flow chart amigas4all social security benefit denial

Cracking the Nut on The 13 Reasons for Denial of Social Security Benefits

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!)

flow chart amigas4all social security benefit denial

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.

Let us know what you think!