7 WAYS SOCIAL SECURITY CAN DENY YOUR DISABILITY CLAIM

 What are some ways Social Security finds to deny disability benefits?  Here are the common ones:

1.  Finding that you do not meet or equal a Listing.  A Listing is a severe medical impairment listed in the "Blue Book."  It is very difficult to meet all the requirements of a Listing.  So, failing to meet a Listing will prevent an automatic approval based on the most severe medical conditions.

2.  Finding that you do not meet a medical-vocational rule or "grid rule."  These rules apply to persons age 50 and over who have physical impairments and often dictate a finding of disabled.  Persons under 50 cannot qualify under a grid rule, neither can individuals who only have mental (non-exertional) disabilities.

3.  Finding that there exist jobs in the US economy that the claimant could perform, given his/her age, education, work history and functional capacity.  For claimants under the age of 50, this will often cause a denial.

4.  Finding that the claimant has worked at substantial gainful activity (SGA) after applying for disability benefits.   Social Security has a hard, fast rule with no exceptions:  a claimant must not work while getting disability benefits.  In 2021, they will find that a person is employed at substantial gainful activity if his/her gross earnings are at least $1,310 per month.  This applies to self-employment, also.

5.  Finding that the claimant can perform one or more past jobs.  Only jobs within the past 15 years are considered for this.

6.  Finding that the claimant stopped working for some reason other than disability.  For example, if a person stops working due to retirement, getting a pension, moving, getting laid off or fired, the employer closed the business, transportation problems or staying home to take care of a sick family member--these will usually not be approved.  The reason is simple:  none of those things are disabling conditions that prevent the physical and/or mental ability to work.  They are not covered by the Social Security Act.

7.  Finding that the claimant does not have a medically determinable impairment which (a) has lasted at least 12 straight months, (b) is medically expected to last at least 12 straight months, OR is expected to end in death.  Social Security will not pay for a short term disability (one that lasts less than 12 straight months). A claimant must have a period of 12 months during which he/she is not able to work at substantial gainful activity (earning at least $1,310 per month).

8.  Finding that the claimant has not worked enough (or recently enough) to have insured status under the Social Security Act.  You need to have earned "work credits" before being covered under the Social Security Act.  The usual rule is:  You must have worked at least 5 years out of the most recent ten-year period.  This work does not necessarily have to be full-time.* But you must have accumulated the minimum work credits.  Most people need 20 work credits to be covered by Social Security disability.

*In 2021, you earn 1 work credit by earning at least $1,470 in a calendar quarter.  In 2020, that number was $1,410 per quarter.  The amount of earnings required for 1 quarter of credit increase year by year.

 

WHAT IS "RECONSIDERATION" AND IS IT USEFUL?

 "Reconsideration" is for disability claims that have been denied.  It is the first appeal after the Social Security disability application is denied.

What happens at "Reconsideration"?

Your case goes back to the state's Disability Determination Service (DDS), which is the agency that denied it in the first place.  Supposedly, a different person re-examines the case and double checks to make sure no errors were made.  In about 90 percent of all cases the claim is rubber stamped "DENIED" and returned unpaid.

Is the process useful?  It is not useful to me and I cannot think of many of my clients it has helped.  As stated, it is pretty much a rubber stamp denial service.  We in the profession often refer to DDS as the "Disability Denial Service."

That is why I always use the word "Reconsideration" in quotation marks.

In theory, "Reconsideration" could be useful in a situation where the claimant has had a sudden worsening of his/her medical condition after being denied.  For example, if the claimant recently had a heart attack, stroke or dramatic decrease in the ability to function--Social Security might pick this up during "Reconsideration" and make a favorable decision.  But this is generally not the case.

The real effect of "Reconsideration" is to delay the process.  In Alabama, it delays the case no more than about 100 days.  On the other hand, in Tennessee a claimant can languish in "Reconsideration" for a year--or more.  Many claimants die before Tennessee can move them out of this process.

Are the claimants denied at "Reconsideration" really ineligible for disability benefits?  Not according to the administrative law judges who later hear their cases.  Among the cases that go on to a hearing, 59 percent are approved for their benefits.

So, at best, the "Reconsideration" process has.....

• A failure rate of about 59 percent.  It makes the wrong decision almost 6 times out of 10.  (Any employee with that error rate would be fired).
  

• Delays of about 90 to 110 days, holding the claimant back from a hearing that could get them approved. 

"Reconsideration" is useful for the government, however.  It saves the US government billions of dollars because thousands of claimants either die or drop their appeals after "Reconsideration."

Therefore, it's hard for me to see this program as anything more than a stalling or delaying tactic to save the government money.

Can it be skipped?  No.  You cannot take a denied claim to a judge unless you have been denied at "Reconsideration."

So the appeal steps are:

1. Denial
2. Reconsideration
3. Hearing
4. Appeals Council
5. Lawsuit in Federal District Court
   

WHAT QUESTIONS WILL LAWYERS ASK, AND WHY?

 You probably want to get a lawyer to help you get Social Security disability benefits.  You need to understand that lawyers cannot charge you any fee unless you win your claim and recover past due benefits.  Therefore, lawyers are careful to only take cases that they believe have a reasonable chance of success.  Otherwise, the lawyer will starve to death.

So, lawyers are going to evaluate your claim to see how solid it is.  To do so, they will ask you several questions.  

Here are the questions:

1.  Are you now working?  If so, how much do you earn?  REASON:  By law, a claimant cannot be working and earning wages of $1,310 per month or more and still qualify for an SSDI benefit.  So, full-time work, or work above the $1,310 per month threshold disqualifies an individual for SSDI, no matter sick he is.

2.  When is the date you stopped working?  WHY?  Your "alleged onset date" may be back-dated to recover more back pay. This is the date you claim to have first become unable to work.  You may qualify for past due benefits back to this point.  But you cannot qualify for a benefit prior to the date you stopped working at "substantial gainful activity."  For example, if you feel that you became disabled on July 1, 2020 but you continued working until September 1, 2020, you cannot claim a benefit prior to September.

3.  What is your impairment?  Will it keep you out of work for at least 12 straight months?  REASON:  Social Security will only pay for an impairment which has lasted at least 12 straight months, that is expected to last 12 months OR is expected to end in death.  Short term disability is not covered by SSDI rules.

4.  Are you getting medical treatment?  WHY THIS QUESTION?  Because the federal regulations require that disabling impairments must be "medically determinable."  This means that a qualified doctor must perform adequate tests and examinations to determine the nature, severity and probable longevity of your condition(s).  Without medical records, there is no chance to get on disability.

5.  What is your work record over the previous 15 years?  WHY?  There are 2 reasons for getting your detailed work history:

• One, a claimant must have worked enough (and recently enough) to have gained insured status with Social Security.  The general rule is, you should have worked at least 5 years out of the most recent 10 year period.  You must pay in before you can take out.  So, work history helps determine if you are covered by SSDI.
  

• Two, at certain ages a claimant may get approved using a grid rule.  These rules rely heavily on past work experience and whether or not the claimant has transferable skills from previous jobs.  Employment history is very important in trying to evaluate whether a claimant can meet a grid rule.

6.  Has there been any other attorney involved in this case?  WHY?  As a general rule, you don't want more than one attorney or representative on your case.  Many attorneys are reluctant to sign on to a case where another representative has been involved because it can complicate the fee process.  No one wants to win a case and then find that someone else is going to get part (or all) of the fee.  It's a matter of fairness.  Ordinarily, it isn't a good idea to change representatives in the middle of a case.  There might be exceptions, of course.  Certainly if you do make a change, the new attorney needs to be made aware of the former representative from the start.

__________

Need help?  Call the Forsythe Firm in Huntsville.  (256) 799-0297. 

Decades of experience.  Free consultations.  

 

3 REASONS SOCAL SECURITY DENIES DISABILITY CLAIMS

 Social Security denies disability claims for many reasons.  In our decades of practice, here are 3 of the top causes of denial:

3.  The claimant has worked since claiming disability.  This causes a firm Step 1 denial, no questions asked.

2.  Mistakes on the Application.  The "Application" includes these forms, too....

• Work History Report (I've never seen one of these filled out correctly)
• Function Report
• Medical Report

1.  Lack of Objective, hard hitting medical evidence.  Claims simply cannot be paid without objective medical evidence, which includes appropriate lab work, X-rays, MRIs, CAT scans or other  studies.

NEED HELP?  The Forsythe Firm can help with all 3 of the above problems.  We build your case with an eye toward winning.  We will never charge you a fee until you win your claim and recover past due benefits.  Our "contingency fee" agreement says that all our work is FREE until you win.  Any fee we earn is taken out of your back payments.  No Back Pay = No Fee.

Get in touch:  (256) 799-0297.

SOCIAL SECURITY DISABILITY: HOW LONG DOES A CLAIM TAKE?

 A Social Security disability claim involves both the state and federal government.  It is one of the slowest processes that one can imagine.  Here are some expected time frames based on our experience and numbers released by the Social Security Administration.  The steps in the process are shown in order.  Approximate approval rates are given at each step.  Of course, not every claim has to go through all these steps, since you could be approved at any step.

1.  APPLICATION PROCESS.  Approval rate 20 to 25 percent.  This process can take between 4 and 6 months.  

2.  "RECONSIDERATION" PROCESS:  Approval rate less than 10 percent.  This will take between 60 and 90 days in Alabama but may take a year or longer in Tennessee.

3.  HEARING LEVEL APPEAL.  Approval rate about 45 percent on average, higher with an attorney).  This process can take about 6 additional months (after "Reconsideration").

So, an unfortunate claimant who must go through all 3 steps is looking at a year or more to get through the process.  And, no, you cannot receive benefits while enduring the application and appeal processes.  You may be able to recover past due benefits that accrue during the long process, however.

What's the best way to deal with a disability claim?

Get a local attorney/advocate who understands the system, the rules, the evidence and requirements.  Follow this professional's advice.  And don't give up.  Remember that most claims are denied TWICE before they are paid.  

A denial by Social Security doesn't mean that you aren't eligible for benefits; it means that the government is being stubborn and demanding more proof.  For all practical purposes, an Administrative Law Judge (ALJ) has the final say (at the hearing level), although other appeals are possible after the hearing.

 Need help but don't want to pay upfront legal fees?  Call the Forsythe Firm in Huntsville for a FREE consultation.  If we represent your case there will never be a fee or out-of-pocket cost to you until you win and recover past due benefits.  Get in touch:  (256) 799-0297.

WHAT IS THE "5 STEP PROCESS" FOR DECIDING SOCIAL SECURITY DISABILITY?

Decision makers at Social Security are required to use a 5-step sequential process to decide whether a claimant is disabled and entitled to a disability benefit.  The process has 5 steps which must be sequential.  They must start with Step 1 and consider it before moving on to Step 2.  A claim may be denied at any of the 5 steps.

Here are the Steps in order:

STEP 1:   Is the claimant working at Substantial Gainful Activity (SGA)?  In 2021, this means wages or self employment income of at least $1,310 per month (gross).  If so, there is a Step 1 denial here.  If not, we proceed to Step 2.

STEP 2:   Does the claimant have at leas one severe impairment which

• Is medically determinable (supported by objective medical evidence) and
• has lasted at least or is expected to last at least 12 straight months OR to end in death.  If the answer is "Yes," we move on to Step 3.  If not, the case is denied here.
  

 STEP 3:    Does the claimant meet or equal one of the Listings in Social Security's "Blue Book"?

• YES - An award or approval is issued here.
• NO -   The claimant's Residual Functional Capacity (RFC) must be determined before proceeding to Step 4.
  

STEP 4:    Based solely upon the claimant's age, education, past relevant work and Residual Functional Capacity, is the claimant able to perform any of the full-time jobs he/she performed during the most recent 15-year period?

• YES -  A denial is issued here at Step 4.
• NO -    The case moves on to the 5th and final step.

 STEP 5:  Based solely upon the claimant's age, education, past relevant work and Residual Functional Capacity, is there any other work in the national economy that the claimant would be able to do?

• YES - Claim will be denied at Step 5
• NO -   An award will made here

 Most cases will go all the way to STEP 5, and will depend on the question associated with Step 5, "Can the claimant do any other work...?"

This is the framework for all Social Security disability decisions.  The steps may seem cut and dried; however, there is a great deal of legal argument that can and should occur at each step.  Even Step 1 isn't cut and dried.  The claimant may indeed be working but that doesn't always mean working at substantial gainful activity.  And "work" may or may not be "past relevant work," according to the regulations.

To get a free case evaluation at no obligation, call the FORSYTHE FIRM in Huntsville.  (256) 799-0297.

 

 

   

WILL SOCIAL SECURITY PAY YOUR DISABILITY CLAIM IN 2021?

 What are the chances Social Security will pay a disability claim filed in 2021?

Answer:  The odds are poorer than at any time in recent history.

However, there are 7 things to help increase your chances and get your disability claim paid:

1.  Don't waste your time without an attorney.  SSDI claims paid without an attorney are about 31 percent, vs. 60 percent with an attorney.  Concurrent SSI + SSDI claims stand at about 6 percent paid without an attorney and 59 percent paid with one.  No need to say more.

2.  See your doctor before filing.  Social Security law declares that impairments must be "medically determinable."  Get all of your disabling medical conditions verified by your doctor(s), then file Social Security disability.  Without medical evidence, it's totally hopeless.

3.  Sign and return every form that Social Security sends you on time.  Fill out and return any paperwork they send you on time.

4.  If Social Security schedules you to attend one of their examinations, show up 15 minutes early (not just on time):

• Take all your prescriptions medicines with you.
• Cooperate with the examining doctor
• Don't exaggerate symptoms 
• Don't pressure the doctor to say you are "disabled."

5.  Listen to the advice of your attorney-representative.  He or she has been through this a lot more often than you have, so trust professional judgment here.

6.  Do not work at Substantial Gainful Activity after filing your claim.  Your work will be substantial and gainful if you earn wages, salary, tips or self-employment of at least $1,310 per month (gross, before tax).  This will make you ineligible for any Social Security disability or SSI benefit.  (It doesn't matter why you had to work. No exceptions).

7.  Stay off of Unemployment benefits during your disability period.  Unemployment benefits are for workers who are able to work, willing to work, and looking for work.  Social Security is for individuals who cannot work, are not seeking work, and could not work if they found a job.  Social Security will usually refuse to pay a disability benefit to persons who are still in the workforce (receiving unemployment benefits).  

Receiving unemployment checks says to Social Security:  "I am just between jobs, looking for work.  So, I am not disabled."  End of case.

 

 

HOW TO SPEAK TO A REAL PERSON AT SOCIAL SECURITY

 We live in an automated world and it's hard to speak to a real person on the phone.  Phones are answered by computers and often you hold for the longest time to speak to someone.  Social Security offices are no different.

Here are a few tips on how to reach a real person at Social Security, when you don't know someone's name or extension number:

1.  Avoid the national toll free number and call your local Social Security field office.  Some of these office numbers are listed at the end of this article.

2.  When your call is answered by the automatic greeting, listen until you're asked to dial your party's extension number or Press 2 for more options.  

3.  Press 2.

4.  When the new recording begins, press 0 for an operator.

5.  Hold a few minutes and listen to more recordings until a person has time to pick up and talk to you.  The wait is usually less than 5 minutes.

Information you need to have available to prove you are who you say you are:  Your SSN, Date of Birth, Place of Birth, and Mother's maiden name.  Note:  Social Security will only speak to you about your own account (not a spouse, friend, or someone you are trying to help--unless that person gives them permission).  Social Security doesn't recognize powers of attorney.

SO HERE ARE SOME OF THOSE PHONE NUMBERS:

(All offices use toll free numbers)

Huntsville, AL       (866) 593-0665

Decatur, AL           (888) 289-9185 (Serves Limestone County)

Florence, AL          (855) 884-3407

Albertville, AL       (800) 521-0073

Birmingham, AL    (866) 592-3734

Gadsden, AL           (866) 803-6323

Cullman, AL           (877) 803-6362

Nashville, TN          (877 808-5461

Madison, AL           (866) 965-6302

Chattanooga, TN    (866) 964-0029

Murfreesboro, TN    (866) 593-3112

Tullahoma, TN         (866) 635-0647

Lawrenceburg, TN    (877) 405-5866

 

WHY FILING A NEW APPLICATION ISN'T THE SOLUTION TO A DENIED CLAIM

When your Social Security disability claim gets denied, it may be tempting to file a new application.  However, in 98 percent of cases, a new application is the exact wrong move.

When you file a new application following denial, here are some things you need to know:

1.  You are starting over in the literal sense of the word.

2.  There's no more chance of success with the new claim than you had with the old claim.

3.  The 2 questions Social Security will ask on the new claim are:

• Does the claimant have substantial new evidence this time that wasn't available before?

• Is there a major difference in this new claim compared to the old claim?  New disease, new diagnosis, etc.

In short, Social Security is asking, "What's new?  What has changed?"  

If the answer is Nothing--expect the same decision.  Another denial.

The application process is a weeding out process. It doesn't produce many awards.  It mostly produces denials.  It's not the most fertile ground to try for approval. In fact, the application process has an approval rate of around 25 percent. Appeals have about a 45 percent approval rate. Get out of the application stage as fast as you can.  File an appeal.

OTHER REASONS NOT TO FILE A NEW CLAIM

• You will almost certainly lose most or all of your back pay.
• You may reach your Date Last Insured and cease to be covered by SSDI benefits.
• A new application delays a favorable decision by 4 to 6 months.  Wasted time.
• A new application is just spinning your wheels, but you go nowhere.
• The same agency that denied your first claim, examines your new claim, too.
• Same information in, same result out.

THE SUPERIOR WAY TO GO

File an appeal.  This keeps your old claim alive but eventually gets it out of the agency that denied it, and sends it "up the ladder" to a higher authority for review.  It preserves your right to appear before an administrative judge (with your representative) and make your case personally to the judge.  You never achieve this with new applications.   

What Does It Cost To Appeal?

Nothing.  You cannot be charged legal fees or attorney fees until after you win and receive past due benefits.  If you don't, there cannot ever be a fee.

 

  

WHERE IS MY CHECK? PROBABLY IN THE TANGLED UP US MAIL

 Where is that check you've been expecting (and needing)?  It's probably tied up somewhere in the US Mail, which has become slow and unreliable in the past few weeks.

 Many Americans depend on the mail to deliver important things, such as Social Security checks, retirement benefits or even pay checks.

 However, it is now taking up to 14 days longer to get mail than it should.

The US Postal Service (USPS) was hit hard by the COVID-19 outbreak.  Further aggravating the situation, the new Postmaster General, Louis DeJoy, implement new policies to save money--and these further slowed down mail delivery. For example, he reportedly refused to allow mail trucks to leave on time if they were waiting on other mail trucks.  

A few days ago, DeJoy announced that he is suspending the new, slower rules to try to get the mail back on time.  This is in response to protests by lawmakers, postal unions and others.  20 states have announced that they will sue the agency and DeJoy; it is not known whether the states will back off the suits now that DeJoy has abandoned his new rules.

Funding is a big problem. The Post Office had requested billions of dollars in new funding from the Trump Administration, which balked at the request.  Thus, the Post Office remains even more cash strapped.

So, if you wonder where your Social Security Check is, or some other important mail, it's a good guess that it's held up in the postal system somewhere, waiting to be delivered.

Whenever possible, think about having your check or benefit direct- deposited to your bank.  This takes the mail delays out of the picture and gets the money to you much faster!

WHAT IS "CREDIBLE TESTIMONY" IN A DISASBILITY HEARING?

 When judges write their decisions, they sometimes refer to "credible testimony."  What do they mean by this term?  Does it simply mean that the claimant has come in with a good, reasonable account of his or her disability?  Or does it mean more than that?

The term credible testimony means that what the claimant says is supported by objective evidence in the medical record.  For example, if the claimant testifies that he has severe back pain on most days, there should be medical evidence to support this.  If he has X-rays and MRI studies that show herniated discs, stenosis of the spinal cord and osteophytes that press against the nerve roots, then this explains the severe back pain and makes it explainable.

However, if an individual tells the judge that he has severe back pain without any objective medical evidence to support it, it may be considered testimony that is "not fully credible," or "not supported by objective medical evidence."  This will generally cause a claim to be denied.

So, there are really two important parts to credible testimony:

1.  A reasonable explanation from the claimant as to the type, location and severity of symptoms, and

2.  Objective medical evidence that is consistent with symptoms that the claimant alleges.

When both of these things are present, you have at least a medically determinable impairment.  Will it pay?  That question involves another step:  Is the impairment so severe that it seriously reduces the claimant's capacity to perform "substantial gainful activity," or full time work?  Does the impairment preclude all work or just work at some exertion levels?  For example, an individual may not be able to work at heavy or medium level jobs but can still work at light or sedentary jobs. 

The point I want to make is this:  Telling a convincing story to the judge will not be enough to get the claim paid.  The federal regulations prevent judges form paying disability claims unless there is objective medical evidence to support the claimant's allegations.  In short you will need X-rays, MRIs, CT scans, laboratory tests or other signs that support your symptoms.  So, it's to the doctor first and to Social Security later.  

The stronger the objective medical evidence, the more likely your claim is to get paid.  If you'd like for a disability specialist to look at your case and evaluate how strong it is, contact the Forsythe Firm at (256) 799-0297.  The evaluation is free and there is no cost or obligation.

PROTECT YOUR SOICIAL SECURITY INCOME - IT'S EASY

 Debt collectors will often try to seize your Social Security income, although it is exempt from most garnishments and liens.  That doesn't always stop creditors from using their court order to grab the Social Security money you have deposited in a bank or credit union.

And you cannot depend on the bank to know that these seizures are against the law.  I've had clients whose money has been grabbed by creditors and the bank didn't seem to understand the law at all.

Here is how you can protect your Social Security income once it has been deposited into a checking or savings account:

1.  Use a special, dedicated account and deposit all Social Security into this one account.

2.  Do not deposit any other income into the account--just Social Security money.

3.  Don't allow anyone else's name or Social Security number to appear on the account.  In other words, no joint accounts.  If someone else, such as a spouse, appears on the account, it can confuse the protection you should have.

4.  If a creditor seizes your account, inform the bank that Social Security money is exempt from most liens, seizures and garnishments.  The bank must do an investigation to show that the funds seized were not exempt as Social Security funds.  This is where it is very helpful not to have any other funds co-mingled with your Social Security funds.

IMPORTANT NOTE:  Certain types of debt are not exempt from seizure or garnishment.  This includes most debts guaranteed by the US government.  For example, student loans, past due child support or VA mortgages may not be exempt and could be legally seized.

This information is provided as general information and is not intended to be legal advice on any particular problem or situation.  If you need legal advice, please call your attorney for a consultation.

IS IT HARDER TO GET DISABILITY BENEFITS NOW?

 For about the last 3 years, Social Security has issued new regulations which are definitely aimed at making it more difficult to get disability benefits.  We'll focus on just 3 of those rules:

1.  Social Security no longer gives special weight to a claimant's treating doctor.  Prior to March 27, 2017, the opinions of your doctor were given preference over those of others, such as one of the agency's consultative doctors.  After that date, however, your doctor's opinion gets no special consideration.  In fact, Social Security's guidelines for evaluating medical evidence gives the advantage of their own consultative doctors, not yours.  This makes it more difficult to win a claim.

2.  Social Security no longer considers illiteracy in making decisions on disability claims.  Under the old grid rules, the inability to read and write English was considered, among other factors, in deciding if a claimant were disabled.  It is no longer considered in most cases.

 3.   Social Security now requires an extra step before a claimant can appear before a judge.  As of October, 2019, claimants who are denied in Alabama cannot appeal directly to an administrative law judge and ask for a hearing.  An extra step called "Reconsideration" must be filed first.  This "Reconsideration" adds 60 to 90 days more waiting time and rarely results in any action favorable to the claimant.  A recent study shows that 55 percent of claims denied at Reconsideration will win before a judge.  Thus, "Reconsideration" gets it wrong 55 percent of the time!  Yet, it adds up to 90 days to the already long disability process. In the last 10 years, award rates have fallen by 20 percentage points.

In 2011, an average of 62 percent of claimants won their disability benefits if they used all of their appeals.  In 2018, however, this number had dropped to 42 percent.

Every time Social Security announces a rule change "in order to better serve our clientele and secuure the integrity of the system," you can bet that the new rules does one thing:  makes it harder to get disability benefits--and take even longer.  I'm convinced that someone in Baltimore is sitting around all day thinking, "How I can reduce the number of new Social Security disability benefits?"

How can you fight Social Security's ever tightening rules and win?

1.  You need excellent medical documentation from your doctors.

2.   You must know what the current rules are.  Imagine trying to play chess if no one had explained the rules to you?  A nightmare.

3.  Get professional help.  You will be going up against seasoned professionals at Social Security. These experts have attended thousands of hearings and they know exactly what to expect. Your appeal hearing will be attended by these professionals:

• a vocational expert paid by Social Security (every hearing)
• an Administrative Law Judge who works for Social Security
• a medical expert (doctor) called by and paid by Social Security (often, not every case).

I advise you:  Do not go before these people unrepresented. It is asking for denial.  In fact, it's begging for it.  Get knowledgeable representation.  Ask for a "contingency fee agreement," so you don't pay any attorney's fee unless you win.  This arrangement is win/win for you.

 

Does every claimant who goes unrepresented lose?

 

No.  Statistics from Social Security state that slightly fewer than  3 out of 10 unrepresented claimants still win.

 

However, about 6 out of  10 claims represented by an advocate/attorney will win.  That's twice the number!  

 

So, in effect, you get to choose your own odds! 

 

DISABILITY BENEFITS FOR CHRONIC PAIN

 Chronic pain can be defined two ways:

1.  Pain that lasts longer than the usual course of an illness or injury.  

2.  Recurring pain that has lasted 6 months or longer.

While Social Security's Blue Book does not have a listing for chronic pain, it may be possible to get benefits.  But there are some things you should know about chronic pain:

1.  Social Security cannot pay for symptoms only.  You must establish that you have a medically determinable illness or impairment that can reasonably explain the chronic pain.

2.  Your medical impairment must be determined by objective medical tests or investigation.  You should have X-rays, MRIs, CAT scans, laboratory tests, etc. to diagnose the condition.

3.  The pain must be a reasonable symptom of the diagnosed medical condition.  

4.  There should be current medical records that documents the location(s), nature and severity of pain.

• In what parts of the body does pain occur?
• Is the pain described as burning, aching, stabbing, throbbing?
• Does the pain occur constantly, frequently, or only occasionally?  Be specific.
• What exacerbates (brings on) the pain?  What relieves it?
• What treatments have you tried to help reduce the pain?

Again, it is extremely important that the chronic pain is understood to be the result of a medically determinable impairment.  It cannot be just that, "I have a lot of pain."  

If possible, get a treating doctor to provide a Treating Source Statement specifying how work-related activity would be restricted by the pain.  In other words, specifically how would it limit such abilities as standing/walking, sitting, bending, lifting, kneeling, using arms and hands, concentration, completion of work tasks, etc.

Social Security may approve a benefit if it is convinced that pain is so severe that it prevents the ability to perform full-time work (i.e., 8 hours per day, 5 days per week or an equivalent schedule).