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Will you get Approved for Disability if you have an Open and Shut Case?



 
Someone in a forum wrote that they filed an application for disability and got approved without the need for an appeal. They were definitely lucky, because the chances of being approved on an initial claim tends to go against claimants, i.e. most claimants are denied and are forced to file an appeal.

This particular individual's situation was interesting to me because, in addition to being approved on his initial claim, he made the following statements (I'm paraphrasing):

1. "I had an open and shut case".

2. "I was still required to see the government's doctors".

3. "If you qualify for disability, there is no reason you should be denied".

Ok, what do we deal with first regarding these statements?

Well, first of all, let me state once again that when a person goes to a social security medical examination, they are not being seen by a "government doctor". They are being seen by a doctor who has their own practice. This doctor has simply agreed to conduct consultative examinations (known as CEs) for social security in exchange for compensation.

Secondly, if you are sent to a consultative medical exam, or CE, there's a more than fair chance that you do not have an "open and shut" case. Why is that? Because claimants are usually sent to CE appointments for one of two reasons (and these are the reasons I sent claimants to exams when I was a disability examiner).

Those reasons are A) the claimant has not been treated for a condition that was listed on the disability application and/or B) the claimant has not been seen by one of their own doctors for a considerable amount of time (as an examiner, I would send claimants to exams if they hadn't been seen in 90 days, but sometimes even if they hadn't been seen in 60 days, depending on the nature of the condition itself).

Basically, being sent to a social security medical exam, by definition, connotes some level of deficiency in the case. That deficiency may, of course, be very small or inconsequential--however, the point is that if you are sent to such an exam, the case is not "open and shut".

Thirdly, "if you qualify for disability, there is no reason you should be denied". This is probably the most off-target statement made by this individual. Social security routinely, and in huge numbers, denies cases in which claimants qualify for disability based on Social Security Disability criteria and what their records have to say about them.

If that wasn't the case, there wouldn't be so many disability lawyers and disability advocates in practice and there wouldn't be the status quo that currently exists in which so many claimants get denied on their claims and then eventually get their cases heard by an administrative law judge at a disability hearing...and get approved.

If you think about it, it's rather crazy that so many claimants finally get approved for Social Security Disability or SSI disability at a hearing when they've been denied on a disability application and then been denied again on a disability reconsideration appeal. You have to ask yourself, what was the point of making a claimant wait an additional two years, often forcing them in to financial catastrophe, if they were simply going to get approved for disability at a hearing anyway (note: not everyone is approved at a hearing, but the statistics indicate that the majority of claimants who go to a hearing do get approved).

Here's an answer that is very cynical, I admit. Many have speculated that the aim of the current system is to have as many people as possible become discouraged and give up on their claims, by not filing their first appeal, and by not filing their second appeal that gets them in front of a judge. Does that sound like a conspiracy theory? It does, and, of course, there may be nothing to it. However, I have made the observation over the years (from working in representation and working as a Social Security Disability claim examiner) that a very hefty percentage of claimants do, in fact, give up after being denied on their claims. And when people learn that going to a disability hearing can involve years of waiting, that only cause many more individuals to give up as well.

Here's a tip: if you get denied on a claim for disability, never give up and always appeal.








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For the sake of clarity, SSDRC.com is not the Social Security Administration, nor is it associated or affiliated with SSA. This site is a personal, private website that is published, edited, and maintained by former caseworker and former disability claims examiner, Tim Moore, who was interviewed by the New York Times on the topic of Social Security Disability and SSI benefits in an article entitled "The Disability Mess" and also by the Los Angeles Times on the subject of political attempts to weaken the Social Security Disability system.

The goal of the site is to provide information about how Social Security Disability and SSI work, the idea being that qualified information may help claimants pursue their claims and appeals, potentially avoiding time-consuming mistakes. If you find the information on this site helpful and believe it would be helpful to others, feel free to share links to its homepage or other pages on website resource pages, blogs, or social media. Copying of this material, however, is prohibited.

To learn more about the author, please visit the SSDRC.com homepage and view the "about this site" link near the bottom of the page.