Why Does That Guy Down The Street Get Benefits And I Don’t?
I am often asked by clients with very serious illnesses or injuries why their neighbor who has 
never worked receives benefits and looks perfectly healthy, while we wait and wait for a hearing date. I used to tell my clients that there was likely something very wrong with their neighbor that wasn’t readily apparent, like a mental health issue. But I kept hearing this complaint, and kept seeing folks who didn’t seem to have a shot at getting approved but got approved right away. I no longer try to explain to my clients why their apparently healthy neighbors already have benefits. My only response is that the system doesn’t entirely make sense, and the only thing that does make sense is to have a lawyer fighting for you.
This isn’t to say that I think the system is broken. At every step, from the time you file your application to the time you get to a hearing, there are rules that Social Security follows in analyzing your claim. Some of these rules involve analyzing your medical records and making a determination about whether your medical conditions meet or equal Social Security’s definition of a particular disability. For example, if the MRI of your back shows that you have a herniated disc, your medical records must also document specific functional problems associated with this to meet a listing. At every stage – the claims analyst, Social Security doctors, and the judge are supposed to read your records thoroughly and apply the rules to your claim. But it isn’t always that simple: the Social Security Administration (SSA) also evaluates your credibility, your doctor’s credibility, the amount of treatment, and countless other factors.
And that gets us to what I think is the biggest issue: Even though there are rules to follow, the SSA is full of human beings interpreting the rules. We all know that people are subjective. By that, I mean that one person at the SSA looking at your claim might feel differently than the next person. One person’s claim might get the seal of approval quickly and without much scrutiny, while yours ends up on the desk of a SSA employee who is very critical. Each judge has a different ratio of approved clams to denied claims. This is why I think it’s so important to have a lawyer at your hearing. I am there to make sure the rules are followed, and to present the best evidence possible to satisfy these rules.
Sometimes people are denied simply because they don’t fit inthe system. Unfortunately, if you
haven’t worked much in your lifetime, and you have a spouse who works you might be left out in the cold. Think of a homemaker with a working husband. If your neighbor receives benefits but has never worked, they probably receive Supplemental Social Security Income (SSI) benefits. In order to qualify, a person must not only be disabled under the rules, but also must meet specific rules for income and assets. The other type of benefits called Social Security Disability benefits (SSD) are based on a lifetime earnings record and your ability to prove that you became disabled within a specific time frame. Generally this is about 5 years after you stopped working.
Many of my clients are upset because they think their neighbor gets benefits for being an alcoholic or drug user. The good news is the SSA does have strict guidelines about this. A person’s claim will be denied if their substance abuse problem contributes to or causes a disability (think hearing voices because of meth use). Of course, even this is subject to interpretation within an individual claim. But generally, no one is this day and age is getting benefits just because they have a drinking problem.
Applying for disability benefits can be a very frustrating process, especially when you know of someone who already gets benefits but seems to have few health problems. Even though
it might seem like you should get approved right away, you might have to fight for your benefits. Having an attorney on your side to navigate this sometimes crazy system might just make the difference between getting approved and denied.
The above information is NOT a substitute for legal advice and should not be interpreted as the dissemination of legal advice. It is only meant as general guidance on various issues which may be applicable to your situation. It is critical that you consult with an experienced attorney before taking any legal action or have specific questions addressing your particular case answered