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Fall 2000

Winning Your Social Security Claim
By Scott E. Davis, Esq.

Disability laws are complex and often overwhelming for the person without a  law degree. In this article, Scott Davis, a Social Security and long-term disability insurance attorney in Phoenix, Ariz., shares his wisdom and relates the 15 most common mistakes people make when applying for Social Security disability benefits.

1.   Don’t assume that an entire year has to pass before you can file a disability claim. The Social Security Administration (SSA) requires that before you can be approved for disability only one of the following must be true: (1) you have already been disabled and out of work for one year, (2) your doctors expect that you will be unable to work for a minimum of one year from the date you last worked or (3) your medical condition is expected to result in death. Many people have had a SSA employee incorrectly tell them they could not file a claim until one year had passed since they last worked.
Advice:   Apply for disability benefits as soon as you believe your condition will preclude you from working for at least one year.

2.   Don’t assume you can handle your own case. Even many attorneys don’t understand SSA disability laws. It is crucial that you understand what must be proven legally. If you do not know what you need to prove, you risk losing.
Advice:   Retain only an experienced disability lawyer who can help build your case, develop a case strategy, obtain a complete set
of your medical records and crucial opinions from your doctors.

3.   Don’t assume that you cannot afford a lawyer. You usually only pay an attorney a fee if you have won your case and received benefits. Further, SSA law limits the amount of money your lawyer can earn from your claim.
Advice:   You can’t afford not to hire an experienced disability attorney if you are to receive the benefits you are entitled to.

4.   Don’t assume any lawyer can help you win your claim. Retain a disability lawyer who is familiar with SSA laws and regulations.
Advice:   Choose a lawyer whose practice is dedicated to disability law and who understands the strategy to help you win.

5.   Don’t assume the disability forms you fill out will win your case. Claimants often hurt their cases by overstating what they can do. In most cases, the SSA and judges rely heavily on medical records and opinions from doctors about your ability to work full-time. Inconsisten-cies in answers you provided on the forms could make the judge question your credibility.
Advice:   When completing the forms, be honest, accurate and brief. Also, when answering questions about what you are capable of doing, answer as though you are working full-time on a sustained basis (eight hours per day, five days per week).

6.   Don’t assume that your symptoms will be enough for the judge to approve your claim. You need detailed medical records that document your symptoms and limitations and specific opinions from your doctors, whose opinions will only be given weight by the judge if you have received continuous and consistent medical treatment.
Advice:   It is crucial that you receive continuous and consistent medical treatment so that you can provide the SSA and a judge with current and complete medical records that support your doctors’ opinions.

7.   Don’t assume that the SSA will be persuaded by any type of medical treatment you choose. You can choose any holistic or alternative therapies you desire, however, the SSA and judges are most persuaded by mainstream doctors (MD, doctor of osteopathy, PhD) and how you respond to their treatment. If you are not taking medications or are not receiving treatment by a mainstream doctor, you may be jeopardizing your claim.
Advice:   Exhaust the appropriate medical treatments your mainstream doctors recommend. If your condition persists, you can then prove that, in spite of treatment, you continue to be unable to work full-time on a sustained basis.

8.   Don’t assume that your family doctor’s opinion is the only one you need. If your diagnosis is usually made and treated by a specialist, you should be treated by both a board-certified specialist and your family practitioner. You want to show the judge that your diagnosis is correct and that you are receiving the best possible medical care.
Advice:   The more experienced your doctors are, the more likely you’ll win. Note: If your HMO will not allow you to go to a specialist, consult with your lawyer, who can help you get appropriate treatment.

9.   Don’t assume that your doctor will support your claim for disability benefits. Some doctors refuse to help patients with their disability claims, don’t know the definition of disability, or don’t know how to complete the forms or write a supportive disability letter. [Editor’s Note: The Association publication, “Disability Evaluation in a Nutshell,” by Douglas Smith, shows doctors how to write disability reports for the SSA.] Because SSA and a judge will want to know if your doctor supports your claim, it is crucial you know the same.
Advice:   Determine if your doctor supports your disability claim. If not, consider finding one who will. One place to find a referral is to attend a local CFIDS support group.

10.   Don’t assume you have to go to a SSA doctor. The SSA often wants you to go to a doctor it chooses, but they often conclude that you are able to work whether or not you can. Once this is included in your file, your claim could be denied. However, you are allowed to have your own doctor perform the disability exam and SSA must pay for all or part of it. Once your doctor’s report that you are disabled is in your file, SSA and a judge may have sufficient information to approve your claim.
Advice:   If you do not have a doctor who supports your claim or who is willing to perform the exam, you must go to a SSA doctor or risk having your claim denied or closed out.

11.   Don’t assume your diagnosis will win your claim. It’s true that the SSA needs a diagnosis, but it also needs medical proof that your diagnosis causes limitations that are so significant and severe that they preclude your ability to work full-time on a sustained basis.
Advice:   Disability cases are won based on your limitations, not your symptoms. Make sure you provide detailed medical records that reflect your symptoms, diagnosis and functional limitations.

12.   Don’t assume you should not hire a lawyer until your case has initially been denied. You can hire a lawyer any time you wish, but many SSA employees will tell you that it is not necessary to hire an attorney until you have been initially denied.
Advice:   Consult with and/or hire a disability attorney as soon as you file your application. If you need help finding an attorney, contact the National Organization of Social Security Claimant Representatives at 800/431-2804 or visit their web site.

13.   Don’t assume that what SSA tells you is true. Many people do not file a disabil-ity claim for years simply because a SSA employee gave them bad information.
Advice:   Review your case with a disability lawyer, who may know more about the law than some SSA employees.

14.   Don’t assume the SSA will approve your claim. The SSA denies 70% to 75% of all first-time claims and 82% of claims that are appealed. However, when cases are heard before judges, 53% are approved.
Advice:   Appeal every denial within 60 days and build a strong case by understanding what information the SSA requires and making sure it is presented properly.

15.   Don’t assume that if you lose before a judge at a hearing, you can file another claim. Your best chance at winning is at your first hearing. A loss is recorded in your file and could have a detrimental effect on the judge at a second hearing.
Advice:   Make sure your case is properly prepared so that you can present your strongest case at the first hearing.

Davis represents clients seeking disability benefits on a broad spectrum of disorders. For inquiries, telephone 602/482-4300.