Initial Disability Claims

Applying for Social Security disability benefits can be overwhelming for someone attempting it for the first time. Initial disability claims become the foundation of Social Security Disability Insurance or Supplemental Security Income cases. Getting it right the first time could affect how long a claim takes to process and its ultimate outcome.

A disability claims lawyer in NY at the Law Firm of Nikki L. Prasad, P.C., helps people with disabilities navigate the initial claims process. We focus on getting you the disability benefits you need and are entitled to by law so you can focus on your health. To get you started, this is a guide to the initial disability claims process.

What Is an Initial Disability Claim?

The first formal application you submit to the Social Security Administration for disability benefits, either through the SSDI or SSI program, becomes the initial disability claim. It’s not as simple as providing your contact information and a brief description of the medical condition that prevents you from working.

Initial disability claims require extensive and detailed information about you, your work history, and your medical history, along with supporting documentation. Providing accurate, complete, and consistent information throughout the application is critical to avoiding processing delays or a denial of the claim.

The initial disability claim is not the place to guess about information or leave blanks in the paperwork because you may not get the chance to fix them later. Getting it right the first time requires careful preparation by gathering all the necessary documents and information before you begin completing the application.

Required Documents & Medical Evidence

The documents to gather for the initial claims application include:

• Proof of identity and personal information: Social Security card, birth certificate, government-issued photo identification.
• Employment information: W-2s from employers, 1099s for self-employed individuals, tax returns, and detailed work records.
• Medical records: Physician’s examination notes, diagnostic test results, imaging reports, and hospital records, if applicable.
• List of prescribed medications and treatment plans: The SSA can deny an initial claim when a person fails to take prescribed medication or follow a treatment plan.
• Contact for all physicians, including specialists, providing treatment for the medical conditions listed in the application for disability benefits.

A diagnosis without objective medical evidence in the form of blood tests, diagnostic test reports, or other supporting documentation of the condition is essential for proving a claim for SSDI or SSI. The evidence must establish that a person is disabled.

The SSA standard for disability requires that a person be unable to engage in substantial gainful activity due to a medically determinable physical or mental impairment, or a combination of impairments. The impairment or impairments must be expected to result in the person’s death or to have lasted or be expected to last for at least 12 continuous months.

Relying on a disability lawyer for help during the early stages of the initial disability claims process can be beneficial. They know which documents and information to gather to present a strong, well-supported, and accurate claim for benefits.

How The SSA Reviews Initial Disability Claims

Initial claims for disability first go to a local SSA field office to determine whether they meet non-medical requirements. For the SSDI program, the primary non-medical requirements would be a long enough work history (this could be at a formal job or through self-employment) with payment of Social Security taxes.

SSI claims do not have a work requirement, so they go through a financial review to determine whether the person meets the income and resource limitations. Claims that meet the non-medical requirements for SSI or SSDI go to a Disability Determination Services agency.

The federal government funds the operation of DDS agencies in each state, where examiners review disability applications for compliance with the medical requirements of the SSI and SSDI programs. The examiners request medical records from the treating healthcare professionals and use the following five-step sequential evaluation process to decide whether a person is disabled:

• Work Activity: If a claimant works, do they earn more each month than the substantial gainful activity income threshold? If they do, they are not considered disabled, and the review stops.
• Medical Severity: The person’s medical condition must be severe enough to last for at least 12 months or result in death. If it is not severe, the claim will be denied.
• Medical Condition Meets or Equals A Listed Impairment: Using a listing of impairments considered by the SSA as severe enough to prove a disability, examiners evaluate medical records. Conditions that meet or equal a listed impairment are severe, and the claimants are disabled.
• Ability to do Past Relevant Work: Claims not approved in the first three steps are reviewed to determine whether the person’s residual function capacity (RFC) with their medical condition allows them to do work they did in the past. If they can, then they are not considered disabled.
• Adjust to Do Other Work: If a person is not be capable of doing past work, does their RFC and their age, education, and work experience allow them to adjust to do other work? If not, then the DDS will consider them to be disabled.

The file goes back to the SSA local field office, and a notice of the decision is sent to the claimant.

Why Many First Claims Are Denied

It’s no secret that many initial disability claims lead to a denial of benefits during the application review process. According to the SSA, denial notices go out to 62% of applicants.

Common reasons for the denial of initial disability claims include:

• Failing to meet the non-medical work requirements for SSDI or the income and resource limits for SSI.
• Working and earning more than the substantial gainful activity threshold.
• Insufficient medical documentation to prove the severity of a medical condition.
• Failing to take prescribed medication and follow treatment plans.
• Applications containing mistakes, inconsistencies, and omissions.

Legal assistance in applying for disability benefits can help avoid processing delays or claim denials.

Benefits Of Hiring an Attorney from the Start

Disability lawyer help from the beginning of the SSI or SSDI application process provides advantages, including someone familiar with the process who can:

• Review the application for accuracy and completeness.
• Identify and gather medical and other documentation to strengthen the claim.
• Ensure that all deadlines are met and SSA requests are complied with promptly.
• Check on the status of the claim to quickly respond to questions or requests from examiners.
• Present limitations caused by medical conditions using terminology that DDS examiners understand.
• Demonstrate familiarity with the appeals process and challenge unfavorable decisions.

Representation by an attorney not only improves the chances of success. It also provides peace of mind for a claimant, knowing they have someone to rely on through a difficult process.

Contact An Initial Disability Claims Lawyer In NY

Before attempting to take on the disability claims process on your own, contact the Law Firm of Nikki L. Prasad, P.C., for a free consultation. Learn how a disability lawyer can make a difference for you and your claim.