By Dennis L. Plank, Attorney
Injuries or illnesses that prevent work are financially and emotionally stressful. Fortunately, a federally funded insurance program can offer a lifeline. The Social Security and Supplemental Security Income disability programs provide monthly benefits to qualifying disabled workers and their dependents, helping to replace some of their lost income.
In January 2022, the program served more than 9 million Americans. But securing those benefits is not always easy, and the process has gotten more challenging due to COVID-19.
The Social Security Administration is not immune to the effects of the pandemic. Reduced staffing and a shift to telework resulted in a backlog of disability claims over the past few years. The agency had 160,000 more initial applications pending at the end of the fiscal year 2020 than at the beginning, and it reported 739,745 pending at the end of September 2021.
With that in mind, it is more important than ever for disabled Pennsylvania residents to understand that mistakes are common, and many claims are denied due to paperwork errors. Many denied claims can be successfully appealed. Here are some of the most common reasons for denied Social Security Disability claims.
Applying for disability benefits is a complex process that requires volumes of paperwork and copious documentation. Applicants need to provide personal information about themselves and their family members as well as work details, including earnings, dates of past employment, military service, and any previous workers’ compensation.
Perhaps most importantly, they must also include detailed medical information such as the names, addresses, and phone numbers of doctors, caseworkers, hospitals, and clinics involved; the dates of all visits; laboratory and test results; all diagnosed conditions; and all medications and other treatments, their purposes, and dosages along with any side effects.
Other required documents might include a birth certificate or proof of citizenship; U.S. military discharge papers if the applicant served before 1968; W-2 forms or self-employment tax returns; and any relevant award letters, pay stubs, or settlement agreements.
It’s important to allow plenty of time to compile documentation, complete the paperwork, and review for accuracy. Make sure that details provided on one form do not conflict with those provided on another. Missing information can delay the processing of a claim, but even the smallest discrepancy, such as a misspelled name or incorrect phone number, can result in a denial.
Someone who suffers from a disabling injury or medical condition may have concerns about how they will support themselves and their family, especially as they await approval of their Social Security Disability claim. Applying for unemployment benefits to bridge that income gap might seem like a good idea, but it could end up being a costly mistake.
While both programs assist when there is a loss of income, their eligibility criteria present a natural conflict. To qualify for unemployment benefits in Pennsylvania, someone must be willing and able to work and actively seeking a job. By contrast, an inability to work is the main requirement for Social Security Disability.
If someone receives unemployment benefits, the Social Security Administration may deny their disability claim because they appear ready and able to work. There are exceptions where it is possible to collect both, including cases where someone can only work in a limited capacity. An experienced Lancaster County attorney can ensure potential conflicts do not result in a denied Social Security Disability claim.
A physician’s word often carries great weight when deciding a claim. While medical records tell part of the story, a letter from a doctor can go a long way toward explaining the severity of an injury and its effect on the applicant’s day-to-day functioning and capacity for employment. It can also detail the expected duration of the disability and any current or future treatments.
Following all a doctor’s orders is an important part of the claims process, especially if the treatment promises to restore the patient’s ability to work. Failing to take medication or follow a prescribed physical regimen and diet can result in a denied Social Security Disability claim if it appears the applicant is not trying to return to employment.
Likewise, attempting to work against a doctor’s orders is also a mistake. Not only can it lengthen recovery time, but it can also hurt the chances of having a claim approved.
Remember, when someone applies for disability benefits, they are asserting they are unable to work. If an employee with a disabling injury or medical condition takes any type of paid job to make ends meet, even if it’s only part-time, the Social Security Administration may assume they can earn a living and deny their claim.
Use of Alcohol or Illegal Drugs
The Social Security Administration will not grant or refuse benefits based solely on drug or alcohol abuse. However, it will deny a claim if substance abuse is a contributing factor that is either causing or worsening an applicant’s disability and their potential to return to a normal work life.
Medical evidence of drug addiction or alcoholism will not affect benefits if the applicant is eligible due to age or blindness, or if the SSA determines they would be unable to work regardless of their substance abuse.
Missed Deadline for Social Security Disability Claim
Filing a Social Security Disability claim is a complex process with strict deadlines. Even after submission, applicants may receive requests in the mail to submit additional information or documentation within a very short time frame.
Don’t ignore correspondence from the Social Security Administration and make every effort to respond to requests as soon as possible. Failure to meet any deadlines associated with the initial submission or additional requests could result in a denial. When the SSA denies a claim, the applicant only has 60 days to file an appeal.
If someone misses a deadline, it is possible to receive an extension for “good cause,” such as severe illness, homelessness, mental illness, incarceration, or misunderstanding.
Don’t Appeal a Denied Claim Without the Help of a Lancaster County Lawyer
Once a claim is denied, it is important to contact an experienced disability lawyer who can review the case, gather any evidence or missing documentation, fix common mistakes, and negotiate deadline extensions if necessary. They can also assist in preparation for the hearing of the appeal.
Contact the Law Offices of Going and Plank in downtown Lancaster today for a free consultation and help in appealing a denied claim. We don’t charge attorney fees unless we successfully recover Social Security Disability benefits.
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