Before we start, I want you to know that there are many reasons disability claims are denied. Today, I will show you the 4 most common reasons disability claims are denied.
I will give you the short list and then I will explain each one. That way you can process the information a little easier and make your own list of things to work on or avoid:
4 Proven Reasons Claims Are Denied Explained
Not enough doctor’s visits and not seeing the right doctors. I talk about this issue at length in my post about How to Fix Your Medical Treatment. Read it carefully!
And please, take notes. See how it compares to your treatment. Feel free to contact me if you have any questions.
Not seeing the right doctors and not having enough visits to these doctors are the biggest and most common reasons people get denied benefits. They are also the most common reason I have to turn down cases! And No attorney likes to turn down cases!!
If the attorney, who wants to help you is already turning you down that means a judge is very likely to deny your claim for the same reason! This rule has exceptions, of course! But unfortunately, it is true in most cases.
So please, get treatment. List all your medical conditions and try to get to the right doctors right away! Your chances to win increase tenfold just by doing that.
2. Drug abuse. This is a “toughie“. Most disabled people are already taking pain medications. Some of these drugs are pretty “heavy duty” like Morphine, Oxycontin or Hydrocodone. So how do you balance the “need” to take these drugs and avoiding abusing them?
For starters, make sure you are only taking medications that you have a prescription for. It seems pretty obvious, but some people will take anything they can get a hold of “just to see” if it works.
Second, make sure you are taking the prescribed dosage.
You would be surprised how many people “run out” of their medications before the next refill
This is when things can get ugly and you can be seen as a “drug abuser”. Imagine you were taking your medications except you took too many because the pain was too strong. In that case, you did not follow your doctor’s recommendations. That’s drug abuse!
The worst part is when you run out of medications then you experience “withdrawal” symptoms and you end up in a hospital. While the hospital will send you home with some medications, they will write in their notes that you came to them because you “ran out” of meds. Hospitals and judges see this as “drug seeking behavior“.
Even when you didn’t mean to take too many pills. Even if you are out of town and you forgot your meds at home. All of this can be seen as “drug abuse” Especially if it happens more than one time. Hospitals will call them “frequent fliers“.
If you need an increase in dosage because your medications are not doing “the job” anymore then talk to your doctor. Don’t self-medicate. Self-medication is “drug abuse“.
3. Medical Marijuana. Trust me, I’m not against using it as a natural treatment. There are many studies out there showing some great benefits with treatments using marijuana. But Social Security is under the “Federal” system and under that system marijuana is still illegal.
Even if your State legalized marijuana and your doctor prescribed it as a good option for you, Marijuana still carries that “bad for you” label. Because of that label, Social Security judges see people using “pot” as “substance abusers“. You don’t want that label in your case. You need to stop using it. Period!
Marijuana and Mental Impairments
If you alleged a mental impairment and you are taking medications for those impairments, you should not add marijuana to your treatment for two reasons:
- Marijuana can potentially interact with your prescription medications and affect your treatment outcome. After all, marijuana is a “depressant”. Why add more “depression” to the mix? and,
- You get automatically denied under Social Security rules if you claim mental impairments and you are using “illegal substances” (Yes, even if they are “legal” in your State).
Proving You Are Clean
If you just stopped using any “illegal” substances (not just pot), to receive disability benefits you will have to be “clean” for 6 months before they consider paying you benefits for a mental impairment. The disability claim process already takes too much time, why get denied your benefits by using substances that are not part of your treatment plan?
If you have a history of drugs and you want to prove you have it under control, talk to your doctor about random testing. I know, I sound like a drug commercial but it’s true!
If you have a good pain management doctor he should be doing that already. But if he doesn’t, ask for it!
Have your doctor do a random drug test every once in a while. That way the court will know you “got over” that problem and they will even commend you for it.
And last but not least:
4. Alcohol abuse: What really constitutes alcohol abuse? For most people, it would be just drinking too much or being an “alcoholic”.
While there are many definitions out there, you really need to understand the term for disability purposes. Alcohol abuse is, of course, drinking too much. And if you fit in this category, you really need to work on this one because Social Security does not like to pay people who drink too much. It’s that simple!
Say, for example, you have a gallbladder problem. You have constant abdominal pain and you cannot work because of that pain. Yet, your records show that you still have a “few drinks” per week. Do you think the judge is going to like that? No! I’m sorry but it’s the truth!
Judges are skeptical of paying someone, even if they are disabled if it means the claimant will be “having drinks” on the taxpayer money. Even worse if your medical condition was clearly caused by heavy alcohol consumption!
The point here is not to make you feel bad about the past but make sure that you “fix” this for the future of your case
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Get treated! Find an AA meeting or other alcohol abuse support groups. Ask your doctor about treatment options.
Here is the thing: if you show the judge that you made an effort and “overcame” this problem, he will completely change his view of your past. I have seen many judges say encouraging words and praises for a “job well done” when a client overcame an addiction.
How about that for a victory? You overcome an addiction AND you win your case! I know, you are still disabled. But you will finally have a source of income to take care of your bills. Why not work on that?
How about those “Social Drinkers”?
Do you want to see a judge (or an attorney) cringe when reading your medical records? When we read in your records that you told your doctor you drink a glass of wine every day!
Why would one glass of wine every day be a bad thing? They say wine is “good for your heart“, it “lowers your blood pressure“, and “insert any other excuse we use to drink wine” (these are just things we hear, no statistics here!).
Here’s the problem with telling your doctor you drink a glass of wine every day: Doctors don’t always write the word “wine” in your medical records. In some medical software, the only entry may be a “check box” for alcohol use.
So even if you tell your doctor that you drink a glass of wine every day, he will be writing “patient has one drink every day”. Or the notes will say “alcohol abuse” just because the doctor considers more than “one drink” per week to be “alcohol abuse”. Why?
Because alcohol abuse can be open to interpretation depending on the reader. In this case, the reader may be a very conservative judge! What if he doesn’t drink at all? What if he sees drinking one glass of wine to be a sin (not trying to get religious here!).
And even if the judge is being overzealous with one drink, do you really want to see your only chance to be in front of a judge “wasted” (pun intended) over a glass of wine?
What You Say Can and Will Be Used Against You
While I’m not suggesting you hide relevant medical information to your doctor, be careful when presenting that information to him or her. Sadly, not all doctors are paying attention to the words you are saying and may write things you don’t want to be out there.
Like I said before, a glass of wine should not be a big deal. But because of how judges see “real” alcoholics when deciding a case, you don’t want the judge to confuse one glass a day with being an alcoholic.
Here is what I know: whether you just drink one glass a week or a day, know that this information CAN AND WILL be used against you in court. And if you happen to have any of the medical conditions typically found in alcohol abusers, then you will have an extra “explaining” to do. Even if you are not under any circumstances an alcohol abuser. Why take that chance?
There are many reasons a case can be denied. The examples I gave you today are the most common. If you fall into any of these categories and you are thinking about filing your claim or have already filed, please work on it. Whether it’s medical treatments or AA meetings, do what it takes to get your case on track. Some of these actions are easier than others, I understand. Take your time, get help and never give up.
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Courses by Realtactics4disabilityclaims
It is finally here!!!
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If you were denied disability and you are looking to appeal with “better” evidence, I created a course about using a Residual Functional Capacity Report to add to your medical records. This is a form you can take to your doctor to complete in support of your claim. The course includes forms for physical or mental impairments and instructions on how to ask your doctor to complete them. You can take a “free sneak peek” to see if this course is for you. Click on the image below and you will be directed to the course page:
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You know the blog, now you can take one step further and learn the process of preparing and filing your claim.
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Until next time,