Appealing Disability Denial

[JEKBreatheandBelieve]

I am wondering if anyone has any advice for appealing the denial of disability specifically related to a state retirement system and not Social Security. I was a teacher and cannot function well enough to perform those duties currently. I applied. At first, I thought that it would be a no-brainer and I would get disability, but then I heard a lot that it is really hard to get so the denial didn't surprise me. Since I only had 30 days to decide whether to appeal or not, I wrote the letter of appeal. I was super angry because their summary uses one description of medical evidence (my first meeting my with psychiatric nurse practitioner) and the fact that I have a Facebook site that talks about PTSD which mentions that I published a book. For some reason they think that means I am functional and gainfully employed. It couldn't be farther from the truth. I mean I can function, but not enough to work. It's hard enough to admit that to myself and I don't know if it's worth the battle. Is it worth appealing? Is there something specific I should make sure to mention? Wouldn't I just appeal functional if I go through with the appeal (so far I can't find a lawyer to represent me because it'st he state)? I am so frustrated right now. I just want to help provide for my family.

 

[jaccat]

It may be of no help to you, because I'm writing from a UK perspective, but had to go though the same thing with social services for my father (retired, disabled, deteriorating). My experience is a lot of the time they just deny straight off, without taking your case seriouly until you appeal. When I appealed I sent them every bit of data I had whether they wanted it or not, even reciepts for house alterations that I had paid for out of pocket. My letter was pretty strongly worded too, and fortunately they accepted it almost immediately.

I think the more examples you can provide, along with evidence, the harder it'll be for them to deny it. Although I get sometimes the evidence is hard to come by and the whole thing can seem a lottery.

The process was pretty stressful though.

 

[JEKBreatheandBelieve]

Thanks, @jaccat for responding. They already have all of my medical records, statements from my former employers, and from my therapist. I have to go to an appeal hearing at which I know I can definitely dispute that I am gainfully employed. Should I re-submit the parts of the other stuff that matches my case?

 

[Cabinfever]

Hi JEK, I don't have definite answer for you, but I have an idea as to where you could potentially go to get assistance. I work for the Aging & Disability Resource Center (ADRC) in my state and routinely help folks with health insurance/disability related questions, applications, appeals etc... I have assisted some of our local teachers with trying to claim disability benefits from the state and with applying for Social Security Disability or Supplemental Security Income.
ADRCs are nationwide and funded in part by the federal government through the Association for Community Living. I believe that there is an ADRC in almost every state now. If your residence state has an ADRC, they might be the people to call to get help with your appeal.

Another place I often go for information is this commercial website called Disability Secrets. Basically, they want to trick you into needlessly hiring one of their disability attorneys, but in the process of trying to trap people they also provide some really solid information on how government agencies/commercial insurance entities view medical disability, and the way in which they want things documented. Most private insurance companies fall back on SSA/Medicare guidelines to make decisions related to disability... so although the information is targeted at people wishing to apply for Social Security disability, it also generalizes to your situation I think. As an example, if you google: Disability Secrets PTSD, you will see at least 3 search options linked back to disability secrets/Nolo. I went to the second search option just now and found information specifically on Medical Evidence, and what types of documentation will assist with winning your case. I know the website looks funky, but I use it all the time at work and have never had any problems with junk or viruses.
I hope that this information will help you. Good Luck!

 

[jaccat]

Re. Resubmitting- I probably would, but I operate on the assumption that they've probably lost the first lot, or will say they have. That might be my trust issues though.

 

[JEKBreatheandBelieve]

Well, I just found an error in their documents. It says my last date after a leave of absence at the end of the 2014-2015 school year and electing to take and unpaid leave of absence for 15-16, that I worked a half day of my own time on December 16, 2105. I can assure you, I was not anywhere near the school that day as I was terrified of going back at that point. And why would I go back and work a half day in the middle of a leave of absence? I mean I know I have DID along with my PTSD, but I would know by now if I had been there that day. I am going to investigate that. Plus they are saying they have no idea why I was out in 2012 before the accident- that was when I had my second son. Amazing that my district has suddenly lost this paperwork along with documentation of accommodations that were tried.

 

[JEKBreatheandBelieve]

I have sent all of my evidence in for the appeal which will happen in a couple of weeks. This has been an unbelievably high anxiety process for me. I knew that the appeal would be extremely high anxiety, but I didn't think abou the collection of evidence. I feel so pessimistic about it, too. I feel like there is no point in even having collected evidence because they are just going to dismiss it anyway and I will never get disability because they make it impossible and don't want to and nothing ever goes right for me anyway so why should this. I know I am future-casting, but I also feel like I have to be protectively pessimistic so that if I am denied again I won't fall into a downward spiral. Anyway, I just thought I would put that update out here because it's been on my mind a lot.

 

[scout86]

I'll be keeping my fingers crossed for you. I'm sure that at least some people qualify, they can't turn everyone down. (Can they?) It might as well be you that gets it!

 

[Breezi]

I just went through that process, Breathe. It was very stressful, but my employer's disability insurance offers an agency that did the paperwork for me and kept me abreast of everything going on and what I needed to do. After my appeal hearing, the judge reached a "fully favorable" decision, but it's been a super long process. Hang in there and don't give up until you've exhausted all of your options.

 

[JEKBreatheandBelieve]

Thank you @Breezi . My actual hearing date was postponed because of weather so I am not hanging on until March! I think my evidence is stronger than theirs is, but alas, I know not to count on them ruling in my favor, but I can cautiously hope.

 

[Deleted member 38242]

They turn everyone down the first time. I did the whole trial thing like several people I know. I had a friend who wirjed for social security, and they turn down people on death beds sometimes. If you wrote a book they consider you abke to work from home. They also will get on your Facebook, and thst is where people tend to try to look healthier than they are, and if you seem even somewhat sane you will get turned down even in court.
I know it's hard but you can't think about how people perceive you when dealing with them, and instead of bringing "good days," or sanity in order to deal with these people you have to bring your crazy.
Get an attorney first and foremost. They work on contingency, and take 1/3 of your final settlement. Meaning they will owe you a back check. I don't know your state, but in California it takes about twi years to get during which you CAN NOT work, go to school, or do anything even part time if its attached to any taxes, or anything that can be found as income, cash for time basically.
I went through this process, but also went to school for a few years to be a social worker, and this is standard information.
Your attorney will suggest what to do, and keep your Facebook from being scrutinized. If you can work at a car wash even drying cars they will turn you down. That is the specialist in court you have to worry about. Rocking back and fourt as a soothing mechanism infront of these people, and showing your worst side is what is going to get you approved. It's not always based on what you did, but on what you can do. A pay cut to them as a car wash towel person doesn't matter. If you can work; then you can work. Mental issues are different, and ptsd is a harder one to get disability for, but I did. Bipolar, schizoidaffective, and schizophrenics are turned down.
A psychiatrist, and medication prescriptions are needed even if you don't tske the pills. Being institutiinalized a few times as well helps. In the mean time foodstamps, and county, or state welfare can hold you over maybe. If your husband works, and makes money its even worse.
Get an attorney I can't stress the importance of that, and again they work on contingency. Best of luck hon. My friend was dying of liver disease, and he had to go to court. He was a social worker, and knew all the loop holes, and they still with being in and out of the hospital had to go to court.
It's not easy, but when you get it, the burden is relieved a bit.

Bring your crazy to court! Dress a little bad. Don't look to good. No makeup helps.