WHAT IS SOCIAL SECURITY DISABILITY?
Social Security is a vital income security net for Americans. As of 2019, there were 64 million Americans, including disabled workers, retired workers, and survivors receiving benefits from the Social Security Administration (SSA).
SOCIAL SECURITY ADMINISTRATION (SSA)
The Social Security Administration (SSA) is an independent agency of the Federal Government. It administers Social Security benefits and has a budget of over a trillion dollars. It employs more than 60,000 individuals.
DEFINITION OF DISABILITY
Disability is defined as the inability to engage in any Substantial Gainful Activity (SGA) by reason of any medically determinable physical or mental impairment(s) which is expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. If the condition is not expected to result in death and it has lasted just short of 12 continuous months, then the individual will not meet the disability standard no matter how debilitating the condition during that period under one year.
Proving a disability to receive benefits from the SSA can be difficult. The SSA evaluates disability claims using its own medical experts and claims examiners. Just because your personal doctor says you cannot work full-time or you believe that you are disabled does not necessarily mean that SSA will agree with your doctor or you.
To meet the SSA’s definition of disability, you must meet the following requirements:
- You must have a physical or mental impairment that is documented by appropriate medical diagnosis from a medical source that is acceptable to Social Security.
- The impairment prevents you from doing any substantial gainful work, and
- The disability must be expected to last, or have lasted 12 months, or it must be expected to result in death.
The basic rule regarding disability is that the condition preventing you from working must be a medical one, meaning that it can be discovered and described by doctors and proved by acceptable clinical and laboratory diagnostic techniques such as X-rays, MRIs, or clinical tests and examinations. The SSA does not rely on your own description of your symptoms and limitations.
PROCESS OF DISABILITY DETERMINATION.
In North Carolina, the Social Security Administration has four decision-making levels:
- Initial decision,
- Reconsideration decision,
- Hearing, and
- Appeals Council
It is in the claimant’s best interest to enlist the services of a North Carolina Social Security disability lawyer who is skilled at handling various issues that may arise throughout the application process. A North Carolina disability attorney has experience dealing with the Social Security Administration and can function as an effective advocate for the claimant. A claimant’s attorney can deal with the complex and time-consuming process, while the claimant focuses on more pressing medical and personal issues.
Initially, the disability claims are processed through a network of local field offices and state agencies called Disability Determination Services (DDSs). In North Carolina, field offices are located throughout the State to service the local populations. DDS is located in Raleigh.
- SOCIAL SECURITY FIELD OFFICES.
When one applies online, or in person, by telephone, or by mail, the application is initially processed at an SSA field office. The application consists of information about the applicant’s impairments, as well as the names, addresses, and telephone numbers of medical sources, and other information relating to the alleged disability.
The field offices verify non-medical eligibility requirements, which may include claimant’s age, marital status, employment details, citizenship status, residency information, and Social Security coverage information. For Social Security eligibility, the field offices verify income, resources, and living arrangement information. The case is then sent to a DDS for disability evaluation.
- STATE DISABILITY DETERMINATION SERVICES (DDS).
The DDS are State agencies that are fully funded by the Federal government. In North Carolina, they are responsible for making an initial determination about whether a claimant is or is not disabled.
In North Carolina, they are also responsible for making a second determination—reconsideration—if the claimant appeals.
The DDS obtains evidence from the claimant’s own medical sources first. If evidence is unavailable or insufficient to make a determination, the DDS may arrange a Consultative Examination (CE) to obtain additional evidence. During a Consultative Examination, an independent physician or psychologist conducts an examination of the claimant. Typically, there are two main types of examinations: 1) a physical examination conducted by a medical doctor, and 2) a mental examination conducted by a psychologist. The Consultative Examiner should have access to the claimant’s medical records that DDS has collected, but sometimes they do not. In addition to these examinations, if medical evidence is lacking or needed, Social Security will obtain imaging to try to obtain objective medical evidence of the claimant’s underlying conditions.
The DDS may refer a case to the State Vocation Rehabilitation (VR) agency if it feels the claimant is a candidate for vocational rehabilitation.
The determination is made by an adjudicating team consisting of a medical or psychological consultant and a disability examiner. The DDS returns the case to the field office after making a disability determination. If the DDS finds that the claimant is disabled, SSA will compute benefits and begin payment. If the claimant is found not to be disabled, then the file of the case is retained by the field office in case if the claimant decides to appeal the determination. An appeal from an initial denial is handled by a different adjudicating team in the DDS, entirely different and independent from the team that made the initial determination.
OFFICE OF HEARINGS OPERATIONS
Claimants who are dissatisfied with the reconsideration determination may request a hearing before an Administrative Law Judge (ALJ). At this stage, it is crucial that a skilled Social Security Disability attorney assist the claimant to increase winning opportunities. Attorney Charlie Hall has assisted thousands of disability claimants with their claims since 2006. The claimant may submit additional evidence to the ALJ, but must do so five business days before the date of the hearing. If the claimant submits records later, the judge has the right to potentially block the evidence from being a part of the record.
Typically, claimants will be given a choice to have an in-person hearing or a video teleconference hearing. Hearings are typically held at the Office of Hearings Operations (OHO). In North Carolina, there are locations in Greensboro, Charlotte, Fayetteville, and Raleigh. In addition to those four hearing locations, there are some local field offices and select locations that have hearing rooms. (During Covid-19, Social Security has ceased having in-person hearings. Two options have emerged: 1) a telephone hearing, and 2) a Microsoft Teams hearing. Both of these hearings have all hearing participants participating from the comfort of their home or office).
The hearing typically only has five participants: judge, hearing reporter, claimant, attorney, and vocational witness. Sometimes there are more participants, including a medical witness, and any other witnesses for the claimant. The judge runs the hearing. The hearing reporter ensures that a good audio recording is kept. The vocational witness is paid by Social Security to attend the hearing, but is required to answer truthfully and independently despite that. The vocational witness, or Vocational Expert as named by Social Security, has professional experience typically in vocational rehabilitation, and is required to acquaint themselves with Social Security Disability and their role in the hearing. Medical witnesses are not as common as vocational witnesses. Medical witnesses provided by Social Security are paid by Social Security to attend the hearing, but are required to answer truthfully and independently despite Social Security paying their fee. The ALJ (Administrative Law Judge) will decide based on evidence on record, including the evidence submitted during hearing before the ALJ. If an ALJ requires additional evidence, the OHO (Office of Hearings Operations) coordinates with the DDS (Disability Determination Services) to obtain it. However, the OHO may also contact medical sources directly for additional evidence.
Hearings typically have three parts, and typically last between 30 minutes to 60 minutes, depending on the complexity of the case and the participants. The first part of the hearing lasts maybe five minutes. The judge has the hearing reporter record the hearing (“go on the record”); will identify the participants; have the claimant, vocational witness, and any other witnesses sworn in; and will ask the attorney a set of legally important questions. The attorney will typically give an opening statement.
The middle of the hearing typically lasts between 20-40 minutes. The claimant is the witness for the middle portion of the hearing, and answers the questions that the judge and attorney ask the claimant. Some judges ask many questions; others ask few. The attorney has to adapt to the preferences of the judge. A skilled attorney will ensure that key evidence is presented regardless of the judge’s preference. The third part of the hearing lasts typically between 10-20 minutes. It is crucial that a skilled attorney assist at all stages of the hearing, but especially during the third stage. In this stage the judge will ask the vocational witness to identify the claimant’s work from the last 15 years. Next the judge will ask the vocational witness to classify key jobs. The key jobs are ones that the judge determines are Past Relevant Work. Past Relevant Work is work done in the last 15 years, done long enough to have learned the job to average proficiency, and performed at Substantial Gainful Activity (SGA) levels. Substantial Gainful Activity (SGA) has an earnings test that changes nearly every year due to Cost of Living Adjustments. SGA for 2021 is $1,310 a month, but in 2011 it was $1,000 a month.
After the vocational witness testifies to the past work, the ALJ will identify which are Past Relevant Work, and then will have the vocational witness classify them according to the Dictionary of Occupational Titles (DOT). The DOT was developed by the Department of Labor, but has not been updated since 1991. The vocational witness sometimes, due the dated nature of the book, will have to use professional experience to classify the jobs (for instance there were no smart phone repairers in 1991). Once the judge is comfortable with the classifications by the vocational witness, the judge will then proceed to ask a series of hypothetical questions about a person of the same age, education, and work experience as the claimant. The hypotheticals generally increasingly more restrictive in abilities. Some judges check the work of the lower-level teams first. Then they proceed to ask increasingly restrictive hypotheticals. The attorney will ask follow-up questions. It is crucial that a skilled attorney participate in this process to ensure that all limitations that are in the relevant medical records are covered in the hypotheticals.
After the third part of the hearing, the judge will close the hearing. Typically, the Administrative Law Judges (ALJs) try to write their decisions in about 90 days. Sometimes they write them quicker; sometimes it can take a lot longer. This difference can be due to a number of factors including: 1) whether the claimant submitted all the records for the ALJ at least five business days before the hearing; 2) the more complicated the case, the longer the decision can take; 3) the judge and the staff assisting the judge can affect this timeline. Generally, it is best not to rush the ALJ and staff while they are writing the decision. Some ALJs will need time to re-review the evidence, including hearing testimony, before making a decision on whether to approve or deny. The ALJ may go back and forth with one of the attorneys who are writing the decision under her direction.
The ALJ’s decision will be mailed to both the attorney and the claimant. If the decision is a win, then the claim will require further processing before the claimant gets his money. Typically, if it is a Title II, or tax-based Social Security Disability claim, then the claim will be processed at a Payment Center, where basically a group of accountants will implement the ALJ’s decision. The monthly payment amount is calculated, as well as calculating the backpay that is owed to the claimant and attorney. This typically can take 60 days. Sometimes it is much quicker, but other times it can take a lot longer due to the large amount of the backpay. For Title XVI claims or need-based Supplemental Security Income claims, the local Field Office will handle the calculations. Sometimes, the local worker will call to gather more information from the claimant.
If the ALJ denies the claim, the claimant has the right to request a review by the Appeals Council (AC) within 60 days from the date of the decision. The AC will review the denial in five instances: 1) if there was an abuse of discretion by the ALJ; 2) if there is error of law in the ALJ’s decision; 3) if the ALJ’s decision is not supported by substantial evidence; 4) if there is a broad policy or procedural issue that affects the public interest; or 5) if there is new and material evidence that relates to the relevant period that the ALJ was considering and that there is a reasonable probability that it will change the outcome of the decision. For the final instance, the claimant must have good cause for not submitting or informing the ALJ about the evidence at least five business days before the hearing.
The AC can either grant review or deny review. If they deny review, they uphold the decision of the ALJ. If the AC grants review, the AC typically will either remand the case back for a supplemental hearing or will agree with the ALJ’s decisions. Sometimes, they will outright reverse the ALJ, but this is quite rare.
If the AC denies review or ultimately agrees with the ALJ’s decision, the claimant will have to file a Civil Action in Federal Court within 60 days of the denial. It is extremely important that the claimant have a skilled Social Security attorney who handles Federal Court work. Attorney Charlie Hall handles both administrative as well as Federal Court Social Security cases.
SOME INTERESTING SOCIAL SECURITY DISABILITY STATISTICS.
- Close to 10 million people are getting disability benefits in the country.
- Fewer than 4 in 10 applicants can expect to eventually receive benefits. Most disability claims are denied on the initial review, and an appeal must be filed.
- 75% of Social Security Disability Insurance beneficiaries are 50 or older. The majority of them suffer from severe mental, musculoskeletal, nervous system, or other debilitating conditions.
- In 2017, there were 1.1 million applications pending and the average waiting period was 21 months. Although, the numbers have dropped since, there is still a backlog of hundreds of thousands of applications to be determined.
- Approvals at the Initial Application Stage in North Carolina (34.3%) is 4.2% less than the national average (38.4%). North Carolina ranked 44th in the nation for approvals at the initial application stage.
- North Carolina historically performs well at the Hearings. The approval rate at hearings for North Carolina was 59.6%, a 8.4% lead over national average of 51.1%. North Carolina ranked 4th nationally for highest percentage of approvals at the hearings stage.
MOST COMMON TYPES OF DISABILITIES.
There are different medical problems that may qualify for monthly disability benefits. The SSA uses a medical guide, called the blue book to determine eligibility.
Some of the conditions that may automatically qualify the claimant for social disability benefits include:
- Musculoskeletal system problems including Arthritis, back pain, Fibromyalgia, Reflex Sympathetic Dystrophy (RSD).
- Mental disorders including mood disorders, Schizophrenia, PTSD, Autism, and depression.
- Nervous system and sense organ conditions such as Parkinson’s Disease, Epilepsy, Blindness, and hearing loss.
THE IMPORTANCE OF BOARD CERTIFICATION FOR ATTORNEYS.
Being certified by the North Carolina State Bar Board of Legal Specialization proves that lawyers have focused their practice on a certain area of law and are capable of passing rigorous peer reviews and tests to prove their excellence.
Clients can be hesitant to trust lawyers with their cases. A Board Certification indicates that an attorney is highly regarded and proficient in his or her work. It gives potential clients additional confidence and insight while selecting an attorney for representation.
Obtaining a certification in North Carolina is not easy and requires a lot of dedication from the participating attorney. It takes a substantial investment of time and money. North Carolina State Bar Board of Legal specialization requires reputable peer evaluations and requires the lawyer to undergo demanding tests.
A Board Certification sets a lawyer apart from his colleagues and peers.
Attorney Charlie Hall has earned his certification in Social Security Disability from the North Carolina State Bar Board for Legal Specialization in November 2014.
CONTACT A NORTH CAROLINA SOCIAL SECURITY DISABILITY ATTORNEY.
Applying for Social Security Disability benefits can be a complex process in North Carolina with many potential road blocks that can lead to a rejection or unnecessary delays. Attorney Charlie Hall and his dedicated team capitalize on their knowledge and experience to diligently fight to get claimants the benefits they deserve. Attorney Charlie Hall works on a contingency fee basis, so you only pay after he has won you benefits and backpay.
Call experienced Social Security Disability Lawyer, Attorney Charlie Hall, at our firm for a free case evaluation right away.
What is Social Security Disability?
Attorney Charlie Hall and team
August 15, 2021