Social Security Disability Denied? The Reasons Why

If you have been denied Social Security Disability (SSD) benefits, you are probably wondering what went wrong. Chances are, you are, or feel that you are, suffering from considerable physical or mental limitations as a result of your condition. Otherwise, you would never have gone through the process of filing in the first place. You may feel, as many others do, that SSD denies as many claims as possible, regardless of the claimants' physical condition, to save the federal government money.

While it is true that it is difficult to win Social Security Disability benefits, the fact is that many applicants are not approved for disability benefits for two primary reasons: 1) they do not have sufficient medical documentation to back up their claim; and 2) they do not take full advantage of the appeals process if their initial application is denied.

Medical records and being denied

Let's look at the first reason most claims are denied; namely, lack of medical evidence. Many individuals who seek disability do not see a doctor for regular treatment of their condition. Not only does this put them at a disadvantage because they have few medical records or physician notes to back up the disabling nature of their condition, but it also limits the social security administration (SSA) disability examiner's ability to make a determination in their case.

All disability cases are decided, fairly or unfairly, on the basis of medical evidence. The more you have, the more your disability examiner must consider when making his or her determination, and the more likely you are to be approved for benefits.

Of course, it is true that if you have not recently (within the past couple of months) seen a doctor your SSA claims examiner will send you for a consultative medical exam with a physician who has been hired by social security to perform examinations. Yet these exams are very brief and shed little light if any on the claimant's physical limitations or symptoms. Their sole purpose is to give disability examiners a recent medical opinion on which to base their decisions, and they are a poor substitute for a visit to an impartial physician who will advocate for the claimant's best interest.

So, if you are unable to afford insurance or to pay out-of-pocket medical expenses, you must do the best you can with all of the resources at your disposal'free clinics, physicians who treat on a sliding-scale fee basis, and even trips to the emergency room. Any medical history that you amass on your own behalf will be more beneficial to your case than that provided by a physician hired by SSA.

Now, as previously stated, the second reason many SSA applicants do not receive benefits is that they are either unaware or unwilling to appeal their denial of benefits. This is really a mistake, and it's so important to keep in mind if you are denied for disability benefits that you are well within the majority'nationwide, a whopping 70 percent of all disability claims are denied upon their initial disability application.

The odds of winning increase with appeals

However, about 11% of all of those who appeal their disability decisions to the Social Security Disability office (called a request for reconsideration) are approved for benefits. If your reconsideration appeal is denied, should you give up? Absolutely not, because up to 60% of those who file a second appeal (a request for a hearing before a federal administrative law judge) are approved for benefits! In short, the more you appeal, the greater your chances of receiving benefits.

There is one other point to make when considering the reasons why disability claims are so often denied, and it probably bears mentioning, here: The social security impairment manual, commonly referred to as the blue book. The SSA blue book lists many physical and mental conditions which it recognizes as disabilities, and the criteria that must be met to prove that an applicant is suffering from a listing in the book. Does your medical condition have to be listed in the blue book in order for you to collect disability benefits for it?

The answer is no, and in fact most disability benefits are awarded for conditions not listed in the blue book on the basis of a medical vocational allowance. In short, if you have a disabling condition that is serious enough to prevent you from earning a certain amount each month, and the condition is expected to last for at least twelve months, you could collect benefits provided you have the necessary medical documentation to demonstrate that your condition is both serious and ongoing in nature.

Which brings us back to square one: The only way to be sure of winning disability benefits is to provide enough medical documentation to prove your claim, and to keep fighting through the disability appeals system if you feel your claim has been wrongly denied.

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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