When you have a medical condition that makes it impossible for you to work, you may seek financial support from the Social Security Administration (SSA) by filing a claim for disability benefits. However, before you file, it’s important to understand the criteria used by the SSA to make a determination about your case. It’s likely your claim could receive a “durational denial.”
What Is a Durational Denial?
Disability benefits are only granted by the SSA if your condition meets the following criteria:
- Your mental or physical condition prevents you from working for 12 months.
- Your mental or physical condition is expected to prevent you from working for 12 months.
- Your mental or physical condition won't improve in 12 months.
- Your mental or physical condition will result in death.
A durational denial means the disability examiner believes your medical condition will likely improve within the 12-month window and won’t interfere with your ability to work long-term.
The Problem With Durational Denials
If your doctor can’t forecast a date for an improvement in your medical condition, and can’t state with confidence, data, or medical fact that your illness will continue after 12 months, the disability examiner is on his own to make a forecast or guess of recovery.
By evaluating a claimant’s medical reports, the examiner decides if the applicant is likely to perform at a substantial gainful activity level in 12 months.
Thus, this forecast or guess of recovery is made by an examiner who has little–to–no experience in the medical field, and by a medical consultant who doesn’t know your condition.
Consequently, because the people involved in making the decision about a claim rely on their own personal knowledge and are subject to their own individual biases, the determination is usually subjective and based primarily on opinion.
Appealing a Durational Denial
It’s common to need Social Security disability benefits if you’ve been in a car accident, suffer traumatic injuries, or experience disability after surgery. However, these are cases that often receive durational denials. While the SSA understands that you’ll be completely disabled while recovering from your injury or surgery, you’re required to provide proof that you’ll continue to be disabled for a year or more.
If you can’t provide this proof, your disability claim will be denied.
After receiving a durational denial, you may wonder how the SSA knows the long-term status of your condition. You might ask, "How can the agency predict or forecast my inability to work?" If your doctor states that your condition will keep you from working for a year, it’s possible that the SSA will agree and approve your claim.
"Lack of Duration"
Particularly, if you sustain a permanent disability, such as the loss of your hands, your case is usually be decided quickly. However, if your doctor isn’t clear about the prognosis, or the disability examiner and medical consultant believe your condition may improve in a few months, the SSA could take a "wait-and-see" approach before granting you benefits.
It’s important to note that durational denials made by Social Security disability examiners are often disputed and reversed on appeal. Thus, if you receive a denial due to "lack of duration," you should appeal the decision quickly.
Contact Cuddigan Law
Social Security disability benefits are critical when you’re unable to work and need financial assistance to get you through a rough time.
However, because over 60 percent of initial claims are denied, the best way to avoid receiving a durability denial is to contact Cuddigan Law for help. Our attorneys understand the complex rules governing Social Security disability law, and we know how to assist you with an appeal should your claim be denied.
Call Cuddigan Law (402) 933-5405 to get help with your disability application today. Let our experienced lawyers go to work for you. Contact us today and speak with an intake specialist for free.