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Obtaining Disability Benefits . . .
David v. Goliath
by Scott E.
Davis, Esq.
Remember the epic battle between David
and Goliath? On paper, David clearly had no chance to win,
fortunately his heart and soul did not know it and with
determination, persistence and divine intervention he prevailed!
Ever wonder what might have happened if he was aware of his
predicament? Would he have fought or ran the other way?
Every day at the Social Security
Administration (SSA), seemingly epic battles between disability
claimants and SSA are fought. The Bounty? Disability benefits.
The battle unfolds like this: you
become unable to work due to a physical and/or mental illness and
apply for disability benefits. After all, you've paid into the
system all these years for this exact situation. Heck, even your
doctor says you can't work. You figure it is simply a matter of
completing paperwork and time until you begin receiving benefits.
But now, you are starting to experience financial problems.
As the months go by without an answer,
you reassure yourself this must be a simple case and the delay is
"due to government bureaucracy." After several more months your
frustration grows, you call SSA and get no answers, or worse, the
ones you get are all different! The bureaucrats you spoke with were
rude and put off by your phone call. You remind yourself SSA is on
your side. It's job is to help people like yourself by paying
disability benefits, right? But . . . you begin to feel like David.
The Big Day . . .
You finally receive an envelope from
SSA, tear it open to find a benefit check and instead read: "We have
Denied your claim for disability benefits as our trained staff and
medical doctors have determined you are not disabled under our
laws."
You're angered, frustrated, scared,
intimidated and now overwhelmed by the thought of fighting Goliath.
. .the Federal Government.
Pages into the decision it mentions
appeal rights, but the decision seemed so final and left you with no
hope. You do not know the law, the system and even if it is worth it
or how to fight. Your alone and defeated. . .exactly how SSA wants
you to feel!
As a disability attorney I meet with
clients everyday who tell me this same story. Fortunately, those
clients took the bold step of appealing the denial and fighting for
benefits.
What should you do? Persevere!
75% of all disability applicants
initially will be denied benefits! Half of those denied will give up
and not appeal the denial! However, 53% of the applicants who
persevere to a hearing before an Administrative Law Judge obtain
benefits!
Now you understand how the system
works, it is designed to deny benefits to as many people as
possible. SSA denies initial applications because it knows 50% of
the people will give up and not appeal! But for those who persevere
and appeal the denials, the majority are eventually granted
benefits.
Understanding the
System
1. Initial application — Every
claim for disability benefits begins with the initial application.
75% of all applicants are denied at this step. SSA looks for a
reason to deny benefits. The decision is based on forms you
completed and medical records, you won't meet with anyone involved
in making the decision. It is surprising when anyone wins at this
step. Don't quit--You must appeal a denial within 60 days.
2. Reconsideration — The second
step in the system but the results are worse. 82% of all applicants
are denied at this level. SSA reviews your file again and issues a
denial, unfortunately it may take months to receive. At this step,
only 50% of the original applicants are still in the system, the
rest gave up. Appeal the denial immediately. Up to this point in the
system you have been a social security number and a file.
3. Request for Hearing before
Administrative Law Judge — Congrat-ulations! You have persevered
in the system and now have a good chance to win benefits. 53% of all
claimants win at this stage!
Why? Primarily because your claim is
entitled to a de novo or new review by a Judge who knows the law and
does not work for SSA. Also, you get to testify before the Judge
about your inability to work and she/he assesses your credibility.
Finally, hopefully you have obtained opinions from your doctors
about your inability to work.
You must win your case at the hearing
stage; if you do not, you can appeal but your claim will be tied up
perhaps for years with the likelihood of success dramatically
reduced.
Increase your
odds of Winning
Now that you have an understanding of
how the system works, here are some tips on how you can maximize
your chance for success.
1. Appeal every Denial — It
bears repeating, DO NOT QUIT after receiving a denial. Now you
understand you must get to a hearing. Up to that point SSA and the
odds are overwhelmingly against you - receiving a denial may be
cause to celebrate because your a step closer to a hearing.
2. Retain a Disability Attorney
— Retaining an attorney who specializes in disability law should
substantially increase your odds of winning. Most claimants have no
idea what they need to prove to win their case. Practically all
disability attorneys work on a contingency fee -you only pay a fee
if you win your case. Also, Federal law sets the maximum amount the
fee can be in your case. An attorney will develop your case by
obtaining the necessary medical and vocational records and opinions
from your doctors that are critical in proving disability.
3. Completing Social Security Forms
— You will complete a dizzying array of forms requesting all sorts
of information. Be honest and very brief when completing forms. You
won't win your case with the information you give on the forms but
you could lose it.
4. Involve your Treating Physician
— Your treating physician is critical to success. Judges give a
treating physician's opinion regarding a patients' disability
tremendous weight. If your physician is not sympathetic to your
claim you may want to make a change to one who is.
The purpose of this article is to
convey hope that you can win your case and obtain benefits with
perseverance and knowledge of the system.
Please do
not give up . . . appeal and keep fighting!
Scott E. Davis is a social security and long-term disability insurance attorney in Phoenix, Arizona. Mr. Davis represents clients throughout the United States. Although Mr. Davis has experience representing clients with a broad spectrum of physical and/or psychological disorders, the majority of his disability practice is devoted to representing individuals with chronic pain and chronic fatigue disorders. In almost every case, a fee is charged only if his client obtains benefits. Mr. Davis invites your questions and inquiries regarding representation.
Call (602) 482-4300, 8:30 am to 5:30 pm, Mon. to Thu., or email: info@scottdavispc.com.
Visit his website at
www.ScottDavisPC.com.
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