Why Does Social Security Disability Get Denied in California?

Social Security Disability (SSD) and Supplemental Security Income (SSI) disability benefits are awarded only to those who can prove that A) they have a severe mental or physical impairment--or combination of impairments--that prevents them from working and earning a substantial gainful income, and B) this impairment has lasted, or is expected to last, a period of not less than twelve months.

Claimants must prove these above two points by supplying medical records from qualified medical sources (alternative medicine practitioners such as chiropractors, acupuncturists, and homeopaths will not do) in support of the claim for disability.

Unfortunately many claimants apply for disability in California on the basis of a condition for which they have received scant treatment or have never sought medical treatment, and thus have no medical records, or insufficient records, documenting either their condition, its functional limitations, their date of onset or a prognosis. Without this information a disability examiner really has nothing of substance upon which to base his or her decision.

Without pertinent medical records supplying this information, a disability examiner will likely have no alternative other than to deny a claim. A lack of evidence or a lack of current evidence may result in a claimant being sent to a CE, or consultative examination. However, these seldom result in a Social Security Disability award when there's not much of a longitudinal medical treatment history to back up the information provided by this type of "snapshot".

In a practical sense, people who apply for SSD and SSI should try to seek medical treatment as soon as their symptoms begin to compromise their ability to do their job. It's also not a bad idea for claimants to review their medical records to be sure that they contain at least some level of detail to give a disability examiner a clear picture of their residual functional capacity (activities that they can and cannot perform as a result of their impairment).

Oftentimes physicians, who typically have very little insight into what is needed to prove a disability claim, leave a lot out in their notes.

They may document their diagnosis, but not the functional limitations and the daily activity restrictions that result from a condition. If a condition is preventing a patient from standing for long periods of time, lifting, concentrating, etc., this--for the sake of substantiating a disability claim--needs to be reflected in the medical records.

Patients who are considering filing for SSD or SSI may find it prudent to be up front with their treating physician, and inform him or her of the need to provide solid documentation for a disability case. True, some physicians do not wish to be bothered with disability matters, and some even dislike the idea of collecting disability benefits because they are opposed to it on principal (the old 'pull yourself up by your bootstraps' mentality, a.k.a., no government handouts). However, it's best to know this before filing for disability, while there is still ample time to develop a treatment history with another physician who may be more helpful and, yes, compassionate.

One final note: If you are planning to file for disability, be scrupulous when it comes to showing up for your doctor appointments and following physician orders. Many physicians will drop a patient who fails to show up for appointments, and actually welcome the chance to get rid of 'problem' cases. In addition, patients who are not taking medication as prescribed may allow social security to conclude that the patient is not severely impaired, or that their limitations might be lessened (and their ability to engage in work activity improved) if they were taking their medications.

SSD and SSI cases are denied due to a lack of supportive medical evidence. And, therefore, in a practical and strategic sense, claimants who wish to collect Social Security Disability benefits must be willing to do what it takes to supply the documentation necessary for approval.

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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