December 28, 2004

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Stop Letting Social Security Disability Cheat You Out of the Benefits You Deserve


After Mary's failed back surgery, her doctor told her he'd

support her claim for disability. His eyes were comforting

and Mary felt like she'd finally found someone who

understood the pain she was in. She'd already gone through

years of undiagnosed Fibromyalgia. Some days she even had

sneaking thoughts of suicide- at least then it wouldn't hurt

so much.

Mary's doctor told Social Security that she was indeed

disabled and could not work. So, Mary waited… and waited…

and waited.

She borrowed money from friends. She assured them her doctor

had promised her she was qualified. Even the Social Security

representative who took her application could see that she

could barely bend and walked with a noticeable limp. In

fact, he'd commented on it.

Mary had paid into the system, and now- unfortunately- Mary

needed help. Rent was behind, she was already on food

stamps… who would hire her in her condition anyway?

Months went by with no word, until FINALLY. The letter from

Social Security arrived. When Mary read the letter she

almost fainted. THEY HAD DENIED HER!

Mary had not taken the time to read the Social Security

website at http://www.ssa.gov/. If she had, she would have

been able to put some personal information into one of their

calculators http://best.ssa.gov/ and determine if she was

eligible for any of their disability programs. Had she read

the website, she would have known that it takes more than

your doctor saying you're disabled to get on disability


The sad fact is 3 out of 10 of today's 20 year olds will

become disabled before reaching the age of 67. And if you

are one of the unfortunate who need to apply, it can take

3-6 months for a decision. And… if you are granted benefits,

you may be asked to serve a 5-month waiting period BEFORE

you can get any benefits at all! And those benefits are NOT

always retroactive!

There are many reasons why your claim can be delayed or

denied, but you will waste valuable time if you don't go in

well informed. While it may be a complex program to

understand, you can arm yourself with the basics before

launching into a prolonged wait that could end up in further

poverty and humiliation.

Some people prefer to ask a qualified attorney to handle

their claim, but if you take the time to read the Social

Security website, you will see that the information is laid

out very logically, is easy to understand and tries to

answer all your questions in an open and honest way. Your

chances of being allowed disability benefits is NOT

increased if you use an attorney- that is simply NOT true.

However, if you appeal the decision to higher levels of law,

then an attorney would be helpful.


There are 10 top reasons your claim is likely to be denied

by Social Security.


You are not insured for disability benefits (SSD). You have

to work a certain amount of years to be eligible and your

insurance can lapse. This one is like car insurance. The

company doesn't continue to insure you if you don't continue

to make the premiums. And … the amount you may get on a

monthly basis may be such a paltry amount, that you couldn't

possibly live on it. It is not based on what you need to

live, it is based on how much you paid in. So if you're a

20-yr-old worker who has only paid in since age 18, you will

not get much money at all. AND, since you are a young

person, your claim may be reviewed more often to see if you

are well enough to work again.

You are not eligible because of your income and resources

(SSI). This program is based on your financial need. If you

have substantial assets, you'll probably be denied. If your

spouse works and you do not live within certain poverty

guidelines- you will probably be denied. The decision as to

whether you are eligible begins with the income and

resources in your household. Then, if you are found eligible

and are approved benefits, the average monthly check will

only be about $550 dollars. That is, unless your state

supplements your check. But even so, it wouldn't be for much


Your impairment, while severe, does not meet the criteria

for severity as recognized by Social Security. You can see

the actual criteria Social Security uses to determine the


severity of impairments by looking at THE BLUE BOOK online

htm. The Blue Book specifies EXACTLY how severe a certain

impairment must be before you are considered severe enough.

The Blue Book is available for the public to view on the

Social Security website (NOTE: The Blue Book is written with

the professional in mind, so be aware that you could

misinterpret or not fully understand parts of it.) Your

impairment is severe, but not likely to last 12 months or

end in death. Let's say you had a bad car accident and broke

both legs, preventing you from working as an auto mechanic.

Chances are, fractures are going to heal within 12 months

and you will be denied. Social Security disability benefits

are for more permanent impairments. Plus, they don't give

you 10% or 40% disability like some insurances do. And other

insurance companies often use different criteria for

deciding if you're disabled. That means, just because the

Veterans Administration or Worker's Comp has found you

disabled- that does not always mean Social Security will

find you disabled.

You're working and earning a substantial amount. This is

obvious, but some people are under the impression they can

continue to work while applying for benefits. This is simply

not true, unless you earn less than $810 a month and the

work is not worth more than that in the national economy.

There are also those who think they can work under the


table. Social Security has an interesting part of their site

th.htm devoted to fraud and the active surveillance and

investigation that goes into claims. They also include some

colorful stories of how they uncover fraud. There are often

fines, restitution and sometimes prison time that some have

had to serve due to fraudulent claims.

You are a fugitive felon. Most people would know enough not

to apply for government benefits when they are wanted for a

felony-- but… apparently it happens. And when it does, you

will be reported to police agencies. Also under this

category would be those who are injured or become disabled

in the course of committing a felony.

And finally, if you are in a correctional institution. You

are NOT eligible for Social Security benefits while serving


You change your address and phone number and don't alert the

Social Security office. Makes sense if they can't find you

then you are going to be denied on a technicality. Similar

technicalities involve not completing the paperwork fully or

properly. It cannot be stressed enough that you MUST,

absolutely, complete the paperwork according to the

instructions and within the specified time frame. If they

ask you for a list of ALL your doctors, you need to list ALL

you doctors. If they say list ALL your jobs for 15 years,

you list ALL your jobs for the past 15 years. Each piece of

paper Social Security sends you is critical. It needs a

response from you. This is not the time to procrastinate or

do something halfway. You MUST, MUST , MUST get this part

right. You generally have 10 days to return forms. This

means 10 days from when it was mailed from Social Security,

NOT 10 days after you receive it. And you need to list ALL

doctors, clinics, hospitals-- everyone you have seen for

your condition. Give full names, addresses and phone

numbers. Use the internet, phone book or do your own

research-- but if they can't find these places, they won't

have the records. And a decision could be made on only half

the story. It is YOUR responsibility to prove you are

disabled. It is NOT Social Security's responsibility to

prove you disabled. This is YOUR claim and it is YOU who

needs to step up and take charge. A poor memory is not a

reasonable excuse. You can enlist the help of a third party,

but it is ultimately your responsibility.

If you can't remember your jobs for the past 15 years, call

the Social Security office and request a printout of all

your jobs for the past 15 years. This will help jog your

memory so you can describe each job. Just because Social

Security already knows you worked at McDonalds in 1990, that

doesn't mean they know what job you performed there. It

would take a different set of skills to be the cook versus

the manager.

And don't assume Social Security knows what a cook has to

lift and carry and how much they have to bend-- this must be

described by YOU. Only YOU know how this job was performed.

Decisions are made based on function and not necessarily

always a diagnosis. Social Security always looks at what you

can still do despite your impairment. Shocking as it may

seem, a diagnosis of cancer will not always get you allowed

for Social Security disability benefits. Your doctor can

write a letter explaining that you will be undergoing

chemotherapy and radiation for breast cancer for the next

several months, and say outright you are unable to work--

and your claim can still be denied. There are many reasons

for this, but it has a lot to do with the type of cancer and

your prognosis for survival. While you may be disabled and

unable to work 11 of those months, by the 12th month you may

be able to perform a very sedentary job. Therefore, you will

likely be found not disabled. While we're on this subject,

although a letter from your doctor is helpful, most doctors

don't know how to write an effective letter to Social

Security. If your doctor has agreed to write you a letter,

it must contain your functional capacity despite your

impairment. That means, it must spell out exactly how much

you can lift/ carry, stand/walk, etc. Your doctor should

follow the format outlined in the Dictionary of Occupational

Titles, which is also online


Your doctor must be able to support his/her opinion with

objective findings that support that opinion. Generally,

that means he/she needs to send all chart notes, tests,

exams, etc. His/ her opinion should be one that would be a

reasonable conclusion based on your diagnosis and remaining

functional capacity. Sad as this may sound, if you can still

sit and push a button- you may not be disabled according to

Social Security guidelines.

Additionally, your doctors need to have the credentials

recognized by Social Security. Generally, that means an MD

or DO for physical problems and a PHD or PSYD for mental

problems. There are others, depending on the impairment-

which you can look up on the SSA website.

You fail to attend a Consultative Exam scheduled by Social

Security. Be prepared to be examined by an independent

Medical Examiner. Social Security will inform you if they

want you to attend an exam. You MUST attend this exam and

cooperate fully- or your claim will likely be denied. This

exam is not for treatment, it is only to examine you so that

Social Security can make an accurate decision on your claim.

This examiner will share those results with Social Security.

The usual doctor-patient relations will not be established

and your confidentiality is compromised by the fact that

Social Security will have access to these exam results. If

you cannot make this appointment, for whatever reason, you

need to call SSA right away and reschedule.

So, there you have it- 10 top ways to get denied right out

of the gate. Of course, there are occasional exceptions to

the above, but generally this is how it works. Fail this

test and you will find yourself holding a denial letter in

your hand and wondering "WHY?"

How Social Security makes disability decisions is not

mysterious. In fact, the information is more readily

available to the public than how the search engines really

rank websites.

There is a myth that says you have to apply for benefits 3

times before being approved. This is absolutely NOT TRUE.

This myth has been perpetuated because it generally takes 3

tries before an applicant understands how to maneuver the

system (or the applicant's condition worsens, he/she ages or

there are other vocational factors that change). And that's

not because it's hard, it's because they don't take the time

to get informed about the program and process.

Not getting properly prepared is like trying to run the

Boston Marathon without any previous training. You are

generally going to fail and be sorely disappointed.




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