Knowledge is power when dealing with the Social Security Administration. Even a small misstep can delay or derail your claim for disability benefits. To improve your chances of success, review the following list of common mistakes made by disability claimants.
- Applying for Social Security Disability While You Are Still Working Full-Time
Many workers apply for disability benefits before they stop working. This is understandable; no one wants a gap in income or to quit a good-paying job (even if they can’t perform the work). However, Social Security automatically denies these applications.
The Social Security Administration uses a five-step analysis in evaluating disability claims. Step One in this analysis is: “Are you performing the substantial gainful activity?” In other words, “Are you working?” If the answer is “yes,” then the claims examiner will never get to Step Two of the analysis. Your claim will be denied, and you will not be awarded disability benefits.
You are performing substantial gainful activity if your monthly earnings are above a minimum threshold ($1,170 in 2017) or you are performing full-time, competitive work. If your earnings or work schedule is consistent with substantial gainful activity, you should not apply for benefits yet. It’s best to wait until you are no longer working or your impairments have caused a reduction in your hours before filing. (If you are self-employed, different rules apply. Consult with an experienced Social Security disability lawyer before filing.)
- Not Applying When You Are Doing Part-Time or Subsidized Work
While substantial gainful activity (“SGA”) automatically disqualifies you from Social Security disability benefits, not all work is SGA. If you are working part-time and earning less than the monthly threshold, then you can, and should, apply for Social Security disability benefits. Additionally, Social Security considers some full-time work to be “subsidized.”
Examples of subsidized work include:
- Employment in a sheltered workplace (doing simple tasks under close or continuous supervision);
- Some “light duty” jobs;
- and Work that involves significant assistance from a job coach.
An experienced Social Security disability lawyer can help you determine whether you are doing subsidized work and, if so, how to present evidence of that fact in support of your application for benefits.
- Applying for Social Security Disability Benefits When You Are Collecting
Unemployment Benefits When you apply for Social Security disability benefits, you assert that you have a severe medical impairment that prevents you from working. When you apply for unemployment benefits, on the other hand, you assert that you are able to work, but have been unable to find work after being terminated from your employment. This contradiction is difficult to reconcile. If you are able to obtain any income by claiming you can work, you may be disqualified from disability benefits.
- Failing to Complete the Required Forms
A Social Security disability application involves a lot of information and a small mountain of paperwork. It is easy to feel overwhelmed. However, if you fail to complete the required Social Security forms accurately and promptly, or if you provide limited or incomplete information, your claim is likely to be denied (or, at best, any award of benefits will be delayed).
- Overstating Your Job Duties or Education
In evaluating your claim for benefits, Social Security assesses your ability to perform both your past work and other full-time work. If you inflate your work duties and/or overstate your education, the claims examiner will take you at your word. He or she will then translate your exaggerated resume into an ability to work—and deny your claim for benefits.
- Basing Your Claim for Benefits on Your Worst Medical Condition Only
When assessing a claim for benefits, Social Security must consider the combined impact of all of your impairments. For this reason, it is important that you list all of your serious medical conditions when you apply for benefits, not just your worst problem. For example, if you suffer from chronic pain, you may also frequently experience depression and anxiety. If considered alone, your depression may not be disabling. However, it may cause problems with concentration, focus, and fatigue. Social Security cannot consider these impairments and resulting symptoms in isolation. Instead, it must determine how your combined physical, mental, and emotional limitations impact your ability to work.
Basing Your Claim for Benefits on Undiagnosed or Self-Diagnosed Medical Conditions
While you should list all of your serious conditions on your application, Social Security will only consider “medically determinable impairments.” A condition is “medically determinable” if there is medically accepted evidence supporting the diagnosis. This includes diagnostic testing (like blood work or an X-ray) and clinical findings (like muscle spasms observed and documented by your treating doctor).
The Social Security Administration (“SSA”) will never consider undiagnosed (or self-diagnosed) conditions when evaluating your disability claim. Your claim must be supported by objective medical evidence from licensed medical providers who have performed acceptable medical tests on you. The opinion or diagnosis of a provider who does not have an actual medical license (e.g., an acupuncturist or a chiropractor) will carry little weight with the SSA. Likewise, your description of your symptoms, alone, will never be enough to prove that you have a severe impairment.
Accordingly, the key to avoiding this mistake is simple: Seek appropriate medical care and tell your doctor(s) about all of your symptoms, so that an accurate diagnosis can be made and documented. If you are confused about your diagnosis, ask questions. If you are concerned that a medical problem is not being taken seriously, discuss this with your doctor.
- Assuming That Your Social Security File is Complete and Current
As part of the application process, you will sign a “release,” allowing Social Security to obtain your medical records. Do not assume, however, that Social Security will obtain all of the information necessary to prove your claim. Some Social Security claims examiners are impatient; if your doctors don’t send the records immediately, your case may be decided without a complete record. Other times, medical records alone are not enough to prove a Social Security disability claim. Your claim may require detailed medical opinions and other in-depth analyses. The claims examiner typically will not develop your case in that much detail. Instead, he or she may order a brief “consultative examination,” review any available records and issue a decision.
It can take six months for Social Security to evaluate an Application for Benefits. If your claim is denied, it typically takes more than a year before a hearing is scheduled. During this time, a lot can change. Your medical conditions may worsen—or new conditions may be diagnosed. Your medications may result in new (and negative) side effects. You may find a new doctor who recalibrates your entire treatment plan. You cannot rely on a busy claims examiner to search your medical records for new doctors or diagnoses or other information, or even to make sure your file is complete.
Bottom line: It is your responsibility to ensure Social Security has all the information it needs to issue a favorable decision and award you benefits.
- Failing to Seek Medical Treatment
It is easy to feel overwhelmed with medical bills, especially if you have limited or no insurance. However, you should not use this as a reason to avoid medical treatment. It is important that Social Security applicants get consistent treatment from licensed medical providers. Again, Social Security will only consider “medically determinable impairments” when evaluating a disability claim. You cannot win your Social Security claim without substantial medical evidence. Additionally, Social Security may question the severity of your impairment if you do not receive consistent and ongoing medical treatment. This is particularly true in cases involving chronic conditions or conditions that can wax and wane (like some types of multiple sclerosis). For this reason, it is important to see your treating doctor(s) regularly and keep all scheduled medical appointments.
- Not Following Your Doctors’ Orders Your doctor will assess your condition and prescribe a course of treatment. If you are noncompliant in that treatment, or if you refuse treatment, you will have a difficult time convincing the SSA that you have a severe and lasting impairment that prevents you from working. After all, your condition might improve if you comply with your doctor’s instructions. It is essential that your medical evidence demonstrates that you have attempted to recover, but your condition endures.
Accordingly, you should follow your doctors’ orders to the best of your abilities. If your doctor refers you to a specialist, make and keep the appointment. Take your medications as prescribed. If you are experiencing negative side effects, report them to your doctor. Your doctor can change your prescription or dosage, and document the side effects. Likewise, follow your doctors’ orders regarding physical restrictions. If your doctor instructs you not to lift over 20 pounds, or to elevate your feet throughout the day, do your best to follow these orders. If you try to do too much, you may exacerbate your condition. Alternatively, Social Security may assume you are capable of working if your medical records show that you make a habit of ignoring your doctor’s instructions.
- Getting Vague or Unsupported Restrictions or Opinions from Your Treating Doctors
It is not uncommon for a doctor to complete a work restriction slip that simply states “No Work,” or “Completely Disabled.” While your employer may honor this restriction slip, it is unlikely that Social Security will approve your disability claim based on this statement alone. Instead, your doctor should provide detailed restrictions that set out your functional tolerances (how much you can lift, walk, stand, push, carry, etc.). These restrictions should be linked to your medical conditions and medication side effects.
A functional capacity evaluation (FCE) or residual functional capacity (RFC) form is even better. An FCE is a fact-based series of tests that gauge your physical abilities. An RFC is a more opinion-based form that discusses your tolerance of specific workplace activities. Social Security may consider a thoroughly completed FCE or RFC to be more persuasive than a brief doctor’s note. If you need help obtaining these forms or testing, speak with your disability lawyer or your treating doctor.
- Failing to Keep a Record of Your Symptoms
One of the best things you can do in support of your application for Social Security disability benefits is to keep a symptom diary. A symptom diary is a written record of the nature of your symptoms and the impact of your symptoms on your daily life. This diary can take many forms, including, e.g., a traditional, handwritten journal; a wall calendar; a pocket calendar; a computer spreadsheet or a handwritten chart. Any format that allows you to regularly and routinely record your symptoms over a prolonged period of time will work. Use a diary to chronicle your pain; headaches; fatigue or other symptoms; or to record your treatment, including your medications and their side-effects.
Why is a symptom diary so important? A symptom diary can play a key role in the success of your Social Security disability benefits claim because it will help you provide compelling testimony at your hearing. There is likely to be a long delay between the time you request a hearing and the day your hearing is scheduled. No matter how good you think your memory is, it will fade over time, and events will become muddled. With your symptom diary as a reference, you will be able to give detailed responses to the judge’s questions, and detailed testimony is always more persuasive than vague generalizations.
- Minimizing or Exaggerating Your Symptoms and Limitations
Be scrupulously honest in all your dealings with the Social Security Administration and with your doctors. Your credibility throughout the application and appeal process is essential to a successful claim for benefits. When you are completing a Social Security form, be honest about your current abilities and limitations. Do not list hobbies that you no longer are capable of doing; if you need extended breaks or rest periods, make sure to note this. Tell your doctor about all your symptoms, so that he or she can properly document and diagnose your condition(s). If the SSA sends you to an examination with an “independent” doctor (a “consultative examination”), be honest and forthcoming with the evaluating doctor. If you exaggerate your symptoms, the doctor will report this to Social Security, and your hyperbole will damage your credibility. On the other hand, if you minimize your problems, the doctor is likely to report that you are able to work. Be honest.
- Failing to Appeal an Initial Denial of Your Claim
Do not assume that your case is lost because the Social Security Administration denied your initial application. Most initial applications are denied. (Social Security only approves about 30% of initial disability applications.) However, Social Security approves a large number of appealed claims every year. Why?
There are many reasons your claim may have been denied in error. It may be that your file was incomplete or out-of-date and missing a key piece of medical evidence. It may be that the claims examiner was rushed or overworked or just overly conservative in his or her initial evaluation and made an honest mistake. Perhaps your application simply failed to provide a complete picture of how your impairment prevents you from working. Whatever the reason for the denial, when you appeal you get the opportunity to present your case to a judge, who can ask questions and make an in-person assessment of your situation. Because the hearing judge will do a more detailed and thorough review of your claim than a claims examiner, a hearing gives you the best chance for success. Don’t give up too soon. Failing to appeal is one of the biggest mistakes you can make.
- Waiting Until a Hearing Is Scheduled to Contact a Lawyer
Many Social Security disability claimants wait until the last minute to hire a lawyer. A Notice of Hearing is sent out at least 20 days before the hearing date. However, it takes a great deal of time to develop a Social Security disability appeal. An attorney typically must:
Meet with you and conduct a detailed interview; Review your entire Social Security file (including medical records, vocational assessments, and other important information); Determine whether there is missing evidence; Order, review, and submit this evidence to Social Security; Draft a comprehensive pre-hearing brief for the judge, and Prepare you (and any other witnesses) for the hearing.
It is incredibly difficult to complete this process in 20 days. It is in your best interests, therefore, to meet with a Social Security disability lawyer in the early stages of the application or appeal process. This will benefit both you and the lawyer. You will have time to find the right lawyer for your needs, and your attorney will have plenty of time to prepare your claim.
- Failing to Hire a Lawyer Because You Think You Can’t Afford To
Being unable to earn an income can be frightening. You likely have mounting medical costs and past due bills; the last thing you want to do is to add legal fees to this burden. However, legal fees are capped by law, and your Social Security disability attorney will not charge a fee for legal services unless and until you recover money from the SSA. Plus, your disability attorney understands that you are unable to work and will help you find resources in your community. Do not delay in seeking legal assistance because you think you cannot afford it.
- Not Asking for an On-The-Record Decision Following the Denial of Your Application
Sometimes it is obvious, based on the medical evidence, that a Social Security disability claim should have been approved at the application level. In those instances, an “on-the-record” decision (OTR) may be appropriate. When an OTR is requested, a Social Security judge (or staff attorney) reviews the entire file. If the judge finds that the evidence supports a finding of disability, then he or she may approve the claim and award benefits without the need for a hearing. An OTR saves time and results in a quicker award of benefits. Not every case is eligible for an OTR. Many strong claims still require a hearing. Your disability lawyer can advise you as to whether your claim is suitable for an on-the-record request.
- Saying Too Little at Your Hearing
Many claimants approach their disability hearing with the attitude that, because they are dealing with the government, they should say as little as possible and volunteer nothing. Although this may be the right approach in certain situations, it is the wrong approach for your disability hearing. Remember, you are asking the government to give you something – to do something for you. You need to provide enough facts, details, and explanations in your testimony to make it obvious to the judge that awarding your disability benefits is the right decision.
For example, if you have an impairment that makes it difficult to breathe, you could tell the judge, simply: “I have trouble breathing just about every day.”
However, you will improve your chances of success if you provide details about the impact of your symptoms and paint a more vivid picture of your daily life. For example:
“I have trouble breathing just about every day. Over the past 30 days, I have had to use my rescue inhaler 19 times. I have been to the emergency room twice. I no longer sleep in my bed because I cannot climb the 12 steps to the bedroom and, even if I could, I have great difficulty breathing when I am lying down. So I sleep downstairs now, propped up on the sofa, every night. I used to watch my granddaughter 3 days a week after school. Last month, (on date), she ran after some ducks at the park and I couldn’t keep up with her because I couldn’t breathe. My daughter was very worried and made other arrangements for child care. Since then, I stay inside most days and try to rest.”
The hearing is your opportunity to talk to the judge – to speak directly to the person who will be deciding your claim. Don’t waste it. Tell the judge everything you want him or her to know about why your condition prevents you from working.
Ensure your chances of getting approved for disability benefits by contacting an experienced Springfield IL disability lawyer today.