The Disability Adult Report Appeal

Welcome to Season 1, Episode 12 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into the complicated topic of "The Disability Adult Report Appeal."

Join host Nancy L. Cavey, an experienced disability attorney, and associate attorney Krysti Monaco as they dive into the disability adult report appeal process. In a previous episode, they covered the disability adult report, and now, with over ninety percent of claims being denied initially, it's time to focus on the key to winning your appeal: getting your paperwork right. A denial doesn't mean you don’t qualify; in fact, most denials stem from insufficient supporting evidence. In this episode, Nancy and Krysti discuss strategies for effectively appealing a denied disability adult report and ensuring you have the necessary documentation to support your case. 

In this episode, we'll cover the following topics:

1 -  What Is the Disability Adult Report?

2 - Common Reasons Initial Claims Get Denied

3 - How to Fill Out the Disability Adult Report

4 - Mistakes to Avoid

5 - What Happens Next?

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


Need Help Today?:

Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.

Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Nancy Cavey [00:00:00]:
 Foreign. Welcome back to Winning Isn't Easy. Social Security Disability Benefits. This is a podcast where we break down everything you need to know about navigating the Social Security disability claim system. I'm your host, attorney Nancy Cavey, and I'm joined today by my associate, Christy Monaco. Now, before we get started, we've got to give you a legal disclaimer. The Florida bar says we have to tell you that this podcast is not legal advice. So we've said it, and nothing will prevent us from giving you an easy to understand overview of the Social Security disability claims process, the games that are played during it, and what you need to know to get the disability benefits you deserve.
 
 Nancy Cavey [00:00:53]:
 So off we go. Now, in the last episode, we talked about the request for reconsideration. Today, Christy and I are going to be taking a deep dive into the disability adult report appeal. And it's one of the most critical documents or forms that has to be completed when appealing a denied disability claim. So if your initial application was denied or rejected, we don't want you to panic. In fact, about 90% of claims are denied the first time around. But the key in part to winning your benefits is getting your paperwork right. Many people think that because they were denied, they were not qualified for benefits.
 
 Nancy Cavey [00:01:37]:
 Social Security does that to discourage you, really, from proceeding on your claim. And many times cases are denied because they don't have the right supporting information from you or your doctors or mistakes have been made in the forms that you have been submitted. So we're going to talk about this. Grab a cup of coffee, bring a paper and a pen because I want you to take some notes. And we want to get into this in some detail. We're actually going to talk about what this blasted disability adult report form is. Number two, the common reasons why that initial claim got denied. Next, how to fill out that disability adult report form.
 
 Nancy Cavey [00:02:21]:
 Mistakes to avoid in these forms. And then what happens next? We're going to cover a lot of ground here. So let's take a break, go get that cup of coffee, and we'll be back in a minute. Okay. See you in a minute. Welcome back to Winning isn't Easy. Ready to get started? You've got that pen, that pad, that cup of coffee. Okay, so, Christy, let's explain what's the adult disability report form.
 
 Nancy Cavey [00:02:59]:
 Sure.
 
 Christy Monaco [00:03:00]:
 Adult Disability Report Appeal form, which is actually officially known as SSA Form 3441, is the form that's going to be submitted when you file both a request for reconsideration and a request for Hearing in front of an administrative law judge. This form is going to update Social Security on any new medical conditions that you may have incurred since your denial, any new treatments or medications that you may have started, changes in your daily activities, progression of anything you may be going through that may further limit your ability to work. Think of this as your second chance to prove to Social Security that you do in fact qualify for these benefits.
 
 Nancy Cavey [00:03:45]:
 So this form is really important because Social Security evaluates disability cases based on current information. Current information. Okay. So if your original application didn't include enough medical evidence, this form gives you an opportunity to correct that and provide updates to strengthen your appeal. You've got to gather essential information to help you fill out this form accurately. And this includes dates of your recent and upcoming medical visits, contact information for any new treating physicians, any new diagnoses or the worsening of a condition that you claimed as the disabling basis for your inability to work, any earnings that you've had since the initial application. Now, many people say, look, I filled this out once. Why do I have to fill it out again? And the answer is, because you have to.
 
 Nancy Cavey [00:04:35]:
 And it makes a difference in whether you're going to win this claim or not win this claim. So we don't want you to ignore it, even if nothing has changed. Confirm all that the information that you originally provided is up to date. Now, most likely it's not, because if you were filing a request for reconsideration, you've probably been in this huge line for at least a year, maybe more. So things should have changed. So there should be updated information that you're supplying to the Social Security administration. And if you skip sections or you fail to submit the form, your claim is going to be dismissed. So think of it like this.
 
 Nancy Cavey [00:05:23]:
 You're in school. The teacher gives you an assignment, and you decide, we already covered that, and I did that in another paper, so I'm just going to ignore this particular question. Or, by the way, I'm just not going to turn in my homework. You know what happens, and that's exactly what's going to happen if you don't fill out this form correctly. Got it. Okay. Hopefully I made an impression here. Let's take a break and let's let that sink in before we talk about the common reasons initial claims get denied.
 
 Nancy Cavey [00:05:56]:
 Got it. We'll be back in a minute.
 
 Speaker C [00:05:58]:
 Are you considering filing for Social Security disability, or has your claim been denied already? Either way, you require a copy of your record rights to Social Security disability benefits, which will cover everything you need to know about the Social Security disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Nancy Cavey [00:06:22]:
 Welcome back to Winning Isn't Easy. Let's talk about the common reasons that initial claims get denied. Now, many people are shocked when their claim is denied because they think it's obvious that they are disabled. Well, obvious is not always obvious. And disabled is a term of art. In the context of the Social Security system, they use a five step sequential evaluation to determine your entitlement to benefits. And you can go back to earlier episodes and watch those episodes or listen to those episodes to understand what that five step sequential evaluation is. Now, denials don't mean you're not disabled.
 
 Nancy Cavey [00:07:01]:
 Denials mean that often your case wasn't strong enough on paper to establish that you met the five step sequential evaluation. So, Christy, let's talk about some of the common reasons claims get denied.
 
 Christy Monaco [00:07:17]:
 Number one, insufficient medical evidence. One, your medical records might not have clearly demonstrated the severity of your condition. Oftentimes, that's on you going to your doctors and saying, yeah, I feel fine or I felt okay, instead of actually talking about what you've been experiencing since the last time you saw your doctor. Oftentimes we're going every three to four weeks. We have flare ups, we have good days, we have bad days, we go to the physician, we forget all of that. We have to make sure that when you're seeing your physician, you are accurately discussing all of the good days and bad days. Right? You may have had a good day, you may have done the dishes and then you paid for it for the next three days. Those are the types of things you need to be making sure you're telling your doctor, Social Security Administration may not have actually received all of your medical records.
 
 Christy Monaco [00:08:04]:
 That's why it's smart to have a representative who's gathering your medical records throughout this process and ensuring that they're uploaded into your Social Security online records so that by the time it gets to Betty at dds, she has all the records. Or Social Security may have deemed your condition not severe enough to prevent you from working. Tip. If Social Security didn't obtain all of your records, you should follow up with your doctors to ensure that everything is submitted properly so that when your appeal is reviewed, they have the records for you.
 
 Nancy Cavey [00:08:33]:
 And of course, one of the things that we do is we actually submit the get and submit those records because we want to make sure that when Betty looks at this, Betty's got everything she needs. So, Christy, what about earnings above the appropriate limitations in A Social Security case?
 
 Christy Monaco [00:08:49]:
 Yeah, this is a big one. So when the field office is looking at your claim for non medical determination, they're looking about whether or not you've earned over what's called substantial gainful activity or sga. And we've done an earlier episode on what SGA is, so you can go listen to that. But if you are working over sga, they're going to assume that you can work. Now in the year of 2025, SGA limit is $1,620 a month gross benefit or gross income for non blind individuals and $2,700 per month for blind applicants. One thing that Nancy said earlier that I really wanted to expound upon is making sure that you're talking about income you have received on this disability adult report appeal since your initial denial. If you are receiving workers compensation benefits or long term disability benefits, you want to make sure you're including that income and providing explanation of benefits to to Social Security so that you can prove that income you're receiving is not earned. If it gets to the field office and they cannot delineate between the earnings they see, they're going to assume it's earned income and you're going to get what's called a technical denial.
 
 Christy Monaco [00:09:58]:
 Technical denials are the bane of our existence. And quickly I'll tell you why you get a technical denial, you have to file an appeal. If that gets denied again, you have to file a request for hearing. You then get to go in front of an administrative law judge and argue your technical denial. And if he says, or she says, you know what, we agree, this was not right. Guess what? You don't win. You go all the way back to the beginning where your denial happened and now they consider your medical evidence. So technical denials, we don't want them.
 
 Christy Monaco [00:10:28]:
 So you want to make sure that you're providing your representation with the EOBs for any income you may be earning so we can adequately explain to them this is not earned income. This is from a benefit plan that you purchased in the past and it's not money you're earning physically right now.
 
 Nancy Cavey [00:10:44]:
 So another huge mistake is the lack of follow up treatment. Not seeing a doctor on a regular basis can weaken and even kill your claim because Social Security relies on your medical records. Social Security is going to assume that if you're not getting treatment, you must be cured and you're able to work or your condition has improved. So that's not a good thing. However, I know that you may be having financial problems and having Difficulty paying to see a doctor. If you can't afford a doctor, look for low cost or free clinics in your area. Really consistent treatment is the key to providing your case and not getting that treatment is a case killer. Christy, talk about the application errors that we see and the impact of those, please.
 
 Christy Monaco [00:11:29]:
 Sure. So this is not only application errors, but appeal errors as well. When you're filling out these forms, missing details, providing incorrect information, or failing to list all of your conditions or all of your treating providers is going to lead to an automatic denial. Again, Social Security is not mind readers. So if you don't tell them about your physical therapy treatment, they're not going to request those records. If you don't put in the the information of what they're asking, they're going to assume it doesn't apply to you and then that's going to hurt your claim. So you want to make sure that you double check your appeal form and your application form and any other form for that matter that Social Security is sending you to make sure that you're not leaving anything blank or failing to put information in before you submit it to them.
 
 Nancy Cavey [00:12:13]:
 Okay. I remember this was in sixth grade a million years ago, and the teacher handed us an assignment and said, make sure that you read this assignment was an in class assignment before you start. Well, some people did, I read it, some people didn't and they started reading this assignment out loud. What the assignment was was, read this through and don't say anything. Okay? Be silent. So clearly the people who couldn't follow instructions made themselves look like fools. The same thing happens here. Double check your application for mistakes.
 
 Nancy Cavey [00:12:56]:
 Don't rush through it. Don't think that you have done this correctly. Put it aside for a day or two or have somebody else look at it before you submit it. So double check your application. Christy, let's talk about the system itself.
 
 Christy Monaco [00:13:12]:
 The system itself? Well, it was designed for individuals to be denied at the first two stages. Initial claims and appeal claims, request for reconsideration are reviewed by Disability Determination Services, dds, those claims processors. They're not medical experts. They're not medical professionals. They don't have any type of medical education at all. Those are the ones that are making the decision. Oftentimes they do have it reviewed by a medical professional, but when we get access to the file, we oftentimes find that those are not qualified medical professionals to be reviewing claims. We see pediatricians reviewing cancer claims.
 
 Christy Monaco [00:13:49]:
 We see gynecologists reviewing fibromyalgia claims. And that's just not Appropriate. So many deserving claims are denied because DDS staff lack the medical expertise to evaluate these complex conditions.
 
 Nancy Cavey [00:14:02]:
 Which is why, as part of our claims process, we gather all the medical records and submit them. Not leaving it to chance for Social Security to get the records. But we also use residual functional capacity forms for the appropriate medical condition. And we ask the doctor to quantify a person's physical, cognitive, and psychological abilities. Because again, Social Security is using the five step sequential evaluation. And so when Betty picks up this file, I want Betty to be able to understand logically why we meet the five step sequential evaluation and where that proof is in the claim. Got it. Okay.
 
 Nancy Cavey [00:14:41]:
 Remember that the appeals process is an opportunity to correct these mistakes and submit stronger evidence. Let's take a break before we come back and talk about how to fill out that blasted disability adult report. Welcome back to Winning isn't how to fill out that disability adult report Form. Okay. This is like doing your homework, and it's a homework assignment that's going to make your entire grade. Okay? You got one chance, maybe two, to get this right. So, Christy, let's walk people through the form step by step and explain what they need to do.
 
 Christy Monaco [00:15:30]:
 Absolutely. Updated medical records. You want to list every doctor, specialist, hospital visit, physical therapy, occupational therapy since your last application. You want to make sure that you provide the contact information and that the contact information is correct. That's the information Social Security and your representative is going to use when they request medical records. Now, I know our office will confirm that that address is correct, but I would bet my bottom dollar that Social Security is not. Is not confirming that that address is correct, and that's the address they're going to use. So if you provide an incorrect address to Social Security, they are going to request records from that address.
 
 Christy Monaco [00:16:14]:
 And when they don't get those records, unfortunately, you just don't have those records in your claim. Tip. Ask your doctors for written statements describing your limitations. It could be a letter or better or residual functional capacity form. And include that in with your medical records when they request the files from your physicians that will be included.
 
 Nancy Cavey [00:16:34]:
 Remember that if the doctor writes a report that says you're disabled, that's worthless. It's Social Security's job to determine if you meet the five step sequential evaluation, not the doctor. So as Christy has pointed out, we prefer the residual functional capacity forms that are applicable to your medical condition or a statement from a doctor that outlines things like how long you can sit, stand, walk, stoop, bend, how much you can lift. Do you have to take Breaks. Those are the kinds of things that will help the claims examiner analyze whether you can do your past work or other work in the national economy. So, Christy, let's talk about new treatments and new medications. What's important here?
 
 Christy Monaco [00:17:12]:
 You want to make sure that you're including any new medications, any new therapies, any new treatments, and specifically document any side effects, even minor ones. You may be taking a new medication and start to experience headaches, and you may think they're just headaches. No. Take those headaches into consideration. With all of your other symptoms, they could be impacting your ability to work. And Social Security is not going to seek out these side effects and medications you may be experiencing. So you want to be sure that you're including all of these on the form.
 
 Nancy Cavey [00:17:42]:
 Well, also, what's important is worsening symptoms. You want to detail how your condition has worsened in terms of your symptoms and functionality. You may have increased pain, increased spasm. You may have flares or other episodes of increased symptoms. So it's really important that you're giving a good interval history of not only the symptoms, what they are, but tie it together with your inability to do daily tasks around your home. So connect the back spasm, if you will, with a difficulty standing in front of the sink doing dishes. So you want to make sure that you're really talking about real life examples, dressing, cooking, you know, whatever it is. And again, we're pounding on this, but we want your doctor to complete a residual functional capacity form, which is a legal tool that will communicate your limitations to the Social Security in medical terms they understand.
 
 Nancy Cavey [00:18:42]:
 So you can see this is a team approach. You've got to give the right history so that Social Security can get the information they need. You need to give a right, an accurate, correct history, if you will, complete history to your doctors of symptoms and functionality, tying them together. And if possible, get that residual functional capacity form that will document your physical restrictions, limitations, any cognitive restrictions you have, any psychological restrictions, so that when that claims examiner finally looks at the claim, they can see why you meet the five step sequential evaluation. And as part of that team, we think you should have an experienced Social Security disability attorney. All right, let's take a break for a moment and we're going to come back and talk about the mistakes to avoid. See you in a minute.
 
 Speaker C [00:19:34]:
 Struggling with your Social Security disability case. The right attorney can make all the difference. Get our booklet the key to hiring a great attorney for your Social Security disability case. Discover how to find an experienced attorney who will fight for your rights. And navigate the process with ease. Don't leave your future to chance. Request your free copy@kvlaw.com today and ensure you have the expert support you deserve.
 
 Nancy Cavey [00:20:02]:
 Welcome back to Winning Isn't Easy. Let's talk about the mistakes to avoid that can seriously damage your appeal and even destroy it. So Christy, let's talk about what people need to avoid at all costs.
 
 Christy Monaco [00:20:18]:
 I feel like a broken record, but I'm going to say it again. Leaving sections blank. You do not want to do it. You want to fill out everything that applies to you. And if it doesn't apply to you, one, you should be asking a representative first if it doesn't apply to you, but if you get confirmation it doesn't apply to you, then you can simply put NA instead of leaving it blank. If you leave it blank, it leaves Betty at DDS to her imagination as to what the answer of that question is. And we don't want Betty to use her imagination Downplaying your condition this also goes with exaggerating your condition. Remember Nancy talked about consistency in last week's episode? We want to be consistent on our forms.
 
 Christy Monaco [00:20:59]:
 We want our medical records to be consistent. So you want to be detailed and honest about your symptoms instead of exaggerating or downplaying them.
 
 Nancy Cavey [00:21:08]:
 Now, some people will downplay mental health issues such as anxiety, depression and post traumatic stress disorder. In my experience, they are just one factor in deciding whether or not you're to your Social Security disability benefits. And so we want to make sure again that you're documenting in your medical records the symptoms you're having, the impact they have on your function, and hopefully having your doctor complete that residual functional capacity form. If you are having physical issues, I think that it's really important to keep a symptom journal documenting those struggles because it can help provide a clear timeline of your worsening conditions. So, for example, if you have migraines, we want to know how often you have the migraines. What is a migraine like, as stupid as that question may sound? So what are your symptoms? How do those symptoms impact your function? Are you in a cool, dark room? How long are you in that cool, dark room? How do you feel after the migraine? What's the pattern? If there is, what is your response to treatment that will help tell the story of your symptoms and functionality? Your medical record should be telling that story. And ultimately, if you're in front of a judge, your testimony is going to tell that story and that story, again, should be consistent. Got it.
 
 Nancy Cavey [00:22:29]:
 So let's take a break and then we're going to come back with the question of what happens next. See you in a minute. Welcome back to Winning isn't Easy. Let's talk about what happens next after you submit that form. And one of our favorite topics these days is that consultive exam. So, Christy, let's talk about what happens and consult of exams. Sure.
 
 Christy Monaco [00:23:04]:
 So Social Security is going to begin to review your appeal. If they feel that the medical records are insufficient or they didn't get the medical records, you might be scheduled for a consultative examination. That is going to be an examination, medical examination, either physical or mental, by a doctor hired by Social Security. Now, Social Security rules say that if your doctor is willing to do the consultative examination, that Social Security should schedule it with your own physician. So one thing we are asking all of our clients to do is find out if your doctor is willing to do a consultative examination and complete Social Security's form and return it back to Social Security. If they are and we get a CE notice, we're immediately objecting to that notice, requesting Social Security to schedule it with our client's physician providing that information and instructing our client not to go. What can you expect at a consultative examination? This is one of the hardest questions I get as an attorney. I don't know.
 
 Christy Monaco [00:24:04]:
 I get feedback from all of our clients that go to consultative examinations. Some examinations lasted five minutes, some of them lasted 10. Some lasted over an hour. Some doctors did physical examination, some doctors didn't. Some doctors sent them for X rays, some didn't. There's really no way for us to tell exactly what they're going to do. But most of the time, these doctors are going to focus on your most limiting symptoms. They may conduct physical testing.
 
 Christy Monaco [00:24:29]:
 They may send you for an X ray or an mri. But one thing you want to make sure that you do, and this is another positive or pro to having a representative, is we can see what information Social Security is sending to that consultative examiner. We can object if we think that that piece of medical evidence they sent isn't relevant to the conditions that they're asking this consultative examiner to review. We can object. We don't think that that consultative examiner has the qualifications to do this consultative examination. The list goes on and on. So it is important that if you are doing this on your own, that you seek out some help or ask the questions of Social Security as to what was sent so that you can make sure that you're representing yourself or that you're being adequately represented.
 
 Nancy Cavey [00:25:12]:
 Now, you do need to understand that unless your treating Physician agrees to do the CE exam and Social Security accepts that you've got to attend the CE exam. And if you don't, automatic denial. And I will tell you, we obviously will file an appeal. But if you get in front of a judge, the judge is not going to be very happy that you didn't cooperate with this ce and they may just deny your claim on that basis alone. So we lawyers will object to CES if we think the doctor isn't qualified, doctor didn't have enough medical records or they conducted themselves improperly in the course of the exam. That's for us to do. That's not for you to do. We actually ask our clients to complete a form after the CE telling us what happened and as need be, we'll file it with the court.
 
 Nancy Cavey [00:26:06]:
 So you've got to attend. Your lawyer or your representative is the person who will be making the appropriate objections. It's not your job. Okay, so, Christy, let's talk about what happens again. If you are denied at the initial application stage and the request for reconsideration stage, what's next?
 
 Christy Monaco [00:26:25]:
 Well, Social Security loves to repeat forms. So guess what? You're filling out the same disability adult report appeal form for your request for hearing. At that point, you're requesting to go in front of an administrative law judge. And honestly, this is your best chance to win. Unlike DDS reviewers, the ALJs carefully examine your medical records. They understand most medical conditions and they understand Social Security law. They're going to hear your testimony, review your forms, review whatever your representation sends in, and that is going to be your best chance for winning.
 
 Nancy Cavey [00:26:58]:
 And of course, as attorneys, we're also submitting a brief to the judge explaining why you meet the five step sequential evaluation. We prepare our clients for hearings. We do that with two videos. One is a hearing about a mock Social Security hearing, so you get to see what one looks like. And we do an hour long video where we go through all the questions that a person potentially could be asked with an explanation as to how you tell your story truthfully, but in a way that Social Security can understand. And then we do a prep session where we go through the logistics of the hearing, but we play the judge and you play you, and we practice these questions and answers. We also require our clients to do what's called a direct exam and symptoms and functionality worksheet. We want our clients to take the time to think about the answers because ultimately, you know, this hearing is only going to last 45 minutes and you're probably going to be testifying for 30.
 
 Nancy Cavey [00:27:56]:
 So there's a lot to cover in a short period of time. So we want you to be writing down this information because we use it in trial also. So understand that you're just not going to waltz into a hearing and think that you are prepared that a judge is going to award benefits just because you're there. That doesn't happen. Okay. Preparation is the key from the beginning of the initial application process to appearing in front of a judge. Got it. Well, that's it for today's episode.
 
 Nancy Cavey [00:28:25]:
 Completing the disability adult report appeal forms. I know it can feel overwhelming, but providing thorough, accurate information and strong supporting documentation is the key to winning your case. Attention to detail makes a difference. This form is an opportunity for you to strengthen your case and address any gaps from your initial application, from the request for reconsideration to the request for hearing. Yes, it's the same form. Yes, they're asking for the same information, but it is crucial. Okay. You don't skip a homework assignment and expect to get an A, do you? If you have found this episode helpful, please like it and share it.
 
 Nancy Cavey [00:29:08]:
 Don't forget to subscribe to our podcast for more expert tips on navigating the Social Security disability claims process. And if you have any questions, give us a call at 727-894-3188. Thanks for listening and we will see you next time where we're going to discuss more forms. The function report. Got it. Thanks.