It would not be entirely wrong to think of the Social Security disability process as an obstacle course. There are indeed many obstacles between you and the benefits you need and may truly deserve.
By recognizing the obstacles we may be able to help you overcome them.
1. Lack of Medical Treatment. I can't over emphasize how important medical treatment is to a disability claim. The law requires medically documented impairments, supported by objective medical evidence. Without it, the case is hopeless on the surface.
2. Failing to Understand the Burden of Proof. It is up to the claimant to prove, in the legal sense of the word, that he or she is disabled according to the rules of the Social Security Administration. This really has nothing to do with common sense, as we might think. It's about knowing the rules and mapping out a strategy to prove the case according to the regulations. And the regulations are very specific and very strict. There is the truth you know ("I know I am disabled"), and the truth you can prove.
3. Failure to Get Your Doctor On Board. Your doctor can be your most important ally. Of course, he/she will provide medical records. But will your doctor give you a residual functional report that shows what your functional limits are? We recommend you speak to your doctor before filing a claim.
4. Insufficient Work Credits. A claimant must have worked and paid into Social Security long enough--and recently enough--to be covered. SSDI is "Social Security Disability Insurance." Yes "insurance." You get the coverage by working and paying FICA withholding tax. Most individuals need to have worked at least 5 years out of the past 10 years to have SSDI coverage.
5. Work After Your Alleged Onset Date (AOD). You should not be working after filing for SSDI or SSI benefits. As of 2020, wages or self-employment earnings of $1,260 or more per month will disqualify a claimant for disability benefits. Prior to 2020, it took even less. The principle is: Social Security is designed to help individuals who have become unable to work. If you are able to work, then you are not eligible for disability benefits. Incidentally, unemployment benefits can have a negative impact on a disability claim, too.
"Straight is the path and narrow is the gate" that leads to Social Security disability benefits.
Thursday, March 5, 2020
HOW MANY STEPS IN THE DISABILITY PROCESS?
By now, you know that it's not as simple as completing an application and waiting or your check to arrive in the mail.
But how many steps are there in the Social Security disability process?
It varies from person to person. But the majority of claimants will take the following journey in the struggle to get Social Security disability.
1. Complete all the application forms, including
3. File a Request for Hearing by an Administrative Law Judge.
4. Attend a hearing
Based on Alabama averages, about 45 percent of claimants will be awarded benefits at the hearing level. Those who are denied at the hearing will file an appeal with the Appeals Council, where the chance of getting a favorable response is less than 15 percent.
No wonder there is a huge legal industry involved in trying to help claimants get what they deserve--a Social Security disability check.
But how many steps are there in the Social Security disability process?
It varies from person to person. But the majority of claimants will take the following journey in the struggle to get Social Security disability.
1. Complete all the application forms, including
- Application
- Disability Report
- Function Report
- Work History Report
- Other questionnaires, as requested
3. File a Request for Hearing by an Administrative Law Judge.
4. Attend a hearing
Based on Alabama averages, about 45 percent of claimants will be awarded benefits at the hearing level. Those who are denied at the hearing will file an appeal with the Appeals Council, where the chance of getting a favorable response is less than 15 percent.
No wonder there is a huge legal industry involved in trying to help claimants get what they deserve--a Social Security disability check.
WHAT IS A TECHNICAL DENIAL?
Over 27% of initial applications are denied before even being reviewed due to what is called a “technical denial.” A technical denial occurs when an applicant does not meet the general, non-medical requirements for disability benefits. Below are some common reasons for technical denials:
- Not enough work history was shown for proper eligibility.
- The claimant is currently working over the allowed limit.
- The claimant is receiving too much in earned and/or unearned income (applies to SSI only, not to SSDI)
- The claimant has too much in assets (applies to SSI, but not to SSDI).
- The appeal was not filed within the required deadline.
A word about work history. Social Security disability (SSDI) is an insurance program sponsored by the federal government. Workers pay into SSDI through payroll deduction. The tax is called FICA through the Federal Insurance Contribution Act. This is the tax that funds SSDI and Medicare. When an individual stops working, he/she stops paying FICA tax. Like any other insurance, when you stop paying, the coverage eventually expires. The general rule of thumb: You should have worked and paid FICA tax for at least 5 out of the most recent 10 year period. It's easier to understand when you think of Social Security disability as an insurance plan for workers. It is the ability to work that is being insured.
Generally, Social Security continues to cover you for about 5 years after you stop working. There can be exceptions. For someone who has not worked in 6 or 8 years, it is unlikely that you are covered by Social Security disability. Call the local Social Security office to find out.
Wednesday, March 4, 2020
APPEAL FIRST: ASK QUESTIONS LATER
Social Security is bad to deny disability claims. Their strict definition of what disability means, their mechanical review of applications, and their unwillingness to give claimants any benefit of the doubt--all make it difficult to win. Around 75 percent of disability claims in Alabama are denied.
The cure for a denied claim is simple: a quick appeal.
Most claims today are won in the appeal process, not in the application process.
In fact, it usually requires two appeals to get approved these days.
The first appeal is for what they call "Reconsideration." In Reconsideration, the same state agency that denied your claim to begin with reviews the denial to see if a mistake was made. Literally 98 percent of "Reconsideration" appeals result in another denial. The only reason to file this appeal is that you are required to.
The second appeal sets you up for a hearing before an administrative law judge (ALJ). This is where you want to be if you have been denied. The judge will review your claim with a fresh look, will consider all the evidence (including new evidence) and give you a totally new decision. You are encouraged to have legal representation for this hearing.
Appeals must be filed within 60 days of each denial. This deadline is firm and has few exceptions. Do not miss the 60 day deadline to file an appeal on any unfavorable decision. Appeal now, ask questions later!
The cure for a denied claim is simple: a quick appeal.
Most claims today are won in the appeal process, not in the application process.
In fact, it usually requires two appeals to get approved these days.
The first appeal is for what they call "Reconsideration." In Reconsideration, the same state agency that denied your claim to begin with reviews the denial to see if a mistake was made. Literally 98 percent of "Reconsideration" appeals result in another denial. The only reason to file this appeal is that you are required to.
The second appeal sets you up for a hearing before an administrative law judge (ALJ). This is where you want to be if you have been denied. The judge will review your claim with a fresh look, will consider all the evidence (including new evidence) and give you a totally new decision. You are encouraged to have legal representation for this hearing.
Appeals must be filed within 60 days of each denial. This deadline is firm and has few exceptions. Do not miss the 60 day deadline to file an appeal on any unfavorable decision. Appeal now, ask questions later!
TOP 3 DISABILITIES IN VETERANS
Trauma resulting from military service can be long lasting. While there may certainly be physical trauma, many veterans suffer from psychological trauma.
The top 3 disabilities we see among veterans are:
1. General Anxiety disorder. This may exhibit itself as excessive worry, poor or irregular sleep, fatigue, nervousness, appetite changes, or many other symptoms.
2. Post Traumatic Stress Disorder (PTSD). There are many symptoms resulting from this disorder: hypervigilence, isolation, dread of leaving home or familiar surroundings (agoraphobia), increased startle reflex, distrust of others, paranoia, erratic sleep patterns and many others.
3. Major Depressive Disorder. Mood changes, feelings of worthlessness, hopelessness, fatigue, loss of interest in usually enjoyable activities, increased or decreased appetite, and other symptoms.
Will Social Security pay a benefit for these or other psychological symptoms?
Yes, if the symptoms are long term and severe enough to cause a major disruption in the ability to work. A medical or psychological impairment must last at least 12 consecutive months, be expected to last at least 12 consecutive months OR to result in death.
In the case of psychological symptoms, treatment should be provided by either a licensed psychologist or psychiatrist. Many veterans receive treatment from one of the VA facilities. These facilities have qualified psychiatrists and/or psychologists on staff. Medical evidence from these providers can be used to as proof of disability.
We should note that Social Security (SSDI) has separate and different requirements than the Veterans Administration (VA). Many veterans qualify for benefits from both Social Security and the VA. However, the SSDI process is totally separate and must be applied for (and often appealed) in a separate process from the VA.
The Forsythe Firm in Huntsville has helped many veterans to apply for and receive SSDI benefits. We are veteran friendly and understand what is required to prove disability to the satisfaction of the Social Security Administration. You can get a free evaluation and we will never ask for a fee unless you are approved and receive a lump sum back pay settlement in addition to your monthly SSDI benefits.
The top 3 disabilities we see among veterans are:
1. General Anxiety disorder. This may exhibit itself as excessive worry, poor or irregular sleep, fatigue, nervousness, appetite changes, or many other symptoms.
2. Post Traumatic Stress Disorder (PTSD). There are many symptoms resulting from this disorder: hypervigilence, isolation, dread of leaving home or familiar surroundings (agoraphobia), increased startle reflex, distrust of others, paranoia, erratic sleep patterns and many others.
3. Major Depressive Disorder. Mood changes, feelings of worthlessness, hopelessness, fatigue, loss of interest in usually enjoyable activities, increased or decreased appetite, and other symptoms.
Will Social Security pay a benefit for these or other psychological symptoms?
Yes, if the symptoms are long term and severe enough to cause a major disruption in the ability to work. A medical or psychological impairment must last at least 12 consecutive months, be expected to last at least 12 consecutive months OR to result in death.
In the case of psychological symptoms, treatment should be provided by either a licensed psychologist or psychiatrist. Many veterans receive treatment from one of the VA facilities. These facilities have qualified psychiatrists and/or psychologists on staff. Medical evidence from these providers can be used to as proof of disability.
We should note that Social Security (SSDI) has separate and different requirements than the Veterans Administration (VA). Many veterans qualify for benefits from both Social Security and the VA. However, the SSDI process is totally separate and must be applied for (and often appealed) in a separate process from the VA.
The Forsythe Firm in Huntsville has helped many veterans to apply for and receive SSDI benefits. We are veteran friendly and understand what is required to prove disability to the satisfaction of the Social Security Administration. You can get a free evaluation and we will never ask for a fee unless you are approved and receive a lump sum back pay settlement in addition to your monthly SSDI benefits.
WHY YOUR DOCTOR WON'T SUPPORT YOUR DISABILITY CLAIM
One of your most powerful allies in the fight for Social Security disability benefits can be your doctor.
But all too often, doctors won't "get involved" in helping you get benefits.
What you really need from your doctor is a Residual Functional Capacity statement. This statement does not draw any conclusion about whether you are disabled or whether or not you can work. Rather, it places limits on your ability to perform certain specific activities: sitting, standing, walking, bending, lifting...,etc.
There could be any number of reasons why your doctor refuses to help you with paperwork that might help you get a fair evaluation
by the Social Security Administration (SSA).
1. Your doctor doesn't want to invest the time. Time is really what the doctor sells. He or she needs to be an efficiency expert in order to be profitable. The doctor knows how many patients he needs to see each day. He also knows how much time should be allocated to each patient. It takes some time, obviously to complete a disability form. Some doctors won't invest the time.
2. There is nothing in it for the doctor. If the doctor doesn't charge the patient for completing a form, there is nothing in it for the medical practice.
3. Your doctor may fear Social Security, or "the government." A doctor may feel that she could be called to testify at your hearing, which would waste most of her day and cost thousands of lost dollars. This is an unfounded fear, for doctors are never called to testify, but many of them don't know this.
4. Your doctor may not believe that you are disabled and doesn't want to say so. It's easier to just refuse to complete the form.
5. Perhaps your doctor never knew about your request to complete the form. Busy doctors surround themselves with employees who guard the doctor's time and how much access patients have to the doctor. You may have been intercepted by a receptionist, nurse or office manager who sees her job as protecting the doctor from people who want to "waste his time." Have you tried talking to your doctor during a scheduled appointment, or handing the form directly to your doctor?
Thankfully, there are a good many compassionate doctors who will invest a little time to give their patient an honest, fair and useful assessment of their abilities.
But all too often, doctors won't "get involved" in helping you get benefits.
What you really need from your doctor is a Residual Functional Capacity statement. This statement does not draw any conclusion about whether you are disabled or whether or not you can work. Rather, it places limits on your ability to perform certain specific activities: sitting, standing, walking, bending, lifting...,etc.
There could be any number of reasons why your doctor refuses to help you with paperwork that might help you get a fair evaluation
by the Social Security Administration (SSA).
1. Your doctor doesn't want to invest the time. Time is really what the doctor sells. He or she needs to be an efficiency expert in order to be profitable. The doctor knows how many patients he needs to see each day. He also knows how much time should be allocated to each patient. It takes some time, obviously to complete a disability form. Some doctors won't invest the time.
2. There is nothing in it for the doctor. If the doctor doesn't charge the patient for completing a form, there is nothing in it for the medical practice.
3. Your doctor may fear Social Security, or "the government." A doctor may feel that she could be called to testify at your hearing, which would waste most of her day and cost thousands of lost dollars. This is an unfounded fear, for doctors are never called to testify, but many of them don't know this.
4. Your doctor may not believe that you are disabled and doesn't want to say so. It's easier to just refuse to complete the form.
5. Perhaps your doctor never knew about your request to complete the form. Busy doctors surround themselves with employees who guard the doctor's time and how much access patients have to the doctor. You may have been intercepted by a receptionist, nurse or office manager who sees her job as protecting the doctor from people who want to "waste his time." Have you tried talking to your doctor during a scheduled appointment, or handing the form directly to your doctor?
Thankfully, there are a good many compassionate doctors who will invest a little time to give their patient an honest, fair and useful assessment of their abilities.
Monday, March 2, 2020
WHAT'S A PARTIALLY FAVORABLE DECISION?
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:
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.
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.
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