This case study shows the importance of diligently pursing your Social Security disability claim by contacting an attorney early in the process, following up and exercising your right to appeal denials, and not becoming discouraged.
Mr. C.S. stopped working in 2009 due to severe injuries from a car accident. Shortly after his accident, he contacted the Social Security Administration to ask about filing a disability claim. He understood that the Social Security employee told him that he did not have much of a chance of winning, so he did not file an application. He should not have listened to the Social Security employee, whose job is not to decide how strong someone's case may be or give legal advice. They are required to help with an application whenever someone wants to file for benefits. At this point, Mr. C.S. should have contacted a lawyer to discuss his situation.
After the accident, Mr. C.S. was living on unemployment benefits, some savings and the help of his fiancee. As time went on, his medical condition did not improve. He lost his medical insurance benefits and was not able to see a doctor as regularly as he should have. His financial situation was becoming more desperate, and he therefore attempted to return to work. But, he was able to last only a few weeks before he could not tolerate it any longer and he stopped working.
In August of 2014, he contacted the Social Security Administration again and finally filed his application for disability benefits. After a few months, his claim was denied. This is not an unexpected result, as approximately 70% of claims are denied after the initial application. He found himself discouraged and instead of exercising his right to appeal the denial, he again tried to go back to work, and again the work attempt failed due to his serious medical condition. Again, he should have talked to a lawyer, who could have explained and helped him with the appeals process.
Still struggling, in June of 2015, once again he applied for disability benefits, and one more time the claim was denied. Finally, he came to see me. After reviewing the medical records, I determined that there was a very good chance of being able to prove that Mr. C.S. was disabled according to Social Security regulations but there were numerous technical problems we had to address.
First, I was able to determined that the date last insured (DLI) in his case was March 2014. The DLI is the last date that a disability applicant has enough credits (quarters of coverage) to qualify for disability benefits. A person earns credits by working, and it is possible to earn up to four credits a year. To qualify for disability benefits, it is necessary to have 20 credits in the 10 year period before the disability begins.
Second, Mr. C.S. applied the first time for benefits in August 2014, which was after the date last insured. When Social Security denied his claim, it was, in effect, a determination that he had not been disabled at any time up to the DLI. Therefore, when Mr. C.S.'s second application from June 2015 was denied, the basis for the denial was res judicata, which is a legal term meaning that the case has already been decided and that Social Security was not required to make a new decision.
I helped Mr. C.S. file an appeal, and as part of our appeal, we requested a reopening of the August 2014 application. In certain circumstances, Social Security can reopen and continue to process an earlier application even though there was no appeal filed.
Unfortunately, although we continued to fight the case, in the end we were not successful. Had Mr. C.S. come to see me at the time he filed his first application, it would have been much more likely that we would have won his claim for benefits based on the severity of his condition.
The bottom line lesson is that it is important to consult a lawyer sooner than later. Contact me for your free consulation to discuss your specific situation.