Getting Medical Treatment
One of the purposes of Social Security Disability (SSD) and Supplemental Security Income (SSI) benefits is to help recipients afford proper medical care. Furthermore, seeing a doctor can help establish documentation of a disability that will be useful in the application process. Medical evidence is the critical element in winning cases. You won’t win if you can’t prove you’re disabled. Solid medical records are the only reliable way to supply that proof. However, medical documentation can only be generated if you’re being treated.
In one case the firm handled, the client was clearly entitled to receive Social Security Disability benefits, yet did not get them until he obtained consistent treatment. In his mid-40s, he worked as a trombone player and warehouseman. Unfortunately, due to alcoholism, drug abuse and mental illness, he lost his home and was living in a shelter. Even though he suffered from severe diabetes requiring daily insulin injections and serious depression, the judge would still not approve benefits at the first hearing. The reason for denial was insufficient medical records.
The firm scheduled another hearing, giving the client time to get a new primary care physician and enter a regular treatment program. Due to the new medical evidence we presented at this second hearing, he was awarded over $25,000 in back benefits and ongoing monthly financial support.
This is another important point about treatment: If medication is prescribed for you and you don’t take it, you’re putting a noose around your own neck and your ability to be approved. Aside from the obvious medical implications, a disability examiner or judge will have no basis on which to evaluate the true severity of your condition. If you take medicine and you still can’t work, your disability is clear. If you haven’t taken the medicine, there’s an open question. That means at least a delay and possibly a denial.
If you’ve stopped taking prescribed medication because you’re having side effects or can’t tolerate it for some other reason, then address that openly with your doctor. Don’t just arbitrarily decide not to take it, because there may be serious medical consequences, in addition to damaging your opportunity to collect benefits. As obvious as this may seem, it is a relatively common problem encountered in the application process.
Realize this, too: It’s not enough to get the case sent back for a new hearing. You need new ammunition that enables you to win when you’re back in front of the judge. If you are not getting treatment, a judge is unlikely to find your impairments serious enough to prevent you from working.
Make sure you get treatment even if you can’t afford a private physician. There are other options. This example illustrates the importance of getting treatment wherever you can. The firm handled a case in which a man developed post-traumatic stress disorder. He’d worked for a law firm as a clerk. At the time of the World Trade Center crisis, he volunteered to help by driving debris out to the Staten Island landfill.
Being exposed to the trauma of viewing body parts triggered his mental illness. In addition, he developed breathing difficulties after working at the WTC site. He received treatment through a Red Cross program for WTC victims. After he was initially denied benefits, the firm compiled complete treatment records from that organization and was able to obtain over $20,000 in Social Security Disability back benefits for him, as well as continuing monthly benefits.
Keep this in mind — it’s very difficult to win benefits if you aren’t seen regularly by a medical professional.
The lesson is: Cooperate with the process, comply with your doctor’s and attorney’s advice, and do what it takes to win.
Ask Your Doctor To Fill Out An RFC
An RFC is a form to document your residual functional capacity. This is what your actual capacity to work is after your disability is taken into consideration.
These forms are used by Social Security to finalize a decision on a case. The form will be used to rate your ability to work and therefore to justify approval or denial of your claim.
The RFC form is an extremely useful tool when your treating physician completes it and can go a long way toward helping to win your case. That’s because a treating doctor has firsthand knowledge of your condition and prognosis, and as previously mentioned, Social Security considers him or her to be in the best position to determine the impact of your disability on your capacity to work.
When the RFC is properly supported with medical evidence, an administrative law judge will give significant weight to your doctor’s opinion.
The problem with medical records by themselves is that they almost never provide direct information on your capacity to work. The RFC form does, specifically stating why and how your illness or injury limits your ability to work. It puts the data into a form that a judge is used to seeing and makes his or her job easier. It’s a positive influence toward interpreting the facts in your favor and winning benefits.
Your SSD/SSI attorney will very likely have his or her own version of RFC forms, which are designed to elicit and present a supporting medical opinion in the strongest possible way for you. These documents often do a better job of convincing a judge than a letter from your doctor because they consolidate, coordinate and present the exact medical proof you need to win your case.
Change Doctors If You Need To
Different physicians can have varying opinions about the severity of a medical condition. Even if you’re limited to an in-network list of doctors, consider getting additional opinions if you believe that your current doctor’s opinion of your capacity to work is not accurate.
It doesn’t necessarily have to take a long time for your new doctor to develop treating source status, if you start to have regular visits.
In difficult cases especially, supportive physicians can be the difference in getting benefits. The firm represented a young woman in her early 20s. Sadly, she had a history of physical and emotional abuse and as a child was shuttled between foster homes. As a result, she suffered from panic attacks, anxiety and depression and was a “cutter,” inflicting mutilating injuries on herself. Additionally, she had attempted suicide more than once.
At the time we began, she was attending college part time and was on public assistance. She couldn’t deal with the stress of juggling a full-time college schedule and work. Her various conditions made her emotionally fragile and unable to get along with co-workers. Although her claim was initially denied, we won her case with the help of supportive doctors. Her back benefits totaled over $10,000 and she got ongoing monthly SSI benefits as well, which enabled her to continue attending school part time.
Be sure your doctor is on your side. Unfortunately, some medical professionals will tell patients that they’ll support a disability claim, but are unwilling to back it up with medical records. If you have doubts, ask your lawyer to help you flush out the truth.
Mental Illness Claims Require Special Handling
Those who’ve never experienced emotional illness rarely have any concept of the profoundly destructive and limiting effect these conditions can have. Unfortunately, this lack of understanding applies to disability examiners and judges, too. One would think that in confronting mentally ill claimants on a daily basis, they would have more insight into the turmoil these people experience, but that’s not always the case.
As a practical matter, what this means is that if you are a victim of mental illness, don’t expect understanding, sympathy or special consideration. This may sound harsh, but it’s a reality in the serious business of strategizing to win your benefits. You’ll need to have much stronger medical proof of mental disability and its constricting effect on your capacity to work.
To win, you’ll need to be in treatment and comply with the therapy and any medication regimen your doctor prescribes. It’s best to have a psychiatrist or licensed psychologist as a treating source, since these professionals will have more credibility with a disability examiner or judge.
Even the most well-intentioned judges can sometimes lose sight of the unique nature of disabilities with mental and emotional roots. In the AIDS case mentioned earlier, which involved mental illness, although the firm presented persuasive medical proof of the client’s disability from a treating psychiatrist, the administrative law judge insisted on seeing “objective” medical evidence, as if an MRI or CAT scan could document an emotional malady. Finally, the judge was convinced that psychiatric reports and treatment notes were the only available medical evidence, and a favorable decision was issued.
If you do suffer from emotional illness that prevents you from working full time, do not hesitate under any circumstances to seek benefits. Sometimes claimants are embarrassed by their conditions. For example, the firm handled a case for a woman in her 40s who suffered from bulimia and anorexia, conditions famous for their symptoms of secrecy. Because she had the courage to come forward, the firm was able to get benefits for her.
Another client was a woman who was afflicted with adrenal insufficiency, which resulted in her having masculine features. The condition also brought on symptoms of nervousness, depression and inability to concentrate. She got benefits, too.
Many times clients have no history of mental impairment, yet when they’re injured and suffer from chronic severe pain, they develop depression. Regardless of how your mental illness presents itself, if it stops or hinders you from working, seek the benefits you may be entitled to.
All the admonitions that apply to physical disability cases apply tenfold to mental illness or impairment claims. Attempting to prove a mental illness disability claim without an SSDI/SSI lawyer or other professional representation is often difficult. Some judges are more skeptical of these cases. Somehow, to them, a mental disease doesn’t seem as real as a physical one. It’s an uphill battle, and even with a compassionate judge, you’ll need all the help you can get to succeed in obtaining an award.
Avoid Missing An Exam
If Social Security schedules you for an independent medical evaluation, make sure you show up. Otherwise, your failure to cooperate can be grounds for denial of your claim.
Generally, if you have a valid reason for missing a scheduled doctor’s visit, a disability examiner will reschedule it. If you repeatedly fail to attend, however, you’ll end up being denied benefits.