Tuesday, August 26, 2008

Reasons for Social Security Disability Cases Being Denied

Social Security Disability (SSD) and SSI cases are denied, in most instances, due to a lack of medical evidence to support an applicant’s claim. In other words, a lack of medical evidence that either allows a disability examiner or a disability judge to extrapolate that a claimant can no longer work, or a lack of evidence that sufficiently documents by itself that a claimant's residual functional capacity is insufficient to allow either past work or other work.

In many cases an SSD or SSI claimant will apply for disability benefits without ever having had any prior medical treatment for their condition, be it physical or mental (I base this on my work experience in processing disability claims as a disability examiner).

It is absolutely critical for any individual contemplating applying for disability benefits to seek medical treatment for their condition as soon as possible. A medical diagnosis from a qualified physician, including a detailed report of exactly how the medical condition prevents the claimant from working at his or her job must, in most cases, be supplied to the disability examiner before benefits are awarded.

Many claimants do not understand this, and apply for disability for conditions such as depression, chronic fatigue, or even rheumatoid arthritis, with little or no history of being treated for their condition. Without some sort of documentation from a licensed medical professional to support the claim, the disability examiner frankly has nothing to evaluate other than the veracity of the person making the claim, and since the DDS (disability determination services, the agency that makes decisions for social security) is not in the business of lie detection, you can bet that any claim with nothing but the word of the applicant to support it will be denied.

For this reason, anyone who files for disability must take steps to document their impairment, including the following:

1. When filing for disability, make sure that the primary medical condition, be it physical or mental, is something for which you have seen a licensed medical professional. It’s okay to list other conditions as well; for instance, many people who are suffering from chronic pain may be suffering from depression as well.

However, any condition that you claim is contributing to your inability to work must be diagnosed by a physician in order to be considered at all in the disability determination process. If you have a disabling condition for which you haven’t been seen by a doctor yet, make an appointment immediately.

2. If you are being treated by a physician for your impairment, be sure to keep all of your appointments and to follow the doctor’s orders. You must be able to demonstrate that, despite your best efforts, your condition is not improving, and that means taking your prescribed medication and seeing your doctor regularly. Also, keep in mind that a physician may discharge you if you do not keep your appointments, and the last thing a disability applicant needs is to have to switch physicians midstream due to their failure to comply with their doctor’s advice. Continuity of medical records and treatment are key to supporting a disability claim, and a lack of cooperation on the part of the patient makes it look like the condition is really not that severe after all.

Review your own medical records periodically. Your physician does not work for social security, nor is he or she a disability examiner, so there is a pretty good chance that details regarding symptoms of your impairment and how it limits your ability to work, will not be included in the physician’s notes. If you see that there is a lot being left out of your medical file regarding your symptoms and physical or mental limitations, talk to your physician about it—be upfront, and let him or her know that you need more details to support your disability claim.

If your physician is not supportive, you must find a new one. After all, if your doctor does not believe that your condition is serious enough to keep you from working, chances are a disability examiner will pick up on this and determine that you are able to work as well.

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