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How to Deal with Disability Benefit Denials

By Scott B. Elkind, Esq.

Most disability benefit claims are denied initially. The common reaction by most claimants is a mixture of anger and frustration. Your disability seems perfectly obvious to you. You live with it everyday. How can this situation not be equally as obvious to the Social Security Administration or a disability insurer?

I have a standard response to this situation. Do not take it personally. I understand it affects your life directly, but the initial decision is typically made by lower level personnel who must operate under very strict guidelines. My opinion remains that initial denials are rendered in order to dissuade many otherwise eligible claimants from pursuing their disability claims. Many of these claimants will simply give up on their claim whether they return to work or not. This results in a huge savings to the disability insurer, both governmental and private.

Disability denials are far more frequent in several circumstances. The younger you are, the greater chance there is that you will be denied benefits. Again, I have a standard explanation for this conduct. The decision was not based on what was written in black and white, but what is written on green. In other words, the younger you are, the more money it will cost over the course of years to pay for your benefits. Therefore, the harder it becomes for you to win your disability claim. This phenomenon is directly reflected in the Social Security Administration guidelines which do not allow more favorable treatment of disability claims until the claimant is over the age of 50 years.

Disability denials are more common where conditions involve subjective complaints. For example, any condition for which pain is the main symptom will be looked upon with suspicion. Pain is subjective by definition. We all understand the concept of pain and are usually quite capable of explaining how the pain affects us. Unfortunately, there is no objective test which measures how much pain a person feels. The lack of precise measurement of pain is often used as a basis for a claim denial. Similarly, conditions causing fatigue (i.e., fibromyalgia, multiple sclerosis, hepatitis C, HIV, etc.) or mental affects (i.e. head trauma, depression, anxiety, etc.) are similarly scrutinized since these symptoms are also incapable of objective verification. Unusual medical conditions are almost guaranteed to result in a denial of benefits as the review personnel receive only limited medical training.

The truth is that an initial claim denial is not the end of your case, but only the beginning. The first thing you should do, if you have not done so already, is contact an experienced disability attorney. The Social Security Administration’s own statistics show that claimants represented by counsel have a much greater chance of being successful in their benefits appeal. The Social Security law is very complex. It involves a complicated statutory scheme combined with an extensive series of internal rulings and voluminous case law. Most private insurance claims arise under group plans governed by ERISA (Employee Retirement Income Security Act of 1974). The statutory law under this Act is more unfavorable to claimants. As you will find out, very few attorneys practice in this complicated area of Social Security and very few undertake private disability claims on a regular basis.

Once you have retained knowledgeable counsel, your case can be better presented by gathering the necessary medical evidence required to educate the insurer as to the exact nature and extent of your disability. This evidence will include how your condition limits your ability not only to function in your daily life, but also how it particularly limits your ability to engage in work activity. Simply put, the keys to successful prosecution of a disability case are knowledge and preparation. To this end, no one can prepare your case better than a knowledgeable disability attorney.

Scott B. Elkind is a principal at Elkind & Shea, The Disability Benefits Law Firm located in Silver Spring, MD. He has handled thousands of disability cases successfully as part of his focused practice in this area of law.

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