WHY SOCIAL SECURITY WON'T PAY YOUR DISABILITY CLAIM
7 out of 10 Social Security disability claims get denied. The most common reason given in the denial letter is:
"We have determined that you are not able to do your past work. However, there is other work which you are still able to perform."
We call these "Step 5" denials and they are very common in claimants under the age of 50. What went wrong? Here are the common reasons Social Security could not pay your claim:
1) Your application did not address your vocational restrictions, including your inability to perform any work that exists in the US economy. If you were employed, for example, as a construction worker for the past 23 years and your doctor tells you that you can no longer do this type of heavy work, it does not mean that you are disabled. It means that you need a career change. To get Social Security, you have to prove that even with a career change--and moving to a lighter, easier job--you would still not be able to work.
2) You may have allowed Social Security to define your "residual functional capacity" (RFC) for you. The RFC is simply the most that you are able to do in terms of work related activities. Social Security may have determined that you are able to perform a full range of Light work, when in truth, you are only able to perform sedentary work--or perhaps not even that. If you are under age 50 and have at least a high school education it is generally necessary to prove that you are unable to perform even sedentary unskilled work.
3) Social Security may have relied too much on one of their consulting doctors and not enough on your own doctor. This may be legal error, subject to reversal. Under 20 CFR 404.1527(c), your treating doctor is in the best position to evaluate your symptoms and the limitations they have on your ability to perform work-like activities. If you were examined by a Social Security doctor, chances are he/she saw you only one time--and only for a few minutes. This exam should not be given the same weight as the opinions of your long-time treating physicians. Worse yet, Social Security may have relied on the opinion of a doctor who never examined you at all. This is wrong.
4) Social Security may have acted on incomplete medical evidence or they may have drawn the wrong conclusions on the medical evidence they had.
The initial phase of the Social Security application process is designed to make sure nobody gets benefits who isn't entitled to them. That's as it should be. Except, the emphasis is on denying benefits to those who are not eligible, not on approving benefits to those who are eligible.
How do you correct a denial of benefits when you believe it is wrong or unfair? It must be appealed. You ask for a hearing by an administrative law judge. There are about 1,700 administrative law judges in the US who consider appeals concerning the denial of benefits. About 1,200 of these judges work with Social Security appeals. The judge will review all of the medical and vocational evidence, including new evidence, and render a new decision. In almost one-half of all cases, the judge's new decision will be more favorable to the claimant.
"We have determined that you are not able to do your past work. However, there is other work which you are still able to perform."
We call these "Step 5" denials and they are very common in claimants under the age of 50. What went wrong? Here are the common reasons Social Security could not pay your claim:
1) Your application did not address your vocational restrictions, including your inability to perform any work that exists in the US economy. If you were employed, for example, as a construction worker for the past 23 years and your doctor tells you that you can no longer do this type of heavy work, it does not mean that you are disabled. It means that you need a career change. To get Social Security, you have to prove that even with a career change--and moving to a lighter, easier job--you would still not be able to work.
2) You may have allowed Social Security to define your "residual functional capacity" (RFC) for you. The RFC is simply the most that you are able to do in terms of work related activities. Social Security may have determined that you are able to perform a full range of Light work, when in truth, you are only able to perform sedentary work--or perhaps not even that. If you are under age 50 and have at least a high school education it is generally necessary to prove that you are unable to perform even sedentary unskilled work.
3) Social Security may have relied too much on one of their consulting doctors and not enough on your own doctor. This may be legal error, subject to reversal. Under 20 CFR 404.1527(c), your treating doctor is in the best position to evaluate your symptoms and the limitations they have on your ability to perform work-like activities. If you were examined by a Social Security doctor, chances are he/she saw you only one time--and only for a few minutes. This exam should not be given the same weight as the opinions of your long-time treating physicians. Worse yet, Social Security may have relied on the opinion of a doctor who never examined you at all. This is wrong.
4) Social Security may have acted on incomplete medical evidence or they may have drawn the wrong conclusions on the medical evidence they had.
The initial phase of the Social Security application process is designed to make sure nobody gets benefits who isn't entitled to them. That's as it should be. Except, the emphasis is on denying benefits to those who are not eligible, not on approving benefits to those who are eligible.
How do you correct a denial of benefits when you believe it is wrong or unfair? It must be appealed. You ask for a hearing by an administrative law judge. There are about 1,700 administrative law judges in the US who consider appeals concerning the denial of benefits. About 1,200 of these judges work with Social Security appeals. The judge will review all of the medical and vocational evidence, including new evidence, and render a new decision. In almost one-half of all cases, the judge's new decision will be more favorable to the claimant.
Remember, you have only 60 days to appeal the denial of benefits. After 60 days, Social Security's denial stands and is not subject to appeal. You may file a new claim, provided you have not reached your 'Date Last Insured.' However, a new claim may not protect the rights you had under the original claim, such as back pay. So, appeals need to be filed within the 60 day deadline. The 60 days start with the date you receive the denial. The government assumes you received the denial notice 5 days after it was mailed.
ReplyDeleteIt's important to say here that you only have 60 days after a denial to file an appeal and ask for a hearing. After 60 days, you cannot appeal and must start all over with a new application--more wasted time. Watch the deadline very carefully.
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