1. The single biggest thing you can do to ruin a claim is not to continue seeing your doctors, and this doesn’t mean a random visit to the ER is fine. They do little testing in the ER and rarely do you see the same doctor(s). The burden of proof in an SSA claim is on you, not SSA. You are presumed to be not disabled until you prove to SSA’s satisfaction you are. You start out at 0% disability and work your way up based on what your records prove. SSA is more convinced by a doctor’s findings on physical exam, lab results, diagnostic test, etc. than your complaints of pain, fatigue, etc.. Do not be surprised if SSA does if SSA does not believe your subjective complaints are not supported by the records. You have a legal problem and a medical problem. Even if a doctor can’t help you medically, i.e. to cure you, you need to continue to see your doctors to prove you cannot work. SSA will not likely believe your allegations of disabling pain if you only see a doctor once a year for renewing your prescriptions. Do not assume you are so disabled that even the SSA doctor will easily support your disability. These doctors rarely perform diagnostic tests and do a cursory physical exam. Certain disabilities are not even apparent on exam, i.e. Crohns. Do not count on Workers Compensation doctors to support disability. Workers Compensation and SSA claims are like oil and water. They do not mix well. You can assume the WC carriers send you to see doctors who do not find disability. Also, WC means only you cannot perform your regular occupation. SSA disability means you cannot perform even simple, unskilled, sitting jobs, meaning ALL work.
2. You need to make sure your medical professional is a doctor. The financial realities of running a modern medical practice means there are people who are advanced nurses (ARNP), physician assistant (PA), etc.. This is not meant to be derogatory to them, but SSA gives greater weight to MD, DO, Ph.D, PsyD, etc.. For applications filed on or after March 27, 2017, an
ARNP becomes an acceptable medical source. For applications filed before, they are considered unacceptable medical sources. SSA will generally give more weight to acceptable medical sources. Do not assure, merely because you call them a doctor and they don’t correct you or because they write you a prescription they are a doctor. This is not an issue of the quality of medical care you receive but how useful your medical records are to prove disability.
3. Always talk to your doctors to see if they are supportive of you being disabled. Do not assume they are merely because you think you are. In over 40 years of handling these claims, I have learned not every doctor believes every patient is disabled. Obviously, there are some doctors that are more conservative than others. There are also some doctors who refuse to get involved in disability claims for all sorts of reasons. The will provide copies of your office notes and records but incredibly rarely are disability issues mentioned in office notes. Many doctors say they are in business to help people get better, not to become disabled. They will not write letters, fill out forms, etc.. You need to find out earlier, not the day before the hearing, that your doctor is not supportive of your claim. Do not ask on your first few visits so your doctor gets a chance to know you better and what is wrong with you. If you ask to soon, the doctor might think you are just seeking disability, not trying to get better, and will not help. Depending on the quality of care you receive, insurance issues, etc., you might even contemplate changing doctors.
4. You must continue to appeal SSA denials. SSA does not approve all claims. The disability criteria vary as applied at different levels and with different types of adjudicators. If you do not appeal a denial, SSA wins the easy way. Do not assume SSA is always right. As virtually every representative charges a fee only if he or she wins, if SSA was right all the time we would starve to death. There is some degree of wisdom to the notion that SSA can get you so frustrated, aggravated, etc., you do not appeal. They only approve about 30% at the initial application stage, some states vary as to higher or lower, and about 10% at reconsideration. Not everyone appeals to the ALJ’s are the single most likely level approve a claim. Unfortunately, there are some ALJ’s with higher allowance rates and some ALJ’s with low allowance rates. The ALJ to whom your case is assigned to will sometimes be more important than how sick you are. ALJ’s are randomly assigned and you do not get to choose your ALJ. This makes the hearing process less perfect, but it is still far better for you to have a face to face meeting with an independent ALJ who has the discretion to believe your subjective complains than for your claim to be decided by adjudicators who are rarely physicians, have little discretion, and are direct employers of SSA. The current ALJ allowance rate is about 45%. Four of five years the ALJ allowance rate was in the mid to high 50’s. The Appeals Council has gotten much more conservative and now only overturns about 10% of ALJ denials. The U.S. District Court is almost a 50-50% proposition, but very few lawyers even take these appeals to federal court, there can be filing and briefing fees, and the process can take a significant amount of time.
