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Filing for Social Security Disability: Pitfalls and Judgment Calls

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People who apply for disability benefits are approved or denied based on their ability to work. Claimants will not be awarded SSD or SSI unless they can prove that their impairment is severe enough to preclude them from performing their current job or any other type of work for which they may be suited.

Disability examiners at the state Disability Determination Services (DDS) agency are in charge of making all decisions on initial applications and reconsideration appeals for Social Security. When a claimant applies for disability, the examiner reviews the medical and work history to determine if the claimant could be expected to earn a living despite his or her impairment.

In reviewing medical records for social security disability and SSI disability claims, disability examiners try to determine what activities a claimant can and cannot perform, known as his residual functional capacity (RFC). Detailed physician notes, preferably from a doctor with a lot of experience treating the impairment in question, can help a lot when it comes to a disability RFC rating. Ideally a claimant’s medical records will include not only a diagnosis and prognosis (how the condition is expected to progress over time), but also specifics as to how the medical condition affects the claimant’s ability to perform routine tasks, such as bending, lifting, memory, concentration, etc.

Disability examiners take into consideration a claimant’s functional limitations before assigning a rating of heavy, medium, light, or sedentary exertional work. In most cases, disability examiners must take their decision to the doctor assigned to their unit for approval before it becomes final, although in some cases Social Security does allow disability examiners to act as single decision makers (SDMs).

Typically, those approved for heavy or medium exertional work have a harder time winning SSD/SSI than those who are approved for light exertional work (with the exception of those filing on the basis of a mental impairment). The medium RFC rating requires that one be capable of lifting 25 pounds frequently, and 50 pounds occasionally.

Unfortunately, there are a lot of people approved for medium work by disability examiners who should have been given a rating for light exertional work, and this may be part of the reason so many DDS denials are later overturned by federal administrative law judges.

This is because, although many will deny it, the disability determination process is not entirely objective, and the personal experiences and beliefs of the examiners do come into play — they’re only human. Consider this: The average disability examiner is under 30, and therefore probably has little or no experience with chronic pain or illness, so it is difficult for the average examiner to truly empathize with most applicants. Also, being relatively young, the examiner may not realize exactly how much stress 50 pounds can place on an older adult, particularly one with a condition like degenerative disc disease, fibromyalgia, arthritis, or spinal stenosis.

Even some physicians lose the ability to empathize with their patients over time. It’s basic psychology — the more you hear complaints of pain and suffering, the more you become desensitized to them. So it’s very important that those filing for SSD/SSI tell their physician that they are seeking disability, and to ask that the doctor include detailed information regarding any functional limitations in his notes.

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About Tim Moore

  • Clavos

    There are law firms and other specialty firms in practically every city which will help an individual get approved.

    When my wife became disabled, her employer’s disability insurance carrier paid for the firm Allsup, which specializes in assisting people to get approved, to represent her.

    Even with their help, it took almost two years and two rejections from Administrative Law judges before she was approved.

  • http://www.joannehuspek.wordpress.com Joanne Huspek

    Sounds like a bummer to me but that’s the government.

    I remember fighting my way through the unemployment line. It’s no fun. Believe me, I’d rather have had my job.

  • Clavos

    The insurance company continued to pay her during the process, and SS paid her retroactively from the date she first applied, which of course, had to be sent to the insurance co.

  • Reading with interest

    I’m a disability examiner. If people had any clue as to how utterly useless disability lawyers are 99% of the time, most of them would be out of work tomorrow. I’ve had claimants go out and hire a lawyer the day before their (approved) case was closed, thousands of their hard-earned dollars going to some suit that literally did *nothing* to help them.

    The only time someone needs an attorney for their disability claim is when they’re about to go before an ALJ. Other than that, save your money. I have never, not once, seen a lawyer do ANYTHING for any of my claimants, other than sign a contract with them. And I do indeed mean *nothing.* They’re nothing but another name in the case file, that’s all.

  • http://delibernation.com Silas Kain

    So true. Disability Law Firms are yet another example of how tort reform is in order. There was a time when attorneys did not advertise on television or in other media the way they do today. Disability lawyers remind me of Chinese manufactured products. The concept is solid, but the product quality is shoddy.

  • debbie wyatt

    wish the gov.. would take care of the diabled amd th elderley firsr and formost including food and cltothing alsohomeless

  • debbie wyatt

    wwe need to focus on our porr our homeless im not saying we shuldnt help other countries but jast take care of our own first i have a son in the maire corps if he was in prision he woul live better and not be as expensive that is so sas/////////////////////////

  • Denise Dewitt

    I worked for over 35 years and endured repeated episodes of major depressive disorder. In the last five years of working, I decomposed repeatedly until finally I had to retire with a $2200 pension, a mortgage and medical expenses. I learned one year later, on the advise of my physician, that my condition was medically eligible for SSDI. I applied for the benefits with the support and documentation provided my my primary, psychiatrist and psychotherapist support. To date, ten months later, I have not received a decision. I have talked to the examiner twice and the last time was five weeks ago when she said that she had completed her write-up and submitted it to the medical consultant. I’ve called her twice since that time and have not been called back. I am 57 years and 11 months old and barely leave the house, don’t answer the phone (all bill collectors), my home is at risk of foreclosure and the Disability Determination Division treats me as though I’m asking for welfare. I paid into the system for over 35 years and am treated like a second class citizen. I am so distressed. Maybe if I were an approved refugee, I would have received benefits by now. I live in California and am considering calling my congressman, before I lose my house and and my fragile mind.