Useful Facts About the Claims Process

SERVING GREATER LOUISVILLE, KENTUCKY, SHEPHERDSVILLE, BARDSTOWN, SHELBYVILLE, FRANKFORT, LAWRENCEBURG, LEXINGTON, & SO. INDIANA

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Fact: Most disability claims (60% +) are denied at the initial level.

If you do not anticipate returning to work in the near future, you need to request an appeal in writing within a specific time frame and complete a Request for Reconsideration Form. In Kentucky, over 90% of claims are denied on reconsideration. The next step in the appeal process, a formal hearing with evidence and testimony before an Administrative Law Judge, could take over six months. Unfortunately, there is no guarantee you will receive benefits. Benefits are often denied to people who have legitimate claims - after their initial application is filed, after reconsideration, after a hearing, and even on higher appeal.

Chart showing majority of Social Security disability benefits claims are denied at first, and on reconsideration, but cases often succeed in hearings.

The Appeals Council considers appeals from hearing decisions, and acts as the final level of administrative review for the Social Security Administration.

The Office of Hearings and Appeals (OHA) administers the hearings and appeals program for the Social Security Administration (SSA). Administrative Law Judges (ALJs) conduct hearings and issue decisions.

Fact: For most claimants, the necessary paperwork is complicated and confusing.

Applications and disability appeals forms are complex. The volume of documentation that the Social Security Administration requires is staggering. The regulations for how to apply for disability are difficult to understand. Many people who apply on their own, after a few months, become discouraged or intimidated, and eventually stop responding to the Administration's seemingly unending requests for documentation even though their claims are genuine and they are entitled to benefits.

Fact: You have a right to be represented by an attorney when you file a claim.

After filing an Appointment of Representative Form (that your attorney will provide you with), your representative can act for you in most Social Security matters.

Fact: When you hire an attorney to represent you before the Social Security Administration...

...you can avoid much of the frustration of completing forms and filing documents, worrying about what information you need to provide, and when and where you need to provide it. Filing for a claim is a time consuming process.

Fact: Your attorney will act as a buffer between you and the bureaucrats.

Claimants receive a great deal of paperwork -- forms, circulars, notices, requests, addendums, affidavits. Oft-times this paperwork is complicated and confusing. What has to be filed? When? Where? With Whom? Why? How? Your attorney knows and will help to ensure that all of your paperwork is completed and filed correctly, and on time.

Fact: When you hire an attorney, you benefit from the attorney's claims-handling experience.

Fact: A competent attorney will help you to maximize your claim.

Your attorney will make sure you understand all of your entitlements. (For example, you may be eligible for Medicaid or Medicare.) Your attorney may provide you with a list of free and low-cost community programs designed to support you in a crisis.

Fact: Social Security Administration statistics reveal that...

...all else being equal, claims presented by attorneys have a higher likelihood of being approved than claims filed directly by claimants.

Why do claimants who hire lawyers do better with the Social Security Disability process?

I can't say exactly with certainty why attorneys experience a better success rate than individual claimants do. There are probably many good reasons. Some of them have more merit than others. Following are some of the reasons that make the most sense to me.

  • Knowing What the Social Security Administration is Looking For. Most disability claims are won (or lost) based on medical records. The information doctors and other medical professionals provide in these records is generally presented from a perspective that is most useful in treating injuries and illness. The Social Security Administration is looking for information that can be useful in determining an individual's capabilities, and the extent of the injury or illness.

    For example, on a claim form, the doctor may state, "patient complains of pain in lower back -- recommend physical therapy and muscle relaxants." What the Social Security Administration needs to know is whether or not you can lift twenty pounds. While an ethical attorney will never encourage anybody to exaggerate or mislead, a competent attorney who knows how to win disability will guide the doctor toward providing the information that is most useful to the Social Security Administration (by knowing which disability questions to ask and how to phrase the questions).

  • Relationships. During the hearing portion of the claim process your attorney will present your case before a judge. While the judge doesn't know much about you, the judge will likely be very familiar with your attorney. The judge will know whether the attorney has a history of credibility or a history of skirting the truth. If the attorney has a credible history, the judge may give the attorney's claims and recommendations more weight in the decision making process.
  • Fewer Errors in Filing. Claims filed professionally are more likely to be error-free. A professional who works with claim forms day in and day out is more familiar with what information is needed. Filing requirements can be tricky. Not mailing required documentation in a timely manner can be sufficient grounds to deny a claim.
  • Better Presentations. Experienced attorneys know what the Social Security Administration is looking for. While an ethical attorney would never mislead a judge, the same facts can be presented in a favorable light, or in an unfavorable light.

Fact: When you hire an experienced, competent attorney, you can rest assured, knowing that your claim will be handled professionally and quickly.

Your attorney will do everything in his or her power to see that deserving people get disability payments, including income and back pay.

Fact: In most cases, hiring an attorney requires no out of pocket costs.

You will not be charged a fee until after your case is won. The Attorney representing you must abide by the Social Security Administration's standards of conduct regarding fee regulations and cannot charge a fee unless that fee is approved by the Social Security Administration.*

*COURT COSTS AND CASE EXPENSES WILL BE THE RESPONSIBILITY OF THE CLIENT