Part II: The Most Common Reasons for a Social Security Denial

In our prior blog entry, we began explaining the most common reasons claimants face denials of their Social Security disability claims, whether it be at the initial, reconsideration or at the hearing level claim level.  Understanding why such denials occur can occur will hopefully help you or a loved one from making the same mistakes.

Yet, another common reason for a denial of one’s claim is the misconception many disability claimants have that if in fact one remains incapable of performing their past work that there should be automatic entitlement to Social Security disability benefits.  While for those individuals over the age of 50, the Social Security Grid Rules do provide a basis for disability for those who have worked labor intensive jobs over the course of their lifetime, can no longer perform such jobs anymore given the  physical limitations they experience resulting from their long-term medical conditions and have no transferable skills that would allow them to return to other, less physical positions, the Grid Rules do not provide such a basis for disability for those who have yet to reach the age of 50.   Generally, the Social Security Administration (SSA) will look to see whether an individual remains capable of returning to some other manner of employment for which they are reasonably suited by their age, education and experience.  With this in mind, we many times find ourselves in the position of having to advise potential disability claimants as to other types of jobs that they may be expected to look into obtaining and working.   Many times, this advice can be the best advice a Social Security lawyer can provide you.

Many times, upon getting involved in a claim that has been denied by SSA, we will find that SSA did not obtain all of the relevant medical evidence.  There are a number of reasons as to why this may have taken place: it is quite common to see that our claimants may have forgotten to provide a complete treatment history: whether it be in their initial application, or on reconsideration: they may have forgotten to list a specialist they were sent to see by their primary care physician, or perhaps a physical therapy department with whom they may have treated for a period of time.  Without providing such information, SSA will not be in a position to obtain the medical records from all of your providers and, even if you have provided all of your treatment history to SSA, you may find that they have failed to obtain all of the medical evidence.  Each state has a designated state agency that is responsible for working up the medical record and for evaluating the medical evidence as part of making a decision: in Maine, Massachusetts and New Hampshire the agency is called Disability Determination Services.  In order for them to do their job properly, it’s essential that your application and appeals forms are filled out completely.

Many times, upon getting involved at the hearing level, we’ll see that Disability Determination Services may have requested records and simply did not follow-up sufficiently to obtain the medical records.  Likewise, we see situations where the state agency simply did not get the records that show the historical background of your condition (which can help show an Administrative Law Judge (ALJ) how you struggled to continue working until such time as your condition had progressed to the point where you could no longer continue working).   There is no more important evidence than that which shows an individual claimant has done everything possible to continue working, while undergoing zealous treatment in an attempt to improve their medical condition .

Finally, probably the most common reason for a denial of a claim is the fact that nobody has requested one’s treating physicians address the nature and severity of one’s medical condition by way of a medical report or questionnaire and, correspondingly, the extent to which the medical condition has impacted one’s ability to undertake functions that are necessary in a work setting (whether these are physical or mental health limitations): this is referred to as a claimant’s “residual functional capacity.”  When SSA requests reports to be filled out by treating physicians (which is quite rare), the reports themselves are quite broad in terms of what they are asking: most importantly, the forms do not ask the doctors to address an individual claimant’s residual functional capacity (that is to say, their ability to lift, carry, push pull, sit, stand, walk, etc. in a competitive work situation) .  This is one of the most important tasks that should be undertaken by the Social Security lawyer you choose to handle your disability claim.

In order to avoid the above pitfalls, it’s extremely important that a potential disability claimant seek the advice and assistance of an experienced Social Security disability lawyer.  With that in mind, contacting the Law Offices of Russell J. Goldsmith at 1-800-773-8622, will allow you to put our 27 years of experience handling Social Security disability claims and appeals to work for you.  Working with you early on in the process can end up making all of the difference with your claim.