Why was I denied disability in California?

The most common reason for a denial of a claim in California or any other state is the lack of proper medical documentation. All SSD and SSI cases are decided primarily on the basis of medical evidence. In most cases, as well, Social Security will review vocational evidence (pertaining to your work history) in addition to your medical treatment history.

However, in every single case, the information that will lead Social Security to approve or deny a claim will come from the claimant's records.

How are disability cases lacking when it comes to medical evidence? In many instances, the Social Security Administration will have difficulty obtaining a claimant's medical evidence simply because the claimant has not provided enough information about their medical treatment sources at the time of application.

This is in particular why we so often stress this one piece of advice: when a claimant has an appointment for a disability application interview, they should take the time to write down their medical treatment history ahead of time. This should include the names of all their doctors, or treating physicians, but also the names and addresses of all medical providers, as well as the names of all diagnosed conditions.

Writing down this information beforehand will often prevent crucial information from being accidentally omitted during the interview. And by giving full and complete information to the claims representative at the Social Security office, the disability examiner who later receives the claim (and makes a decision on it) will be in a position to get all the needed records ordered and gathered in as timely a fashion as possible.

Note: the single largest delay in receiving a decision on a disability claim in California has to do with how long it takes SSA to get the medical records gathered.

But difficulties in gathering the evidence is only part of the problem. In the final analysis, a disability claim will be denied because the claimant's case does not include evidence that proves that they are no longer able to work and earn what SSA refers to as a substantial and gainful income.

To be considered disabled under Social Security administrative law and procedure, it must be shown that they no longer, as a result of their condition, or conditions, possess the ability to engage in substantial and gainful work activity.

How is this proven? In the majority of claims, it will boil down to analyzing the claimant's work history to determine what was required of them in the past, as well as what skills they have that may allow them to do some type of other work.

If the claimant and/or their disability attorney or disability representative can build a case that "proves" that the functional limitations caused by their physical or mental condition eliminates A) their ability to go back to a past job and B) makes it impossible for them to switch to a new type of work, they may be approved for disability.

Proving a case, however, often requires an indepth knowledge of Social Security regulations (title 20 of the federal code), as well as the vocational grid rules that direct decisions of "disabled" or "not disabled" on claims, as well as some knowledge of various SSRs (social security court rulings).

It is precisely for these reasons that claimants who are typically unrepresented at the first two levels of the disability claim system (application and reconsideration appeal) and who also have scant knowledge of how cases are decided are generally denied. And it goes without saying that at the hearing level, possessing a substantial knowledge of Social Security administrative law and procedure will be even more important, as the case will be presented to a federal ALJ, or administrative law judge.

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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