Persistent belief amongst the people I’ve spoken to about SSA disability is that virtually all first-time claims are denied. I can’t find any statistics on the matter, and have no idea if it is true or one of those old wives’ tales that tend to get attached to governmental processes.
If it is true, why? Because there are so many invalid claims, or because they deliberately attempt to delay claims in the hopes the claimants will go away or, well, die?
Julie
Second hand information, from a friend who manages Triangle Disability Advocates:
The claim is true. The SSA process is deliberately designed to make getting an award difficult, in order to weed out the large numbers of fraudulent or debatable claims so as to conserve resources for the smaller number of truly deserving candidates for the funds.
Sometimes they carry it a bit too far – e.g., present practice appears to be to summarily reject anyone who cannot produce at least three years of medical records proving inability to work, and/or a gradually worsening condition that has eliminated all possibility of work at the time of application.
The appeals process is only marginally better.
Second person chiming in - I used to work in long term disability administration. It’s true. The “joke” around the office used to be that if you’re able enough to fill out the forms you’re not disabled enough to get it, and if you are so disabled you can’t do the forms you still won’t get the award because the paperwork will never be filled out.
I saw crazy stuff - we had one woman so disabled from mental illness she could not speak intelligibly, could not be trusted to keep her clothes on or remember that she was toilet trained, and so on - her claim was denied because a form with her signature was not provided turning power of attorney over to her brother - apparently a court order declaring her incompetant and giving her brother custody wasn’t proof enough.
Had a woman without eyes - as in, they had been surgically removed - and thus totally blind turned down for social security.
Had a man who was a respirator dependent quad turned down for social security. (The signature wasn’t his, you see…)
Had woman who was quadrapeligic from MS as well as totally blind turned down for an award. (I forget what the problem was there. Anyhow, she paid a visit to Dr. Kevorkian before the appeals process finished. And that’s not a figure of speech - she really did end up in Dr. K’s Van O’ Death)
Now, all but the last of those were won on appeal - and then the lawyers took 30% of the award money up front, plus expenses.
It’s a real mess.
Although, to be honest, those were the worst stories of the lot. But yes, virtually no one got in on the first go round, everyone seemed to have to appeal at least once.
Well, I guess that at least tells me what to expect. My husband has severe CAD, diabetes, anxiety disorder, agoraphobia, and depression. Compared to some of the people in your post, Broomstick, he’s a picture of health! 
Thanks for the information.
We’ve been going at this lawyerless for the initial claim. Are we going to end up needing a lawyer before it’s all done?
Julie
I believe if the appeal is successful the SSA pays your attorney’s fees and your benefit payments are retroactive. Ask an attorney about this. Maybe they have to agree to take what SSA pays. I agree, the whole system stinks. Here’s one site where you can ask questions.
http://www.disability-benefits.com/disability_benefits_questions_answers.html
The biggest problem with the people I mentioned was incomplete paperwork.
My recommendation to anyone attempting to file for this sort of benefit is to consult a lawyer with experience in this area to make sure you have filled out the paperwork and properly assembled the documentation before submission. Sometimes how you word something is important. This is different than hiring one for an appeal, and should cost considerably less. It is also a case where you would pay the lawyer up front - do NOT do that on a contingency fee basis. If the lawyer starts giving you a hard sell walk out the door and get a different one. Just because a person is disabled doesn’t mean they aren’t in charge.
Be very careful to follow the instructions for filling out the application to the letter. Ask questions if you have the least doubt. If you’re good at filling out paperwork it is possible to do this on your own. Back when I was in the business we did have people and resources to help folks through the process - ask your doctor, your nurse(s), the office staff, or any rehab people you’re dealing with for references.
jsgoddess, psychological factors are particularly difficult to get disability for. However, your husband might well qualify on just the CAD and diabetes alone. The important thing is to document the degree of disability.
By the way - social security does NOT pay lawyer’s fees. In the case of an appeal SSI might cut the check going to the lawyer, but the money comes out of the beneficiary’s award money. As I said, it’s typically 30%. Benefits are retroactive. So if, hypothetically, you’re owed 2 years of back benefits and hired a lawyer to help you get them, you’d get those benefits in a lump sum, the lawyer takes 30% off the top of that, and once a month thereafter you receive a check. So it’s worth it to have a go at it on your own, because that way you get checks sooner and keep all of it, but if you’re turned down get a lawyer. 60% of a back award is better than none.
By all means - use all the resources available to you to fill out that application. Back when I was involved with this we didn’t have the Internet as a resource. Use it.
And try not to let the horror stories get you down. You CAN get through this. There will be some rough spots, but it is doable.
No - it is false.
The following stats are the most recent I could find in a brief search of internal Soc Sec docs.
Awards of all DIB/SSI disab appliocations at various levels of review for the year 2000:
Initial review: 38%
Reconsideration: 18%
Hearing level: 57%
Sorry I cannot link to this, as it is from SSA’s internal net. If you want more info or numbers I could probably find them for you, but I’m not realy chomping at the bit as it is too close to work! Or, if you disbelieve me, I could try to find something in the public domain.
Of course, you realize that not everyone who applies and is denied requests recon, and so on.
I believe the statsd are publicly available. Search the SS site and get back to me if you can’t find what you desire.
Oh shit, I did ot notice the “why” part of your question.
Having done SS disab litigation for the past 17 years, I am unaware of any nefarious plot to deny deserving people. However, it is a statutorily created scheme, and people must meet certain criteria to qualify. Most significantly, having a medically diagnosable impairment that renders you unable to perform your usual job does not mean you are entitled to SS disab bens.
Also, a great deal of disab claims are driven by economics. It is not coincidental that disab claims rise with unemployment…
Moreover, many SS disab claims are the result of attempts at cost shifting: businesses and insurers wish to get folks off their private disab plans, states wish to get them off their plans. In fact, in order to receive many private and state disab bens, a claimant is required to apply for SS. And a determination by any other agency using their own standards does not mean a person will be entitled to SS.
It is a complex scheme with numerous factors, so I will not attempt any more generalizations here absent a specific query…
Broomstick is spot on with her comment about insufficient documentation. The claimant is required to prove that they are disabled. Very important are detailed doctors’ opinions - not general conclusions of disability. But detailed statements of what a person can or cannot do with cites to the medical evidence supporting that opinion.
A lawyer can be helpful in identifying the correct pigeonhole your husband will need to be classified in, and developing the record to get him there.
Attorney fees are somewhat complex, and I don’t want to go into them here and now. But my opinion is that an attorney is worthwhile, especially if you have already been denied, and very much so if you are attending a hearing. A lot depends on your personal ability to obtain medical records, and deal with a complex regulatory system. Also depends on how important the back benefits are to you, as opposed to getting monthly checks.
Good luck.
Well, we did the initial filing online and our first conversation with anyone from SSA was them complimenting us on how well we (I actually) had filled out the forms, so that’s a plus.
The cites I can find say that if his medical info is incomplete, they’ll schedule him for an additional appointment with a doctor who would do a review? We didn’t have to do that for the cardiology/diabetes, though we did have to go for “psychological testing” which was a very weird experience!
Julie
I don’t have any personal experience with these matters in the manner of some of the previous posters, but I do deal with the results in the capacity of an actuary setting disability reserves. And the assumption that we use - which I’ve heard from everyone who knows anything about the subject, and is reflected in the tables that we use, as well as the data I’ve seen - is that the OP is correct. Generally any detailed census of disabled employees will have a high percentage of recent claimants in various stages of SS appeal or administrative law judge review.
I would also add one note to the legal fees issue. This is not something that I’ve ever dealt with. But what I would stress is that for people who have private (or employee sponsored) disability coverage, there is generally an offset provision, under which payments made by the private insurance are reduced by the amount of the SS award. So if a lawyer is going to be taking a chunk of the SS payments, you might be worse off on a net basis. (Of course, some plans require or incent SS applications - I am merely raising the issue).
js - there’s a big difference between a record being incomplete such that it cannot be determined, as opposed to being insufficient to prove your case. I do not believe reviewing and consulting physicians hired by the agency are biased, but IMO you would be best to not depend on them to make your case for you.
And it is standard - in fact required - to obtain a psych exam for someone who - as your husband - claims multiple psych impairments. There is a huge continuum between someone who is sad to someone who is disabled due to clinical depression. As well as possible overlay with other conditions. Your family doctor may not be sufficient evidence as to your mental/emotional condition. Of course, a single consult exam says nothing about one’s condition over time…
IMO&E allegations of psych impairments are a source of considerable - uh - exaggeration in disab claims. Written unsympathetically and briefly - say you have some guy who is not working do to a back injury, money gets tight and (understandably) he feels depressed about it. That doesn’t mean he should be given bens for depression. Maybe he should get off his ass and get a job. Might make him feel better.
Or you have the alcoholic who, once substance abusers got kicked off of SS disab, now claims to be depressed.
Note, none of this is intended to deny the existence of real and potentially disabling mental and emotional conditions. Nor did I personally support the legislation terminating bens for drug and alcohol abuse.
We were hesitant to put the mental health things on the claim because of the sort of hassle we imagined from “proving” that he’s got these issues. But the way the forms are written, you are supposed to list all health concerns, not just health concerns that you feel are contributing to the disability. So, even though we feel that if his mental health were perfect he would still be unable to work, we put down the psych history, and the SSA went with that.
The weird thing about the psych evaluation was how little evaluation there seemed to be. We were told it could take up to three hours. We went and were handed some paperwork and told to fill it out. We spent 20 minutes doing that, answering questions about the severity of things like “Anxiety” or “Disturbing thoughts.” Then we spent 2 hours waiting. Then, despite having all of our paperwork in a folder on his desk, the psychologist asked hubby a couple of questions about his work history and we were done.
IANAP, so perhaps there was more there than met my very unpracticed eye, but it seemed weird.
Julie
Historically, the problem would be with claimants alleging solely phys impairments, so the agency works them up as such. Then the hearing comes up, and the person says - oh yeah, I’m depressed. Courts were remanding adverse decisions due to lack of development of the mental aspect. So now, the slightest hint of mental/emotional impairment triggers a consult.
As far as consult psych exams go, I also ANAP, but I have serious doubts about anyone’s ability to accurately assess someone’s mental/emotional ability to function over time based on a single exam. Someone else will have to discuss the specific elements that comprise a psych exam.
I had to drop out of college when my medication stopped working abd the depression came back. I’ve been receiving pills and therapy since the third grade, when I was diagnoses with ADHD. Over they years, it became clear that I also suffer from social anxiety, OCD, panic attacks, and manic depression. When I applied, I was able to give statements and records from the same psychiatrist and the same therapist I’d been seeing for years.
As I said, I’ve been dealing with mental health forms since the third grade. My father worked for the department of defense for 37 years. We know how to fill out paperwork correctly and completely.
I was turned down anyway.
We appealed and were turned down again. We were actually in the office of the lawer when we found out my case had finally been approved.
He dealt specifically with social security cases. After he had told us I was approved and that there would be no charge, I asked why my case could have possibly been turned down.
"It's pro forma. Everyone gets turned down the first time."Well, I learned something. I always thought SS paid the attorneys fees. Anyway, I found this on Kraftlaw.com:
In all Social Security Disability and Supplemental Security Income (SSI) cases, the rules for calculating attorney fees are the same. The fee is set by federal regulation – 25% of the back benefits obtained for the claimant, up to a maximum fee of $5300.
As an example, if a claimant received back benefits of $10,000 the attorney fee would be 25% of that amount – $2500. If the back benefits were $30,000 the attorney fee would be limited to the maximum of $5300, even though that is less than 25% of the total back benefits.
SSI and Social Security fees are paid in two different ways. In Social Security cases, the fee is withheld from the back benefit paid to the successful claimant. Twenty-five percent is withheld, Social Security approves the fee and the fee is then sent directly to the attorney. In SSI cases, no fee is withheld. This means the client must pay the attorney when the client receives the back benefit check.
Confusion may arise when a claimant is paid both SSI and Social Security, a very common occurrence. Part of the fee may come from each, but in no event will the total fee be more than $5300.
The Social Security Administration sends award letters to claimants after they win their claims. Unfortunately, these letters often give incomplete or misleading information about the attorney fee calculations. Customarily a fee is paid by an SSI claimant as soon as the award check is received by the claimant. However, federal law requires that this money be held in an attorney escrow account until the fee is actually approved by the Social Security Administration.
Thought I’d give an example of the difference between good and bad documentation. These aren’t taken from a real case (confidentiality and all, and also I’m 7 years away from the business) but to serve as an illustration.
(so I’m going to avoid using medical jargon although in real life the wording would be much more technical)
Example One, Poor Documentation
Note from doctor says “Claimant disabled due to back injury and chronic pain interferring with life activities.”
Example Two, Better Documentation
“Claimant disabled due to back injury and chronic pain. Patient’s range of motion is restricted in following manner: unable to bend backward at all. Can only bend forward 10 degrees from vertical. Can bend to the right only 10 degrees, to the left only 5. X-rays and MRI’s show herniated disks. Patient has had 5 vetebrae fused with no beneficial effect on pain. Patient unable to tie shoes. Patient requires assistance to clip toenails. Patient unable to carry more than 10 pounds. Patient unable to rise from bed without assistance. Patient required to modify toilet at home by raising seat due to inability to sit normally to defecate. Requires pain medicaion X in dose Y as often as Z times per day. Unable to raise arms over head. Unable to raise arms to shoulder height without severe pain. Poor/weak reflexes exhibited in legs.”
See the difference? But regular doctors don’t always write in excruciating detail.
I also noticed a tendency in some folks to minimize their problems “Oh, I can manage if I do this.” Folks, this is NOT the time for a stiff upper lip. You need to be explicit. I mean, it’s wonderful if you can cope, but if you can’t wiggle your left thumb anymore you need to say so - not discuss how you work around the problem.
Age is also a factor at times. In the example I gave above in regards to the blind woman, part of the problem is that she got coy about her age. Now, if an 18 year is blinded that’s a tragedy, but they’re young enough to adapt and given their projected lifespan it makes sense to get them into a rehabilitation program. This lady, however, was in her 70’s and also suffered from diabetic neurapathy, meaning her feet and hands were numb which would make learning braille almost impossible and even manipulating a recording device for books on tape or a computer keyboard very difficult. She refused to give her age the first time (“a lady never tells” :rolleyes: ) and totally neglected to mention the diabetic complications (“but I’ve coped with that for years…”) . She was asked for further documentation (including her age) and refused to give it all the way through denial. When the lawyer was hired he documented her year of birth and the diabetes and she was a shoo-in.
So, if you’re filling out one of these applications be honest, be brutally frank about the problems in your life, document everything, and answer all the questions.