Your Claims File
Social Security will base its initial decision and the first appeal of a denied claim solely on your claims file. We review our client’s claims file to find out why Social Security denied a claim, and what we need to hunt down to make the claim.
Here is a breakdown of the claims file contents:
Payment Decisions
If a client comes to us with an initial claim denial, the claims file will include a Disability Determination Explanation. This document explains why a claim was denied. It includes critical information like the alleged onset date, the conditions our client feels are disabling, a summary of the medical evidence, prior work experience, and an explanation of why the claim is disabled. Reviewing the Disability Determination Explanation is often the starting point for us in building a claim for the claim.
Jurisdictional Documents
This part of the claims file includes the letter that notifies a claimant of a claim denial. When a client retains our firm, our fee agreement and appointment of representative form are included in this part of the claims file.
Non-Disability Development
This part of the claims file will include information not directly related to a disability determination. For example, a claimant might provide wage information to show she is not working enough to reach the level of “substantial gainful activity.” Documents like this will be included in this part of the claims file.
Disability Related Development
Correspondence to and from the claimant, completed forms from the claimant or other witnesses, work history forms, and appeal questionnaires are all included in this part of the file. Social Security will also provide reports if a claimant has prior denied disability claims, or if there is work activity after the alleged onset date.
Medical Records
Medical records are the backbone of any Social Security Disability claim. This is because a claimant must show they have a “medically determinable impairment.” A medically determinable impairment is a medical diagnosis supported by objective medical findings.
Other Categories
Depending upon where the Social Security claim is in the appeals process, a claims file may include recordings of a Social Security Disability hearing.
Exhibit Files: Prior to Hearing
An exhibit file will contain everything in a claims file and more. An exhibit files prepared for an Administrative Law Judge prior to a Social Security Disability hearing. Exhibit files also contain detailed earning records and estimates of benefit amounts if the disability application is granted.
Our Experience
We frequently find that the medical records portion of the claims file is not complete. Often, medical records from a specific medical provider are not complete or are missing altogether. Social Security does not often follow up with providers that do not respond to medical records requests. Social Security will also not request older medical records that would help show a claimant’s disability. For example, many of our clients suffered on-the-job injuries and have workers’ compensation claim files that show long-standing permanent but partial disabilities. This is often relevant to determining our client’s residual functional capacity, and their ability to do any work.
Questions?
If you have a denied Social Security claim, contact us. We can open a file, obtain and review your file from Social Security, and let you know where you stand with the claim. Social Security will not let us charge a fee unless we obtain benefits on your behalf.
