How likely is it that my Social Security disability claim was denied because my case worker was a jerk?
July 13, 2012 5:21 PM Subscribe
How likely is it that my Social Security disability claim was denied because my case worker was a jerk?
First the incriminating details:
- I missed an appointment, which had to be rescheduled.
- A paper questionnaire was sent to me when I first applied back in December. I never received this.
Here's the narrative version:
The above-mentioned initial physical exam (not a full physical, took at most five minutes) was rescheduled because of the Chicago NATO summit back in May. This was not held against me. I missed the rescheduled exam because I was sick. I called the doctor's office but was too out of it to think to notify my case manager, who I had never communicated with at this point. This appointment was on a Friday, so I left a message on her voicemail the following Monday morning.
Over the next two weeks I left at least two more messages on her voicemail, could have been three. Again, I had never talked to her before, I just had a name and number on the letters I'd received. After this, I received an angry voicemail from her saying I had missed my appointment and hadn't turned in the questionnaire. I left another voicemail asking about these. A couple days later she called and I finally talked to her. She was very brusque and rude, and I explained that I had never received the mailed questionnaire and was sick for the exam. I try to never give CSR people shit in general, and was extra careful to word my messages to her politely to try and defuse whatever was going on. Bad week for her? I dunno.
In June, a new questionnaire was mailed out, and I made the re-rescheduled exam. When we spoke she said the questionnaire had a 10-day turnaround time after which my claim would be automatically denied, and told me to notify her when it arrived and when I sent it out, which I did via voicemails. A couple days before the 10-day deadline she left a voicemail asking where the questionnaire was, and saying she would be gone on a two day training thing. I left another voicemail saying I had sent it out. This was late June.
Now today I received the decision letter saying my claim was denied.
I'm going to appeal, but I'm not really sure how to proceed. The paperwork I got today said that none of the people who made the first decision will be part of the appeal. So first I'm going to make an in-person appointment to talk it out, see what other info they think I should collect, but unsure how much the first case manager affected the initial decision.
First the incriminating details:
- I missed an appointment, which had to be rescheduled.
- A paper questionnaire was sent to me when I first applied back in December. I never received this.
Here's the narrative version:
The above-mentioned initial physical exam (not a full physical, took at most five minutes) was rescheduled because of the Chicago NATO summit back in May. This was not held against me. I missed the rescheduled exam because I was sick. I called the doctor's office but was too out of it to think to notify my case manager, who I had never communicated with at this point. This appointment was on a Friday, so I left a message on her voicemail the following Monday morning.
Over the next two weeks I left at least two more messages on her voicemail, could have been three. Again, I had never talked to her before, I just had a name and number on the letters I'd received. After this, I received an angry voicemail from her saying I had missed my appointment and hadn't turned in the questionnaire. I left another voicemail asking about these. A couple days later she called and I finally talked to her. She was very brusque and rude, and I explained that I had never received the mailed questionnaire and was sick for the exam. I try to never give CSR people shit in general, and was extra careful to word my messages to her politely to try and defuse whatever was going on. Bad week for her? I dunno.
In June, a new questionnaire was mailed out, and I made the re-rescheduled exam. When we spoke she said the questionnaire had a 10-day turnaround time after which my claim would be automatically denied, and told me to notify her when it arrived and when I sent it out, which I did via voicemails. A couple days before the 10-day deadline she left a voicemail asking where the questionnaire was, and saying she would be gone on a two day training thing. I left another voicemail saying I had sent it out. This was late June.
Now today I received the decision letter saying my claim was denied.
I'm going to appeal, but I'm not really sure how to proceed. The paperwork I got today said that none of the people who made the first decision will be part of the appeal. So first I'm going to make an in-person appointment to talk it out, see what other info they think I should collect, but unsure how much the first case manager affected the initial decision.
Best answer: Is this your first claim? A significant majority of first claims are denied.
posted by Sidhedevil at 5:26 PM on July 13, 2012 [1 favorite]
posted by Sidhedevil at 5:26 PM on July 13, 2012 [1 favorite]
Best answer: Yeah, a friend of mine is a lawyer that specializes in pursuing SSD claims, and she says that initial claims are pretty much always denied.
posted by restless_nomad at 5:31 PM on July 13, 2012 [1 favorite]
posted by restless_nomad at 5:31 PM on July 13, 2012 [1 favorite]
Response by poster: Yes, this is my first claim. I guess it makes cynical sense for them to deny most first claims.
posted by Evilspork at 5:32 PM on July 13, 2012
posted by Evilspork at 5:32 PM on July 13, 2012
Best answer: I would suggest not making contact with the local Social Security Office and especially not to try to meet with the initial case handler. Just completely and accurately and timely file your appeal from denial forms.
This is not legal advice and I am not your lawyer.
It has been more than a few years ago, but I represented hundreds of different claimants when I worked for a local non-profit legal center. The main reason most initial claims are denied, cynicism aside, is that there are very specific rules for documenting the existence of a disability which meets the Social Security standards. Almost no one initially provides detailed enough medical records AND a medical opinion which addresses the SPECIFIC requirements. It isn't enough for your care provider to opine that you are disabled. Specific limitations must be found to exist based on evidence.
At the appellate level Social Security will arrange for you to be examined by medical personnel who will have some familiarity with the regulations (some much more than others). Your claim will be handled by workers who are significantly more knowledgeable about the rules and regulations and who have access to medical experts in the field(s) involved.
I strongly urge you to, at the least, consult an attorney or office experienced in representing claimants. You can successfully represent yourself, but in most cases you will need to become very familiar with the regulations and the "magic words" which get claims granted, and have access to knowledgeable health professionals and know the questions to ask them. When I last practiced in the area fees were charged only when a claim resulted in benefit payments and only in an amount authorized by the Social Security Administration.
Good luck. If you are seriously disabled, i.e. unable to work within the meaning of the regulations, pursue your claim to the final stage, if necessary. Sadly, this can take quite some time so do your parts of the process as quickly and correctly as you can to avoid adding unneeded delays.
posted by uncaken at 6:12 PM on July 13, 2012 [4 favorites]
This is not legal advice and I am not your lawyer.
It has been more than a few years ago, but I represented hundreds of different claimants when I worked for a local non-profit legal center. The main reason most initial claims are denied, cynicism aside, is that there are very specific rules for documenting the existence of a disability which meets the Social Security standards. Almost no one initially provides detailed enough medical records AND a medical opinion which addresses the SPECIFIC requirements. It isn't enough for your care provider to opine that you are disabled. Specific limitations must be found to exist based on evidence.
At the appellate level Social Security will arrange for you to be examined by medical personnel who will have some familiarity with the regulations (some much more than others). Your claim will be handled by workers who are significantly more knowledgeable about the rules and regulations and who have access to medical experts in the field(s) involved.
I strongly urge you to, at the least, consult an attorney or office experienced in representing claimants. You can successfully represent yourself, but in most cases you will need to become very familiar with the regulations and the "magic words" which get claims granted, and have access to knowledgeable health professionals and know the questions to ask them. When I last practiced in the area fees were charged only when a claim resulted in benefit payments and only in an amount authorized by the Social Security Administration.
Good luck. If you are seriously disabled, i.e. unable to work within the meaning of the regulations, pursue your claim to the final stage, if necessary. Sadly, this can take quite some time so do your parts of the process as quickly and correctly as you can to avoid adding unneeded delays.
posted by uncaken at 6:12 PM on July 13, 2012 [4 favorites]
i was just talking with a friend on disability who told me exactly the same thing - she was initially denied out of hand, and didn't get approved until she had jumped through a lot of hoops and finally hired a lawyer.
posted by facetious at 6:12 PM on July 13, 2012
posted by facetious at 6:12 PM on July 13, 2012
Best answer: Get a lawyer to pursue the appeal. Really. You are doing yourself a favor by doing so. The lawyer will get 25% (I think it is still that) of back proceeds ... it is well worth it. I have watched this scenario numerous ties among friends and associates.
posted by batikrose at 6:14 PM on July 13, 2012
posted by batikrose at 6:14 PM on July 13, 2012
"In 2006, only 32.1 percent of disabled workers applying for Social Security disability benefits were found to be entitled to an award, according to the Social Security Administration's annual report. That figure includes applications reviewed at all stages in the process from the initial claim to reconsideration to the hearing stage.
The National Organization of Social Security Claimants Representatives, in Englewood Cliffs, N.J. -- a group made up of lawyers who represent people applying for benefits -- reports that in 2007, the SSA denied 65.4 percent of disability claims at the initial level and 87.3 percent of claims at the reconsideration level."
I'm on disability, and the lawyer I retained when my disability was reviewed and subsequently denied (he got me back on) almost fainted when I told him I got disability on the first shot without legal representation.
posted by xyzzy at 8:58 PM on July 13, 2012
The National Organization of Social Security Claimants Representatives, in Englewood Cliffs, N.J. -- a group made up of lawyers who represent people applying for benefits -- reports that in 2007, the SSA denied 65.4 percent of disability claims at the initial level and 87.3 percent of claims at the reconsideration level."
I'm on disability, and the lawyer I retained when my disability was reviewed and subsequently denied (he got me back on) almost fainted when I told him I got disability on the first shot without legal representation.
posted by xyzzy at 8:58 PM on July 13, 2012
Response by poster: ...the "magic words" which get claims granted...
I've been through the VA disability process, and this concept is unfortunately very familiar to me. Thank you.
posted by Evilspork at 10:00 PM on July 13, 2012
I've been through the VA disability process, and this concept is unfortunately very familiar to me. Thank you.
posted by Evilspork at 10:00 PM on July 13, 2012
Response by poster: So first I'm going to make an in-person appointment to talk it out...
I want to clarify this real quick. As far as I know my case manager is at the Illinois SSA office in Springfield, while I'm in Chicago. The letter I received said that I could schedule an appointment with my local/Chicago office to clarify what extra info they needed for an appeal. I did not mean to imply that the appointment was to confront the first case manager or complain, and I already did not expect to have to interact with her again.
posted by Evilspork at 10:08 PM on July 13, 2012
I want to clarify this real quick. As far as I know my case manager is at the Illinois SSA office in Springfield, while I'm in Chicago. The letter I received said that I could schedule an appointment with my local/Chicago office to clarify what extra info they needed for an appeal. I did not mean to imply that the appointment was to confront the first case manager or complain, and I already did not expect to have to interact with her again.
posted by Evilspork at 10:08 PM on July 13, 2012
I helped my brother get on SSDI and he was approved the first time. We used a Patient Advocate to help with the process. It is a mental health related disability and he was incapable at the time with dealing with the paperwork.
I kept a file and a calendar with the dates marked for when items were due and notes on who I talked to, what time and the subject discussed. It was one big fucking hassle even with the advocate.
Good luck.
posted by cairnoflore at 10:14 PM on July 13, 2012
I kept a file and a calendar with the dates marked for when items were due and notes on who I talked to, what time and the subject discussed. It was one big fucking hassle even with the advocate.
Good luck.
posted by cairnoflore at 10:14 PM on July 13, 2012
I've assisted people with SSDI claims and yes, they almost always deny claims the first time around.
Also I think the default personality for SSI workers is somewhere in the "jerk" range.
I'm sorry if that offends a mefite Social Security worker; I'm sure you're the exception to that rule.
posted by dchrssyr at 10:27 PM on July 13, 2012 [1 favorite]
Also I think the default personality for SSI workers is somewhere in the "jerk" range.
I'm sorry if that offends a mefite Social Security worker; I'm sure you're the exception to that rule.
posted by dchrssyr at 10:27 PM on July 13, 2012 [1 favorite]
Best answer: By all means, you should file for a reconsideration and, if that is also denied, file for a hearing. You can certainly meet with someone at the SSA field office, but I'm not sure they'll be of much help at this stage since they don't handle the disability determination. I don't know that there's any value to retaining an attorney for the reconsideration, but I do think having representation for the hearing process is advisable. The attorney's fee is capped and there are rules to prevent him/her from taking advantage of you.
When you filed your initial claim, SSA determined whether you were eligible for benefits based on non-medical criteria like legal residency, income, and earnings history. The medical portion of the determination was made by a State-run agency in Springfield, not by SSA. The State agencies collect and review medical evidence as well as consider your vocational skills to decide if you are able to work or not. The disability examiner doesn't have much leeway in making the decision, it's an objective, by-the-book sort of thing.
For the reconsideration, your file will go back to the State agency and be reviewed by a different disability examiner. You will have the opportunity to submit new medical evidence to support your claim. The disability examiner doing the reconsideration follows the same rules and procedures as the initial examiner, so, again, it's by-the-book. If your claim was denied out of spite, it will show up during the reconsideration.
If your reconsideration is denied, you will file for a hearing. The SSA field office will send your claim file to the SSA hearing office who review the file and prepare information for the administrative law judge who will hear your case. Once again, you will be given the chance to submit new medical evidence. Unlike the examiners at the State agency, the judge has the discretion to consider some subjective factors when making a decision. After the hearing, the judge will issue a final decision and you'll receive a letter informing you of that decision.
Is it likely your initial claim was denied out of malice? No. The high initial denial rates aren't due to pissed off caseworkers or cynicism, they're due to a system that is designed to be rigid,equitable, and restricted to people who can't do any work at all. The fact that people who are denied at the intial level are allowed at reconsideration and hearing is due to a combination of additional (often better) medical evidence and the inevitable decline in claimants' health over time. Besides, SSA funds the State agencies and hounds them constantly over productivity and accuracy--a disability examiner who denies too many claims that are allowed on reconsideration is likely to find themselves unemployed.
posted by weebil at 12:06 AM on July 14, 2012
When you filed your initial claim, SSA determined whether you were eligible for benefits based on non-medical criteria like legal residency, income, and earnings history. The medical portion of the determination was made by a State-run agency in Springfield, not by SSA. The State agencies collect and review medical evidence as well as consider your vocational skills to decide if you are able to work or not. The disability examiner doesn't have much leeway in making the decision, it's an objective, by-the-book sort of thing.
For the reconsideration, your file will go back to the State agency and be reviewed by a different disability examiner. You will have the opportunity to submit new medical evidence to support your claim. The disability examiner doing the reconsideration follows the same rules and procedures as the initial examiner, so, again, it's by-the-book. If your claim was denied out of spite, it will show up during the reconsideration.
If your reconsideration is denied, you will file for a hearing. The SSA field office will send your claim file to the SSA hearing office who review the file and prepare information for the administrative law judge who will hear your case. Once again, you will be given the chance to submit new medical evidence. Unlike the examiners at the State agency, the judge has the discretion to consider some subjective factors when making a decision. After the hearing, the judge will issue a final decision and you'll receive a letter informing you of that decision.
Is it likely your initial claim was denied out of malice? No. The high initial denial rates aren't due to pissed off caseworkers or cynicism, they're due to a system that is designed to be rigid,equitable, and restricted to people who can't do any work at all. The fact that people who are denied at the intial level are allowed at reconsideration and hearing is due to a combination of additional (often better) medical evidence and the inevitable decline in claimants' health over time. Besides, SSA funds the State agencies and hounds them constantly over productivity and accuracy--a disability examiner who denies too many claims that are allowed on reconsideration is likely to find themselves unemployed.
posted by weebil at 12:06 AM on July 14, 2012
« Older I need to reëxamine my love of the New Yorker's... | Cash only? Or is a check just fine? Newer »
This thread is closed to new comments.
What I would say is focus on the facts of your disability, and try to let the experience you had with the caseworker go. That will most likely help your case more than anything.
posted by xingcat at 5:26 PM on July 13, 2012 [2 favorites]