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Official Criteria Age Education Past Relevant Work (PRW) Nature or severity of impairment Medical Impairments Meet a listing Supportive test results Medical opinions -CE and otherwise ADL's GRIDS Personal care limitations Compliance Unofficial Factors Mental vs. Physical Subjective vs. objective complaints DA&A issues Financial need Insured status The adjudicator or judge considerations
Introduction: Here are some mistakes that clients or reps make at different stages of the application process. Pre-Claim: Making close to SGA Actively receiving unemployment benefits Filing too early without severity Client has filed for disability for the last 20 years and has had multiple hearings and continuously refiles while their spouse pays the bills. Post-Claim: Errors on SSA-3373 No personal care limitations Minimal limitations Missing CE appointments Errors on SSA-3369 Pre-Hearing: Allegations of malingering in the client's file SGA after alleged onset Evidence of drug abuse Actively looking for work while Not being compliant with meds or staying actively in treatment Hearing: ADLs Caring for a disabled minor child Testifying that your 'disabled' spouse does all of the household chores Caring for an elderly relative Client trips or vacations during period of alleged disability Making false statements that conflict with evidence in the file Work: Telling the judge that there is or are categories of work that client 'can do' Denying work that appears on DEQY or New Hire reports unless not actually performed Minimizing exertional requirements of PRW Credibility: Allegations of malingering Testifying that you "have been looking for work" since your AOD Denying drug usage despite multiple positive blood tests in the file Incarcerations due to stealing, drugs, physical violence, or moral turpitude Active hobbies or interests that are not consistent with your alleged 'disabilities' Smoking despite 'severe' COPD Drinking alcohol despite cirrhosis of the liver or liver failure Medical Issues: No assistive devices despite lumbar, hip, knee issues ER visits after after hunting, horseback riding, or fishing accidents Medical source statements that say you can work Doctor(s) refuse to complete medical source statements Medical source statements not consistent with treatment notes Doctor(s) not prescribing the appropriate tests to document onset and severity of condition No specialist treatment despite having medical insurance Over-documenting the case with too many tests, opinions, despite weak test results