Most disability claims are denied by Social Security and must be appealed. The appeals are rather complex and I want to share how I approach preparing an appeal case.
An appeal is really taking the denied case before a US administrative law judge for a hearing. This is the only time the claimant gets to sit down face-to-face with a decision maker.
First, it is absolutely essential to obtain and submit all medical records prior to the hearing. This gives the judge ample time to review what is in the claimant's medical files. The decision ultimately will rest on evidence contained in these files. I will be very involved in getting all the medical files from doctors and other treatment providers.
Next, the medical records must be read and analyzed. What severe impairments does the claimant have? Where are they documented? What are the restrictions in function or activity reasonably produced by the impairments? In other words, how do the symptoms translate into the inability to perform work-like activities?
The claimant's vocational record must be analyzed. At Step 4 of the decision-making process, a judge will review all the jobs the claimant has held during the past 15-years. If the judge finds that even one of these "past relevant jobs" can still be performed by the claimant, the case will again be denied. So, work history needs to be set forth accurately. It is most important to properly classify each past job in terms of skill level and exertion level.
Most likely, I am going to contact the claimant's doctors and try to get statements supporting the disability claim. What I really want is a form called a "Medical Source Statement" from the doctor listing specific functional limitations--things like limitations on sitting, standing, walking, bending, lifting, memory, concentration, etc.
Also, I am going to analyze the entire body of evidence in relation to Social Security laws and regulations. I will be looking for a legal theory of the case: how do the regulations direct a finding of disability and approval of an award? The judge is bound to follow the law and I want to help him or her get to the correct decision as easily as possible. I nearly always submit a detailed written brief to the judge which maps out a legal reason to pay the claim. Does the claimant meet one of the Listings? Is there a Medical-Vocational Guideline that directs a favorable decision? Does the claimant have any transferrable skills? A lot of questions to answer!
Another important step is to meet with the claimant prior to the hearing date and prepare for testimony that will be given during the hearing. The claimant needs to know what to expect. What questions may be asked? What is meant by specific answers? What are the strong points in the case? The weak points? What problems may we encounter at the hearing? How do we avoid these problems or deal with them if they occur?
There are probably a thousand other details that I will address prior to the hearing date. I view a disability appeal as a complicated jigsaw puzzle. The pieces are never put together right until someone finds all the pieces and arranges them to show a complete picture. That is my job.
A friend of mine, who doesn't have a clue what a disability appeal involves, once told me, "You have a great job. You spend 30 minutes in a hearing and earn a nice fee." Of course, that's not true at all. I spend dozens of hours on a case before it ever gets to hearing. A good student does not spend 30 minutes taking a test and just happen to make an A. He studies long and hard before the test and that work pays off during the 30 minutes of the test. That's a pretty good analogy of the work that must be done prior to a hearing. The preparation is intense, personal and detailed.
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Contact Charles Forsythe at (256) 799-0297
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