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Sacramento Social Security Disability Legal Blog

Understanding a denial letter when seeking SSD benefits

The process faced by California applicants for Social Security Disability benefits can often be difficult and arduous. Many deserving claimants are denied benefits and receive a denial letter at the initial stages of their application, even if they are later approved. When people receive a notice of disapproved claim after filing for benefits, the letter will generally state that the applicant is not disabled according to the definitions used by the Social Security Administration for these benefits.

The letter will then list the medical information sources that the evaluator relied upon in order to reject the claim. While this will often be the same list that the applicant submitted with the application, it may omit some sources or add additional providers that were not listed. If the case goes to a hearing later, a disability attorney can review the medical records obtained and used by the SSA. If important records are missing, they can be added to the file at the hearing stage.

Getting SSD benefits without medical records

A California resident who has no health insurance may not have medical records to submit when applying for Social Security Disability benefits. In such a scenario, an applicant would need to attend a consultative examination. These exams are designed to measure the physical or mental impairment a person may face. However, the doctor that performs the exam may not have the experience needed to treat a person's specific ailment.

In fact, the purpose of the exam is not to provide treatment to the patient. It is simply a tool used to help gather information to make a decision about disability benefits. Those who want to obtain recent information regarding their physical or mental condition should look for a free clinic in their area. It may also be possible to visit an emergency room to have testing done or to obtain other types of treatment records.

Benefit cases can be won before a hearing takes place

California residents and others who have their disability benefit case heard by a judge have a 65 percent success rate in having their claims approved. While many cases do go to the administrative hearing level, there is a chance that a claim will be approved sooner. Roughly half of applicants receive a favorable outcome in their cases at either the initial application or reconsideration stages.

However, only 10 to 15 percent of cases are won at the reconsideration level. When examining a claim for benefits, an examiner will gather evidence such as medical records to determine if a person is legitimately disabled and cannot work. The only difference between the initial application and reconsideration stage is that a different person handles the appeal. Therefore, only an error by the initial examiner or new evidence submitted by the applicant will increase the odds of winning a case on a first appeal.

Don't just hope your injury goes away

People have a tendency to hope that an injury or ailment will simply go away on its own. They try to "walk it off" or "gut it out." They figure that giving it time will help it heal without that trip to the doctor's office.

This is often a waste of time. Hoping it goes away just means you're neglecting the medical care you really need. Some injuries get worse over time, especially if you try to live the same way you did before it happened. For instance, you can absolutely make a minor back injury far worse by trying to lift something that is too heavy while you're at work.

Applying for Social Security Disability with back pain

Back pain can make California patients' lives miserable and make it painful or impossible to return to work. As a result, many sufferers may apply for Social Security Disability benefits based on their back pain. However, both applicants and former disability examiners have noted that people whose applications are based on back and spine conditions often face problems being approved for disability benefits. The disability impairment listings used by the Social Security Administration include back and spine problems, but the criteria listed can often be difficult to meet.

In many cases, back pain can be caused by conditions that are difficult to quantify through objective testing. In general, the harder it is to objectively measure the harms suffered by an applicant, the more difficult it can be to receive a positive determination for a Social Security Disability benefits application. In many of these cases, the amount of pain suffered varies greatly from person to person.

How representatives help during a disability hearing

As with any other court proceeding, being prepared and making strong arguments makes it easier to win a disability benefit case. When California residents have an attorney or other representation, it makes it easier to prepare for a case. One of the things that a representative will do prior to a hearing is gather as much evidence as possible to bolster a person's claim of being physically or mentally disabled.

For instance, the representative may send updated medical records to the judge assigned to hear the case. An applicant's representative may also get a statement from that applicant's physician prior to the hearing. This is helpful because the form used to obtain the statement will be accepted into evidence. Furthermore, the representative will know what the disability judge is looking for in terms of specific evidence that could be used to verify that a person is disabled.

What to know about receiving disability benefits

California residents may be entitled to Social Security Disability benefits even if their mental or physical disability may substantially improve in the future. However, they will need to show that they are totally disabled to receive benefits. This means that an individual cannot obtain employment that will allow him or her to make more than the substantial gainful activity amount for at least one year.

As SSD benefits are awarded through a federal program, the standards for obtaining them are the same regardless of where a person files. This is different than the workers' compensation system that is run at the state level, which means that requirements could be different depending on where a person requests them. After a person has an SSD or SSI application approved, it may be necessary to submit to a continuing disability review.

Experts' role in disability cases in question

When people in California apply for Social Security Disability benefits, they may sometimes feel as if they are facing a difficult and even uncaring bureaucracy. The process of application and appeals can be challenging, particularly for people who are already struggling due to the effects of their disabilities. Expert testimony can play a significant role in a case with both positive and negative effects, and now the U.S. Supreme Court will hear a case that could potentially require expert witnesses to back up their assertions with data and documented evidence.

The case was accepted by the Supreme Court after a string of lower-level appeals by a man whose eventual approval for disability benefits was dated to four years after his original application. The man, who worked as a construction laborer and carpenter before leaving work due to complications from degenerative disc disease, hepatitis C and depression, applied for disability benefits in 2009. After an initial denial affirmed at a disability hearing, he appealed to federal district court, which returned his case for further processing based on a lack of medical evidence.

Nursing injuries can easily take you out of rotation

When you work as a nurse, the daily wear and tear of caring for others can often take a great toll on your physical health. Nursing duties can cause significant injuries that require special care and recovery time.

For many workers, the ongoing strains of offering ongoing personal care places a great deal of pressure on their bodies, which frequently results in serious injuries. In many cases, nurses who experience ongoing pain or injuries may need help getting the care they need and taking time to recover properly.

Medical records are a vital part of a disability claim

A California resident who is unable to work may be eligible for Social Security Disability benefits. In order to get these benefits, applicants have to be able to prove they're disabled and that the condition they have is expected to last at least 12 months. Examiners use medical records to determine whether applicants are eligible for benefits. Without current records, it may be more challenging to get a disability claim approved.

Anyone who applies for benefits but cannot provide information that could help the examiner obtain current medical records may be asked to have a consultative examination with a physician who is paid by the Social Security Administration. Because this examination is brief, the doctor may not be able to provide all of the information the examiner needs to approve the claim. An initial denial is not the end of the process. Anyone whose disability claim gets denied at this stage may appeal.

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