Monday, December 17, 2007



Social Security Disability Denied - Why did this Happen?

Why do applicants for social security disability and SSI get denied on their claims? There are a number of different ways to approach this question. The easiest perhaps is to say that claimnts who are denied for disability failed to satisfy the requirements of a listing and failed to achieve a medical vocational allowance. In other words, they failed to meet the social security administration's definition of disability.

Answering the question this way, however, requires some explanation. What is a listing? What is a medical vocational allowance, and what is the social security definition of disability?

Listings are basically specific disability approval criteria that appear in the SSA blue book. This is a manual that lists the approval requirements for many physical and mental impairments. Not every impairment is contained in this manual, and, in fact, most aren't. But this isn't a bad thing if you consider the fact that it is very difficult for most claimants to be awarded disability benefits on the basis of satisfying the requirements of a listing.

What if you have a condition that is not contained in the listing manual? Can you get approved? Yes, you can, and the mechanism for this is known as a medical vocational allowance, a system under which most approvals are granted. Medical vocational allowances are based on the social security administration's unique definition of disability. In other words, if a claimant has a condition that is severe, has lasted at least a year (or can be projected to last that long), and this condition has prevented the individual from engaging in their past work and from engaging in suitable other (as determined by a number of different factors, including age and work skills), then they will be approved for disability.

However, another way to look at the question of why claimants receive a denial of disability benefits is to consider "strategic issues".

For instance, the unfortunate truth is that the majority of claimants who get denied on a claim for disability will give up and choose not to appeal. This, obviously, is a mistake. Especially since claims that are appealed to the ALJ disability hearing level have a good chance of winning (statistics indicate that a claimant who has been previously denied and who appears at a hearing with representation has a sixty percent chance of winning benefits). In other words, claimants that get denied and fail to appeal will remain stuck in the "denied" category, while those who appeal have a strong statistical likelihood of eventually being awarded benefits by a judge.

Secondly, claimants with a sparsely documented history of medical or mental treatment put themselves at a great disadvantage. This is because the adjudication of SSD and SSI claims is based solely on the evidence provided by a claimant's medical records. Consequently, individuals who have not received recent medical treatment or have a spotty history of treatment (being seen by a doctor once a year will not provide the type of documentation that the social security administration is looking for) will have an uphill battle in attempting to win disability benefits.

What if you can't afford to go to a doctor? This is a fairly common scenario. However, if you do not have health insurance and do not have the funds needed to pay a physician or clinic out-of-pocket, you should look for alternate sources of treatment. Even being seen in a hospital ER or at a free clinic is better than providing no treatment history at all.

Won't social security send me to one of their doctors if I don't have the means to go to one? Yes and no. The social security administration does not employ physicians for this purpose. They do have doctors on staff who assist disability claims examiners in the task of evaluating your claim. However, these doctors are consultants only. When it comes to what is commonly thought of as a social security medical exam", SSA will send you to a consultative exam that will be performed by an independent physician who has contracted to provide this service. This physician will not provide treatment to you and, generally, the consultative exam will only last about ten minutes. Of course, you will typically only be sent to this sort of examination if you have not been seen by your own doctor in more than two months.

However, the point to remember about such exams is this: they seldom form the basis for an approval. Why do they send claimants to these exams, then? Simply for the sake of being able to state that recent medical evidence was obtained and evaluated. In other words, if you aren't getting treatment on your own, and as a consequence do not have a well-developed history of treatment...don't count on a social security medical exam to come to the rescue.



Return to the Social Security Disability SSI Benefits Blog