Remember our last post about the Top 13 Reasons Your Social Security Case Is Being Denied And What To Do To Improve Your Chances At Winning (see here)?
Now we will be going through each of the 13 reasons one by one so you can understand and hopefully minimize some of the possibilities of any of these happening to you and if they do happen, what you need to do to fix it.
Today we start with the number one reason for denials: 90% of cases are denied in the first try. What to do?
Appeal it. Do not let it go or reapply later. Time goes by and you may get approved on the next round (see below about this step) or by a judge on the third round.
A lot of people simply don’t follow through and give up after reading the “denial” letter. What you don’t know is that a lot of those letters are similar in content: they are what we call “cookie cutter” letters. They all say something like “we see that you have some limitations but we think you can do some work”. I have read denial letters that practically said “even though you are lying in a coffin we still think you can work”! (not in those words but pretty close!). So if you get a denial, don’t give up! It’s not personal. They did not specifically write that entire letter for you. They just insert some language to a “canned letter” and voila: a denial letter is done.
Realize that these are just letters that are sent to you hoping you simply accept their reasons for denial and go away. Also realize that people who have received these letters and appealed somehow have obtained benefits. Why? Because the lower level decision makers were either not qualified to make that decision or were simply dead WRONG! I even warn all my potential clients who are still in the application process that they will get denied on their first try. I tell them I hope to be wrong but that they should consider the first denial as “part of the process”. I know it shouldn’t be like that if you have enough evidence to show you have a disability but it’s just the way it is. Now you ask, as an attorney why do I accept that as the norm? Because I’m only one and you are a voter and it should be your civic right and duty to contact your congressman/woman to change that. Until then, we work we what we have.
Now, on the second run: First, note that not all States have this second step. In a lot of States once you are denied you can go straight to requesting a hearing. But if your State is one that has the reconsideration step after the first denial then you will be requesting a reconsideration (pretty obvious name for it). So where States give you that extra change at a lower level reconsideration, your chances of getting benefits increase a little more (though not a promise at all). This is a step (where available) they are more likely to send you to medical reviewers or consultative examiners who will examine you in person and will confirm what they saw on paper. They will also do a better job at looking at your medical evidence.
Other times, unfortunately, the doctor will look at you for 5 minutes, will have you hold his/her finger for a second to show you have enough strength to grip and will also have you walk down a hall on the tip of your toes to show you can still balance. The doctor will then conclude that you can sit for 6 to 8 hours a day, lift up to 20lbs occasionally which means you can do a “simple job”. Whatever that means…
Occasionally, you see claimants with mental conditions that were sent to a “physical doctor” or a claimant with a physical condition sent to a “mental doctor” for assessment. Why? I don’t know. It makes no sense to most people. They just do it. Of course, as attorneys we will use those mistakes to try to reverse these denials based on this limited examination of the claimant but sometimes that chance only happens at the hearing level when you were denied twice (see re States with that extra step) and waited many months to see a judge.
The hearing level comes after the Reconsideration period (As mentioned above, see if your State offers that step). Once you request your hearing your file will leave the “local office” and will be sent to the ODAR or the “hearing office”. Once they get your file, the hearing office will organize your electronic file however there is one MAJOR consideration when your file reaches the hearing office. While during the first (filing of the case) and second round (first appeal-if availalbe) the “local office” will order medical records from your doctors, the hearing office (after the second appeal-if available) will no longer order records. This means that it is YOUR duty to get copies of your medical records from all your doctors and send them to the hearing office.
DO NOT count on the hearing office doing that for you. A lot of people go to these hearings thinking that the hearing office ordered records from their doctors. Or worse, somehow claimants believe that because they once had some treatment but no recent treatment, these claimants believe these records on file will be enough to prove disability. Remember and memorize: no treatment equals improvement in the eyes of Social Security!! Even if you’re not better. Even if you don’t have insurance. It doesn’t matter. If you are sick and disabled and you are not treating with doctors (and I mean, Specialists in your medical impairment(s) this will be seen as “it’s not as bad because if it were you would be seeing doctors”. So pretty please. As you are seeing doctors, you need to order records from the time of disability to the time of the hearing so your file is completely up to date when you finally get your day in court.
Here’s a handy flow chart to follow so you can get the big picture of the disability process (remember: some States do not have the Reconsideration process!)
If you have questions about this process, feel free to put it in comments but you must be aware that an attorney/client relashionship is not being established, nor that this content constitutes legal advice. Also note that because the comment section is not private any information you post will be public and anyone can see it. If you have questions that you wish to keep private you can certainly consult with a local attorney.
Join us next time when we talk about item 2 of our Top 13 Reasons Your Social Security Case Is Being Denied And What To Do To Improve Your Chances At Winning.
Today I will give you the short list of the top 13 reasons for denial of benefits and a very short tip on how to fix each one and in the next few posts, I will explain each one in more detail. Remember that this list is not exhaustive. There are many other reasons for a claim denial but these are the most common. So here it goes:
top 13 reasons for DISABILITY DENIaL
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1) 90% of cases are denied in the first try. Don’t give up. Appeal it!
2) It could be your medical records. Get your doctor to describe your medical issues better.
3) You are not receiving the right treatment(s) for your condition(s). Get 1referrals. Get treatment.
4) Your records are too old and you are not seeing doctors now. You need to see new doctors or more visits during and after the adjudication of your case.
5) Diagnosis alone does not win cases. Once you are diagnosed ask your doctor if your condition is severe enough to prevent you from working. Permanently!
6) You think you are disabled but you are not. Social Security only needs to show that you can do some other job than the one you can’t do anymore and case closed. In most cases, you must prove you can’t work ANY jobs. At all!
7) Your doctor may not be supporting the notion that you are disabled. It goes back to item 6.
It gets worse:
8) Some of your treatment may be a violation of the rules. I know, it’s weird but it’s true. Eg, medical marijuana. Legal in some States, not legal in the federal system yet (Remember Social Security is a federal benefit).
9) Your case is less than sympathetic because you may be doing a lot of things to yourself. Illegal drugs if you have a mental disability, smoking when you have lung issues, drinking when you have cirrhosis. The list goes on…Get help!
10) Procedurally you don’t qualify or you need to overcome a remote onset of disability. This is a big one. It means you haven’t worked in years and you may not qualify, or you have too much money to qualify (see my next post on this one).
11) It’s too early to file. You need to show that your condition has lasted or is expected to last 12 months. The clock starts ticking from the time you stopped working. If you just quit and file a week later you are more likely to be denied.
12) Anger issues and bad attitude shown in your medical records. In mental disability cases, it’s expected. In physical cases, it a no, no! Do not throw tantrums at your doctor’s office. They will write it in your medical records and it looks bad!
13) Incarceration. You can’t get benefits while incarcerated. Simple as that.
See you soon,