Mar 23 2020

Texas state disability insurance #Successfully #Applying #for #Disability #Benefits #in #Texas

Texas state disability insurance


Applying for Disability in Texas
How to apply, meet filing requirements, and the criteria to qualify for Benefits in TX

Approval and Denial Statistics for Disability Claims in Texas

Note: If you have already filed a claim and been denied for disability, or are wondering what to do in the event of a Social Security denial, proceed to the reconsideration and hearing appeal sections below.

Level I: Disability Application – More than 60 percent of all disability claims in Texas are denied in any given year. This is in line with most states: The average rate of denial at the disability application level tends to hover around 70 percent.

Due to a variety of factors, the majority of claimants will not meet the qualifications for disability benefits until one or more appeals have been filed. And in most cases, winning disability benefits will require pursuing a claim to the second appeal level, the request for hearing before an administrative law judge.

Qualifying for disability can be difficult. The Social Security Administration uses a unique definition of disability. It is not enough to have a percentage loss-of-function, or to lose the ability to return to a former job. An individual must have a severe medically determinable impairment (which may be mental, physical, or both) which must last for one full year or longer.

However, if the condition has not lasted a full year by the time the application for disability is filed, this is not necessarily an issue as a disability claims examiner can review the medical evidence and make a projection as to whether the individual’s state of disability will last a year or longer.

In addition to the duration requirement, the condition must be severe enough that it impacts normal daily activities and interferes with the ability to perform basic work activities.

Each Social Security Disability and SSI Disability claim decision is both medical and vocational in nature, meaning that the limitations posed by the claimant’s condition, or conditions, are considered in the context of how it affects their ability to work.

Filing for disability in Texas will involve initiating a claim with the Social Security Administration online, or by contacting a local Social Security office.

Contacting a local office offers distinct advantages over the online process. While the online process is touted as saving time, an SSI application cannot actually be filed online.

This means that an individual whose claim will involve SSI–either entirely or as part of a concurrent Social Security Disability and SSI application–will still have to be contacted by a Social Security Claims representative. Translation: the online process may not save any time at all.

Additionally, the act of contacting a local Social Security office offers the advantage of being able to ask questions and receive answers about a) the process of filing for disability and b) the requirements for qualifying for disability benefits. This, by itself, can avoid confusion and eliminate mistakes.

However the claim is initiated, each disability claim in Texas will eventually involve a claimant having to undergo a disability application interview with a CR, or claims representative, at a local Social Security office. The interview can be conducted in person.

For individuals who have mobility or transportation issues, however, the interview can be conducted over the phone. This may also be requested for claimants who simply prefer a phone interview.

Who makes the decision on the disability claim

After the claim has been taken, it will be transferred to a case processing specialist known as a disability examiner. This is at a separate state-level disability agency known as DDS, or disability determination services. The examiner at the Texas DDS will be responsible obtaining the medical evidence that is needed to make a decision on the case.

However, the examiner can only gather records from the sources indicated by the claimant on their disability report form at the time of filing for disability. For this reason, claimants should be sure to include all pertinent information regarding their medical treatment history, including their dates of treatment, the names of their treating physicians, and the names and addresses of all hospitals and clinics.

The correct name for a medical facility is especially important since Social Security will use this information to send out letters requesting medical records. If a claimant supplies an incorrect name, the disability examiner may fail to obtain the needed records which can pose a significant disadvantage to the case.

At the very least, it may cause a significant delay in receiving a decision on a Social Security case. The wait for medical records, in fact, constitutes the longest portion of the time needed to process a disability application.

What is the actual process of evaluating a claim?

The process is as follows:

1. The claimant’s medical records are gathered, read, and evaluated. If it becomes apparent from the analysis of the records that they have a condition that satisfies a listing in the Social Security Disability list of impairments, they may be approved on this basis.

2. If the claimant does not have a listing-level impairment, the information from their medical records will be used to determine what their current mental limitations and/or physical limitations are. This is their RFC, or residual functional capacity. The RFC rating is then compared to the demands of the jobs that were performed in the 15 year time period prior to becoming disabled.

Note: This is why it is extremely important for a claimant to supply a complete and detailed work history during the interview for the disability application — in fact, this is why it is generally a good idea to write down both the work history, as well as the medical history, prior to the application appointment at the Social Security office so no important details will be omitted.

3. If the claimant’s limitations do not rule out the ability to return to their past work, meaning they can return to one of their former jobs, they will be denied on this basis.

If their limitations are great enough to rule out their past work, the case will move on to the final step, which is to determine whether or not they have the education and skills needed to perform some type of other work (which they have never done), given consideration of their age and functional limitations.

4. Individuals whose condition is severe enough to make it impossible to do their past work, as well as other work that relies on their education and job skills, will meet the requirements for disability.

In other words, they will be found to be disabled and will qualify to receive disability benefits on an ongoing monthly basis, in addition to receiving whatever back pay they may be eligible for.

As stated, the majority of claims are denied at the disability application level. Most claims, of course, are denied on the basis that the claimant can do some type of other work.

Claims for disability are usually decided within 90-120 days. There are exceptions to this, of course. Claimants who are scheduled for consultative medical examinations by Social Security and do not keep their appointment will add unnecessary delay to their case.

Also, claimants who have had recent heart or eye surgery, or who have suffered a stroke will usually have their case deferred for three months so that Social Security can evaluate the residual effects.

Since the large majority of claims in Texas are denied by Social Security, claimants should be ready to file an appeal upon denial. The first appeal is the request for reconsideration.

  • Disability application denial rate: 67 percent.
  • Disability application approval rate: 33 percent.

    • Filing a Social Security Disability Application – How to File
      and the Information needed by SSA
    • What Happens when you file a disability application?
    • What happens after you file a disability claim?

    Level II: Request for Reconsideration – A person who is denied for disability benefits in Texas at the initial claim level has two options: 1) file a new disability application, 2) file a disability appeal.

    Filing a new claim is not advised. New claims that are filed immediately after the denial of a claim are seldom approved. This is logical considering that the new claim simply goes back to the same disability agency (DDS) and undergoes the same process of evaluation.

    The reconsideration process little chance of being approved. In fact, the rate of denial on a reconsideration is usually higher. That said, there are cases in which a reconsideration level disability examiner will find an error on the part of the initial claim examiner. And that, in itself, makes filing a request for reconsideration worth the effort.

    For most claimants, however, the true value of going through the reconsideration phase is that it allows an individual to file a request for a disability hearing once the reconsideration is completed. Hearings offer substantially higher opportunities for approval, particularly when the case is well prepared and properly presented to an administrative law judge, complete with:

    b) statements from treating physicians (most disability representatives and disability lawyers will attempt to obtain a supporting medical source statement prior to the hearing), and

    c) a well-reasoned “theory of the case” i.e. a rationale for approval.

    A request for reconsideration is made by contacting the Social Security office where the initial claim was filed. The appeal must be requested before the appeal deadline, which is 60 days–plus 5 added days for mail time–from the date of the denial of the disability application.

    Claimants who are represented will have their appeal submitted by their disability representative. Just the same, a claimant who is represented should contact their representative upon receiving their denial letter to ensure that both parties are aware the case has been denied.

    Also, either the claimant or their representative should contact Social Security within 10-14 days of submitting the appeal to ensure that the appeal was received so a late appeal situation can be avoided.

  • Reconsideration appeal denial rate: 87.3 percent.
  • Reconsideration appeal approval rate: 12.7 percent.

    A hearing in Texas must be requested within 60 days of the date of the prior denial, but, ideally, should be requested immediately after receiving notification of the denial of the reconsideration appeal to avoid unnecessary case processing delays, as well as the possibility of a missed appeal deadline.

    Basic facts about disability hearings

    1. Who makes the decision at the hearing level? – Unlike the first two levels of the disability system, hearings are not decided by disability examiners, but, rather, by administrative law judges (ALJs) at the office of disability adjudication and review, or ODAR.

    Judges, however, make disability decisions in the same manner as examiners, i.e. they review the medical evidence that is in the file (which includes the evidence that was gathered by the disability examiner, as well as the evidence that has been submitted by the claimant or the claimant’s disability lawyer) and then determine if the claimant’s case meets the requirements for disability.

    2. What are the requirements for disability at the hearing level?– To be awarded for disability at the hearing level, the case must satisfy the definition of disability. This is done by first demonstrating, through the information contained in the medical records, that the claimant has a severe medical impairment. The impairment must be disabling for at least one full year or longer for the claimant to qualify for disability.

    If this is not the case, the claim will fail to meet the qualifications for disability and will be denied on the basis of duration.

    3. What makes the impairment disabling? The severity level of the condition. For Social Security purposes, a physical or mental condition will be considered severe enough to be disabling if it either A) meets or equals a listing in the Social Security list of impairments or B) prevents the claimant from engaging in work activity that provides a substantial and gainful income.

    4. How long does it take get a disability hearing in Texas scheduled? – This will vary tremendously depending on whatever hearing backlogs currently exist at a particular hearing office. It is not unusual, however, for a hearing to take several months to schedule.

    After a hearing request has been made, the claimant or their disability lawyer may wish to periodically check the status of the appeal. This can be done by contacting the Social Security office where the claim was originally filed, or by contacting the hearing office.

    In fact, it is usually a wise idea to check the status of the hearing request several weeks after the hearing request has been submitted to verify that the case has actually been transferred from the Social Security office to the hearing office.

    5. What happens when the case is ready to be heard? – The claimant and their disability lawyer or disability representative will be sent notification of the hearing date, time, and location. Depending on the hearing office involved, a copy of an exhibit list may also be sent out prior to the hearing notice. The exhibit list is a listing of everything in the claimant’s file, including medical evidence that was previously considered.

    Typically, the claimant’s attorney will use the receipt of the exhibit list as an indication that the hearing is close to being scheduled. This may prompt the attorney to begin sending out requests for medical records to the claimant’s various doctors and other sources of medical treatment.

    Medical record updates are crucial to a case because without them the only evidence that would be available at a hearing would be the evidence previously gathered by the Social Security examiner at the first two levels of the system. Of course, by the time the hearing takes place, all of this evidence is dated and does not include anything “recent” that would allow an administrative law judge to approve the disability claim.

    Note: An approval for disability cannot be made if the claimant cannot present recent medical records, recent being defined as not older than 90 days. Older records are necessary for establishing the longitudinal aspects of a claimant’s condition or illness, as well as establishing the onset date for a claim which determines A) how much back pay the claimant may be eligible to receive and B) when the claimant may be eligible for medicare coverage (assuming their claim is for Social Security Disability and not SSI which provides medicaid).

    6. Do the odds of winning improve at the hearing level? – Statistically, the Social Security Disability hearing offers the best chance of winning benefits for individuals who have been previously denied at the disability application and reconsideration appeal levels. Typically, a claimant will have at least a fifty percent chance of receiving a disability award from a judge. With representation, the odds may easily increase to sixty percent or more.

    The reasons for this, of course, are obvious: representatives generally have experience in gathering the type of evidence that is productive to winning a disability claim. Moreover, a disability representative or disability attorney who has been handling cases for an appreciable length of time will have familiarity with the judges at a particular hearing office and will know what to expect.

  • Disability Hearing denial rate: 56.9 percent
  • Disability Hearing approval rate: 43.1 percent

    Individual hearing offices have both higher and lower rates of approval, ranging from 31.8 percent to 52.2 percent. Processing times for disability hearings in Texas will vary from 174 days to 325 days. The state-wide average for processing times; however, is 265 days.


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