FORMS, FORMS, AND MORE FORMS
Your DDS specialist will ask you for a whole lot of information when they are assessing your disability claim. He or she will want to know about your day-to-day ability to function, your work history, details about any specific medical conditions, who all lives in your household with you, the list goes on. Your specialist will be mailing you forms to complete about some of this information. Warning: many of the forms are lengthy and ask for a lot of detailed information. The manner in which you complete these forms can have a huge impact on how your case gets decided. Before I discuss a couple of the forms specifically, there are a few basic things to keep in mind:
- Don’t Expect Your Attorney to Complete the Forms for You.
People hate paperwork. Our clients often call our office and are aggravated because they’ve received an envelope full of paperwork from DDS. They don’t want to complete this pile of paperwork and want us to do it for them. While we love helping our clients and certainly wouldn’t mind completing the paperwork in theory (they did hire our office to handle the claim, after all), these forms are not designed to be completed by attorneys. Your attorney will not possess the level of knowledge about you that is needed to effectively complete them. How is your attorney supposed to know the heaviest weight you lifted at every job you’ve had in the last 15 years? Or whether you had to complete reports on that job? Or how often you shop for groceries? Or how often you go outside? I have heard from people who worked for Social Security that when they receive one of these forms and it’s been filled out by the claimant’s attorney, they are suspicious of the accuracy of the form and usually end up ignoring it. While we are always available to answer questions and give advice about completing these forms, it’s ultimately best for the client’s case if he or she completes the forms on their own.
- Don’t Disregard the Forms
One of the most common reasons that your DDS specialist might deny your claim is because you didn’t send your paperwork back in. If your specialist doesn’t get the paperwork back, they can simply say they don’t have enough information to make a decision on your case and deny it based on “insufficient evidence” or “lack of cooperation.” This happens a lot. Almost once a week I run across a case where the person’s application was denied for this reason and often, the application would have likely been approved had DDS gotten the requested information back. Fill the forms out and send them back asap. And if you are confused about how to answer something and you have an attorney, call and ask them about it. If you have trouble reading/writing, get help from a family member or let your attorney know so that they can arrange for you to give this information to your DDS specialist over the phone. Whatever you do, don’t ignore the forms, or your case might end up taking much longer than it has to.
THE WORK HISTORY REPORT
One of the forms that tends to trip people up the most is the Work History Report. The Work History Report asks you to list all of the full-time jobs where you’ve done substantial work in the last 15 years and describe the duties and physical demands of each job in detail.
I cannot overstate how important this form is. For applicants that are 50 and older, this form is even more important because of the Grid rules. I’ll get into the Grid rules in another post, but for now what you need to know is that if you are 50 or older, there are special rules that take into account age, education, past work experience, and the ability to adjust to other jobs that may be less physically demanding. The Grid rules often make it easier for people to qualify for benefits. I cannot tell you how many times that my client and I won in court under the Grid rules after clearing up the client’s work history in front of a judge when the client had filled out the Work History Report incorrectly during the application process.
Below are some of the most common mistakes we see on the Work History Report.
- Including Jobs From More Than 15 Years Ago or Incorrectly Reporting the Duration, Hours, and Pay of a Past Job.
When trying to decide if a person could return to any of their past jobs, Social Security looks at all of the jobs the person has worked in the last fifteen years. In order for Social Security to consider a past job in its analysis of a case, the claimant must have worked there for long enough to actually learn how to do the job and earned substantial income at the job. Social Security sets the amount that they consider to be substantial and it changes every year. For 2020, the amount is $1,260/month pre-tax. Generally speaking, Social Security won’t consider part-time jobs or jobs that a person only worked for a short time when deciding whether a person could return to past jobs.
It is common for a claimant to struggle to remember the details of his or her work history from 10-15 years ago, especially in cases where the person has moved or changed jobs a lot. We often have cases where our client inadvertently reports a job they did more than fifteen years ago or incorrectly states that they worked full-time at a part-time job. While it may seem like a harmless mistake, these types of inaccuracies can lead to the denial of an application that would otherwise be approved.
Example: Sally is 57 years old. She has worked in the same factory for 35 years in a job that required heavy lifting. She develops arthritis in her knees and can’t handle the job any longer, so she quits. After she stops working in the factory, she gets a cashier job at Dollar General where she works about 30 hours a week making $8/hour. There are a couple of weeks where another employee is out of work and Sally covers some extra shifts, working 40 hours. After six weeks on the job, Sally decides that even this part-time work is too strenuous for her and quits. She then files for disability benefits. She lists both the factory and the Dollar General on her Work History Report. She reports working 40 hours per week at the Dollar General since she did work 40 hours on a couple of occasions. She cannot remember the exact date she was hired so she quickly jots down that she worked there for about three months. DDS decides she is limited to light duty because of her knees. That clearly rules out the factory job, but DDS denies her claim anyway because she should still be able to do her past work at Dollar General. Sally did not even work full-time at this job and did not earn enough money there for Social Security to count it as a past job that she could return to, but her DDS specialist relies on the information provided in her Work History Report and issues the unfavorable decision based on Edna’s representation that she worked 40 hours per week at $8 per hour, earning $1280 per month. Had Sally clearly indicated that she only made $240/week at this job during all but two weeks and only worked there for six weeks total, DDS would not have considered her job at Dollar General and her case would have been approved under the Grid rules.
I’ve seen scenarios like Sally’s play out many times. To avoid being denied like Sally was, make sure your Work History Report is as accurate as possible. Try to round up old resumes, tax records, and bank records; log into your online account with SSA; and talk to your family and friends about what they remember about your job history. If you only worked somewhere for two months, make sure that’s clear on the form. Verify that the hours and wages you worked are accurate. It’s better to spend some extra time checking and making sure the numbers, jobs, and dates you report are correct than to take a wild guess and pay for it later.
- Understating the Physical Demands of a Past Job
Generally speaking, for cases that may be analyzed under the Grid rules, the more physically demanding your past work is, the better shot you have at getting your application approved. That’s why it’s crucial that you are as specific as possible about the physical demands and duties of each job you’ve listed on your Work History Report. Your DDS specialist takes the information from the Report and tries to match your job up with a job that’s listed in the Dictionary of Occupational Titles (the DOT for short). The DOT is a big book of jobs that Social Security uses that describes the duties, skill level, and physical demands of most imaginable jobs. If you are not specific enough about the duties and physical demands of your past jobs, your DDS specialist might mis-categorize your past jobs and find that a specific job was much easier than it actually was, leading to an unnecessary denial.
Example: Phil is 60 years old. He has worked in the same automotive plant since he was 25 years old. His job requires that he lift parts on an assembly line weighing 35-40 lbs off and on all day. Phil hurts his back and takes early retirement from the plant. He also files for disability benefits. Phil is annoyed with all of the paperwork he is being sent and completes his Work History Report in a rush. He has never really thought about how much the parts he lifted actually weighed, and he hurriedly checks a box saying the maximum weight he lifted was 20 lbs. DDS finds that Phil is limited to light duty. Because he reported lifting only 20 lbs in the auto plant, DDS finds his past work to be light duty work, concludes he should still be able to do that kind of work, and denies his application. Had Phil only took the time to think about how heavy the parts actually were and checked the right box, his claim would have been approved.
I often see Work History Reports where the person reported doing something very physically demanding, such as pouring concrete, but reported they never had to lift anything heavier than 10 lbs on the job. Take your time and really think about what you did on each job. Think about the hardest parts of the job and the duties that were difficult for you. Be specific.
As you can see, being accurate and specific is the key here. Don’t get denied because you rushed through the Work History Report. If you are willing to spend a little extra time on your Work History Report, you may avoid ending up like Phil.
THE ADULT FUNCTION REPORT
The other form that DDS sends in every case is the Adult Function Report. This form is more straightforward than the Work History Report because it contains questions about your current ability to function on a daily basis—your ability to complete household chores, do yardwork, and shop for groceries. The two biggest mistakes I see with this report is when people either understate or overstate their abilities.
Example 1: Jimbo files for disability. He has numerous chronic conditions. He’s had two lumbar fusion surgeries and isn’t able to walk really well, he’s had pacemaker put in recently, he has severe arthritis in his right shoulder, he is diabetic and requires insulin to control his blood sugar. Up until the last year or so, Jimbo has always worked and been very active. He doesn’t like admitting that his health isn’t great and he is embarrassed that he’s filing for disability. He receives his Function Report in the mail. Jimbo states on the function report that he mows his lawn, walks two miles every day, does all the chores in house, and babysits his small grandkids. In reality, Jimbo rarely feels like doing any of these things and is lucky if he has two days in a month where he can be this active. But Jimbo does not want to admit how limited he is. While there are a ton of medical records showing all of Jimbo’s health problems, DDS takes one look at his Function Report and concludes that his medical problems aren’t stopping him from doing his normal activities. They deny his claim.
Example 2: Edna applies for disability benefits. She has rheumatoid arthritis and depression. When she fills out her function report, she states that her pain is constantly a 10/10, that she rarely gets out of the bed because she’s in so much pain, and that she can’t even lift five lbs. While it is true that Edna has several days each month where this is the case, she also has good days where she feels great and can be productive. DDS gets the records from her therapist and reads that she’s been stressed out because she’s been providing care for her elderly mother that had a stroke and that she recently started taking a salsa dancing class. Edna’s credibility with her DDS specialist has now gone out the window. DDS denies Edna’s application because the limitations she reported are not consistent with her medical records.
The errors that Edna and Jimbo made on their Function Reports will follow them to their hearing with the judge, who gets a copy of it in the hearing file. It will be up to Edna, Jimbo, and their attorneys to try and clear up any inaccuracies in Function Report during their respective hearings. Don’t be like Edna or Jimbo. Fill out your Function Report in a way that is accurate and fair. If you have good days and bad days, make that clear and state how many of each you normally have in a week. Do not overstate your abilities or your disabilities.
These forms are an important part of your claim. The most important thing is that you complete them and turn them in. But almost more importantly, you need to do it accurately.
Once your DDS specialist has gathered all your medical records and received all of your completed paperwork, he or she still may not have enough information to decide whether or not you qualify for benefits. Social Security rules provide that in this situation, DDS can order a Consultative Examination (“CE” for short) so that an outside doctor can evaluate you. Obviously, the CE is very, very important to your claim. Chapter Four is all about tips and information about CE’s.