What Is A Social Security Durational Denial?
A When a condition is disabling, even according to social security guidelines, but does not last for 12 months, or improves before a twelve month period elapses, the claim may be denied for duration.
Durational denials have been somewhat controversial for Social Security because they are based upon a forecast of recovery. Disability examiners evaluate a disability applicant's medical information and determine if they feel the applicant will be unable to perform work at a substantial gainful activity level for at least twelve months.
If the disability examiner determines that a disability applicant's medical condition is likely to improve within twelve months, they may deny the disability claim. This is a durational denial for disability benefits.
As stated, the problem with durational denials is that forecasts tend to be very subjective. Often, disability examiners give durational denials for disability cases that involve traumatic injuries, injuries sustained in an accident, surgical interventions, or other impairments that have some chance of improving to a "finding of not disabled" prior to the end of the twelve month durational period.
However, there have been times when disability examiners routinely denied disability claims on the basis of duration that involved severe mental impairments and other conditions that have very little chance of medical improvement.
Disability examiners with no formal medical training make Social Security Disability determinations with input of their managers, case consultants and unit medical professionals. Each individual involved in deciding the disability claim is subject to their own biases with regard to an individual's chance of medically improving. This is why durational denials tend to be some of the most subjective in nature.
If an individual receives a durational denial, they should appeal that decision all the way to an administrative law judge disability hearing if necessary, even beyond that to an Appeals Council review. The chances are they will win their disability case at an ALJ hearing; if they do not win, they have a choice to file another disability claim or appeal the ALJ decision to the Appeals Council.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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