Why does social security deny strong disability claims?

The fact is, SSA routinely denies exceptionally strong claims. As a disability examiner (former), I particularly recall one case in which an individual was denied at the disability claim application level. The DDS (disability determination services) physician who signed off on the case did so using the rationale that the victim's burns did not cause enough stricture (narrowing of tissue resulting in limitations in movement) to prevent a return to work activity.

But...the individual had suffered 2nd and 3rd degree burns to 25 percent of the body, confined mainly to one side and the Director of the Hospital Burn Center had taken it upon himself to write a letter explaining that, with injuries so severe, the patient would not be able to return to work. In fact, the patient had very recently been released from the hospital, had gone into shock and renal failure, and then been re-admitted to the hospital for a long, extended period.

Very good disability claims are routinely denied by social security. That is without question. And the question then becomes "Why does social security deny strong disability claims?".

It has a lot to do with how the federal disability system is structured. Bad decisions are made at all levels of the system. However, they (bad decisions) tend to be made most often at the lower levels of the system, which would be the initial claim and reconsideration appeal levels. These are the levels at which SSD and SSI claims are decided by disability examiners and the physicians and psychologists and psychiatrists who work with them as consultants.

Of course, it's not surprising that this occurs. Why? Well, all you have to do is consider how different the system operates at these levels in comparison to the hearing level.

1. Disability examiners are often pressured to make decisions on disability claims that conform to the decisional patterns of the disability determination services agency they work in. And very often that even includes the decisional patterns of their immediate supervisors. In other words, disability examiners are not exactly independent decision makers.

2. Disability examiners really do not give proper weight and consideration to the statements provided by a claimant's treating physician when such statements have been obtained or delivered.

3. The social security process at the lower levels of the system does not allow an opportunity for the claimant and his or her chosen representative to take an active part in the disability claims process.

At the hearing level, of course, things change considerably. Administrative law judges who rule on Social Security Disability and SSI claims operate independently, tend to give proper consideration to the opinion of a claimant's treating physician, and, if a claimant is represented, will receive the efforts of the claimant's designated representative, either a disability attorney or a non-attorney representative.

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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