Successfully Applying for Disability Benefits in Missouri

Applying for Disability in Missouri

How to apply and qualify for SSD, SSI in Missouri (MO)

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 - Disability approval rates vary from year to year. However, in any given year, approximately 30 percent of claims for disability in Missouri are approved at the initial application level, while 70 percent of disability claims in Missouri are denied. This makes it necessary for the majority of claimants to follow the appeals process in order to win disability benefits.

Fortunately, by the second appeal, the request for hearing before an administrative law judge, claimants with well-prepared cases (meaning those that satisfy the qualifications and requirements of the Social Security Administration's definition of disability) will be statistically likely to win.

Applying for disability in Missouri

This should begin with initiating a claim with an SSA field office. Disability claims can be filed online; however, this only allows a title II Social Security Disability claim to be taken. SSI disability claims cannot be taken online.

Since many claims will involve both SSD and SSI (called a concurrent claim), and, furthermore, since all disability claims for minor-age children are filed under the SSI program, it typically makes more sense for claimants to start the process at a local Social Security office.

Contacting a local Social Security field office will result in an appointment date being set for a disability application interview. The interview can be conducted in person. Or, in cases where transportation or physical mobility is an issue, the interview may be conducted over the phone. This may also be requested for claimants who simply prefer a phone interview.

In either case, however, starting the process at a local office, versus online, will allow a claimant to directly interact with the CR, or claims representative. The CR is the individual who will handle the intake portion of the claim and prepare it for delivery to a disability examiner at the state disability processing agency (usually known as DDS, or disability determination services).

The primary purpose of the disability application interview is for the claimant to provide all the information that is necessary to process the claim to a decision point. This means information regarding various sources of medical treatment (including names of physicians, dates of treatment, diagnoses made) and also information regarding one's work history (including job titles, dates worked, and duties performed for each job).

When your disability began determines how much back pay you receive

For medical information, the Social Security Administration should be able to gather documentation at least as far back as the AOD, or alleged onset date, provided by the claimant at the time of filing. This is basically the date the claimant states that they became disabled.

Note: When the evidence of the case confirms that the claimant was disabled as of the date that they alleged, the approval is considered to be fully favorable.

A fully favorable decision, of course, will typically mean a higher amount of disability back pay. It may also mean, in the case of title II SSD benefits (versus title 16 SSI disability benefits), that the waiting period for medicare coverage will be more likely to have expired, meaning the claimant will not have to wait for medicare coverage.

Additionally, the SSD, or Social Security Disability, program, unlike SSI, allows for up to 12 months of retroactive benefits. Retroactive in this case does not refer to backpay, but, rather, benefits that are payable up to 12 months prior to the date of filing. To reiterate, SSI does pay retroactive benefits.

Obviously, the ability of the disability claims examiner to obtain medical records as far back as possible will be very important, particularly when it comes to determining back pay. However, gathering this information will also be completely dependent on the extent to which the claimant has supplied accurate and detailed information--on the disability report form at the time of application--regarding their medical treatment history.

Regarding work history information, claimants should know that the requirements for disability in Missouri as an adult claimant involve the following:

1) Reviewing the medical records.

2). Determining the extent to which the claimant is functionally limited, both mentally and physically.

3). Comparing the residual functional capacity (this is a rating of the person's limitations, and is basically an assessment of what they are still capable of doing) to the demands of their past work, as well as the demands of other work that they might be considered capable of switching to.

In cases where the available evidence indicates that the claimant cannot perform their past jobs, or switch to some other type of work (based on the information revealed in their work history and medical records), they will meet the criteria and qualifications for disability benefits.

For a child filing for disability in Missouri, the process is identical; however, in place of using information obtained from a work history, a child's case often involves an evaluation of their school records to determine if they are capable of performing the same activities as their same-age peers.

Disability application denial rate: 69.5 percent.

Disability application approval rate: 30.5 percent.

Level II: Request for Reconsideration - Reconsideration is the first level of appeal in the SSA disability system. The request for reconsideration may be made after the denial of a disability application in Missouri.

It must be requested within 60 days (plus an added 5 days for mail time) of the date of denial of the disability application. This date is usually stamped in the upper right hand corner of the denial letter, or notice of disapproved claim.

Special Note: Individuals who submit a reconsideration appeal should make a copy prior to sending in the appeal in the event that the appeal paperwork is not received by Social Security. Also, a person who has submitted a reconsideration appeal should make a followup status call sometime within 10-14 days to verify that the appeal was actually received.

Appeals that are not received, or are received late, will require the claimant to start over with a new disability application which will be costly in terms of lost time. However, there is an additional cost to starting over with a new claim and that is the possibility of losing back pay benefits.

Claimants who are represented by a disability attorney or non-attorney disability representative will not have to contact Social Security to request an appeal since their representative will appeal their case for them.

However, it is a good idea to contact their representative after receiving their denial so they may verify that their representative also received a copy of the notice. Again, this will help to avoid a late appeal situation.

The disability evaluation process at the reconsideration level is identical to the disability application. For this reason, it should not be surprising that reconsiderations in most states have an even higher rate of denial.

Typically, an approval will not be made at the reconsideration level unless the second disability examiner discovers that the examiner for the initial claim made a clear error, or unless new and compelling medical evidence is obtained.

Claimants who are denied at the first appeal level should immediately the second appeal, the request for a disability hearing.

Note: Reconsideration appeals are presently suspended in the state of Missouri. Conjecture holds that the reconsideration appeal may return; however, currently, individuals who have been denied on a disability application may immediately file a request for a disability hearing.

Reconsideration appeal denial rate: 79 percent.

Reconsideration appeal approval rate: 21 percent.

Level III: Request for Hearing before an Administrative Law Judge - The disability hearing is the second Social Security appeal available to claimants in Missouri 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

1. How do I request a disability hearing? - To request a disability hearing, a claimant in Missouri need only contact the Social Security office where their claim has previously been handled. That office, upon request, will mail out the necessary paperwork to be signed and returned. Once the appeal forms have been received by SSA, the appeal will be processed.

Unlike the reconsideration appeal (which is assigned to a disability examiner at the state disability processing agency known as DDS, or disability determination services), however, this time the case will be transferred to ODAR, the office of disability adjudication and review. Or, simply, the hearing office.

Individuals who already have representation, provided by a disability lawyer or non-attorney disability representative, will most likely not have to submit the appeal themselves.

This is because once Social Security becomes aware of the fact that a disability representative is involved in the case, the representative will receive copies of whatever correspondence has been mailed to the claimant, including appointment letters for medical examinations, letters requesting that the claimant contact Social Security to provide needed information (known as call-in letters), and notices of decision.

Typically, once a disability attorney or disability representative becomes aware of a denial having occurred, they will submit the appeal paperwork to SSA, maintain a copy of the appeal paperwork for their office records, and also send a copy of the appeal to the claimant to maintain in their own personal records.

The attorney's office keeps a copy of all paperwork generated to a) later ensure that the work was actually done and b) to make it easier at later points to keep track of the status of the claim.

Having said this, though, anytime a claimant receives a notice of denial from the Social Security Administration, they should contact their representative immediately to notify the representative that the case has been denied.

This is because the representative's office may not have received their copy of the denial notice yet. And in a certain percentage of cases, they may not receive it at all (one of the benefits of having representation is that if two parties are designated to receive notifications from SSA, hopefully at least one of the parties actually will).

In any event, contacting the disability representative should help ensure that the appeal deadline is not missed. As stated, all disability appeal deadlines are 60 days (plus an added five days for mailing time) from the date of the last denial that occurrred on the claim.

2. What happens after the case goes to the hearing office? - At the disability application and reconsideration appeal levels, a disability case is immediately assigned to an examiner who will begin the work of evaluating the claim, including gathering medical evidence, speaking to the claimant regarding their activities of daily living, reviewing the work history, and consulting with a medical doctor and a psychologist who are part of the examiner's case processing unit.

At the Social Security hearing office, however, none of this occurs. This is because the main thing that a disability case does once it arrives at the hearing office is simply...wait. Hearing request appeals will ordinarily sit waiting for several, or many, months before the claim is scheduled for a hearing date, or even assigned to a Social Security administrative law judge.

Note of caution to unrepresented claimants at hearings: Because a disability case will sit waiting to be scheduled for many months at a hearing office, the medical evidence in the file will grow old. For SSA, all medical evidence in a file may be used to arrive at a decision.

However, older records establish when a condition began--which is important for establishing the onset date which helps establish how much a claimant may be owed in Social Security back pay--whereas an approval can only be made when "current" medical record documentation is in the file.

If there are no current records available, which would be true for any case that has been sitting at a hearing office for months, it will not be possible to qualify for disability and for benefits to be made payable. Added to this is the fact, which many claimants may not be aware of, that though Social Security will obtain the claimant's medical records and other evidence at the lower levels (application for disability), at the hearing level none of this case development occurs.

At the hearing level, the responsibility for obtaining recent and new evidence falls to the claimant, and to the claimant's disability lawyer or representative if they are represented.

The primary lesson to keep in mind is that claimants who intend to get disability representation should do so before the hearing is scheduled.

Claimants who do not intend to get disability representation, on the other hand, should obtain a copy of their disability case file, review the basis for the prior decisions (i.e. why they were denied disability benefits in the first place), analyze the medical and vocational evidence, determine what additional supporting evidence should be obtained, and then work to obtain this information--with important emphasis placed on getting an objective medical source statement from a treating physician.

To meet the qualifications for disability, the statement should list the claimant's current functional restrictions and prognosis and the doctor's opinion should be in line with their own treatment notes.

The difficulty for an unrepresented claimant, of course, will be timing when they obtain their evidence updates to when their hearing takes place. Improper timing will result in evidence that is obtained already being out of date by the time the hearing takes place.

Disability Hearing denial rate: 55.8 percent

Disability Hearing approval rate: 44.2 percent