DEALING WITH THE STATE + THE FEDS

With a Social Security disability claim, you have to contend with both the state government and federal government. It's enough to make you pull out your hair!

Your state will make the initial decision about whether you meet the requirements to receive a disability benefit. In Alabama, this agency is called the Disability Determination Service or DDS. It's manned by state employees working under contract with Social Security. This will be your first experience when filing a claim.

DDS is looking for claims that obviously meet the criteria for disability, with no complications, gray areas or reservations. If they see a rare case which meets one of the published Listings, they are likely to approve it. Nearly all other cases, including any case that has questions, reservations, uncertanties or which is doubtful in any way--will be denied.

Now, you file an appeal and begin to deal with the federal government. Your case is shipped over to the Office of Disability Adjudication and Review (ODAR), which is the appeal unit within the Social Security Administration. You will be scheduled for a hearing before an Administrative Law Judge (ALJ).

In the good old days, judges might take a claimant's word about his pain level or other symptoms that made it difficult to perform activities of daily living. Today, however, the judge will look for solid and extensive medical evidence. They will want to see MRIs, X-rays, CT scans or other diagnostic tests that graphically explain the cause of your impairment. Without this evidence, most of them simply are not going to approve a claim.

I think it takes twice as much medical evidence today as it did ten years ago to win a claim. Judges have become more skeptical, the media has sensationalized a few cases of fraud, and congressional lawmakers are hollering about too many people getting Social Security benefits. If you don't have the medical evidence, it's very hard to get a judge to award you any money.

One of the jobs of the disability advocate or attorney is get the medical evidence, explain the medical evidence, and show how the medical evidence proves disability according to the regulations. It's a very technical process that must follow the federal regulations.