Are you considering the need to apply
for disability through your employer's coverage or through the Social
Security Administration? Undoubtedly, by now you've heard that being
approved for disability benefits can be incredibly difficult. While
this is discouraging news, understanding the reasons can help you
more successfully navigate the system. Here is a short guide to the
main reasons why you face an uphill battle.
1. There Are More Claims Than Ever
Two fundamental challenges faced by
disability benefit programs are the sheer volume of applications and
the lack of funds to pay them. With an aging workforce and better
medical care available to all, many individuals who previously may
not have survived long enough to live a disabled life now need the
support of the disability system.
The trust fund that provides the money
is suffering from sustainability issues, creating a (conscious or
unconscious) bias toward not approving as many recipients as before.
In addition to the funding problems, there simply aren't enough
agents or offices assigned to the arduous task of reviewing and
processing claims.
2. Employer Disability Has
Conflicted Interests
The SSD program has some inherent
conflict of interest, as it works for the government, who pays
benefits if approved. But your employer's disability insurance has
even more glaring conflicts of interest.
Claims are reviewed by agents working
for the insurance carrier rather than by an unbiased third party or
advocate for the employees. This means that they sometimes find both
legitimate and illegitimate reasons to deny claims. And the carrier
generally must provide only a minimum of evidence that it did its
duty toward the claimant.
3. Explaining Medical Issues Is
Complex
Social security disability claims must
meet a certain set of very specific conditions. But health and
medical issues often do not meet exacting criteria. In order to show
how a claimant's disability problems do fit into the established
categories, significant documentation is required to establish
everything. The burden of proof is not on the insurer but rather on
you, the person applying for benefits.
4. The Appeal Process Is Long
Many applicants are turned off by the
long wait times between steps in the claims process. Around 70%of initial SSDI claims are denied, leaving most claimants to rely on
a second hearing. Due to staff and time constraints, that hearing may
be months down the line. A majority of second claims are also
routinely denied, leading to a wait for a third appeal.
A person applying for disability must
be able to wait it out, which can be a particular challenge. After
all, they may not be physically or mentally able to work due to their
disability. They likely also have medical costs building up. These
factors alone often force a person to give up and attempt to find
another solution.
5. You Must Be Very Detailed
Because this is a very complicated
subject, the applicant needs to have all their ducks in a row, so to
speak. First, you must be intimately familiar with your company's
insurance policy. Any error or failure on an initial claim can cause
it to be denied. While denial of a Social Security disability claim
means waiting months for a new hearing, denial by a private insurer
can rob you of a chance for positive resolution at all.
With all these challenges in mind, what
is your best bet to find success? It's having an experienced
disability attorney on your team. A disability lawyer has dealt with
all types of obstacles and understands better than anyone how to move
your case through the steps toward a good outcome. The
Law Offices of James B. Gillespie, Jr., PLLC
, can help. Call to
make an appointment and learn more today.
