Clients frequently ask what the most common mistakes people make when they apply for Social Security disability and how they can avoid them are. The two most frequently-seen mistakes are failing to appeal an unfavorable decision and failing to obtain appropriate medical care.
File An Appeal if You Were Denied
Many people apply for Social Security benefits and receive an unfavorable decision after 3 to 4 months. After a claimant receives the unfavorable decision, there is a 60-day time limit to appeal. However, many people with disabling impairments do not appeal that decision. The claimant can request a reconsideration if denied on the initial application. If a claimant is denied on reconsideration, they can request a hearing. All it takes is filing a written statement with Social Security stating that the claimant disagrees with the decision because they are disabled, and that will suffice to move the claim to the next level of appeal. Unless there is "good cause," however, if the claimant fails to appeal an unfavorable decision within 60 days, then that claim is closed, and, in the best case, the claimant would have to re-file from the beginning, causing lost time and benefits. In the worst case, the claimant may only be able to re-file if the date last insured has passed in Title II claims or if the claimant has acquired too many countable resources in Title XVI claims.
Seek treatment, even if you don't think you need it.
Another common problem made is failing to obtain appropriate medical care. Most areas of the state have some form of a low-cost or free clinic that provides some form of health care. Social Security is aware of this fact. When a claimant does not obtain medical care, even if they lack insurance, Social Security might conclude that their impairments are not severe enough to warrant treatment. Many claimants become frustrated that they suffer from a chronic condition and do not feel that doctor visits help them, so they stop going. This can be a mistake for their health and their claim. Those with chronic medical conditions are usually the ones who most need regular visits with their physician. And the medical records generated from doctor visits make up a vital part of a person's claim for Social Security disability. If there are few records, there is little evidence to support the claim.
When a claimant timely appeals their decision and regularly sees a doctor for treatment, that person has successfully avoided two of the most common problems when applying for Social Security benefits.
Constructive Actions You Could Take
Few Social Security Disability (SSD) cases lack complications. Setbacks are part of the process, from outright claim denials to lengthy appeals. Unfortunately, they cause constant stress, which can further harm your compromised health. The better you can handle inevitable setbacks, the better outcomes you'll enjoy for your legal case and your health.
A shocking 65 percent of SSD claims face initial denial. Many more people need help to obtain the evidence they need to win appeals. With such tough odds, the saying "Expect the worst and hope for the best" definitely applies.
Focus on the Big Picture
An immediate victory would be incredible, but that's different for many people. With SSD applications, it's all about persistence. You stand a strong chance of success if you work diligently with your attorney, but you can kiss benefits goodbye if you throw in the towel at this early stage.
Emphasize Next Steps
Stop worrying about your previous inability to secure SSD benefits; shift your focus to the road ahead. First, meet with your attorney to discuss a viable backup plan. Then, write a brief to-do list based on that plan, and tackle at least one task each day. If nothing else, prompt action will prevent you from ruminating on your latest SSD failure.
Determine a Plan B
You're dead set on securing SSD benefits, but what if that doesn't happen? You'll feel far more confident if you plan for the worst-case scenario. Outline the likely impacts of repeated claim denials, and draft a step-by-step plan for getting by even if you never achieve the benefits you deserve.
Advocating For Yourself Assertively as a Patient—Do's and Don'ts
You may spend far too much time in clinics and hospitals as a patient with a chronic health condition. Nobody will hold your hand as you seek proper care; it's up to you to advocate assertively on your behalf. The following do's and don'ts should help you navigate medical endeavors more efficiently:
Do: Gather and Organize All Medical Records
From seeking a second opinion to disputing claim denials, documentation is essential. Collect all lab tests and diagnostic reports, and be prepared to present them when necessary.
Don't: Rely on the Advice of Just One Medical Expert
Medical professionals are far from infallible. If your gut tells you to seek a second opinion, don't hesitate to visit another physician or specialist. That different opinion could save your life.
Do: Ask Specific Questions About Symptoms and Treatment
Be honest about your symptoms and response to treatment. Speak up for yourself, and ask your primary care physician or specialist about all the options available, including those that don't require extensive physical therapy or surgery.
Don't: Arrive at an Appointment Without an Outline
Make the most of every minute by developing an outline and note page ahead of time. This should include every issue you intend to address with your physician.
Do: Take Advantage of Patient Technology
Online portals and smartphone apps make it easier to access much-needed information. If you suffer from limited mobility or struggle to discuss issues with your physician in person, advocate for yourself online.
Don't: Rely Exclusively on Patient Technology
Technology can make life as a patient easier, but it should be different from face-to-face appointments. Don't rely on an app to get you through severe physical suffering; schedule an appointment as soon as possible.
You can advocate for yourself when seeking treatment, but you don't have to in court; that's your lawyer's job.
The right attorney can make all the difference as you file for Social Security disability or appeal denied claims. Keep the following considerations in mind as you prepare for a productive consultation with your lawyer:
Pay Attention to What Has Your Attention About Your Case
If a burning concern about paperwork wakes you up at night, write down what's bothering you. Suppose you have insight into your lower back symptoms while in the shower; jot it down as soon as you dry off. Get in the habit of recording productive thoughts when you have them and then circle back to process them later. This process will make communication with your lawyer more efficient – fewer email strings and long voicemail messages. It should also give you insight into your symptoms and what relieves them.
Get As Organized As You Can Before You Meet with Your Lawyer
The Social Security Administration demands ample documentation of your condition. To prove eligibility for disability benefits, bring the following to your consultation:
Your Social Security disability attorney's chief goal is to help you secure the benefits you deserve while reducing the potential for a complicated appeals process. To accomplish this end, your attorney needs an honest picture. How are you suffering? What's your course of treatment? It can be tempting to exaggerate or downplay your symptoms, but this could lead to a smaller award than you deserve or an outright denial of your claim.
Ideally, your attorney will get back to you promptly when you call or email. However, the attorney-client relationship goes both ways. Return calls and emails promptly to expedite the legal process.
Like many federal programs, Social Security Disability has many rules and regulations governing its administration. Knowing how the Social Security Administration calculates Social Security Disability (SSD) benefits can save you time and stress if you need to apply.
The government uses the amount you have worked and the nature of your disability to determine SSD eligibility. If you are eligible for benefits, the government decides your monthly payments by your average lifetime earnings since the time of your disability. Typical payments range from $700 to $1,700 each month. The government may reduce your payments if you receive disability benefits from other sources.
Calculating SSD Payments
The Social Security Administration uses a complex formula to calculate each individual's benefits. Every case is unique, and so is the amount of money you may receive. The office bases the formula for your benefits on how much you have paid into the Social Security system. The payroll taxes that the government deducts are called "covered earnings."
The Social Security Office calls your average covered earnings over a set period your average indexed monthly earnings (AIME). Then, the SSA applies a formula of fixed percentages to your AIME based on your income. This determines your primary insurance amount (PIA) – the amount you receive in Social Security benefits before retirement age.
To stay on top of your covered earnings history, check your Social Security Statement, which the SSA sends out every five years. The SSA's website also allows you to check your statement online. This is valuable information if you need to file for SSD benefits later.
Disability payments that you receive from private insurance companies for long-term disability will not have an impact on your SSD benefits. However, suppose you also receive government-regulated benefits such as worker's compensation or temporary disability from the state. In that case, you will not receive more than 80% of the average amount you earned before your disability from the combined benefits. In addition, the benefits you receive from Supplemental Security Income (SSI) and the VA will not affect your SSD benefits.