At present, about 69 to 70% of workmans compensation claims are denied each year. For most claimants, an appeal process is necessary. Luckily, many of them can appeal to an administrative law judge. If their presentation has been prepared for properly, with the help of a social security disability lawyer who can help the would-be claimant get his or her case in order, this could mean success. Keep in mind if your injuries were caused by an accident, you may also need to consult a local car accident lawyer.
Why Most Disability Claims Are Denied
Most disability claims are denied due to unfortunate technicalities, most are hard to spot, if one is not an expert in this field. The asset limit of $2000 is only applicable to SSI. Please note that in most cases, people have too much earned income at the time they filed for this or they have incurred assets that exceed the allowable limit. The Social Security Disability Program doesn’t take assets into consideration.
Aside from assets, many disability claims are denied because the case of a claimant has failed to pass the medical requirements for disability based on the SSA guidelines. The medical requirements are the most important issue as this is the main way to determine if the person is truly disabled.
To prove that a person is truly disabled, Social Security uses a certain standard or definition of disability. The claimant should have a severe impairment, making him or her unable to perform his or her work activities for a period of no less than one full calendar year.
Therefore, medical record documentation should prove that the claimant has a mental or physical impairment (in some cases, both) that will make it hard o0r impossible for them to engage in activities of daily living (ADLs). The disability should render them unable to perform basic work-related tasks.
The claimant should have such a severe condition that he or she can be proved to be unable to perform past work-related tasks which they have performed in a 15 year period prior to becoming disabled. This should further rule out their ability to use their limited skill set and education to perform another type of work.
The Disability Determination Process
Once the disability application is taken at your local Social Security office in Pennsylvania, it will be transferred to the state disability agency. This agency is known as disability determination services or DDS in most states. The case will be assigned to a certain disability examiner. His or her role is to determine of the claimant is disabled based on both vocational and medical evidence.
Medical records from the claimant’s treatment facilities will be examined thoroughly. He or she will obtain information from the claimant’s workplace as well. Both sources will serve as the basis for the whole case.
This is why it is important that claimants list down all their treatment sources for the disability application interview. This should include names of all doctors the claimant has visited, addresses of all treatment and diagnostic facilities visited and dates of treatments as well.
Failure to list any information properly can result in a delay the disability examiner’s task, which is to obtain all necessary records. Worst case scenario, this can make it impossible to obtain these records.
With regard to work history, the claimant should have a complete list of work history. This should include job titles, job descriptions and the duties they entailed. This should be completed before the interview, which can also be done over the phone in some cases.
What the Evidence is Used For
The information that the disability examiner obtains from the claimant’s medical records will be used to gauge if the person is truly disabled. It will help the examiner determine if the person is functionally limited. This will show if he or she is physically, mentally or both ways unable to rejoin the workforce for at least one year due to injuries sustained.
With regard to physical limitations, the claimant should be unable to sit, walk, stand, grasp or reach properly. Mental limitations will include a reduced ability to assimilate new information, concentrate or remember things. This is determined by an assessment process called residual functional capacity or RFC. This is a rating system that helps examiners rate claimants based on what they are able to achieve despite their disabilities.
If the examiner determines that the claimant is unable to return to their past job and they are unable to perform another type of work based on their current skills or the education that has prepared them for their past job, they may be qualified to receive disability benefits. This type is called a medical vocational allowance, which is part of the workmans compensation.
Please keep in mind that some claimants may be awarded without regarding his or her vocational considerations. This happens when the medical condition the claimant suffers from is listed in the Social Security Disability’s list of Impairments or the blue book. Even so, not all conditions are listed in the blue book. Therefore, people who are injured by product defects, or suffer from these conditions may have a harder time as the qualification criteria will be harder to meet.
Do keep in mind that the same process is used to qualify disability in children as well.
A person who has been denied his or her initial request to receive disability benefits should consider appealing instead of creating a new claim. Starting over might result in the case being denied once again or may cause limitations with regard to the amount of disability back pay he or she would have been qualified to receive.
The best option would be to file an appeal after receiving a letter of denial. This will more or less be a repeat of the Social Security evaluation process that was made use of to determine disability. The case will be reassigned to a disability examiner, perhaps a different one, after the Social Security office has received the appeal paperwork.
Reconsideration appeals have quite a high denial rate. There is unlikely to be any changes in the decision unless the new disability examiner notices that the first one to handle the case made an error or if there is new evidence to make the case stronger.
However, the good thing about the reconsideration step is that, should a claimant be denied, e or she may file a second appeal. This will be a request for a hearing. At this point, a federal judge will make the final decision. If the necessary paperwork is complete and all medical and work history records are present, it may shift in the favor of the claimant.
It is important to file for a request for consideration by contacting the Social Security office where the application was passed. This should be done within 60 days from the date of denial. It is also important to note that at present, Pennsylvania has suspended reconsideration appeals. Therefore, those who were denied disability may file for a court hearing.
This is why it would benefit claimants who were denied disability claims if they were to enlist the services of a social security disability lawyer before filing anything. Doing so would assure them of a better chance at avoiding any unnecessary legal procedures, as the lawyer would be well-versed in this particular field and able to tackle all concerns that could contribute to denial of a legitimate case.