Tips for Winning

Appeal ALL denials in a timely manner.

The SSA denies 66 percent of cases filed at the initial application level. According to the SSA, more than half of those denied never appeal their case. At reconsideration, about 82 percent are denied. The good news is at the hearing level, when a person finally gets to go in front of the person who is actually going to decide his or her case, 53 percent are approved. With the help of an experienced and knowledgeable lawyer, the odds of getting approved go up even more.

get medical treatmentIf you don't appeal all denials within 60 days, you lose the right to appeal and have to file a new application. At the very least, this is time wasted. Moreover, you might lose benefits. You may have to settle for a later date of disability on the new application, and thus get less in past due benefits. Depending on your work history, you might even be precluded from filing a new application if you do not have enough work history (known as quarters of coverage) within the right period of time. Generally, you must have 20 quarters of coverage within the last 40 quarters to have insured status to receive social security disability benefits. This translates to at least some work history during 5 of the last 10 years prior. If your insured status expires, you may be precluded from filing a new application.

There are also rules which may allow you to reopen a previous application which was not appealed if you file the new application within the right period of time, generally within one year from the first denial, or 4 years from the first denial if you can produce new and material evidence which would change the result.

Get medical treatment.

A diagnosis is not enough to obtain SSD or SSI benefits. You must have functional limitations which are caused by your physical and mental impairments which prevent you from working 8 hours per day, 5 days per week or an equivalent schedule; in other words, a 40-hour work week.

There is a Treating Physician Rule in SSD and SSI cases. The opinion of the claimant's treating doctor must be given controlling weight that the opinion is well supported by the medical and other documentary evidence and is not contradicted by any other evidence in the record. This rule makes the opinion of your treating doctor very important indeed. Certain factors affect the weight that SSA has to place on this opinion. The opinion is entitled to more weight if the doctor is a specialist in the field. For example, the opinion of a neurologist treating your multiple sclerosis is entitled to more weight than your family doctor, primary care physician or internist.

The longer you are treated, the more valuable the opinion. The opinion of a doctor who has treated you for 6 months is less valuable than the opinion of a doctor who has treated you over many years. The frequency of treatment affects the weight SSA has to place of the opinion of your treating doctor. The more frequently you see the doctor, the more weight his or her opinion is given because he or she will be more familiar with your medical conditions and your functional limitations.

The extent to which the medical records support the doctor's assessment is important to making sure SSA gives full weight to your doctor's opinion. The doctor's opinion is entitled to more weight if there are objective tests, such as X-rays, CT scans, MRIs and blood tests, which support not only the diagnosis but the severity of your condition. The ALJ will also evaluate the doctor's findings upon physical examination, and any limitations and problems you have which were written down in your medical record.

Talk with a specialist.

The opinion of a specialist is more valuable than the opinion of a family doctor or primary care doctor.

See your doctor frequently.

If you are not seeing a doctor regularly, you are jeopardizing your case.

Have all the tests your doctor(s) recommend.

Having all of the tests your doctor recommends provides the documentation not only for the diagnosis but also for the level of severity of your condition. The testing makes the opinion of your treating doctor more valuable because there is objective medical data to support the opinion.

Make sure you tell your doctor about all of your limitations and complaints AND make sure this information is placed in your medical record.

For example, if you have a herniated disk in your lumbar spine (lower back) and you see your orthopedist and you do not complain or tell the doctor of any symptoms you are having, he may simply write, herniated disk and not mention any symptoms you are having. If you tell the doctor, you have pain, spasm, you can't sleep at night, the pain interferes with your ability to concentrate, focus, pay attention, you are short-tempered due to pain, you can't bend, you can't sit too long, you can't lift anything over 10 pounds and the orthopedist writes down these complaints, your medical record will be much more detailed, which helps the ALJ to make a decision in your favor. So make sure you tell your doctor everything that is bothering you, and make sure the doctor writes it down.

Take all of the treatments and medications your doctor recommends.

Failure to follow prescribed treatment is one of the things SSA can use to deny your claim. If you take all medications and treatments as prescribed, your claim will present to the ALJ as much more credible.

Talk to your doctor about your social security disability claim.

When you are considering filing an application or when you have recently filed an application for benefits, talk to your doctor and make sure he or she is supportive of you receiving Social Security Disability or SSI benefits. Find out if the doctor will be helpful to you. If not, you should seriously consider finding a new doctor quickly. Remember the opinion of your treating doctor is extremely important to the success of your case. If you find out that your doctor is not willing to respond to SSA or will not complete opinion forms requested by your attorney, it is important to discover this information early. The longer a doctor, especially a specialist, treats you and the more frequently you see the doctor and the more treatments and tests you undergo, the more likely your claim will be successful.

Do not use or abuse drugs and/or alcohol.

If drugs and/or alcohol are material to the finding of disability in your case, you will be denied. A case is much less likely to be approved if there is evidence of drug and/or alcohol use.

Hire a lawyer early in the process.

SSA begins developing the record on your case on the day you contact them to file your application. SSA will have you complete many forms requesting a lot of information regarding your impairments, symptoms, treatment, age, education, work history, your activities of daily living and your pain symptoms.

At the hearing before the ALJ, any testimony you give which is even marginally inconsistent with information you provided at the initial or reconsideration levels can be used later to deny your claim.

It is important to get the expertise of an attorney early in the process to review the particulars of your case, to explain the process, and how we are going to go about proving to an ALJ that you are disabled. We also review all the forms before they are sent to the state agency.

Keep your responses on SSA forms short and to the point.

Keep your answers short and succinct. Do not embellish, give unnecessary information or provide additional pages. If you have good days and bad days, explain what your bad days are like. If you cannot work 8 hours per day, 5 days per week or an equivalent schedule, you are disabled. If you have a lot of bad days, you need to describe what your condition is like on those days.

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