Individual Infos

After Mary’s failed back surgery, her doctor told her he’d
support her claim for disability. His eyes were comforting and
Mary felt like she’d finally found someone who understood the
pain she was in. She’d already gone through years of undiagnosed
Fibromyalgia. Some days she even had sneaking thoughts of
suicide- at least then it wouldn’t hurt so much.

Mary’s doctor told Social Security that she was indeed disabled
and could not work. So, Mary waited… and waited… and waited.

She borrowed money from friends. She assured them her doctor had
promised her she was qualified. Even the Social Security
representative who took her application could see that she could
barely bend and walked with a noticeable limp. In fact, he’d
commented on it.

Mary had paid into the system, and now- unfortunately- Mary
needed help. Rent was behind, she was already on food stamps…
who would hire her in her condition anyway?

Months went by with no word, until FINALLY. The letter from
Social Security arrived. When Mary read the letter she almost
fainted. THEY HAD DENIED HER!

Mary had not taken the time to read the Social Security website
at http://www.ssa.gov/. If she had, she would have been able to
put some personal information into one of their calculators
http://best.ssa.gov/ and determine if she was eligible for any
of their disability programs. Had she read the website, she
would have known that it takes more than your doctor saying
you’re disabled to get on disability benefits.

The sad fact is 3 out of 10 of today’s 20 year olds will become
disabled before reaching the age of 67. And if you are one of
the unfortunate who need to apply, it can take 3-6 months for a
decision. And… if you are granted benefits, you may be asked to
serve a 5-month waiting period BEFORE you can get any benefits
at all! And those benefits are NOT always retroactive!

There are many reasons why your claim can be delayed or denied,
but you will waste valuable time if you don’t go in well
informed. While it may be a complex program to understand, you
can arm yourself with the basics before launching into a
prolonged wait that could end up in further poverty and
humiliation.

Some people prefer to ask a qualified attorney to handle their
claim, but if you take the time to read the Social Security
website, you will see that the information is laid out very
logically, is easy to understand and tries to answer all your
questions in an open and honest way. Your chances of being
allowed disability benefits is NOT increased if you use an
attorney- that is simply NOT true. However, if you appeal the
decision to higher levels of law, then an attorney would be
helpful.

———————————–

There are 10 top reasons your claim is likely to be denied by
Social Security.

———————————–

You are not insured for disability benefits (SSD). You have to
work a certain amount of years to be eligible and your insurance
can lapse. This one is like car insurance. The company doesn’t
continue to insure you if you don’t continue to make the
premiums. And … the amount you may get on a monthly basis may be
such a paltry amount, that you couldn’t possibly live on it. It
is not based on what you need to live, it is based on how much
you paid in. So if you’re a 20-yr-old worker who has only paid
in since age 18, you will not get much money at all. AND, since
you are a young person, your claim may be reviewed more often to
see if you are well enough to work again.

You are not eligible because of your income and resources (SSI).
This program is based on your financial need. If you have
substantial assets, you’ll probably be denied. If your spouse
works and you do not live within certain poverty guidelines- you
will probably be denied. The decision as to whether you are
eligible begins with the income and resources in your household.
Then, if you are found eligible and are approved benefits, the
average monthly check will only be about $550 dollars. That is,
unless your state supplements your check. But even so, it
wouldn’t be for much more.

Your impairment, while severe, does not meet the criteria for
severity as recognized by Social Security. You can see the
actual criteria Social Security uses to determine the severity
of impairments by looking at THE BLUE BOOK online
http://www.ssa.gov/disability/professionals/bluebook/index.htm.
The Blue Book specifies EXACTLY how severe a certain impairment
must be before you are considered severe enough. The Blue Book
is available for the public to view on the Social Security
website (NOTE: The Blue Book is written with the professional in
mind, so be aware that you could misinterpret or not fully
understand parts of it.) Your impairment is severe, but not
likely to last 12 months or end in death. Let’s say you had a
bad car accident and broke both legs, preventing you from
working as an auto mechanic. Chances are, fractures are going to
heal within 12 months and you will be denied. Social Security
disability benefits are for more permanent impairments. Plus,
they don’t give you 10% or 40% disability like some insurances
do. And other insurance companies often use different criteria
for deciding if you’re disabled. That means, just because the
Veterans Administration or Worker’s Comp has found you disabled-
that does not always mean Social Security will find you
disabled.

You’re working and earning a substantial amount. This is
obvious, but some people are under the impression they can
continue to work while applying for benefits. This is simply not
true, unless you earn less than $810 a month and the work is not
worth more than that in the national economy. There are also
those who think they can work under the table. Social Security
has an interesting part of their site
http://www.ssa.gov/oig/investigations/caseofmonth/caseofmonth.htm
devoted to fraud and the active surveillance and investigation
that goes into claims. They also include some colorful stories
of how they uncover fraud. There are often fines, restitution
and sometimes prison time that some have had to serve due to
fraudulent claims.

You are a fugitive felon. Most people would know enough not to
apply for government benefits when they are wanted for a
felony– but… apparently it happens. And when it does, you will
be reported to police agencies. Also under this category would
be those who are injured or become disabled in the course of
committing a felony.

And finally, if you are in a correctional institution. You are
NOT eligible for Social Security benefits while serving time.

You change your address and phone number and don’t alert the
Social Security office. Makes sense if they can’t find you then
you are going to be denied on a technicality. Similar
technicalities involve not completing the paperwork fully or
properly. It cannot be stressed enough that you MUST,
absolutely, complete the paperwork according to the instructions
and within the specified time frame. If they ask you for a list
of ALL your doctors, you need to list ALL you doctors. If they
say list ALL your jobs for 15 years, you list ALL your jobs for
the past 15 years. Each piece of paper Social Security sends you
is critical. It needs a response from you. This is not the time
to procrastinate or do something halfway. You MUST, MUST , MUST
get this part right. You generally have 10 days to return forms.
This means 10 days from when it was mailed from Social Security,
NOT 10 days after you receive it. And you need to list ALL
doctors, clinics, hospitals– everyone you have seen for your
condition. Give full names, addresses and phone numbers. Use the
internet, phone book or do your own research– but if they can’t
find these places, they won’t have the records. And a decision
could be made on only half the story. It is YOUR responsibility
to prove you are disabled. It is NOT Social Security’s
responsibility to prove you disabled. This is YOUR claim and it
is YOU who needs to step up and take charge. A poor memory is
not a reasonable excuse. You can enlist the help of a third
party, but it is ultimately your responsibility.

If you can’t remember your jobs for the past 15 years, call the
Social Security office and request a printout of all your jobs
for the past 15 years. This will help jog your memory so you can
describe each job. Just because Social Security already knows
you worked at McDonalds in 1990, that doesn’t mean they know
what job you performed there. It would take a different set of
skills to be the cook versus the manager.

And don’t assume Social Security knows what a cook has to lift
and carry and how much they have to bend– this must be
described by YOU. Only YOU know how this job was performed.

Decisions are made based on function and not necessarily always
a diagnosis. Social Security always looks at what you can still
do despite your impairment. Shocking as it may seem, a diagnosis
of cancer will not always get you allowed for Social Security
disability benefits. Your doctor can write a letter explaining
that you will be undergoing chemotherapy and radiation for
breast cancer for the next several months, and say outright you
are unable to work– and your claim can still be denied. There
are many reasons for this, but it has a lot to do with the type
of cancer and your prognosis for survival. While you may be
disabled and unable to work 11 of those months, by the 12th
month you may be able to perform a very sedentary job.
Therefore, you will likely be found not disabled. While we’re on
this subject, although a letter from your doctor is helpful,
most doctors don’t know how to write an effective letter to
Social Security. If your doctor has agreed to write you a
letter, it must contain your functional capacity despite your
impairment. That means, it must spell out exactly how much you
can lift/ carry, stand/walk, etc. Your doctor should follow the
format outlined in the Dictionary of Occupational Titles, which
is also online http://www.oalj.dol.gov/libdot.htm

Your doctor must be able to support his/her opinion with
objective findings that support that opinion. Generally, that
means he/she needs to send all chart notes, tests, exams, etc.
His/ her opinion should be one that would be a reasonable
conclusion based on your diagnosis and remaining functional
capacity. Sad as this may sound, if you can still sit and push a
button- you may not be disabled according to Social Security
guidelines.

Additionally, your doctors need to have the credentials
recognized by Social Security. Generally, that means an MD or DO
for physical problems and a PHD or PSYD for mental problems.
There are others, depending on the impairment- which you can
look up on the SSA website.

You fail to attend a Consultative Exam scheduled by Social
Security. Be prepared to be examined by an independent Medical
Examiner. Social Security will inform you if they want you to
attend an exam. You MUST attend this exam and cooperate fully-
or your claim will likely be denied. This exam is not for
treatment, it is only to examine you so that Social Security can
make an accurate decision on your claim. This examiner will
share those results with Social Security. The usual
doctor-patient relations will not be established and your
confidentiality is compromised by the fact that Social Security
will have access to these exam results. If you cannot make this
appointment, for whatever reason, you need to call SSA right
away and reschedule.

So, there you have it- 10 top ways to get denied right out of
the gate. Of course, there are occasional exceptions to the
above, but generally this is how it works. Fail this test and
you will find yourself holding a denial letter in your hand and
wondering “WHY?”

How Social Security makes disability decisions is not
mysterious. In fact, the information is more readily available
to the public than how the search engines really rank websites.

There is a myth that says you have to apply for benefits 3 times
before being approved. This is absolutely NOT TRUE. This myth
has been perpetuated because it generally takes 3 tries before
an applicant understands how to maneuver the system (or the
applicant’s condition worsens, he/she ages or there are other
vocational factors that change). And that’s not because it’s
hard, it’s because they don’t take the time to get informed
about the program and process.

Not getting properly prepared is like trying to run the Boston
Marathon without any previous training. You are generally going
to fail and be sorely disappointed.

Comments are closed.