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Why Your Disability Claims Can Get Denied

Posted on: September 7th, 2015 0 Comments    Workers' Compensation Attorneys Cleveland Ohio

The clearest answer to why a disability claim gets denied probably comes from a FAQ on the Ohio Bureau of Workers’ Compensation website. The agency states, “If a claim is denied, it is often because of a lack of information.”

Exactly like a nutshell, though, that answer conceals the actual meat of the matter. What information got omitted? Can an applicant and his or her Ohio worker’s compensation attorney provide the missing info as part of an appeal? How must that additional information be presented, by when, and to whom?

We address several of those concerns elsewhere on webpages prepared by Cleveland Social Security lawyers and disability lawyers who practice at Agee Clymer Mitchell and Portman. Here, let’s focus on the specific issue of what evidence an injured or ill person needs to submit in order to have a short- or long-term disability.

Each case and, therefore, every disabled person’s application for benefits will differ in specifics. Still, the general requirement of needing to establish that a temporary or lifelong condition prevents you from working enough to support yourself financially always exists. Accident reports, medical records, expert opinions from physicians and other health care providers, and evaluations from occupational specialists can stand as proof. Disability applicants who can produce multiple forms of such evidence have a greater chance of qualifying for benefits.

To understand how evidence for a disability gets assessed, it makes sense to look at the most-common reasons applications for Social Security Disability Insurance (SSDI) get denied. An audit covering 1992 through 2010 revealed that the majority of people denied federal disability benefits

  • had an impairment that was not expected to last 12 months,
  • had an impairment that was not considered severe,
  • were able to perform his or her usual type of work,
  • were able to perform another type of work
  • had an impairment resulting from drug addiction or alcoholism
  • provided insufficient medical evidence
  • failed to cooperate
  • failed to follow prescribed treatment
  • did not want to continue development of the claim, or
  • returned to substantial work before disability could be established.

 

Two of these reasons merit special consideration, especially as they might apply in workers’ comp and other non-Social Security disability cases.

First, denial on the grounds of being uncooperative points to requirements a disability program places on applicants and beneficiaries to submit to physical examinations and interviews by specialists selected by the program. Refusing to get checked out by program doctors and staff almost automatically flags an application for denial.

Similarly, the mentions of “prescribed treatment” points directly to the reality that receiving Ohio workers’ compensation benefits often depends on participating in occupational therapy sessions. Proof of enrollment and keeping appointments are essential for keeping disability status.

 

Get Help With Avoiding and Appealing Disability Denials

Whether you want to ensure you submit all the information you need to have a first-time disability application approved or you have received notice of a claims denial, an Ohio worker’s compensation attorney or SSDI lawyer with Agee Clymer Mitchell and Portman may be able to help. Anyone who has already heard a “no” should definitely seek legal advice and representation because the deadlines for filing appeals and collecting additional information are tight.

We offer no-cost consultations on even the toughest workers’ comp and Social Security cases. Reach out to us through this site or call (800) 678-3318 to ask your questions.


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