COVID-19 has altered our lives in more ways that we can count. The Social Security Administration’s appeal and reconsideration process, which is usually a part of the benefits process, has changed as well. But for the most part, these changes are structural. Beneath the surface, little has changed. Applicants still face an uphill climb.
Not all these coronavirus changes are bad, especially in the SSA realm. The advent of remote hearings should reduce waiting times. In Tennessee, most Social Security claimants wait over six months to have their day in court. Rather disturbingly, this wait time is one of the shortest ones in the country.
Remote hearings or otherwise, the Social Security Disability appeals process is usually long and frustrating. Denials and setbacks are common. It’s important not to get discouraged and settle your case for less that it’s worth.
The SSI lawyers near you at the Heermans Social Security Disability Law Firm are here for you, regardless of the forum. We are just as comfortable making live arguments as we are when we present our cases remotely. As outlined below, these appeal hearings are the same in many ways. However, they can be very different in other ways. In this article we will explore the ways SSI/SSDI reconsiderations and appeals will very likely proceed in the Coronavirus era.
The Sequential Evaluation Process
When Administrative Law Judges evaluate claims, they go through a five-step process. If the answer to each question is correct, the claimant is entitled to benefits. To many claimants, that task sounds daunting. Fortunately for Heermans Social Security Disability Law Firm, SSI/SSDI disability lawyer in Memphis and the midsouth, the burden of proof on each point is relatively low. Therefore, a little evidence goes a long way. An independent medical examination, in addition to a vocational expert’s report, usually provides sufficient evidence.
Substantial Gainful Employment
If the claimant is earning enough money to live above the poverty line, the claimant is not entitled to disability benefits, no matter how sick or injured s/he is.
As of 2020, this amount is $26,200 for a family of four. If the claimant is disabled, the limit is higher, usually $39,300. This amount includes the household’s total income. If a teenager mows lawns or gets paid to babysit after school, this money usually counts too.
So, it does not matter where the money comes from. It also does not matter why the family’s income is below the SGA level. Some claimants must work rather menial jobs, like Walmart greeter, crossing guard, or fast food order taker. Others must limit their hours.
Usually, SGA is an average amount. The SSA usually does not look at a snapshot month. Instead, the ALJ typically averages the family’s income over several months.
Severity of the Condition
We still have not reached the “disability” portion of this process. This inquiry focuses on the claimant’s symptoms. These symptoms must be permanent. In this context, a condition is “permanent” if it is terminal or expected to last at least twelve months. Generally, the SSA reviews this portion of a disability claim every year. This can be compared to having to prove that you are still disabled on a yearly basis.
The disability must be actual as opposed to theoretical. Epilepsy is a good example. Many epileptics can function fairly well if they take certain medications. These medications often have side-effects which are usually not disabling. But not everyone can take these medicines for a variety of reasons. Additionally, for those who do experience side-effects, they can vary widely among different people. Once again, the SSA usually reviews this area every year.
Furthermore, the disability must significantly impair a physical or mental work function. Physical functions mostly include everyday actions, like sitting, standing, lifting, and walking. A few other physical disabilities are listed here. Mental impairments include the inability to hear, understand, remember, and/or execute instructions, the inability to prioritize tasks or make other simple judgement calls, the ability to get along reasonably well with others, and the ability to deal with workplace changes.
This step also seems rather straightforward. The claimant must have a current medical diagnosis of a listed condition, or a substantially similar condition. A significant number of claims involve the subjective substantially similar prong, and these cases are rather subjective.
An RFC assessment is also part of this inquiry. Essentially, Residual Functional Capacity measures what the claimant can do, as opposed to what s/he can’t do. Limitations and restrictions affect RFC in different ways. Briefly, limitations are physical and restrictions are medical. Some people cannot physically do certain things, and that’s that. But the restrictions Doctor A imposes are often different from the ones Doctor B considers necessary.
Past Relevant Work
Given the claimant’s disability and RFC, can the claimant perform PRW? PRW or Past Relevant Work is a job, or a similar job, which the claimant has worked at, and mastered, in the last fifteen years.
The “similar job” inquiry trips up many applicants. For example, if the claimant was a teacher, the SSA often claims that a private tutor is PRW. But anyone who has ever done both jobs knows that there are some major differences between the two.
Adjustment to Other Work
An SSA law firm has the burden of proof on every point except this one. If, based on the applicant’s age, education, work history, and a few other factors, the applicant can find gainful employment in another area, the claimant is not disabled as a matter of law.
Let’s go back to the teacher example. The SSA might claim that a disabled teacher could write or review textbooks. But theoretical possibility is not enough. The SSA must also prove that such jobs are available, they pay above the SGA level, given the applicant’s limitations, and the applicant is qualified for these positions.
The sequential evaluation process holds true in live and remote hearings. But there are some gatekeeping issues. Your case could be rock-solid in each of the five areas above. But if an ALJ Administrative Law Judge does not see it, none of this matters.
If a Claims Examiner denies your application, which some statistics say happens 2 out of 4 times, you have four appeal options, as follows:
- Request for Reconsideration (SSA-561-U2),
- Request for Hearing by Administrative Law Judge (HA-501-U5),
- Request for Review of Hearing Decision/Order (HA-520-U5), or
- Federal Court review.
Most people request ALJ review. Procedurally, that’s the least complex option. It’s also the only alternative which always allows you to present new evidence.
To file an appeal electronically, simply go to the SSA’s website, navigate to the Appeal a Decision page, and click the desired option. You may also mail or fax a form to the SSA. The physical address, fax number, and form requirements are on the Appeal a Decision page.
If you missed an appeal deadline due to the COVID-19 pandemic, and the deadline was before August 30, 2020, the SSA often grants extensions. Throughout Memphis and the surrounding midsouth area, Heermans Social Security Disability Law Firm (SSI disability lawyer in Memphis) can help you prepare this request. The same things apply if you missed a disability determination or other deadline. Let Heermans help you today with a free evaluation.
For more information about the new normal at the SSA, contact the Heermans Social Security Disability Law Firm.
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