SSD Disability

Tuesday, June 9, 2009

Totally and Permanently Disabled, Why Can't I get Social Security Disability?

Here's a recent question: "My father was classified as permanently and totally disabled and has still been denied for disability two times. Why?"

To the questioner: I'm not sure what your father's situation is because you say two things that, at the outset, might seem a bit contradictory. First of all, that your father has been classified as "permanently and totally disabled" and, secondly, that he has been denied for disability twice.

If the social security administration had reviewed his medical records and determined that he was disabled according to the rules and guidelines of the social security disability program, he would not have been denied once or even twice.

That's because in order to even get a medical review of his case he would have had to been insured for title II (social security disability) benefits. In other words, if you are not insured for title II via work activity (enough work credits), then the case is not sent to the state disability processing agency and no review of the case is done.

So, when you state that he has been classified as permanently and totally disabled, I have to wonder--by who? You may be referring to the fact that his personal physician has stated that he is disabled. However, even if this is the case, it begs several questions. Did the physician tell you or your father that he/she considers your father disabled? Did he provide a statement to this effect? If so, was the statement a short cursory note stating something to the effect of "my patient is disabled".

In the social security disability evaluation process, a statement from a patient's treating physician can have a favorable effect on the outcome of a case. But such statements need to be detailed to the extent that they indicate the claimant's functional limitations. This is why the opinions of treating physicians are often (and best) captured on what is known as an RFC, or residual functional capacity, form (for a free downloadable form, visit the home page of Disability Secrets and scroll to the bottom of the page).

Statements that are short and lacking detail tend to be fairly useless. Of course, many claimants will not be aware of this fact and, indeed, even some physicians seem to have this fanciful notion that, just because they have an M.D. a short two-line sentence supplied by them can result in a social security disability approval. Reality check: that's not how the system works.

Then, there is also the unfortunate fact that even a very strong RFC statement--also referred to as a medical source statement--from a claimant's doctor may do little to influence the outcome of a case...if the case is being decided at the disability application or request for reconsideration level, versus at the disability hearing level (where such statements provided by treating physicians tend to be accorded more weight and influence).

Unfortunately, there's no real answer as to why a legitimately disabled person might be denied two times. If the social security disability system were truly federal (disability examiners working for the federal government versus working in state agencies as state employees), and examiners received better medical information training AND they and their supervisors were held to higher adjudication standards (there's no justifiable reason why you have a such a huge disparity in approval rates between the lower levels of the system and the disability hearing level)---then things might be different.

As things stand, however, it is simply a fact of life for the average disability applicant that they might be denied twice. However, claimants who have been denied twice at the initial claim and reconsideration levels often have a much greater chance of being approved later at a disability hearing, statistically speaking.