisable to interact truthfully with the physician, and if a Claimant is in possession of medical records, it may be advisable to share those records with the consulting physician to provide additional background and insight into a condition.

Responding to Disability Examiner Questions

During the initial claim for disability benefits, a Claimant will likely interact with a Disability Examiner.  Disability Examiners will often seek insight regarding the disabling conditions, past work, past earnings, education, and when the disability is claimed to have begun.  The answers provided to these questions are pivotal to them as they analyze claims.  As such, it is wise to have a strong handle on work history, timing of treatment, and a Claimant’s health history before speaking with them.  Additionally, failing to answer their questions in a timely and complete manner may result in a denial of the initial application.

There are a number of significant components to consider when filing for disability.  Consulting with an disability attorney may be a wise decision.  The disability lawyers at O’Brien & Feiler offer a free consultation, and only receive legal fees when claims are successfully made.  For more information visit the OBF Knowledge Base, Blog, or OBF TV.

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