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I am helping a close relative apply for coverage from a private disability company. Two doctors have told us that both social security disability and private disability companies look for certain words or phrases in reports that indicate whether or not a person qualifies as being disabled.
For example, he had extensive cognitive testing a few years ago but was denied SSD (we are still working on that). He has now had cognitive testing completed by a different psychologist who found very similar/worse test results indicating brain damage. I asked the second doctor why she thought he was denied SSD when he clearly met the critiera of a decrease of at least 13 IQ points. In several areas he scored 50 to 60 IQ points lower than his baseline IQ, to the moderate mentally retarded range from someone who had been well above average in intelligence. She said that he was probably denied SSD because the doctor didn't use the "magic words" (she called them that) and proper phrases that they look for in long reports with lots of data.
I believe that these "magic words" are things like "unable to complete the tasks needed to be a (name of occupation)" or "in spite of special assistance and job modifications unable to do X,Y & Z needed in his profession".
Neither doctor would tell us which words are important or key words. I now find that I have a several page, very detailed form to fill out to apply for coverage under a private disability policy.This will go with the medical reports. The irony is that he could have applied for this over a year ago but due to his disability (brain damage & memory loss) it was overlooked.
He has been handicapped and unable to work for 18 months and it may be a long time before he qualifies for SSD. Needless to say he is almost totally out of money and is even worried about losing his house. So it is especially important that I fill everything out carefully and completely to get this approved ASAP. Any help that someone can give me either on this thread or through a private message would be greatly appreciated.
Thank you for reading my long post and for your help.
Last edited by germaine2626; 08-02-2012 at 06:46 PM..
The magic word that is looked by a disability examiner whether expressed or implied is "truth".
Your application is first the means to apply, describe the conditions of the disability and provide consent for the medical records. It is not the the primary supportive documentation for the alleged disability; it is the medical records supplied directly by the medical provider.
The medical terms used to define a disability are used by the supplemental reports of the medical examiners and the supporting documentation of the medical professional and attempting to mimic such terms in the application is not necessary or always prudent as it can be viewed as a deception because you may not always know what the medical supporting documentation will say. These medical documentation would be separate from the application and are retrieved by the insurance company and social security after your authorize the transmission of the medical records.
In the case of Social Security Disability, a physician statement that a person is disabled is not accepted as definitive proof because a medical provider does not make the determination of disability but only provides the results of the examination of the of the physical or mental problems.
"Good experienced disability lawyer" might be the magic words.
Excellent advice. When I called several disabilty lawyers in my area they said that they wouldn't get involved until he had been denied SSD twice (because they get paid by a percentage of the back payment due).
Ironically, the person who I am fighting to get SSD for was an attorney for 20 years before his brain damage and other serious health problems. It is very sad because now he couldn't handle a job at McDonalds, yet he still remembers when he was "smart enough" to be published in Law Review and be a successful trial attorney.
The magic word that is looked by a disability examiner whether expressed or implied is "truth".
Your application is first the means to apply, describe the conditions of the disability and provide consent for the medical records. It is not the the primary supportive documentation for the alleged disability; it is the medical records supplied directly by the medical provider.
The medical terms used to define a disability are used by the supplemental reports of the medical examiners and the supporting documentation of the medical professional and attempting to mimic such terms in the application is not necessary or always prudent as it can be viewed as a deception because you may not always know what the medical supporting documentation will say. These medical documentation would be separate from the application and are retrieved by the insurance company and social security after your authorize the transmission of the medical records.
In the case of Social Security Disability, a physician statement that a person is disabled is not accepted as definitive proof because a medical provider does not make the determination of disability but only provides the results of the examination of the of the physical or mental problems.
Livecontent
Obviously, I am going to tell the truth. But, I'm not so sure about some of the other people who apply for SSD.
It is so frustrating because his two primary doctors have both stated that he is totally disabled and were shocked that he was denied SSD. He had his first denial in April. Someone at the Social Security office told me August 1st that the paperwork backlog is so large that it probably will be a few more weeks before his file is even assigned to another person. And, they had no idea how long it would be after that.
Thank you for your response. I'll just complete the forms as acurately as possible and hope for the best.
Excellent advice. When I called several disabilty lawyers in my area they said that they wouldn't get involved until he had been denied SSD twice (because they get paid by a percentage of the back payment due).
Ironically, the person who I am fighting to get SSD for was an attorney for 20 years before his brain damage and other serious health problems. It is very sad because now he couldn't handle a job at McDonalds, yet he still remembers when he was "smart enough" to be published in Law Review and be a successful trial attorney.
While that may be the case, I think the issue is almost EVERYONE gets denied the first time for SSDI and it isn't worth their time to start on an appeal when people almost always get accepted the second time. I don't know why it is that way but it is and has been for many, many years. My guess is that they want to make you jump through hoops so it isn't too easy to qualify, which is a good thing. File again and see what happens. Had you called the lawyers before they probably would have told you the same thing and told you to start your paperwork for your second go round right away.
[quote=golfgal;25470819]While that may be the case, I think the issue is almost EVERYONE gets denied the first time for SSDI and it isn't worth their time to start on an appeal when people almost always get accepted the second time. I don't know why it is that way but it is and has been for many, many years. My guess is that they want to make you jump through hoops so it isn't too easy to qualify, which is a good thing. File again and see what happens. Had you called the lawyers before they probably would have told you the same thing and told you to start your paperwork for your second go round right away.[/quote
Thanks for your response.
I sent the SSD paperwork back within 24 hours after he was denied. Juat received another stack of papers to fill out. ARRRGG!
It is the private disability insurance that was over-looked and not filed right away.
While that may be the case, I think the issue is almost EVERYONE gets denied the first time for SSDI and it isn't worth their time to start on an appeal when people almost always get accepted the second time. I don't know why it is that way but it is and has been for many, many years. My guess is that they want to make you jump through hoops so it isn't too easy to qualify, which is a good thing. File again and see what happens. Had you called the lawyers before they probably would have told you the same thing and told you to start your paperwork for your second go round right away.
You are stating incorrect facts about everyone gets denied the first time around and almost always get accepted the second time around and it is not worth starting the appeal--not correct.
You do not understand the process. You should fully go through the appeal process in your first application. The issue really is many people are denied in the first consideration and more people are latter approved in subsequent levels of an appeal. There are many levels of the appeal, not just one.
The first issue to note is that the determination of disability is done by each individual State Board of Disability, not by the Federal Government.
If you are denied, the first appeal is a reconsideration from someone else that has not reviewed the first application, at the State Level. It cost nothing to have this reconsideration and is very easy step to take this appeal. It is foolish not to do this appeal.
If you are then denied, you appeal to an Administrative Court Judge at Social Security at the Federal Level. This is when you hire an attorney to represent you and he takes a pre-determined fee authorized by Social Security.
If you are then denied, you can appeal to the Social Security Appeals Council.
If you are then denied, you can then go to the Federal District Court and appeal.
It is wrong to suggest not to go through the whole appeal process on your first claim for disability, especially if they are no cost or minimal cost. You have a misunderstanding; it is at these different levels of appeals is where more applicants are approved for disability, not on a second application for disability. Filing again for disability when you have not yet exhausted will only put you on the bottom of the list and you will have to start again and that will take a long time, when you may very well be approved on a subsequent appeal which is a much shorter time.
Also your use of the word "people almost always get accepted the second time" is wrong because you cannot speak of such without looking at the type of disability, the age of the applicant, and other factors with statistical measures. The appropriate word would be "more" are approved through an appeal and certainly not to say "almost always" are approved in a second application--that is an unsupportable statement.
If one is denied the first time around, a second application at the same age with the same alleged disability is fruitless because there is no more that can be offered. Of course, if one re-applies at a latter time when you are older and with a more advanced state of disability, then the new application presents an entirely different set of factors that are not tied to the original application. The Age of Disability is a big factor and is codified as more substantial in determining the same disability than one applies at a younger age because adaptation to the ability to work is less. However, always go through the full disability appeal process.
Livecontent
Last edited by livecontent; 08-03-2012 at 07:02 PM..
I should have said that people that really have a disability usually get accepted the second time around and I stand by my statement that MOST people get rejected the first time for SSDI.
Now, since the OP has come back and said this is for private DI, the issue comes down to how the policy is worded and written. Is it an any occupation policy or an own occupation policy--that is the first thing you need to discover. If it is an any occupation policy, it's hard to get those to pay out because the policy owner can be retrained to do something else. For those you pretty much have to show total disability to get coverage.
I should have said that people that really have a disability usually get accepted the second time around and I stand by my statement that MOST people get rejected the first time for SSDI.
Now, since the OP has come back and said this is for private DI, the issue comes down to how the policy is worded and written. Is it an any occupation policy or an own occupation policy--that is the first thing you need to discover. If it is an any occupation policy, it's hard to get those to pay out because the policy owner can be retrained to do something else. For those you pretty much have to show total disability to get coverage.
I'm sorry that I was unclear. He is applying for both SSD and private DI and it was the private form that I am currently handling.
I'm almost certain that it is an OWN occupation policy. Thank you very much for mentioning thst there are two types as I wasn't aware of that fact.
Now I'm back to the paperwork.
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