If you live with bipolar disorder, you often experience shifts in your conduct, energy, and mood, making keeping a job challenging. Since the symptoms of this mental health condition can affect your daily functioning, you might qualify for Supplemental Security Income benefits. Regrettably, the Social Security Authority denies most applications because you have failed to follow the recommended treatment. A denial is not always the end; you can file an appeal. A lawyer can help you adhere to deadlines and strengthen your claim using persuasive medical proof to increase your chances of success.
A Brief Overview of Social Security Disability Benefits for Bipolar Disorder
If you live with bipolar disorder, you might experience episodes of manic conduct that alternate with episodes of depression.
Bipolar disorder can be a disabling mental health impairment. To obtain disability benefits, you should prove beyond a doubt your diagnosis. You should provide proof that the condition is so severe that you cannot function effectively to work full-time for a year.
You can get the disability after requesting an appeal hearing before an administrative law judge. The process can be lengthy. You can obtain disability in any of the following:
- You have met the requirements of the listing for bipolar disorder in the Blue Book
- You have a residual functional capacity restriction that rules out every job
To be eligible based on your bipolar disorder diagnosis, the medical records should document more than three (3) of the symptoms below:
- Swifting thought patterns quickly
- Exaggerated self-esteem
- Distractibility
- Reduced need for sleep
- Increased goal-directed activity or physical agitation
- Engaging in risky conduct without knowing the painful repercussions
You should also demonstrate that the symptoms lead to a loss of capabilities in the given areas of your mental functioning.
You must prove that you have more than a severe (marked) limitation in two or an extreme limitation in one of the areas below:
- Managing yourself or adjusting to change (knowing how to evade hazards, practicing proper hygiene, and having reasonable personal skills)
- Focusing on and completing tasks
- Using, understanding, and remembering information
- Interacting with other people using socially appropriate conduct
If you cannot prove that you are currently losing these abilities because you have been residing in a well-structured environment, undergoing therapy, or in a protected setting, you can be eligible for benefits after proving that you have minimal ability to adjust to demands that are not in your everyday life or changes in your environment.
Proving Bipolar Lowers the RFC
If the SSA does not believe that you have adequate proof to satisfy the bipolar disorder disability listing, it will decide your work abilities and limitations. The process is known as reviewing the mental residual functional capacity. If you have bipolar, the RFC will include explanations of how you can interact with others, your capacity to withstand stress, your reliability in attending work, and your communication skills.
If your bipolar symptoms are more invasive, the more restrictions you have in the RFC. The more limitations you have in the RFC, the higher your chances of being found disabled.
Ensure you inform Social Security about the healthcare providers you have sought medical attention from for the bipolar symptoms. Even signs and symptoms that might seem trivial in isolation, when integrated with other restrictions in the RFC, can increase the possibility of a successful bipolar disorder disability claim.
Defining Failure
The SSA can decide that you have failed to abide by your prescribed treatment if all the conditions below are true:
- The proof proves that your impairment precludes participating in a substantial gainful activity
- The condition is anticipated to endure for a year from the beginning of bipolar disorder disability or has lasted a year, or can lead to death
- A medical practitioner has prescribed treatment that can restore the ability to participate in an SGA
- There exists evidence that you have refused to comply with your prescribed treatment
A treating source is a licensed physician who provides your medical care. If you do not have an attending doctor, the treating physician in a healthcare facility where you go for medical attention will be deemed a treating source.
A disability determination services (DDS) physician is not your treating source. Additionally, a physician with whom your relationship is a consulting examiner is not your treating source. Consequently, if a consulting examiner establishes bipolar disorder disability and suggests that certain treatment can restore the capability to participate in an SGA, the SSA should not deny your claim for failing to abide by the treatment.
Although it is your treating source that should prescribe treatment for the subject of failure to arise, the SSA decides whether the prescribed treatment could restore your capability to work. The SSA can consider your treating source's opinion on whether the prescribed treatment will restore your ability to work. If the SSA thinks the treatment will restore your ability to participate in an SGA, but the treating source has not prescribed it, the SSA will make a determination of allowance, and the DDS will refer you to a vocational rehabilitation agency.
If your treating source has recommended your treatment, anticipated to restore your ability to participate in an SGA, but you are not undergoing the treatment, the SSA should make appropriate development to assess whether you are justified to fail to undergo your prescribed treatment.
You should be allowed to explain why you have refused to follow your prescribed treatment. The SSA will ask you whether you understand the type of your treatment and its prognosis with or without your prescribed treatment.
Once you have documented your statements regarding the treatment refusal, the SSA will contact your treating source to verify what you were told. The type of details obtained from your treating source varies considerably based on the facts of your bipolar disorder disability case. For example, if you claim that the medical practitioner advised that you are less likely to obtain a good outcome, the SSA will ask your treating doctor whether they told you about your prognosis with or without treatment. The SSA will also ask about how you reacted to accepting the treatment.
Below are circumstances when your failure to abide by your prescribed treatment can be considered justifiable:
- Accepting your prescribed treatment is contrary to your religious teachings—The SSA will require you to identify your church affiliation. The agency will also obtain a statement from members of that religious order or from church authorities to verify that you are a member of that church. The agency will document the church's opinion on medical treatment by obtaining statements from church authorities or by citing church literature on the church's teachings
- You cannot afford your prescribed treatment, which you are willing to accept, and there are no free community resources available
- A certified treating source who has treated you advises against your prescribed treatment for bipolar disorder. In other words, the matter of the failure should not arise if you have two treating sources with different opinions on your treatment, one advising against it and another recommending the same treatment
The Appeal Process
If your application for bipolar disorder disability benefits has been denied, you can bring a disability appeal. The notice the Social Security sends you after denying your disability benefits will entail details on how to appeal that decision.
You should file your appeal within sixty days of when you received the notice. Additionally, you should comply with the instructions in your denial letter.
There are 4 (four) levels of bipolar disorder disability appeals. At every phase, you have two months to submit the appeal to move to the subsequent stage. Most bipolar disability claimants are denied on their initial attempt. Therefore, you are likely to be denied more than once, so you should wait for some time before the next determination.
Request for Reconsideration
Once the SSA refutes your first application for bipolar disability benefits, your initial appeal is requesting the Social Security Administration to review the denial. It is known as reconsideration.
Reconsideration is defined as a thorough analysis of the claim that happens at the DDS stage. DDS is the phase authority that processes local cases for federal bipolar disorder disability benefits. While DDS issues the first denial, a claim examiner and a health consultant who were not part of the first decision perform the reconsideration.
During the reconsideration, the DDS reviews every piece of proof considered in the first determination alongside new proof, including recent hospitalizations or medical examinations that the DDS acquires or you submit.
The first denial notice contains a paragraph about bipolar and details on your entitlement to request reconsideration. You can file your request for reconsideration either by printing the relevant form, completing it, and sending it to a nearby SSA office or by filing online.
You can expect to know of the decision at the reconsideration approximately five (5) months after the initial denial notice.
Typically, prevailing at this stage is difficult. Most claimants have not corrected the errors in their applications that led to the initial denial, and it is less likely that new medical evidence will sway examiners. You are more likely to file another appeal. It takes approximately nine (9) months from when you request the hearing until the date the hearing is scheduled.
A Hearing Before an ALJ Appeal Level
If the Social Security Authority denies your bipolar disability benefits again, you should next request a hearing with the ALJ. You achieve this by filing Form HA-501 with the SSA office.
The examiners at this stage do not work for the California DDS offices but for the Social Security Office of Hearings Operations. The judge at the OHO handling cases in your area will handle your disability case.
The hearing can be conducted by videoconference, over the telephone, or in person. You can choose your preferred manner of hearing appearance. During the hearing, you should persuade the ALJ why they should deem you disabled.
After the hearing, you should wait for the ALJ to make their decision. You will receive it by mail about three months after the hearing.
Appeal Council Level
If the ALJ renders a negative ruling, you can request the Appeals Council to review the decision. You can achieve this by filing Form HA-520 or submitting your request online.
It takes a year to receive a decision on the analysis request. Typically, the Appeals Council denies the requests because it gives the ALJ the leeway as the trier of fact who has spoken to you, questioned you, and seen you. The trier of fact is a person who listens to the evidence and decides the disputed facts. The appeal council does not analyze disability claims unless the judge made a reversible error.
A reversible error is a mistake that would alter the results of the disability case if the ALJ had not made it. The error can be substantive, including ignoring essential medical proof, or procedural, including failing to give you adequate notice before your hearing.
If the Appeals Council determines that the administrative law judge committed a reversible error, it will remand the bipolar disability case to the ALJ with guidelines for the issues to be reviewed.
Federal Court Level
The appeal council is the final phase of administrative appeals; there exists no additional action you could take within the SSA to get this authority to grant you the bipolar disability benefits. If the appeal council did not review your case, you can appeal the claim further by filing your claim with the federal district court.
The judges listen to bipolar disability claims without juries. The judges utilize the Federal Rules of Civil Procedure to analyze the claim for legal mistakes. While you are likely to prevail on appeal at this stage, especially if you are pursuing a termination of disability benefits, it is lengthy and costly, making it the wrong option for many claimants.
Deciding Whether You Should File an Appeal
Before you bring an appeal, thoroughly analyze the denial notice. The notice will discuss why the SSA denied the claim with reference to bipolar disorder and the medical records the SSA considered. You can request your file from the SSA so that you can analyze a more comprehensive technical rationale for denying you benefits.
When analyzing the decision, search for incorrect opinions or statements that you can challenge on your appeal. For instance, were there essential medical records that the SSA failed to include in its denial decision? You are likely to win the appeal if you find the material mistakes the SSA made.
Generally, it is sensible to appeal the denial. Filing the appeal will not cost you anything, and you can get benefits after you have appealed at the hearing level. Nonetheless, there are other factors to consider when determining whether you should bring an appeal.
Find Competent Legal Assistance Near Me
The SSA recognizes bipolar disorder as a disabling mental health condition per the Blue Book. However, it denies most disability applications. The denial is not the end; you have a right to appeal the case. Leland Law, a California-based law firm, can review your denial letter, collect convincing evidence, and help you file an appeal. We can also guide you through your appeal process. Please call us at 866-449-6476 to schedule your consultation.
