The Importance of Credibility When Submitting a Disability Benefits Claim

Summary: Fraud has become a serious issue when it comes to submitting disability benefits claims. The government has created a claims system designed to weed out suspicious claims, but this can make it more challenging for honest claims to be approved. Establishing credibility is an important part of the claims process, and there are several different ways to do it, including only submitting honest and consistent information with up-to-date medical records.

One of the main reasons it’s so hard to apply and qualify for Social Security Disability Insurance (SSDI) is that many people commit social SSDI fraud. As a result, the government uses a claims system that helps them discover suspicious claims. Unfortunately, this makes approval for legitimate claims more difficult. Therefore, establishing your credibility when submitting a disability benefits claim becomes very important. Here’s why credibility is important, with tips to help you qualify for the money you deserve.

What is Social Security Disability Fraud?

Social security disability fraud occurs when someone knowingly files a disability claim when they aren’t qualified to receive benefits. Social Security Administration (SSA) has the difficult job of weeding out fraudulent claims which can include:

• Knowingly misstating information on the claim
• Submitting false medical records
• Not notifying the SSA your medical condition has improved
• Not providing updates on your employment status

The claimant can commit fraud on their own, or in hand with medical professionals, a spouse or even an SSA adjudicator. A spouse also commits fraud if they continue to cash checks after their loved one dies.

All the above acts are considered fraudulent. This is the main reason you need to establish credibility when you apply for disability benefits.

What are the Consequences of SSDI Fraud?

If charged and found guilty of SSDI fraud once you’ve filed your claim, you face steep fines of up to $250,000, and/or up to five years in prison. Those who help you commit disability claim fraud face up to 10 years in prison and $7,500 for each fraudulent statement or record they submit on your behalf.

What is Credibility?

Credibility establishes you are trustworthy and believable. When applying for benefits, this takes shape based not just on the information about your medical records, but any other information or statements you provide.

How is Credibility Established?

SSDI benefits claims require a long list of medical evidence and information to establish you suffer from a legitimate, SSDI-approved medical condition. The only way to establish your claim to be credible is to submit honest, consistent information in hand with up-to-date legitimate medical records.

This is the information the SSA adjudicators use to determine whether your case is legitimate and whether your condition qualifies to receive benefits. They review every answer, comment and piece of medical proof you provide ensuring your claim is consistent and doesn’t raise suspicion.

Why is Consistency Important?

The SSA ensures everything adds up between your answers, the medical records provided, testimony provided by yourself and others, and every finding submitted by your medical professionals. When an inconsistency is detected in the application process, it provides a clue on which the SSA can follow up.

Inconsistencies can be found anywhere in your SSDI benefits claim including:

• Work history
• Medical evidence
• Testimony at the Hearing
• Complaints and symptoms
• Ability to work

The evidence submitted with your claim must not just be consistent in pointing to your condition, but also how you live.

What are Examples of Inconsistency?

This is a very important question, as your credibility relies on medical, mental and activity level evidence:

• Medical Evidence: A medical inconsistency might be rating back pain a 10 on the pain scale, yet no medical findings explaining the pain such as an MRI.
• Activity: You might also claim you can’t stand for long periods of time keeping you from working, yet witnesses see you playing golf every day.
• Mental: If you testify you suffer from severe depression and can’t leave the house, but are always seen at your child’s school volunteering, this again is inconsistent with your claim.

As you can see, all evidence submitted overlaps and must be consistent to establish credibility.

Questionnaire Processing

The SSA sends you questionnaires you and a third party must complete. This is a prime example of where inconsistencies in your answer can lead to denial. Why? Even when answering honestly, you really have no idea what the SSA wants you to say.

The answers you provide tell the SSA how your impairments affect your day-to-day activities. However, if not worded correctly, they might find your answers don’t support your claim you are unable to work.

Third-Party Answers

The third party’s answers can unwittingly conflict with your answers. This can be something as simple as them saying you cook your own meals. If you can complete certain tasks at home, but not at work, your credibility comes into question.

Work History

Your work history also impacts your eligibility for SSDI. The information submitted must prove your current medical condition prohibits you from fulfilling your current work duties. However, it also must show you can’t work in other jobs.

This is determined based on a “medical-vocational analysis.” This test determines the type of work, if any, you can perform despite your condition. The analysis rates your ability to perform rated from heavy work to less than sedentary work.

Anything above less than sedentary, means you are able to perform work to some level and therefore are not eligible for benefits. In this case, the SSA decides what type of work you can perform. Therefore, your activity answers must be consistent with your medical-vocational analysis to build credibility.

Disability Advocates Support Credibility

Despite your claim being completely legitimate, you can have subtle inconsistencies on your application and questionnaires. These inconsistencies are the red flags the SSA looks for when processing your submission.

A disability advocate understands the process and ensures your answers and supporting evidence align while being truthful. This avoids inconsistencies. At Princeton Disability we use our own questionnaires our clients complete in advance. This ensures the SSA has the information they need to establish credibility.

Princeton’s experienced advocates help avoid inconsistencies that not only impact your credibility but also lead to delays and rejection. For more information on how we can help get your claim approved, or assist with denial, speak to our disability claims assistants today.