Know Your Legal Rights: Common Legal Barriers to Getting Social Security Disability Benefits

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Know Your Legal Rights is a bimonthly column distributed by the State Bar of Wisconsin. It is written by members of the Lawyer Referral and Information Service (LRIS) of the State Bar of Wisconsin, which connects Wisconsin residents with attorneys throughout the state. Learn more at wislaw.org.

By Attorney Leah Drexler-Dreis

Applying for disability benefits is not an easy choice. However, if you have health issues that interfere with your ability to work successfully, sometimes this is one of the only options people have for earning an income.

Unfortunately, the process of obtaining disability benefits is often long. Avoiding these common obstacles could make all the difference.

File a timely appeal

After you file an initial claim for disability benefits, you wait for an initial decision. In case of refusal, you can file an appeal for review. If this is denied, you can appeal for a hearing before an administrative judge (ALJ). Subsequent appeals are also possible.

Generally, appeals must be filed 60 days after receipt of a denial letter. It’s easy to get discouraged after receiving a rejection letter in the mail. Some people give up, thinking they don’t have a valid claim. Others decide to start over. However, a claimant’s highest likelihood of success is at the ALJ hearing – the third stage of the invalidity process.

In 2021, only 36% of cases were approved at the initial stage; only 13% of cases were approved at the reconsideration stage. However, 51% of the cases were approved in an ALJ hearing.

These statistics do not vary much from year to year. To get to the hearing level — the level at which you have the best chance of having your claim prevail — you must file timely appeals of your first two denial letters.

Must present medical proof of disability

Social Security disability claimants bear the burden of establishing that they have impairments that cause them significant limitations. Generally, you do this with medical evidence.

The more doctors you see and the more often you see them, the more evidence there is to support a disability claim. The more you talk – in detail – about your symptoms and how they affect your functioning, the more the quality of this evidence is affected.

Some people assume (sometimes correctly) that they can go to their doctor and say there have been “no changes” since their last visit and still get the treatment (or a change in treatment) they need. However, for a disability claimant, doctor visits serve a dual purpose: getting needed treatment and communicating with the Social Security Administration (SSA).

SSA staff comb through your medical records for notes regarding symptoms and limitations. If you don’t tell your doctor about these things, there won’t be much substance to back up your case.

Being very specific is also helpful. SSA tries to quantify your limits. Telling your doctor you’re in pain isn’t as enlightening as describing that you can only stand for 10 minutes to cook dinner before you have to sit down, or that neuropathy in your feet requires you to hold on to furniture. your home to keep your balance while you try to walk.

Follow the prescribed treatment

Although you do not need to take risky treatment or treatment you cannot afford, failure to take your medication as prescribed or follow directions (including not taking alcohol or illegal drugs) may complicate your case.

This forces SSA to try to guess what your likely functioning would be if you followed the prescribed treatment. The SSA is unlikely to assume a finding in your favor.

Cooperate with the social security administration

The SSA will sometimes schedule exams for you with their doctors. They will often send out questionnaires about your daily activities and work history. They will ask you to sign (sometimes several times) the medical waivers and/or contact them to answer any questions they may have about your file.

These requests will have deadlines. Failure to meet these deadlines or communicate with SSA regarding their extension may result in refusals for non-cooperation.

If you cannot meet a deadline, call the reviewer whose name appears on the letter and discuss your situation with them. Always keep a written record of who you talk to and when.

Leah Drexler-Dreis practices only Social Security Disability Law at the Disability Benefits Law Center in Milwaukee with her father, David Dreis. She has been practicing in this field since 2008 (and as an attorney since 2012) and works at all levels of the disability process, including the Federal Court for the Eastern District of Wisconsin. She is a member of the State Bar of Wisconsin Lawyer Referral and Information Service, which connects Wisconsin residents with attorneys throughout the state. Learn more at wislaw.org.

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