At the Sullivan Law Office, we interview a myriad of prospective disability clients weekly. While many of them are anxious to discuss their reasons for believing they are entitled to benefits, our lawyers also like to focus on any relevant personal facts or circumstances that may provide reasons or grounds for the denial of benefits. At times, these reasons may be within the control of the applicant and therefore avoided to prevent any such denial. This is one of the main reasons why the representation of an experienced disability attorney is vital to the initial application process. This is the first part of a blog on reasons why the SSA denies an applicant Social Security benefits. Please stay tuned for its continuation!
Lack of Evidence
The SSA will deny disability benefits if there is insufficient medical evidence to prove that it hinders or impedes an applicant’s ability to work.
The SSA will deny disability benefits if there is insufficient medical evidence to prove that it hinders or impedes an applicant’s ability to work. As we consider how the SSA adjudicates these cases, we eventually end up at the question as to the quality of the medical proof. The Agency demands medical proof of disability. They look for objective proof of an underlying medical condition. Think X-ray, MRI, CT scan, Labs, etc. They look for limitations that stem from these underlying problems (for example a patient with a multi-level spinal fusion can no longer bend very well), or they look for medical proof conditions known to cause pain and limitation of function. The SSA will look for a longitudinal medical record- which means medical treatment over time. If you go 1-2 times to your family doctor, you are not helping your cause. The SSA will look for consistency across medical providers- which means your doctors tend to agree as to your impairments.
Any restrictions from a treating medical provider can be quite helpful, but they need to make sense. For example, if your problem is Crohn’s disease and you need a restroom hourly during flares of GI distress, restrictions on standing and walking do not make a lot of sense. Such a case would turn on a worker needing an unreasonable number of breaks to attend to their GI distress. Also, for episodic conditions, consider keeping a diary such as a seizure log. It can help add to your credibility.
Lack of Cooperation
Refusing to: release medical records, provide requested necessary information, complete and endless number of SSA forms, attend consultative examinations, or missing your own medical appointments are examples of “failures to cooperate.” Certainly there may be times where there is good cause for such an event, but in general, such developments this can provide grounds for a denial of benefits. While the SSA recognizes certain valid excuses for failing to cooperate it is best to go into a disability case with the clear goal of fully cooperating with the SSA and all other involved parties.
An applicant’s failure to follow “prescribed medical therapy” is a separate category and may be grounds for a denial of benefits. This can get confusing and there is law on point. In general, such a refusal may be excused if reasons exist beyond the applicant’s control, such as a severe mental illness that limits or prevents compliance with the prescribed treatment. An applicant may be limited from following the prescribed therapy without special assistance, perhaps due to other physical limitations. Some acceptable nonmedical excuses for failing to follow prescribed therapy would be an applicant’s religious beliefs, the treatment is simply too expensive, or a second physician disagrees with the treatment.
Just about any reasonable refusal to submit to proposed medical treatment will suffice. We have even cases where a person testified they had relatives who had spine surgery and ended up worse, so they are not inclined to go under the knife. In any event, if the prescribed medical therapy is unlikely to result in restoring an applicant’s ability to work, it is pretty much irrelevant to the disability inquiry and the SSA won’t find this to be a failure to cooperate. For example, if a case is based on bone cancer or a leukemia, and the proposed treatment is cataract surgery, it really has no bearing on the underlying disability case. More to the point, if the case is based on a spinal degeneration and the proposed fusion surgery is designed to stabilize the spine and prevent future damage, and not restore function, a refusal for such a procedure is unlikely to hurt the case.
One of the best ways to improve your chances of avoiding the denial of benefits is by retaining the services of a qualified Kentucky Social Security Disability attorney. Working with an attorney that is experienced in Social Security Disability cases ensures that you have the best chance of initially filing a successful disability application. Contact Sullivan Law Office today. We offer free consultations, so you have absolutely nothing to lose! We look forward to hearing from you. Call 888-587-0228 or visit us online.