Disability Claim Denials, Is This the Wrong Time to Be Disabled in America?

14 million Social Security disability applications were denied in a single decade, between 2000 and 2010, while the percentage of denials escalated from 34 percent to 65 percent. Is this the wrong time to be disabled in America?

Note the following headlines:

Federal Disability Traffic Jam The Washington Times

Soldiers risk ruin while awaiting benefit checks Associated Press

Disability Claims can be tough to collect Wall Street Journal

It’s time to stop billions of dollars of disability benefits from being denied, unnecessarily.

Does the Disability Safety Net have holes in it? If more than 60 percent of Social Security disability claims are denied initially, then why are 63 percent approved at the hearing stage? What causes the turn around? Unfortunately 39 percent of claimants give up before determining if they would be successful going through the appeal process!!

1.2 million Social Security Disability applications were filed in 1999 (48 percent of 579,000 were declined). In 2009, ten years later, 2.8 million Social Security Disability applications were filed (and 65 percent or 1,830,530 were declined). The number of disability applications more than doubled while denials more than tripled. In one year, more than $23 TRILLION dollars of annualized benefits were lost. That’s 1.8 million Americans who won’t collect benefits they thought they were entitled to.

Based on the 2010 average payment to those who qualify, that represents more than $19.5 million of monthly benefits that won’t be paid. Annualized, $23+ trillion dollars per year is an overwhelming amount of disappointment.

Many initial disability claims are denied for simple mistakes and omissions which have absolutely nothing to do with the claimant’s disability status. Think about what it is like to wait 17 months to hear you didn’t answer one question. Then you can wait another 17 months after you’ve added one simple answer. There must be a better way. Those facing claim denials are filing an unprecedented number of appeals burdening the already damaged system even more. With an average of nearly 17 months waiting for a judge to hear their appeal, what’s happening in the meantime?

Currently there’s three-quarters of a million Americans stuck in the Social Security disability backlog. Not being able to pay their bills causes the man of the house enormous mental anguish. The state of marital relationships in these situations deteriorates rapidly. Soon our divorce courts will be experiencing the same type of backlog the Social Security Administration is now facing.

Is this the wrong time to be disabled in America? Tens of millions of dollars in disability benefits go unpaid by private insurers. Over 40 states jointly investigated how one insurer handles their disability claims. Another state set up a system to scrutinize the handling of every rejected claim. What led to the dramatic change in the handling of disability claims? Or has anything changed at all and there’s just more adverse publicity?

As reported in USA Today… 22,500 Veteran’s PTDS disability claims denied as personality disorders. How is it possible that a personality disorder, assuming it existed prior to military service, is diagnosed when psychological evaluations aren’t done prior to induction?

According to the data obtained through the Freedom of Information Act, more than 25 percent of Iraq and Afghanistan vets seeking care at the VA have PTSD. And this statistic doesn’t include the mentally ill vets who haven’t had treatment at the VA due to the stigma associated with PTSD. In the meantime, families go on welfare and food stamps. Homes are being foreclosed. Drugs and alcohol disrupts any hope for family harmony. Homelessness occurs! Suicides begin to take lives that the battlefield didn’t.

One very simple yet insurmountable obstacle is the application process itself. The VA has a long history of bureaucracy. The disability claim form itself is a 23 page document. How many vets are accustomed to 23 pages of paperwork? The word “intimidation” comes to mind as a reason many veterans will never file a claim. A claim for benefits they were eligible for.

Each year TRILLONS of dollars in Insurer, Social Security and Veterans Administration disability claims WILL continue to be denied. It’s imperative the claimants understand how to correctly file a Long Term Disability claim, “doing it right” the first time and dramatically improving the likelihood of collecting benefits.

The U.S. Census Bureau recently projected a 75 percent increase in the age 65+ population by 2030. That will increase the number of age 65+ Americans to 69 million, more than 20 percent of the entire population. An aging population brings with it an automatic growth in the disability “TSUNAMI”. Since the Americans with Disability Act forces disability insurers to continue disability coverage to those over age 65, an older workforce guarantees more claims.

We haven’t seen any valid creditable source that has identified any reason for the escalating rate of claim denials or what we’ll call disability claim “deterioration”. Hence, I can offer what I believe is happening in the backrooms of the insurers claims departments.

Americans currently face the highest unemployment level we’ve experienced over the last three decades. The current state of the economy has impacted our American workforce in disastrous proportions. There’s a natural escalation of disability claims incidence with increasing unemployment.

Mortgages are being foreclosed at an unprecedented rate. Several states have begun to deny previously valid claims as Medicaid budgets have become overwhelmed. Is it any wonder that the cost of medical care, and not being able to pay for it, is the largest cause of mortgage foreclosures?

To continue, we now have causes of disability that didn’t exist two decades ago. Carpel tunnel and chronic fatigue syndrome are being diagnosed more than at any other time in our history. When we add fibromyalgia to the new list, we have an evolving problem that’s creating a nightmare for the disability insurers. These are known as “self reported” disabilities in that there’s no specific medical testing that can diagnose these conditions. It’s easy to understand how disability claim examiners can mistrust “self reported” symptoms. This makes it an onerous process for those who are truly adversely effective by one of these conditions from collecting benefits they’re entitled to.

In summary, we now face a dramatic increase in the 20 percent of the population in an older age group. They’re still working with an increasing incidence of disability. Unemployment compounds the problem even more. And adding new causes of disability and our litigious society results in more PROMISES UNKEPT.

Allan Checkoway

Copyright 2011

Appealing Your VA Disability Claim at the CAVC

As a disabled veteran, did you know that you have the right to fight back if the Department of Veterans Affairs (VA) denies your disability claim at the final level of your appeal? You can take your case to the United States Court of Appeals for Veterans Claims (CAVC) in Washington, D.C.

What is the CAVC?

The CAVC is not part of the VA. It is a national court created to give disabled veterans the opportunity to seek an unbiased review of their case after they have been denied at the Board of Veterans Appeals. This is the place to go to if you want to present your reasons for why you deserve the disability compensation that has been denied to you.

Likewise, if you take your case to the CAVC, you can expect that the VA will defend their decision to deny you the disability benefits you believe you deserve.

It is strongly advised that if you choose to take your case to the CAVC, you should get legal representation to help you. Why? Because a VA disability attorney, or non-attorney representative, has experience in appealing claims at the CAVA, and know how to formulate the best possible arguments to help you win.

Who Should Legally Represent You?

You will want to make sure that you get a legal representative who is not only savvy about veterans disability and VA law, but is also someone who really cares about veterans and understands what they are going through.. The person you choose can be either an attorney or a non-attorney who has been admitted to the bar and has an attorney present while arguing your case at the CAVC.

You should know that there is no cost for representation services at the CAVC. This is because of the Equal Access to Justice Act (EAJA), which requires that the federal government take responsibility for paying your legal fees.

Once you find your legal representative, it will be his or her task to develop a convincing argument in your defense. You can expect that the VA attorneys will be doing the same.

When to File For A Review

You have 120 days after the Board of Veterans Appeals has made their final decision about your case to file a Notice of Appeal with the CAVC.

What Could Happen at Court

After arguments from both sides have been heard, the CAVC will decide your appeal. The CAVC could reverse the Board of Veterans Appeals’ decision, in which case you’ll get your benefits. Or they could request that your claim be sent back to the Board of Veterans Appeals for reconsideration.

The important thing to know is you don’t have to settle for a VA disability claim decision that you do not agree with. As a disabled veteran you have rights.

Appealing your claim at the Court of Veterans Appeals is recourse available to you. The CAVC has been in existence since 1988 for the purpose of ensuring that disabled veterans,are getting their fair share from the VA.

How to Claim Veterans Disability Benefits

A veteran who has experienced an injury or disease that was caused or made worse by their military service can receive disability benefits. The amount of time that has elapsed since their active duty does not matter. Anyone who is eligible to receive veterans disability benefits should apply to claim them as soon as possible.

Methods of Application

– The federal government provides an online application for veterans disability benefits. Visit the Department of Veterans Affairs website to initiate the application process.

– Applicants can also submit their paperwork by mail. Visit the Veteran Affairs website to download the correct form, and then mail it to your closest Veterans Affairs (VA) office; they are located throughout the country.

– If you are within the United States, you may call the VA office at 800-827-1000 to submit an application by phone. Veterans located outside of the United States should call 412-395-6272.

Additional Assistance

It’s also possible to receive help filling out and submitting paperwork. A disability lawyer can help you complete your claim, or you can visit a VA organization or service office to receive help from their representatives.

Completing the Paperwork

The application requires information about medical conditions that necessitate the compensation. When completing these forms, include specific information about diagnosed conditions, injuries, and illnesses. If possible, add specific details, such as the date on which you first began experiencing symptoms and the specific medical diagnoses you received from your physicians. Submit copies of your medical records that verify and substantiate your claim for disability, if possible. You have up to one year to submit the necessary documentation. If you don’t have all your records, the federal government can request your records on your behalf.

The Process

When you receive confirmation of your disability or illness, apply for compensation immediately. Early application preserves this date as the effective date for benefits, which can affect the amount of benefits you receive. Do not allow a lack of medical documentation about your disability to stop you from completing the process; you can submit verification paperwork later, if necessary.

Time Line

The approval process for veterans disability benefits can vary. You may receive a decision within a few months, but it can take up to three or more years of processing to reach a decision. Some applicants may be able to fast-track the approval by submitting complete medical records with the initial application. This can effectively streamline the review time and enable the government to more quickly return a decision.

Special Status

Some people are eligible for special fast-track status. Former POWs, as well as those who have suffered sexual trauma in connection with the military or have post-traumatic stress disorder, receive priority processing on their claims. In addition, Vietnam veterans who were exposed to Agent Orange and are submitting a claim will receive special priority processing. Those who are homeless or who have emergency financial needs can also receive priority service.

If you are unsure of how to proceed with an application for veterans disability benefits, ask for professional assistance so that you can submit your claim in a timely manner.

Avoiding a "Self Reported" Disability Claim Nightmare

1,200,100 Social Security Disability applications were filed in 1999 (48 percent or 579,000 were declined). In 2009, ten years later, 2,816,200 Social Security Disability applications were filed (and 65 percent or 1,830,530 were declined). The number of disability applications more than doubled while denials more than tripled. In one year, more than $23 TRILLION dollars of annualized benefits were lost.

In 2011, TRILLIONS of dollars in Insurer, Social Security and Veterans Administration disability claims will continue to be denied unnecessarily.

Disabled Americans diagnosed with serious medical and psychological illnesses are just beginning to process the enormity of the physical, emotional and financial challenges they will be facing. This is the worst imaginable time to be filing a disability claim.

Insufficient preparation and inadequate presentation of a long-term disability (LTD) claim form increases the likelihood that your application will be denied substantially, especially when it’s a claim for chronic fatigue or another “self-reported” (fibromyalgia, carpel tunnel) disability.

Review your LTD policy. Does it offer total disability benefits only or does it provide partial or residual (long-term partial disability) benefits so that you don’t have to be totally disabled to collect benefits? Hopefully it’s the latter. What’s the policy’s definition of partial disability? Does it state your inability to perform one or more of the material daily duties of your occupation and/or is there reference to performing the duties of your occupation in a reduced capacity?

For “self reported” disability claimants, we’d like to share some “tips” to improve your chances of collecting disability benefits.

TIP # 1: It’s been our experience, over a three-decade career specializing in the disability insurance business, that an improperly completed LTD claim form increases the chances of the claim being denied, even when the complete information is submitted to the insurer after the initial claim has been submitted. Remember you are applying for benefits to replace your lost wages. You’ll need to prepare your application for benefits with the same (or better) attention to details as when you applied for your job..

TIP #2: You will need to have a focused conversation with your physician about the specific ways in which you will need his or her cooperation as you navigate the LTD claim process. As noted: You absolutely, positively must have the complete cooperation of your physician as well as his or her agreement with you as to the extent of your disability. Complete documentation of your “self reported” disability, supported by irrefutable evidence from your treating physician(s) (who are recognized experts and authorities in the treatment of your specific condition is absolutely essential in the initial filing of your claim).

TIP #3: Is your treating physician a specialist (an expert) in the treatment of your specific condition? Very few are. If he or she is not, take heed. Due to the specialized nature of a diagnosis, your insurer will expect your physician to have expertise in the treatment of your specific condition. A disability insurer looks for expertise in the treatment of any illness, especially “self reported” disabilities. This, however, does not mean you have to change doctors. Your primary care physician (PCP) has possibly already referred you to a specialist for diagnosis and initial treatment. In such a case, your PCP would probably follow your course of treatment, with an occasional update with your specialist.

TIP #4: What has been your doctor’s experience in helping other patients with “self reported” disabilities obtain disability benefits? Has he or she had significant success or great difficulty? Your physician needs to be your ally in the claims process, especially until you’ve begun receiving benefits.

TIP #5: What type of testing has been utilized to confirm a diagnosis? When “self reported” disabilities first began to be recognized as unique and difficult-to-diagnose illnesses, considerable controversy surrounded the various methods of diagnosis. Leading researchers and clinicians, the Centers for Disease Control and Prevention, and the National Center for Infectious Diseases developed various guidelines for evaluating your condition. (For more, we urge you to do a web search and read “Social Security SSR 99-2P: Your Guide to CFS Claims Success).

Summary

In reviewing a multitude of long-term disability claims that were denied by insurers there’s one predominate theme: the claimants’ personal physician and/or other subsequent medical documentation does not support or validate the extent of the disability. The claimants were expecting a certain outcome (for their claim to be paid) while the medical information attached to their claim form did not validate the extent of the disability. In essence, claimant and physician just have not communicated properly. The Bottom Line… do it right the first time.

Copyright 2016

Allan Checkoway, RHU