Successfully Applying for Disability Benefits in Illinois

Applying for Disability in Illinois

How to apply and qualify for SSD, SSI in Illinois (IL)

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 - In a typical year, more than 71 percent of individuals filing an application for disability in Illinois will be denied on their initial claim, or disability application. The high rate of denial necessitates that the majority of claimants will need to utilize the disability appeal process before receiving a Social Security Disability award or SSI award.

Regardless, however, of the level at which benefits are won (application, reconsideration appeal, or hearing), the disability requirements are the same. Being approved for Social Security Disability or SSI disability will depend on proving that a case satisfies both non-medical and medical eligibility criteria.

Qualifying for disability

To qualify for disability benefits as an adult in Illinois, through either the title 2 Social Security Disability or title 16 SSI disability program, a claimant will need to demonstrate that they have one or more physical or mental conditions that preclude the ability to engage in work activity--that earns a substantial and gainful income--for at least one year.

According to the SSA definition of disability, a disability exists when a condition, or set of conditions, lasts for this minimum length and presents this level of severity.

Cases in which individuals are disabled but whose condition improves before the one year time period (or is projected to improved based on the the medical records) will be given a durational denial.

Additionally, cases in which individuals are disabled but still working and earning a substantial and gainful income will be denied for SGA, or substantial gainful activity.

The disability decision process

What is the actual process of determining if an individual is disabled and qualifies for disability benefits? After a disability claim is transferred from the Social Security office where it has been taken, it is sent to a state DDS, or disability determination services agency, where it becomes part of a disability examiner's caseload.

The disability examiner's primary function is to obtain the medical evidence and ascertain in what ways and to what extent the claimant is functionally limited, either physically or mentally, or both.

There are two ways to approve a disability claim

Disability examiners may approve a claim in two separate ways. The first is by reviewing the medical evidence and determining that the claimant has a medical condition that satisfies a listing. A listing is simply a medical condition, physical or mental, that is contained, or listed, in the SSA list of disabling impairments, which in printed form is known as the blue book.

When a claimant has a condition that is contained in the listings, meaning it has its own listing, and the claimant's medical records satisfy the approval criteria that is designated for that listing, they may be awarded disability benefits on that basis (referred to as meeting, or equaling, a listing).

Most claims, of course, will not be approved on the basis of a listing due to the fact that the approval criteria is very specific, often more specific than the information that can be extracted from the claimant's medical records. Possibly 20-25 percent of disability approvals are made on the basis of a listing.

When it becomes clear to the disability examiner that the claim cannot be awarded benefits through a listing, the examiner will widen their inspection of the available evidence to include information obtained from the claimant's work history, as well as the medical treatment history.

The process goes as follows:

1. The examiner will evaluate the medical evidence looking for indications of functional limitations. Examples of physical functional limitations might include a reduced ability to sit, stand, or walk for longer than a certain amount of time, or a reduced abilility to lift more than a certain amount of weight, or a reduced ability to bend at the waist or see or hear. Examples of mental functional limitations might include an impaired ability to use long or short term memory, or maintain attention or concentration, or interact with others in a work setting.

2. The examiner will rate the claimant's functional limitations on an RFC, or residual functional capacity, assessment. The RFC rating is essentially a rating of what the claimant can still do despite their medical impairment. The RFC rating is compared to the demands of the claimant's past work and the determination is made as to whether or not the claimant can return to their past work.

If the claimant does not possess the physical or mental capacity to perform the functions of their past work (which can potentially include any job they have performed in the 15 year period prior to becoming disabled), they will be one step closer to being awarded disability benefits.

However, after a person has been found incapable of doing their past work, a final determination must be made. That determination is whether or not the claimant can, with consideration of their age, education, work skills, and level of functional capacity, be expected to have the ability to switch to some of other work.

If the claimant cannot do their past work or perform other work, they will qualify for disability under SSDI (Social Security Disability insurance) or qualify for SSI.

Applying for disability for a child

A child filing for disability in Illinois will need to prove a similar level of severity in order to be approved. However, the qualifications criteria will compare the functional limitations of children to their ability to engage in age-appropriate activities, meaning that they will be evaluated to determine if they are on-pace with same-age peers.

As with adult claimants, medical evidence will form the cornerstone of any disability decision for a child's disability application. However, in place of vocational work history information, the focus will usually be on academic records (grade reports, IEPS, teacher questionaires) and the results of IQ and achievement testing.

Disability application denial rate: 71.1 percent.

Disability application approval rate: 28.9 percent.

Level II: Request for Reconsideration - Since the majority of applications for disability are denied in Illinois, the filing of a Request for Reconsideration will be necessary in most cases.

The reconsideration is the first appeal. It is handled in the same manner as an application and the same disability qualifications apply.

In other words, the claimant must prove that their condition satisifies the SSA definition of disability which states that they must have a severe impairment that lasts for at least one year and which renders them incapable of engaging in work activity that earns a substantial and gainful income.

A reconsideration must be requested within the 60 day appeal deadline from the date of the denial, or it will be considered untimely. In such instances, the claimant may be required to start over with a new claim unless they can show that they have good cause for submitting a late appeal.

Reconsiderations are usually denied. And considering the fact that the process for this appeal is identical to the way a disability application is evaluated, this should come as no surprise. While, on average, 70 percent of applications are denied, the rate of denial for the first appeal is usually much higher.

Reconsiderations are often viewed by disability representatives as simply a stepping stone to a Social Security hearing.

Reconsideration appeal denial rate: 91.7 percent.

Reconsideration appeal approval rate: 8.3 percent.

Level III: Request for Hearing before an Administrative Law Judge - The disability hearing is the second Social Security appeal available to claimants and may be requested only after a reconsideration appeal has been denied.

A hearing 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 in Illinois

1. The hearing will take place at an ODAR - Social Security Disability and SSI hearings are conducted at the Office of Disability Adjudication and Review. Depending on the size of the state, there may be one or several hearings offices. For some claimants, getting to a hearing office may pose some difficulty if they lack transportation, or are physically unable to drive.

Fortunately, the hearings office will notify a claimant of their appointment for a disability hearing at least 20 days in advance of the hearing date. In most cases, claimants will have over a month's advance notice.

Prior to the hearing being schedulded, a claimant may wish to inquire into the status of their hearing appeal request. If this is the case, a call can be made to the Social Security office where the claim was initiated. However, the Social Security office will usually have very little information to impart when a case has made it to this level.

The best advice regarding obtaining the status of a hearing request is for a claimant to either contact the hearing office (ODAR) themselves, or have their disability attorney or non-attorney representative do this for them.

2. The hearing decision in Illinois will be made by an ALJ - The disability application decision is made by a disability examiner at the state disability agency that handles disability determinations for the Social Security Administration. In most states, this agency is called DDS, or disability determination services. At the hearing level, the decision on an SSI claim or SSD claim is made by a federal ALJ, or administrative law judge.

Judges perform the same functions as disability examiners. They review the medical evidence, and often vocational evidence (i.e. work history) as well, in order to determine if a claimant's case satisfies the SSA definition of disability. The definition specifies that a claimant must have a severe condition that renders them disabled for at least a year.

The condition must also be severe enough that it meets the requirements for receiving disability in one of two ways: 1) by satisfying the criteria of a disability listing or 2) by making it impossible for the claimant to engage in SGA, or substantial and gainful work activity.

The basic assumption regarding the federal disability system is that, to qualify for disability benefits, a person's condition must be so severe that it renders them unable to work and earn a self-supporting, or substantial and gainful, income.

3. The judge may have expert witnesses present - An administrative law judge at a disability hearing may have one or more witnesses present. This can include a medical doctor serving as a medical expert. If a medical expert appears, their purpose is to provide exert testimony regarding the claimant's medical condition and how the condition limits their functional capacity. If a vocational expert is present, their purpose is to comment on the claimant's potential employability, given their age, education, skills, and functional limitations.

Expert witnesses may be cross-examined by the claimant or their disability attorney.

4. The judge may send you to a medical exam - This does not always happen. However, in some cases the judge will decide to send you to a consultative medical examination. A CE generally happens when a case is being determined by a disability examiner at DDS. However, judges may find it necessary to do this as well, particularly if the claimant is alleging a medical condition for which they have never received treatment.

As with the lower levels (disability application and reconsideration appeal), the medical exam will be conducted by a doctor who is not an employee of the Social Security Administration, but, rather, has contracted to perform exams for SSA for a fee. Normally, after the exam has been done, the examining doctor will return a written report of findings to SSA (which will be reviewed this time by the judge). It would be safe to say that this usually occurs within two weeks time.

5. The requirements for disability are the same at a hearing - How a case qualifies for disability does not change between the hearing level and the first two levels of the disability system. At all levels, the decision-maker, in this case an administrative law judge, must decided if the case meets the qualifications for Social Security Disability or SSI.

The process that is used to render a determination goes as follows: a claimant's medical evidence will be obtained from the treatment sources listed at the time of filing for disability and then reviewed to see if the claimant has a condition meets or equals a listing in the Social Security list of impairments.

If a listing is not satisfied, the examiner will review the medical records to look for evidence of mental functional limitations and physical functional limitations. These limitations will be used to give the claimant a rating (known as a residual functional capacity assessment).

The RFC rating will be used to determine whether or not the claimant can return to their past work. If they cannot return to their past work, the determination will be made as to whether the claimant, in light of their job skills, education, age, and functional limitations, has the ability to switch to some type of other work. If they cannot do other work, they may qualify for SSD or SSI disability benefits.

Disability Hearing denial rate: 50.9 percent

Disability Hearing approval rate: 49.1 percent