When there are disagreements about when your disability began, or how long it is expected to last, you may find yourself receiving what is known as a partially favorable decision. But what exactly does that mean?
There are two different types of partially favorable decisions.
The first type is for a closed period. This means that Social Security found that you were disabled for a period of time, but your disability has ended. So has your eligibility to receive benefits. For example, Social Security finds that you became disabled on 6/1/17 and your disability ended on 11/30/19 due to medical improvement. So, you would be eligible for benefits only for that closed period between 6/1/17 and 11/30/19 (minus the waiting period). There will be no future or ongoing benefits.
The second type is a finding of disability with a later starting date than you applied for. This case will pay ongoing benefits, but starting at a later date than the application requested. For example, your applications states that you became disabled on 6/1/17. Decision makers find that you did not become disabled until 5/13/18. So, you will be paid benefits beginning on 5/13/18 (minus the waiting period). There are two effects of this partially favorable decision:
- Your back pay will be reduced.
- Your Medicare eligibility date will be postponed*
Partially favorable decisions are subject to appeal, if you choose to file one. You should keep in mind, however, that the entire decision goes under appeal, not just the part you disagree with. For example, you may only disagree with the date of onset of disability. You cannot appeal just the onset date. When you file an appeal, the entire decision goes under review. The new decision may be more favorable, less favorable or the same as the original decision.
Note on Medicare: You become eligible for Medicare 29 months after your onset of disability. If the onset date is moved forward, the Medicare coverage is also moved forward.
When an adult or head of family becomes disabled, Social Security may also provide benefits for his or her dependent children.
To get dependent's benefits, a child must be under the age of 18, or if still in school, not over the age of 19.
Your local Social Security can give you more information about dependent's benefits. If you have applied and received a denial, consider getting representation to appeal your case.
(a true Social Security Disability story)
A young man came to me for help getting Social Security disability. He had a condition that caused both physical and mental symptoms. His doctor told him there was no cure, and eventually he would die from the disease.
He had applied for SSDI and SSI a couple of years before I met him. Both claims were denied, as usual. He had correctly filed an appeal and asked for a hearing. He had no attorney or representative at that time.
The problem is, a hearing was scheduled but the claimant says he never got the message. Not knowing about the hearing, he failed to appear. The judge sent him a letter. The claimant says he never got that letter, either. We don't know why. So, the judge dismissed the claim. The claim ended, terminated right there. There would be no hearing; the case was dead.
Now, we would usually file a new claim and start over. It would be a long delay but it would get us back in the game. The problem was, this young man had not been able to work in a long time. His SSDI eligibility period had expired. He wasn't eligible to file a new claim. Old claim dead, new claim not possible. Game over, or so it appeared.
The administrative law judge who dismissed the claim had no power to reinstate it, even if he had wanted to. It was now out of the judge's hands.
I decided to file an appeal of the judge's dismissal with the Appeals Council, a body that sits in Falls Church, Virginia. I argued that the claimant suffered from severe physical and mental impairments and that he either did not receive his notice of hearing, or he didn't know what it was due to his severe impairment. I argued that the withdrawal should be reversed and the claimant's hearing should be rescheduled. Evidence was submitted to support my pleadings.
After about 120 days, the Appeals Council ruled: It would rescind the dismissal and remand the case back to the administrative law judge for a hearing. A "dead" case had literally been resurrected. Not only did my client get his day in court, he also got to potentially keep all of his retroactive benefits--just as they would have been in the original application. In short, he wasn't going to be penalized just because his case had been dismissed. He was back in the game at the same place as when he got kicked out.
But, of course, we still had to win at the hearing. About 3 months after the Appeals Council remanded the case, we attended a hearing. It went well. About 1 month after the hearing, the judge issued a Fully Favorable decision. My client got a substantial amount of back pay, a monthly benefit, and Medicare to help pay for the complex treatment he needed.
This could be one of the most satisfying cases I've handled. A lot of clients in this young man's shoes would have given up, seeing this situation as hopeless. A lot of representatives would never have taken this case because it just involved too much work and very little chance of a payday. Today, I'm thankful that neither of us gave up. A long, hard fight rewarded this claimant with the benefits he needs and deserves.
The moral of the story: Never, never, ever quit!
Stalled can refer to something which is moving abnormally slow, or isn't moving at all.
Social Security disability claims are often stalled. They can be stalled by numerous factors, sometimes by the simplest of things. And once they lose momentum they can linger in limbo for months and months.
The Social Security disability system is very slow to begin with. It's designed to be measured in terms of months and years, not days and weeks. But when your claim is moving even slower than usual, you have been stalled.
Common reasons for stalls:
1. Incomplete paperwork. You haven't returned all the requested forms.
2. Your doctor hasn't sent in the requested records.
3. You didn't keep your consultative medical exam appointment.
4. You failed to give Social Security a detailed and accurate job history.
5. You are administratively stalled in the system.
6. You are waiting on an appeal which moves at a snail's pace
7. You were medically approved but waiting on Social Security to determine your financial qualifications for SSI.
8. You have been approved for both SSDI and SSI but Social Security won't pay either until they get their accounting worked out for both claims. One claim delays the other.
One of the things I try to do when I take a new case is to figure out why it is stalled. What can I do to get the case moving again? What is the next step? Who has the paperwork on their desk right now? Who do I need to call?
At best, the disability process is slow and laborious. But if you are stalled out, it can just go on forever. A stalled out can can eventually be denied or dismissed because Social Security won't wait forever.
Are you stalled? Call me. Let's see if I can help.
Many of my clients who file for Social Security disability have severe sleep disorders. The question is, do these sleep problems equate to disability?
The answer is, how do the sleep problems restrict the ability to perform full-time work? What are the symptoms? How frequent and how severe are the symptoms.
Symptoms of insomnia, obstructive sleep apnea, narcolepsy or other sleep disorders often include:
- excessive daytime sleepiness
- fatigue
- loss of memory
- lack of concentration, persistence and pace
- irritability - unable to get along with supervisors, co-workers or customers at work
If the medical record indicates treatment for these symptoms which has failed, then a finding of disability may be appropriate. For example, if a person has obstructive sleep apnea which can be corrected by using a CPAP machine, then it is not disabling. If a CPAP has been tried and failed to fix the problem, then we have valid medical problems that may help us win disability.
Usually, a claimant with sleep issues will also have other problems. For instance, a person may have back problems, diabetes or a psychiatric problem, plus sleep problems. All of these problems may combine to make him or her disabled.
The longer I practice the more I realize that just being diagnosed with a particular disease will not win benefits (unless, of course, it is a terminal or catastrophic illness). It is the combined affects of all the claimant's symptoms that usually win disability benefits.
The bottom line for any impairment is: How does it keep you from working?
It's true that age 50 is the sweet spot for disability claims.
That is due to the Medical Vocational Guidelines or "grid rules" that can help older claimants get approved.
The grids combine the following factors to determine a decision:
- Age
- Education
- Past work experience
- Residual Functional Capacity (functional limitations)
Social Security law assumes that an individual who is 50 or older will not adjust to new types of work as easily as a younger individual. And they make allowances.
A person with the same medical condition and the same functional limitations may not qualify for a benefit at age 49, but may get a benefit at age 50. That's the difference the grid rules can make.
Let me emphasize, a 55 year-old claimant must still prove disability with medical evidence. It's just that it's a little easier to prove at 55 than it is at 35.
Another factor that may help the older claimant is work history. He or she may have a long, steady work background that argues for credibility. A person who has worked for 30 years or more will be unlikely to give up the work just to get a meager Social Security check.
You are a unique individual, not duplicated by any of the 5.5 billion people living on earth. Your fingerprints are unique, your smile is unique, and every cell in your body is unlike those of any other person.
Likewise, every Social Security disability claim is unique.
Your claim is not like anyone else's claim.
That's why I cringe when I hear someone comparing their claim to someone else's. No! It just isn't possible.
"My sister's claim was approved in just 24 days!"
"Uncle Albert's claim was paid without having a hearing."
"My neighbor said his hearing only lasted 5 minutes!"
Never, ever take what happened in somebody's else's case to be any indication of what will happen in yours. No two cases are alike.
I just made a list of all the things can be different between two Social Security disability cases. This list probably isn't complete, but it will give you an idea:
- different ages
- different past work experience
- different medical conditions
- different medical treatment
- different doctors
- different judge hears the case (no they are not all alike)
- different residual functional capacity
- diffferent lifting limits
- different education level
- different job skills
Well meaning people can give you a lot of information about disability claims. But what you really need is advice based on your set of facts and unique scenario that is YOUR claim.
The best 15 minutes you ever spend may be talking to an experienced disability advocate or attorney. Someone who has set before a judge hundreds (or thousands) of times and seen how the unique set of facts in a case determines the outcome.
Let an advocate analyze your facts on your case.
A "one size fits all" approach is no good at all.
And the fact that Uncle Albert won his case should give you absolutely no comfort at all.
