
Winning Isn't Easy: Navigating Your Social Security Disability Claim
Nancy L. Cavey, a seasoned attorney with over thirty-nine years of experience, explains the complex world of filing for Social Security Disability benefits. Filing for disability can be a confusing, life changing event, so with her deft expertise, Nancy will guide you through:
- The ins-and-outs of qualifying for Social Security Disability benefits (such as age and insurance requirements).
- Information regarding the process and lifespan of a claim, from the initial application to the request for hearing stages.
- Traps one can fall into while navigating the Social Security Administration's step-by-step Sequential Evaluation.
- Insights, overviews, and claimant stories regarding disease-specific content (ranging from commonplace ailments such as workplace injuries or accidents, to difficult to diagnose illnesses such as Fibromyalgia, Multiple Sclerosis, and POTS).
- Pertinent news happening in the disability world, and
- Much, much more.
Each episode of our podcast Winning Isn't Easy will expose you to invaluable tips and tricks for surviving the disability claims process (a system that is often wrought with pressures and pitfalls designed to encourage you to give up the benefits you rightfully deserve). As host, Nancy will often be joined by guest speakers who themselves are industry experts, ranging from lawyers specializing in related fields and doctors focusing on the diagnosis and treatment of specific diseases, to our associate attorney Krysti Monaco.
In her late teens, Nancy's father was diagnosed with leukemia. As someone who witnessed firsthand the devastating emotional and financial impact on both individual and family that being disabled and filing for benefits can have, Nancy is not just an attorney, but an empathetic presence who understands what you are going through.
Do not let disability insurance carriers rob you of your peace of mind. As a nationwide practice, The Law Office of Nancy L. Cavey may be able to help you get the disability benefits you deserve, regardless of where in the United States you reside. Remember - let Cavey Law be the bridge to your benefits.
Check out the links below to engage with us elsewhere:
Website - https://caveylaw.com/
YouTube - https://www.youtube.com/user/CaveyLaw
Winning Isn't Easy: Navigating Your Social Security Disability Claim
Understanding Social Security Disability Claim Denials
Welcome to Season 1, Episode 29 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into the complicated topic of "Understanding Social Security Disability Claim Denials."
Getting denied for Social Security Disability benefits can feel like the end of the road - but it isn’t. In fact, the majority of applicants are denied the first time around. Nearly 7 out of 10 initial SSDI claims are rejected, often not because your medical condition isn’t real, but because of a system stretched too thin and decisions made without a full picture of your life. In this episode of Winning Isn’t Easy, host Nancy L. Cavey takes you inside the realities of the Social Security Disability process. She explains why initial denials are so common - whether due to incomplete medical records, outdated vocational data, or rushed reviewers - and how to read between the lines of a denial letter to understand what happened. Nancy also lays out your next steps: how the Reconsideration stage works, why updated documentation is critical, and what to expect as you move toward a hearing before a judge. Most importantly, she shares why the appeals process gives you a far better chance of success than that first application. If you’ve just received a denial - or are bracing for one - this episode will show you why it’s not the end of the journey. With the right knowledge and persistence, you can turn a “no” into the benefits you deserve.
In this episode, we'll cover the following topics:
One - The Harsh Reality of a Social Security Disability Claim Denial
Two - The Appeals Process: Why Reconsideration Is Often Just a Speed Bump
Three - Why You Don't Want to Speed Up Your Appeal for Social Security Disability Benefits by Filing a Waiver of Timely Written Notice of Hearing
Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.
Listen to Our Sister Podcast:
We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com
Resources Mentioned In This Episode:
LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits
FREE CONSULT LINK: https://caveylaw.com/contact-us/
Need Help Today?:
Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.
Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.
Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.
Nancy Cavey [00:00:11]:
Welcome back to Winning Isn't Easy, Social Security Disability Benefits, the podcast where we break down everything you need to know about navigating the Social Security disability system. I'm your host, Nancy Cavey. Before we get started, I've got to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar association says I have to tell you this. And now that I've told you this, I want you to know that nothing will prevent me from giving you an easy to understand overview of the Social Security disability claims process, the games that are played during that process, and what you need to know to get the disability benefits you deserve. So off we go. Now, in the last episode, I talked about working while your Social Security disability application is pending.
Nancy Cavey [00:00:57]:
But in this episode we're going to face a tough truth. Most people who apply for Social Security disability benefits are going to be denied at the initial application stage. I know that you've worked, I know you've paid into the system, and I know that you're out of work because of a real medical condition. You filled out paperwork, you've submitted your records and you only are waiting for a favorable decision. You might be stunned when you open up that mailbox and you get a dreaded denial letter, but I want you to understand that this is something that happens to nearly 7 out of 10 initial Social Security applications. It may not be comforting, but I want you to know that you're not alone. These rejections often have less to do with the facts of your case and more to do with how the overworked, underfunded and flawed system really is. In today's episode, I'm going to break down why denials happen so frequently, whether it's a lack of medical documentation, outdated job data, or a decision maker who spent 10 minutes scanning your file and not giving it the attention that it really needs.
Nancy Cavey [00:02:03]:
I'm also going to talk about the agencies behind the process and why their decisions often don't reflect the full picture of your day to day limitations. We're also going to teach you how to decode a denial letter, what it means for you in the next steps, and why the appeals process, while frustrating, is your best shot at turning things around. I'm going to walk you through appeal stage called the request for reconsideration, the importance of updated medical records, and what to expect if your claim is denied. Of course you're going to have to file another appeal called a request for a hearing that gets you in front of the judges. And I'm going to talk with you about what to expect when you're finally able to get get in front of a judge. Now, if you've just received a denial letter or worried that one might be coming, this episode is for you. We are going to give you the tools to understand what's happening, what went wrong, how to fix it, and why. Now is not the time to give up, but rather to file an appeal if your claim has been denied within 60 days of the date of the denial.
Nancy Cavey [00:03:09]:
I'm going to talk about three things today. One, the harsh reality of a Social Security disability claim denial. Two, the appeals process and why reconsideration is often just a speed bump and, in my humble opinion, should be eliminated. And three, why you don't want to speed up your appeal for a Social Security disability case by filing a waiver of timely written notice of a hearing. Okay, we're going to take a quick break before we get into this episode. Got it.
Speaker B [00:03:38]:
Are you considering filing for Social Security disability or has your claim been denied already? Either way, you require a copy of your rights to Social Security disability benefits, which will cover everything you need to know about the Social Security disability claims process. Request your free copy of the book@kvlaw.com today.
Nancy Cavey [00:04:13]:
Welcome back to Winning Isn't Easy. The Harsh Reality of a Social Security Disability Claims Denial. Look, I know that you've worked. I know you've paid into the system. I know through no fault of your own, you're unable to work due to a serious medical condition. You have done the right thing. You've applied for your Social Security disability benefits and you've gotten a denial letter. Now, I want you to understand, nearly 70% of initial applications are denied.
Nancy Cavey [00:04:40]:
And it's not because your disability isn't real. It's not because you're exaggerating. It's not because you're faking it. It's because the Social Security Administration operates, in my opinion, with a deeply flawed and overwhelmed system that is quick to deny and slow to approve. And regardless of your political affiliation, has gotten worse in the recent months. Now, what makes this worse is that many of these denials happen without a full and fair evaluation of the medical evidence. Each state has contracted with an agency called Disability Determination Services, and it is a state agency. And Social Security is contracted with that state agency to evaluate claims at the initial and reconsideration level.
Nancy Cavey [00:05:25]:
I will tell you that there are a lot of great people who work for dds, but they are overburdened and they are underpaid. It's as simple as that. Now, what that means is that because there is in many states a hiring freeze and there's now been a 25 reduction in staffing at the DDS level, this situation is getting worse. Before this, it took about a year from the time you filed that initial application until a claims examiner was assigned. Now, as I said, because of the reduction, that time delay is getting worse. Now, I will also tell you with all due respect that I think that the recent layoffs and retirements have led to a loss of institutional knowledge about how that Social Security claims process works at the AI level, and that they don't necessarily have the staffing resources or knowledge to have questions that they might have answered. So it's easy just to ignore documentation or pass on the question and deny than to be able to understand the process or get a person of senior status to actually answer the question and question the. Answer the question properly.
Nancy Cavey [00:06:42]:
Now, the other thing we need to understand is that the reviewers at DDS are not doctors treating your condition. They will typically have consulting physicians with limited knowledge of your specific impairment. Is that the DDS doctors can be podiatrist, gynecologists, pediatricians, you know, all sorts of doctors who may have a medical degree but don't specialize in your specific impairment. I think that's absolutely stupid. Their decisions are often based on brief medical file reviews. And I'm not even sure, quite frankly, that they have the entire medical record. And they'll do checkbox style residual functional capacity assessments documenting that you might be able to sit this long, walk this far, lift this much. And it's just sort of a cookie cutter approach in my view, to the residual functional capacity.
Nancy Cavey [00:07:35]:
And I'll explain why that's important in a minute. They also are applying generic medical listings that really don't reflect the true day to day limitations caused by many disabling conditions. And that's a test. At step three, I find that complex or invisible illnesses such as autoimmune disorders, POTS, chronic pain syndromes, mental health conditions, fibromyalgia, PD, MS, sodrons, all these types of cases I see are disproportionately denied at the onset. Then you've got the letter itself, and I'll talk about decoding that later in this episode. But the decision letters often use boilerplate language and it's difficult to understand exactly why your claim was denied. Was it the lack of documentation, an incomplete work history, A determination that OR condition doesn't meet the definition of disability? So you'll read this whole denial and which actually you should do is just flip to the last page and look at the last two or three paragraphs and it will tell you in Social Security language why it is your claim was denied. They may even have a list of the medical records they say they consulted or may have a list of records that are incomplete.
Nancy Cavey [00:08:52]:
So without a detailed explanation other than this boilerplate language, many people feel lost, confused and discouraged. If your claim was denied, please don't panic. It doesn't mean that your claim isn't valid. It doesn't mean that your benefits aren't due and owing to you. It just means you're entering the next phase of a system that often requires you to fight for what you've earned. And that fight begins with understanding the appeals process where preparation, persistence and experience, legal guidance and can also make all the difference. Got it. Let's take a break.
Nancy Cavey [00:09:35]:
Welcome back to Winning Isn't Easy, the Appeals Process and why Reconsideration Is Often Just a Speed Bump we work very closely with our clients in preparing and filing an initial application. And one of the things that we do aggressively is to get residual functional capacity forms from our clients treating physicians documenting their functional, physical, intellectual and psychological restrictions, limitations. And the idea here is that when the claims examiner finally picks up the file, they don't necessarily have to think. The RFC form explains why at step three the person may meet a listing or at step four and five you can understand why based on those restrictions and limitations, the person can't physically, intellectually or psychologically do their past work and at step five gives them an idea why you couldn't do any other work in the mythical, hypothetical, not real world national economy in view of your age, education and whatever those functional restrictions and limitations have been assigned by your physician. Now, as I've said more often than not, DDS is going to have at the initial application level their medical review. Doctors review it. And I hate the medical reviews that I see. I don't think that they have all the medical information.
Nancy Cavey [00:10:53]:
I don't necessarily think they're competent or qualified to render an opinion. And I think they're simply doing this to earn some extra bucks to pad their income. And I certainly don't think that they, if there is a residual functional capacity form, there are really looking at them because after all, their job in my view is to give DDS a reason to deny a claim and not to pay a claim. Now often I will tell you at a hearing the judge is going to go back to that original disability examiner's analysis and the opinion of the medical provider who reviewed it at the DDS level. So we want to start combating that from the very beginning. So, okay, you filed your initial application, and. And it's been denied. What happens Next? You have 60 days to file a request for reconsideration.
Nancy Cavey [00:11:43]:
It's called an appeal. Now, to me, it's a formality. The same agency that denied your initial claim is going to be asked to reconsider it, and they're going to assign a new claims examiner. Is it any surprise that about 90% of these reconsiderations are also denied? But that doesn't mean the step isn't important, though I would strongly suggest that the Social Security administration eliminate that. I doubt that that will happen in this current regime simply because the delay is in their favor. But in any event, you need to understand that you have to file your initial application, file your request for reconsideration, and if you get denied, then you have to file another appeal, which is a request for a hearing that's going to get you in front of the judge. And in my view, that's where most successful disability claims are finally approved. Now, during reconsideration, you should absolutely submit any new or updated medical records, doctor's letters, and not a doctor's letter that says you can't work.
Nancy Cavey [00:12:45]:
Social Security doesn't care about that. What they want, quite frankly, is at residual functional capacity form they'll never tell you about. Then your doctor may not even know about. But they're also going to be looking at your medical evidence for documentation of worsening symptoms, both based on your complaints, based on and your physical exam findings and diagnostic studies. I think that every piece of information you add can help build the record that the judge will ultimately review. Now, in some cases, you may be requested to undergo an informal consultative exam called a ce and it's arranged by Social Security. Now, that can be helpful if your treating doctor hasn't provided a detailed report or if you're lacking recent clinical assessments. However, these exams can be hit or miss, and as I've said before, they could be with the absolute wrong specialist.
Nancy Cavey [00:13:35]:
It could be a podiatrist, it could be a pediatrician, it could be a gynecologist, though I haven't seen that happen in a while. But these exams are generally by doctors who are, in my opinion, not necessarily competent or qualified, but once again, are also trying to earn additional money to supplement their income. I find that these evaluations are brief. They don't actually capture the severity of the limitations. And that makes your medical documentation even More critical. Now, by the way, you can't skip this consulting exam. If you don't show, you're going to get a denial. But there are ways to combat these reports if ultimately they are unfavorable.
Nancy Cavey [00:14:16]:
I think the request reconsideration stage is also an opportunity to start organizing your claim with legal precision. That means not just dumping medical records into the file, but making sure that the records speak to the criteria that Social Security uses at each step of the five step sequential evaluation process. So the question, of course, is going to be, look, do your records show an objective evidence of your diagnosis? Do they outline how your condition is progressing? Do they address how your medical condition prevents you from performing your past work or other work? Now, I know it might be tempting to try to fast track your way through this stage and rushing through forms that Social Security is asking you to fill out or failing to continue to get medical treatment. That's not the game here. We don't want to miss a deadline. We don't want to file incomplete paperwork. We want to make sure that your medical records are giving a great history of symptoms and functionality. And all of that combines to really helping Social Security ultimately make the right decision.
Nancy Cavey [00:15:22]:
I see each stage of this process as a stage to strengthen your claim. And the stronger your claim, the better your chances are once you reach a judge. So that brings us to the hearing level. Now, if you've already been denied twice at the initial application stage and the request for reconsideration stage, you need to request a hearing and you have to do so within 60 days of the date of the denial on the request for reconsideration. Now, I know that there's like five days mailing, but that lulls people into false belief that they've got time to do things. I want you to get that request for reconsideration of the request for hearing in and then we'll deal with building the claim. But if you blow the deadline, you got to start all over. That's crazy.
Nancy Cavey [00:16:07]:
I understand that this is time consuming. I understand the wait times are long and they're getting longer. But it is not something to be rushed. We're going to talk about that in our next segment.
Speaker B [00:16:20]:
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Nancy Cavey [00:17:01]:
Welcome back to Winning isn't easy. Why? You don't want to speed up your appeal at of your Social Security disability claim at the hearing stage by filing a waiver of a written notice of hearing. That's a lot of gobbledygook language, isn't it? Well, to me, the Social Security disability claims process can be unduly complex and they face massive processing delays. There are probably over a million more Social Security disability applications that are pending and you might be part of the backlog. And I got it. But you've got to go through the initial application stage, as we've discussed. You have got to file the appeal. If your claim is denied, you have to go through the request for reconsideration stage.
Nancy Cavey [00:17:47]:
If that gets denied, then you get to ask for a hearing. You just can't go straight from the initial application to a hearing, even though I know you need a decision now. So let's talk first about the cause of the delay at the IA stage and the request for reconsideration stage. One of the major reasons is the fact that there has been a 25% reduction in the staff at DDS, the state agency that processes the initial application and requests for hearing stage. There has been a hiring freeze instituted and we're in Florida. I think that freeze has been in place since March of 2022. So people are leaving. But guess what? The state is inadequately funding the ability to hire and there's a hiring freeze.
Nancy Cavey [00:18:33]:
Well, duh. What do you think that means? There's a staffing level issue. And quite frankly, we are having issues from a procedural standpoint because of the way that this whole claims process works. The Social Security site crashes regularly, which is very frustrating. We try to file things in the electronic record and sometimes it's down. When you try to call the Social Security office, you now have to call to schedule an appointment to. To schedule a call with a claims examiner. How stupid is that? Now I know it's stupid because of the funding cuts and the technology issues.
Nancy Cavey [00:19:22]:
They are overworked and overwhelmed. And I get it. And I'm sorry for these people who are on the. On the front line, but it is incredibly frustrating. But there's also some fundamental issues, I think, with the way that Social Security goes about analyzing a claim. They have a five step sequential evaluation test. And at steps four and five, the question is, can you go back to your past work and is there other work in the national economy? They're using the updated dictionary of occupational Titles to determine your eligibility for benefits. And quite frankly, in the last nine months we've had jacked up vocational testimony about this particular issue.
Nancy Cavey [00:20:02]:
Social Security is having VE's use methodologies which we Social Security lawyers believe are scientifically invalid and they're not reliable. We have VE's who are basically trying to, in my view, make up numbers about how these jobs exist and how many numbers they exist. And the Social Security hearings at questions at step four and five have gotten quite contentious. You know, cross examining the vocational evaluator about their testimony and having to do a post hearing brief. I certainly don't want a Change where the VE's have the ability to make up numbers using their experience and training, blah, blah, blah, blah, blah. I think that we really, if we're going to improve this system, really need to take a fundamental look at the five step sequential evaluation. But enough ranting about what's going on. The question is, how can I speed up the process at the hearing stage? If your claim has been denied at the initial application, in the request for reconsideration stage, you have to file a request for a hearing.
Nancy Cavey [00:21:04]:
Now it can take an average of a year and a half to get a decision on the initial application. I don't know what the current statistics are here in St. Petersburg. All I can tell you is it's getting worse. If the claim's denied, you have to file a request for reconsideration. Got to do that in 60 days. It's taking eight months, maybe 10 months to get a decision. And don't hold me to these, because it's changing.
Nancy Cavey [00:21:34]:
And depending on where you live, it could be shorter, but probably it's longer. Now you've been denied a second time and you're thinking, this is crazy, I'm going to give up. You should not give up. But you have to file a request for a hearing and you have to do so within 30 days. Depending on where you live, it can take as long as another year to get in front of a judge. Again, depends on where you live. Under the Social Security rules, you have to be given at least 75 days notice before a scheduled hearing. Now some people have suggested that you could speed up the process by filing a waiver of timely written notice of hearing.
Nancy Cavey [00:22:11]:
That means you could get an earlier hearing date. But the downside is that you have less time to prepare your case and that's problematic, particularly if you're coming to our office at this stage. I want to make sure of the following is happening. One, do we have our clients Updated medical records. And that could take 45 to 90 days to obtain the records because doctor's offices are behind and have staffing issues. So if I get a hearing in 75 days, do I have all the records? No. Number two, if we don't have a residual functional capacity form, we want one. And if we have one, we want one that's going to get updated.
Nancy Cavey [00:22:48]:
Why? What your doctor has to say about your functional, physical, psychiatric, cognitive restrictions and limitations can impact the judge's hypothetical that they're going to give to that vocational evaluator. And that can mean the difference between getting your benefits and not getting your benefits. Because we want to make sure that that hypothetical is set up properly based on your testimony, your medical history, the RFC form. Because if it's not set up properly by the judge and you lose, we might have an appealable issue. Now, it's also important that you be prepared for the hearing. Now, in our office we have a mock Social Security disability hearing video which we send to our clients and say, here it is, because you can't go in and watch one. We also have done another video that I call the direct examination video. It's a generic video, it's about an hour long.
Nancy Cavey [00:23:42]:
And I go through in that video the general questions that a person is asked in the course of a hearing. And I explain how to truthfully, honestly tell the judge your issues in a way that the judge understands. And quite frankly, it's symptoms and functionality. But we also give our clients that direct exam sheet and ask them to complete it. Because we have a preparation conference. We actually use that document that our client has paired in getting them ready for the hearing. I play the judge, they play them, and we go through all of the questions that I think that this particular judge is going to ask my client. We also want to make sure that the ERE the electronic record file is complete.
Nancy Cavey [00:24:29]:
And if it isn't, we want to make sure that we're getting that ERE complete. We also do a memorandum of law for the judge or prepare a request for a decision on the record. And if we don't have all of the material we need to be able to write that memorandum of law, it is going to be problematic. I want to put, and I know every Social Security lawyer wants to put on the best case possible. And that 75 day notice doesn't give us enough time to do that. It's crucial that your claim is well developed and well prepared. In my opinion, what should be happening is not a 75 day waiver notice. Of a hearing, but working on speeding up the initial application and request for reconsideration timeline.
Nancy Cavey [00:25:17]:
Don't you agree? Now, that's it for today's episode of Winning Isn't Easy. Thank you for listening to some of my ranting here, but you can hear that I'm really passionate about the Social Security disability claims process and the improvements that I think need to be made to make this a smoother process, a fair process, and one in which we have faith and confidence in the decision making process. I hope you understand that the denial is not the end of the road. It's often the beginning of a process that requires patience, persistence and the right Strategy. Remember, nearly 70% of initial claims are denied not because your condition isn't real, but because the system is flawed, underfunded and overburdened. Now that you understand why denials happen, how to decode the denial letter, and what steps you can take at every stage of the case, I hope you understand that there is a way to win these cases. It takes an understanding of five step sequential evaluation, how Social Security went about denying this claim, the nature of your medical conditions, and the nature of the proof that the Social Security Administration or a judge ultimately wants to see in your file. Winning a claim can take time, so if you've recently received a denial or worried that one might be coming, please don't go alone.
Nancy Cavey [00:26:41]:
A Social Security Disability attorney can help you navigate each stage of the process, from gathering the right medical records, to gathering residual functional capacity forms, to making sure your medical records tell the story of your symptoms and functionality, and to preparing you for your hearing. You want to move forward with confidence and not confusion. If you found this episode helpful, please take a moment to like our page, leave a review, share it with your family or friends, and subscribe to this podcast. Join us please next week for another insightful discussion where I'm going to be talking about one of my favorite topics, medical records. Medical records can make or break your claim, so please stay tuned to the next insightful episode of this podcast. Thanks for listening.