Social Security Disability Insurance claims are deceptively straightforward. Many applicants believe SSDI benefits are like any other government benefits. If you meet the minimum qualifications, the checks start coming. But SSDI is different. The initial approval rate is under 50 percent in Tennessee. A question about any of the three major prongs of an SSDI claim could trigger a denial.
The 3 major prongs are as follows:
- Are You Working?
- Is Your Condition Severe?
- Is Your Condition Found In The List Of Disabling Conditions?
Heermans Social Security Disability Law Firm specializes in building a client’s disability claim by addressing all 3 prongs directly and upfront, so that your case is strong on all points, when it’s examined by the SSA for approval.
According to the Social Security Administration, applicants are eligible for benefits if they have a chronic condition which prevents them from working for at least twelve months. Some applicants have listed chronic conditions. But often, a Heermans Social Security disability attorney must use a substantially similar condition. That’s more subjective. Additionally, not all chronic conditions are disabling for all people. Medical, educational, economic, and other factors affect the outcome. Finally, one doctor might say a disability is permanent, and another one might say the applicant’s condition will improve.
If a Disability Determination Services officer initially denies your application, don’t give up. A disability lawyer from the Heermans Social Security Disability Law Firm has several appeal options and we help new clients that come to us after their claim has been denied. After we review your case, we lay out the alternatives for the next step, carefully explaining the pros and cons of each one. Once we start working for you, we don’t stop until we obtain the best possible results.
Quite frankly, the initial appeal level usually doesn’t change the result. Usually, reconsideration is a second paper review from a senior DDS officer. Most bosses don’t like to second guess their employees. However, reconsideration could change a result if the initial DDS officer was clearly wrong or clearly biased.
Factual errors may be more common today than they were before the pandemic. The law requires DDS officers to consider the applicant’s complete medical history. Due to coronavirus shutdowns and associated issues, not all medical records from different facilities are available at the same time. That’s especially true if the records were older or from a smaller facility and therefore they aren’t digital or easily accessed. Many private clinics have gone out of business since the pandemic and in these cases, it can be very difficult to track down medical records that have been stored away in an unknown location .
Legal errors may happen because SSDI claims have lots of moving parts. As mentioned, medical records often come from different sources. It’s sometimes challenging for inexperienced DDS officers to put the pieces together. That’s especially true if, as is often the case, different doctors have different opinions.
As for bias, a Heermans Social Security disability lawyer often relies on published statistics. If the DDS officer has an abnormally high refusal rate, there is reason for the attorney to take note of this and be especially prepared. On a related note, some officers may not know how to handle disabilities that are unfamiliar to them.
In all these cases, a second look from a more experienced officer might change the result. If nothing else, reconsideration orders sometimes contain instructions. The original DDS officer reviews the case again, but must keep certain factors in mind. These instructions point the review in a different direction.
Administrative Law Judge Hearing
The likelihood of a different result increases exponentially at the next level. Basically, an Administrative Law Judge mostly has the same powers as an elected or appointed district or other judge. The big difference is that ALJs have little or no power over nonparties. In many cases, they cannot even sign off on subpoenas.
Procedurally, ALJ hearings are like short, private trials, without nearly as many restrictive rules. These hearings are closed door hearings, and no one else knows where and when the hearing occurs. Once the proceedings start, there’s usually no official court reporter. This relaxed situation can significantly benefit applicants. Attorneys can concentrate solely on their client and matter at hand with significant legal resources at their fingertips.
During an ALJ hearing, your attorney can make legal arguments, introduce evidence, and challenge medical or vocational opinions. As mentioned, attorneys are usually on their own when it comes to presenting evidence. Attention to detail is important. It’s also important to cultivate a relationship with Judges and Court staff. Experience with the local office is valuable.
Disability attorneys understand that winning a claim and securing long-term benefits is the entire goal of the claim process. In other words, it could be better to take a sure approval than fight about onset dates and other procedural details.
Usually, ALJ approvals are the final decision. ALJs substitute their findings for the DDS officer findings. Additionally, from this point forward, the appeal process gets much more hospitable for applicants. So, one way or another, the ALJ hearing usually ends an SSDI appeal.
Social Security Appeals Council Review
As far as applicants are concerned, reconsideration and ALJ appeals are available for the asking. As long as a lawyer files a review request on time, that request cannot be denied. At the SSAC stage, the rules are different. The Council only agrees to review cases if a majority of the council members believe the ALJ’s decision was wrong. Usually, attorneys prepare extensive briefs which lay out the ALJ’s error(s).
If the SSAC agrees to hear the case, it could ask for a live review or conduct a paper review. Based on this review, the SSAC either affirms the ALJ’s decision, reverses it, or remands the matter with instructions for reconsideration. That third outcome is the most common one, if the council agrees to hear the case. Note that most appeals council reviews are lengthy and result in a denial of remand and an essential affirmation of the ALJ’s decision.
Federal Court Appeal
The SSAC review is somewhat informal. If the council hears the case, it really just wants to make the right decision. Federal court appeal, the next level, is a lot different. Federal courts have a lot of specific procedural requirements. These requirements include minutiae like font requirements for briefs and strict time limits for oral arguments. A slight misstep could lead to an adverse result.
Federal courts hardly ever reverse disability decisions, unless the lower reviewers repeated the same legal error. That’s pretty unlikely! Much more often, if a federal court agrees to review a case and it determines the decision was wrong, it remands the claim to the ALJ level with instructions.
For more information about the disability claims process, contact the Memphis disability lawyers at the Heermans Social Security Disability Law Firm. Heermans offers a FREE Disability Claim Evaluation and disability claim representation in the greater Memphis Metro Area and throughout the mid-south states of Mississippi, Arkansas, and Louisiana. More value added FREE information can be found in our online articles. Call or text 24/7 at (901) 244-0057.
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