Although Social Security assists claimants to a certain degree, SSA will most likely not be very helpful to you in processing your claim. Social Security strives for efficiency, but often falls short on its mission. SSA has over 50,000 employees and 120,000 contractors to process claims, and most of these people are dedicated and hard-working. Despite this, the average time to get a claim to adjudication is between 12 and 18 months. Appeals Council (AC) requests for review are averaging 17 months after an administrative hearing.
We realize that dilligent file maintenance is the core of developing a successful case. At SSA, documents often get misplaced, incorrectly filed, or outright lost. Information from submitted documents is sometimes incorrectly entered into SSA's computers. This is where an experienced representative can be invaluable to your case. An experienced representative can spot clerical errors and problems in your case, and fix them before they cause any real trouble.
Social Security law is a conglomeration of several different sets of laws and regulations, based on federal statutes, state laws, and Social Security Administration rules and regulations. In addition, the rules change as your case moves from your state agency to the federal (hearing) office. Initial claims and reconsiderations (1st appeal) are processed by the local SSA office and Disability Determination Services (DDS), and administrative hearings (2nd appeal) are done at the Office of Disability Adjudication and Review (ODAR). The rules that SSA's Administrative Law Judges (ALJs) are bound by are the same nationwide. All cases are judged on a 5-step evaluation of the claimant's alleged impairments. The claim can be denied at any of these steps.
There are some basic do's and dont's for developing all Social Security disability claims.
1. COMPLETE ALL PAPERWORK THOUROUGHLY AND ACCURATELY
If you have trouble understanding or filling out the forms, get help. SSA uses every word on every form to evaluate your claim. They use the information on the Disability Reports to request medical and other records. Accurate, complete phone numbers and addresses of your doctors and healthcare organizations will help SSA get the right records and reduce the time it takes to process your claim.
2. DON'T REPRESENT YOURSELF
You've heard the old addage, "he who represents himself has a fool for a client". Representing yourself is almost always detrimental to your case. SSAs laws, rules, and regulations are difficult for experienced representatives and lawyers to understand sometimes. You may think you know what you are doing, but you may be hurting or delaying your claim unnecessarily. And SSA will not likely be helpful to you. Most claimants who get representation believe that getting 75% of retroactive benefits and 100% of all future payments is a good deal, and believe that the 25% of retroactive benefits that goes toward a representative's payment is a good investment.
3. GET REPRESENTATION AS SOON AS YOUR CLAIM IS DENIED
Don't wait until just before your hearing to get help. Getting a representative at the last minute is never good. A competent representative needs time to study your case and become thouroughly familiar with all aspects of it. He will need to research how to apply the law, set up your defense, write briefs, etc.
4. SUBMIT DOCUMENTS IN A TIMELY MANNER
There is a fairly generous time frame to submit SSA documents, but there is a 60 day time limit (from the day you receive any denial) to file an appeal. The faster you get completed documents back to SSA, the quicker your case will get to hearing.
5. TREAT AGGRESSIVELY
You must demonstrate that you are doing everything you can to treat your illness or injury. SSA does NOT care if you cannot afford medical care. They believe that medical care is available to everybody. SSA rules and regulations prohibit any awards of disability benefits to claimants who are not treating their symptoms on a regular and ongoing basis. Period. The more you see your doctor, the better chance of winning your claim. This is because of SSA's heavy reliance on medical records. SSA will NOT take your word for anything. A claimant's credibility plays a HUGE role in their claim. It is not enough to tell what your symptoms or limitations are. SSA wants everything quantified. They need to know what makes it hurt, how bad it hurts, how long does the pain last, what do you do to alleviate the pain, and when does it stop hurting? The way to tell SSA these things is in the development of MEDICAL RECORDS!
6. DO NOT EXAGGERATE THE SEVERITY OF YOUR SYMPTOMS
It will harm your case if you exaggerate the symptoms or limitations of your impairment(s). SSA needs verification of the severity of your symptoms and your physical and/or mental limitations. Your case will be based largely on your MEDICAL RECORDS. This is particularly true for claimant's under 50 years of age. Don't listen to stories about how someone's friend or relative got benefits simply because they were an alcoholic or drug addict. Or how someone "fooled" SSA into getting benefits by claiming a non-existent psychological problem. These stories are simply false. It is difficult for truly disabled people to get benefits, virtually impossible to get them by making false claims. Don't lose a case because SSA finds you not credible.
7. BE TRUTHFUL IN YOUR STATEMENTS
Don't be less than forthcoming about the other aspects of your life. Don't understate your income or deny any drug or alcohol problem, past or present. These things can be dealt with by your representative at the appropriate time.
8. NOTIFY SSA AND YOUR REPRESENTATIVE OF ANY CHANGE OF ADDRESS OR PHONE NUMBER
Nothing will stop a claim in its tracks as quickly as returned letters and unanswered phone calls by SSA. SSA sends out endless documents and questionnaires that MUST be completed and sent back in a timely manner. They must also be able to reach you by phone. If you have no phone, give SSA the phone number of a trusted friend or relative. If you can't afford a phone, there are several government programs that offer free cell phones to the disadvantaged. You can read about tham at http://www.huffingtonpost.com/2013/03/05/california-free-cellphones_n_2814939.html
Timothy E. Fairbanks, ADR, EDPNA
at Fairbanks Disability
2740 Fulton Ave
Sacramento, CA 95821
Phone: (916) 480-1268
Cell: (916) 747-1069
Fax: (916) 481-2230
Or use our contact form.
We can be reached during the following hours:
Monday - Thursday 9:30am-5:00pm
Mobile notary services available on weekends and holidays by appointment.