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I'll try to condense down the details into something readable. I've been fighting to get on disability for nearly a year now. the social security office takes for-ev-er to even look at your claim. after that near-year, they schedule you to see THEIR doctor. In my case, the doctor gave me the checkup, agreed "Yes, you have fibromyalgia and CPS (chronic pain syndrome)", and sent me on my way. Then bam, claim denied. Apparently something like 65-80% of claims are just flat out denied. my representative from social security said that i could get a lawyer to appeal the claim. I've called several lawyers and they wont even bother with my case. i can try to appeal the case without a lawyer but it feels like even that's going to be a waste of time. the pain i'm in constantly is near on unbearable, i can't even sit for longer than half an hour at a stretch without needing to lie down. walking is difficult, and standing is out of the question. the lawyer's aide said that i'd need to go see a specialist for treatment, which i'll look into i guess, hopefully there's one that medicare will fully pay for without needing a co-pay because i'm entirely broke at this point. tried to start a gofundme for expenses to get me by until i can get everything sorted out, but that's going to be tough too. I'm just at the end of my rope here, it's really an unpleasant situation all around. i hate asking for help, but i really don't know what else to do at this point, so if anyone has any pointers, i'll take any advice i can get.
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Mar 10, 2023 18:03
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Odd that none of the lawyers you spoke to will do it. I'm sure each condition is different but from what I've heard they auto decline everyone's first request no matter what their disability is unless they have a lawyer. Had a family member get a lawyer and they got through the process and approved pretty quickly. You still have to go see them at their offices and go through a ton of bullshit questions and paperwork though.
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Mar 11, 2023 09:40
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It's a pretty messed up process. You can go through the whole appeals process for years and then you get a disability lawyer and go in front of a judge for like, an hour, and get approved based on that hearing. If you get approved the lawyer takes a big chunk of the backdated lump sum you get from social security.
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Mar 11, 2023 10:18
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Said process is working as intended, as right-wing policy is to gatekeep social programs as hard as possible knowing most people will just give up rather than push through it.
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Mar 11, 2023 18:03
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I would reach out to more lawyers in your state, check reviews. Many work on contingency because they know they win, they know they get paid, and it’s not a ton of work.
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Mar 12, 2023 08:42
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Aishlinn posted:I'll try to condense down the details into something readable. I've been fighting to get on disability for nearly a year now. the social security office takes for-ev-er to even look at your claim. after that near-year, they schedule you to see THEIR doctor. In my case, the doctor gave me the checkup, agreed "Yes, you have fibromyalgia and CPS (chronic pain syndrome)", and sent me on my way. Then bam, claim denied. Apparently something like 65-80% of claims are just flat out denied. my representative from social security said that i could get a lawyer to appeal the claim. I've called several lawyers and they wont even bother with my case. i can try to appeal the case without a lawyer but it feels like even that's going to be a waste of time. the pain i'm in constantly is near on unbearable, i can't even sit for longer than half an hour at a stretch without needing to lie down. walking is difficult, and standing is out of the question. the lawyer's aide said that i'd need to go see a specialist for treatment, which i'll look into i guess, hopefully there's one that medicare will fully pay for without needing a co-pay because i'm entirely broke at this point. tried to start a gofundme for expenses to get me by until i can get everything sorted out, but that's going to be tough too. I'm just at the end of my rope here, it's really an unpleasant situation all around. i hate asking for help, but i really don't know what else to do at this point, so if anyone has any pointers, i'll take any advice i can get. I used to work for SSA doing this sort of stuff so here is an info dump but please know I don't agree with the way things are done and I think it sucks big time. This is not advice and I don't work there anymore so I don't know anything, yadda yadda. Assuming you are applying for SSI or SSDI there are a specific set of severity requirements you have to meet in order to be allowed. If you are interested in some of the nitty gritty of how this is decided, here is a quick explainer. Your first application is considered your initial claim, and the denial letter will give you information on how to appeal. The first appeal (second application) is called a reconsideration. This is essentially just another examiner and doctor looking at your case and making sure that there were no technical mistakes made or information missing on the initial claim. After you get a decision on reconsideration (assuming this is also a denial), this moves to third step where you can appeal to what is called an ALJ or administrative law judge. This is the step where a lot of people denied on initial might be allowed because the legal guidelines are a little looser than the first two steps. It's also the first step that really finds a benefit to having a lawyer. If they sent you for a CE or consultative examination, that means they didn't have sufficient evidence from doctors you have seen on your conditions (or it's been a while since you've been seen). Especially with chronic pain/fibro you really are going to have a hard time proving sufficient severity if you don't have a record of being seen regularly in a pain clinic. If you have insurance or the means to establish regular care with a specialist for your condition, consider doing that. Additionally, especially if you are under 50, establishing treatment for any mental health conditions you may have might help your case as well because it may potentially rule out past work or other work. Good luck with your appeals, I'm sorry the system sucks so bad.
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Mar 12, 2023 21:16
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thanks to everyone for the answers. i'm in the process of getting a rheumatologist, so the lawyer will take the case. losing a chunk to a lawyer beats 0 in my opinion, and seems like it will be the most expedient route.
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Mar 16, 2023 21:40
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So... OP is a goon buddy, he's a really good guy, and I know he's really suffering with this thing, and the bullshit of having to deal with the system is just adding unnecessary suffering on top of the illness, so, fellow goon reading this (Yes, you!): if you can find it in your heart to help by donating a couple bux, please click the link and send a few credits his way, or share with someone who can, every little bit helps  https://www.gofundme.com/f/help-me-get-by-until-my-disability-is-settled I know OP only made the thread to ask for advice, and he probably didn't feel right asking for help here, so I'm doing it for him, because drat it, it's not fair (Mods please forgive if I've broken any rules, if this deserves a probe I'll take it)
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Mar 18, 2023 03:56
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Aishlinn posted:thanks to everyone for the answers. i'm in the process of getting a rheumatologist, so the lawyer will take the case. losing a chunk to a lawyer beats 0 in my opinion, and seems like it will be the most expedient route. There are generally tight timelines for appeals in administrative law. Be sure you keep an eye on this. I hate saying good luck because this is such a crappy situation.
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Mar 19, 2023 22:47
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As an actual pain specialist what have you actually tried before going for disability?
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Mar 20, 2023 01:35
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I worked for a disability law firm as a non-attorney representative before burning out. This is my experience with Social Security Disability Law. It doesn't surprise me to learn that the lawyers you spoke with do not handle Social Security disability cases. In my experience in my region (Pacific NW), law firms either specialize in disability cases or they do not touch it at all. I've only heard of a few lawyers, usually ones just starting out, who handle different types cases that include disability cases. The firm I worked for exclusively practiced disability law and would refer out other legal issues to other attorneys. You may have been explained that there are four levels in the claims process: Initial Application, Reconsideration, Hearing, and Appeals Council. The plurality of cases that win do so at the hearing level. Most claims are denied at the Initial level, and the office that makes that determination (Disability Determination Services, which are state-level agencies) is not required and does not give a detailed explanation for why you've been denied. You then have the option to file your first appeal and move to the Reconsideration level. Your claim goes back to DDS to a new analyst and you are even more likely to get denied. You then can appeal to request a hearing, and here is where your odds may finally turn in your favor. On average, in our region, it takes people about 1.5-2 years from applying to going through the appeals and getting in front of a judge. In my opinion, the single biggest determinant about your chances of success is the judge that gets picked to hear your case. Some judges approve ~80% of their cases. Some approve ~%15. This is one of the most frustrating parts about the hearing system. No one could explain to me how this was fair. The statistics on Social Security Administrative Law Judges is also publicly available at https://www.disabilityjudges.com. If you are denied by an ALJ, they are at least required to provide a detailed explanation for their reasoning. If you do not get approved at the hearing level, you may appeal your case to the Appeals Council. In my opinion, the AC is a waste of time. An appeal will wait for like a year for a ruling from the AC, the vast vast majority of appeals are denied. In my 3.5 years working at the firm, I saw one favorable appeal, and that just means the case gets sent back for a hearing, usually in front of the same ALJ that denied the case. The AC wastes time but legally a case must go through the AC before it can potentially be taken to U.S. District Court. Not every firm takes a case to USDC, since it's a different level of law. You can hire an attorney at any time. The fee structure is the same across every disability firm because the rules are set by SSA. If you win, typically the lawyers will get 25% of your past-due amount (commonly called the backpay) with a cap at $7200, (used to be $6k). I say typically because there are exceptions (if more than one firm worked on your case, or if your case went to Federal court, the fee is more complicated). It generally does not affect the fee whether you hire the firm at the beginning of your case or at the hearing level. You can petition the ALJ to lower the fee to your lawyer if you felt that they didn't put in very many hours into your case after winning, but it's fairly easy for a firm to counter-argue that they should get the full 25% or the cap by showing an itemized breakdown of hours worked on your case and setting a high hourly fee for their time. Most of our clients hired us before they even began applying for disability, so we would help complete the application with them. We would track their case, file their appeals, and prepare them for their hearing. If they didn't win at the hearing, we would file their appeals to the AC. When the Appeals Council would almost invariably deny their appeal, we would consider taking their case to U.S. District Court on a case-by-case basis. A minority of our clients would come to us at the hearing level. The story I would hear is that these clients applied on their own, filed their own appeals, and finally went before an ALJ unrepresented. The ALJ would then strongly recommend that they get a lawyer, and the ALJ would postpone their hearing until they can hire one. I don't think an ALJ can force you to get a lawyer, but you may really want to get one. The hearing office does not even request medical records, so they may not even have your complete file at that point. It's your responsibility (or your lawyer's if you hire one) to submit your complete medical record. In terms of what can help your case, getting a supportive medical provider on your side can really help. Have you talked to your treatment providers about applying for disability? Are they supportive of your decision? If so, you may want to get them to support your case. They can write a letter, but what may be even more helpful to a disability case is if they would complete a Residual Functional Capacity questionnaire on your behalf. Law firms have these RFCs on hand, but you can also find free ones online. The more detailed the treatment provider is on their RFC, the more persuasive it will be for an ALJ. And even if you get a lovely ALJ who denies the vast majority of their cases, the stronger your overall medical evidence is, the weaker their justification for denying you will be, and therefore the stronger your chances will be on ultimately winning on an appeal in Federal court. So it may behoove you to hire an attorney early because (a) statistically, you will likely need to go to the hearing level to win your case, and (b) a law firm will file your appeals for you, and (c) a good law firm will actually try to actively strengthen your case early and work with you personally on hearing prep. Psychologically, it can also be nice to just have an organization that is on your side. The disability claims process is not supposed to be adversarial, but it's clear that SSA isn't heartbroken if you give up on your case, but at least hiring a lawyer means you have someone who, if not morally, is at least financially invested in seeing you win. It is a needlessly broken system, and I feel you for having to go through it. Best of luck, please don't miss your appeal deadlines, and illegitimi non carborundum
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Apr 3, 2023 12:30
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Caufman posted:I worked for a disability law firm as a non-attorney representative before burning out. This is my experience with Social Security Disability Law. This is a great overview, thank you!
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Apr 4, 2023 01:13
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I'm an attorney representative, OP so all I do is review cases and attend hearings. I could throw out a lot of information here, but in general if you already have a claim and it has been denied at initial/recon then this is the time to consider looking for an firm to represent you whether attorney / non-attorney rep since they can help order medical records and elicit medical opinions on your behalf. Keep in mind you don't have to. If you appeal on your own and get up to the hearing level and meet with a Judge they will advise you of your right to representation and give you basically a final chance to obtain a rep. The absolute best thing you can do is continue to seek treatment for your medical conditions because you build a paper trail that way. Even if it is with your PCP instead of a specialist, by seeing your doctor you are building a relationship with them, so that hopefully they will be willing to fill out or write narrative helpful opinions as to your limitations can be instrumental winning a case. If nothing else the judge can see that you see Dr. A and Dr. B on say a monthly basis, on 5 times a year, and what is contained with both your reports of pain, and their objective examinations, etc. hopefully they actually do a good job with their notes. Also you mention you have fibromyalgia. You are going to want to make sure that with your own providers that the requisite tender points testing is in fact showing on your medical records. I have had way too many clients who are simply told they have fibro (or tell their doctors they have it because they were told they had it like 10+ years ago) really without evidence of it ongoing. Fibro is treated differently than an arthritis type case where you can see the severity on an XR, CT, MRI. Good luck. SSA disability is a long process.
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Apr 9, 2023 03:01
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Caufman posted:In my opinion, the single biggest determinant about your chances of success is the judge that gets picked to hear your case. Some judges approve ~80% of their cases. Some approve ~%15. This is one of the most frustrating parts about the hearing system. No one could explain to me how this was fair. The statistics on Social Security Administrative Law Judges is also publicly available at https://www.disabilityjudges.com. If you are denied by an ALJ, they are at least required to provide a detailed explanation for their reasoning. Unfortunately I think this is mostly true. I have had plenty of crappy cases that I wouldn't pay go before a 60-75% payer and still manage to go get paid, and no matter how strong a case I still dread going to the 5-10% payers who seem to be mostly located either in Texas or Alaska. Otherwise the other two biggest factors are: 1. Is the claimant over age 55? And 2. Do they have any sedentary past relevant work?
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Apr 9, 2023 03:12
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I lawyered up early on. Having to wait for a hearing result is rough. Apparently losing my control of the body, falling, psychosis, monster depression and just sort of - stop functioning because I get anxiety. I got denied the first go. So I swapped lawyers and am working on the second go. It's Texas.
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Jun 13, 2023 07:21
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