What Special Terms or “Magic Language” Do Disability Adjudicators Seek in Reviewing Claims Files?
Currently, Social Security Disability uses multiple levels of review and appeal to evaluate disability claims. The first level of review is called the initial application. This review is conducted by an “adjudicator” who works for the “State Agency.” The State Agency is a part of the government of your State - SSA contracts with State Agency offices in each State to conduct the initial level of review.
If your claim is denied by the State Agency adjudicator, you must file a Request for Reconsideration appeal to the State Agency. Your reconsideration appeal must be filed within 60 days of the date on the initial denial.
Your reconsideration appeal goes back to the State Agency where it is reviewed by a second adjudicator. If your case is denied at reconsideration (as most claims are), then you receive a denial notice that advises you of your 60 day deadline to file a Request for Hearing Appeal.
When your case goes to the hearing office (called the Office of Disability and Review or “ODAR”) your file again returns to the custody of the federal government - the State Agency is no longer part of the picture after it issues a reconsideration denial.
State Agency Adjudicators Have Limited
Authority to Approve Your Case
When your file is at the State Agency (initial application through reconsideration review), the State Agency adjudicators have the duty of evaluating your claim. Because State Agency adjudicators are not judges, they have very little room for discretion. They can only approve a claim if falls into very specific categories.
Specifically, State Agency adjudicators will look for language that suggests that your claim meets a “Listing” set out in Social Security’s Listings of Impairments. You can look at the Adult Listings here.
When you review the listings you will see that Social Security has divided the body into 14 different, numbered categories. Within each category are between five and fifteen subcategories along with very specific medical testing requirements.
A medical problem described in a listing will always be severe and it will be a condition that can be evaluated by one or more medical tests like an x-ray, an MRI, a CT scan, or other diagnostic testing equipment.
As a rule, State Agency Adjudicators will only approve a case if it meets a listing. This makes sense, if you think about it. State Agency adjudicators are not trained to interpret medical records nor are they trained as judges. They are trained to look for specific language in your medical record that equals what is set out in a listing.
How To Improve Your Chances at an Early Approval
Therefore, if you want to improve your chances at winning at the initial or reconsideration levels, you should:
- identify the listing that most closely tracks your condition
- print out a copy of that listing and take it to your doctor. Explain that your medical records or a letter from the doctor needs to follow the language of the listing closely
- write the adjudicator to advise him/her that you believe that you have a listing level condition and enclose those pages from your medical record that support your listing argument.
To the extent that State Agency adjudicators are trained to look for listing level cases, the language of the listings are truly the “magic words” in a Social Security disability claim.
|
