Understanding Social Security Disability Benefits

Applying for Social Security Disability Benefits The Social Security Administration is a branch of the United States federal government that provides disability benefits to individuals who cannot work due to long-term disability. The benefits are paid through two programs: Social Security disability insurance (SSDI), which pays benefits to people with disabilities who have worked long enough, and Supplemental Security Income (SSI), which provides benefits based on financial need. Applying to either program requires you to make a claim by filling out an application and providing the necessary documentation. It can be a complicated process, so here are some things to keep in mind. Apply as soon as possible. It is important to initiate your application as soon as possible so that you do not lose benefits. Social Security will not pay benefits for time periods earlier than the effective date of your application, so it is best to get started as soon as you can. [native] You can apply online, by phone, or in person. If you are applying for SSDI, you can apply online (at www.socialsecurity.gov). This method allows you to complete the application in the comfort of your own home and on your own schedule. You can even save your application and come back to it later. Unfortunately, you cannot apply for SSI online. And, even if you are applying for SSDI, you may still want to apply in person so that you can have the opportunity to ask any questions you may have. To apply in person it is best to make an appointment (by calling the toll-free number 1-800-772-1213). Getting through to Social Security on the phone can sometimes be a challenge, so it may be helpful to try calling first thing in the morning. Once you get through, you can make an appointment to visit your local Social Security office in person or to be interviewed over the phone, whichever option is more convenient for you. Once you make an appointment, you will be mailed application materials. Gather all the paperwork prior to your appointment. Prior to your appointment, make sure to have all the required documentation ready. Make copies of everything – one for your application and one to keep in your files – in case anything gets lost in the process. The documents that you should have ready include: Your Social Security number; Your birth certificate; Contact information (names, addresses, and phone numbers) for doctors, caseworkers, therapists, hospitals, and clinics where you have been treated; Names and dosages of all the medications you take; Medical records and lab results; Dates you were seen, tested, and/or treated for your condition; A copy of your most recent W-2 (or most recent tax return if you’re self-employed); and A summary of where you worked and what kind of work you did, including the dates you started and ended your employment and the tasks you performed in each position. Check to see if your condition is listed. Social Security maintains a listing of medical impairments, often referred to as the “Blue Book” or “Listing of Impairments.” This list is divided into both adult and childhood impairments and includes specific criteria for each type of condition. Meeting the criteria specified for your condition does not guarantee that you will be awarded benefits. However, if your medical condition does happen to be listed, it should help you determine the type of information you will need to help support your claim. If your medical condition is not listed, the reviewer will have to determine if you have an impairment that is equivalent to one that is listed in terms of medical severity. Remember what you are trying to prove. Keep in mind that Social Security has a very strict definition of long-term disability. To qualify for benefits you need to prove that you have a severe, medically determinable impairment that limits your functioning to the point where you are unable to work. This includes the type of work you did previously and any other type of work. If the reviewer believes that there is other less physically or mentally demanding work that you would be capable of performing your claim will be denied. The only exception to this rule is that Social Security regulations may not expect those over 50 to be able to adjust to new work, depending on your education and previous training. Let your doctor(s) know early in the process. A disability claims examiner will likely need to be in contact with your doctor(s) to verify the medical issues in your claim. For this reason, it is important to try to make sure that your doctor(s) are willing to cooperate. Try to inform your doctor(s) in advance that you are planning to file a claim for disability benefits, and ask if there is anything you can do to make it easier for them to meet their requirements. Remember your rights. Applying for disability benefits can sometimes be an overwhelming process, so keep in mind that you have several rights: You have the right to representation by a lawyer of your choice whenever you do business with Social Security. It is especially recommended that you seek legal advice if your initial claim is denied and you decide to appeal. You have a right to be notified in writing about any decision regarding your application. A copy will also be sent to your lawyer if you have one. You and your lawyer have a right to examine or get a copy of all the information in your case file. Lastly, you have the right to appeal if you don’t agree with the determination made about your eligibility or benefit amount. Be patient and follow up if necessary. How long a Social Security application takes to process depends on many factors, such as how many cases a particular reviewer has and how long it takes a reviewer to gather the necessary information. You can help speed up the process somewhat by providing all of your own medical records, instead of relying on the reviewer to contact your doctor. Still, there is really no way to know if your claim will be processed in a month or whether it will take several months. If you need to follow up on your claim, start by calling your state’s Disability Determination Services (DDS) office. Although you file your application through the Social Security office, it is DDS that will make the initial disability determination on your application. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] Though the statistics vary somewhat from state to state, nationwide about 65% of all disability claims are denied on the first application. Luckily, receiving a denial does not mean that you will never be able to receive benefits. You can always appeal the decision of the Social Security Administration (SSA) – but you must be sure to do so within 60 days from the date of your denial notice! Don’t Start A New Claim If your original application for disability has been denied, the wisest course of action is to appeal your claim. If you start a brand new application, it will likely be denied for the same reason as the first application. By contrast, filing an appeal will eventually lead to a hearing with an administrative law judge (ALJ), where the odds of being approved are substantially higher. Even if you have to go through the appeals process more than once, you are still more likely to be approved for disability benefits than a claimant who files multiple initial disability claims. File Your Appeal To start the appeals process, the very first thing you should do is contact your local SSA office and let them know you want to initiate an appeal. This will prompt the SSA to send you the necessary forms. In most cases, the forms needed to initiate an appeal are the “Request for Reconsideration” and the “Disability Report-Appeals.” Completing this paperwork is actually fairly simple, and can even be done online. Before you submit your forms, review everything to make sure you have included all the necessary information and any updates since your initial application. For example, if you have visited your doctor recently, started seeing a new doctor, or if your condition has worsened since your original application, all this information should be included. Make sure you get everything to the SSA within the 60-day deadline. (You are actually allowed an additional five days for mail time, but note that your appeal has to actually be received by the 65th day, not simply postmarked by that date). It is also a good idea to make a copy of anything you mail so that you will have it for your records. [native] Follow Up On Your Appeal It isn’t sufficient to simply put your appeal in the mail or submit it online. Ideally, you should always contact the SSA one to two weeks after sending in your appeal to verify that your appeal was actually received. If they have no record of your appeal request, make another copy of the copy you have in your records and mail it again. Because if the SSA does not receive your appeal within the 60-day time frame, you will have no choice but to start again with a new claim, and many months of your valuable time will have been wasted. Reconsideration There are some states where the reconsideration review step has been eliminated. Those states include: Alabama, Alaska, California (Los Angeles North and Los Angeles West Branches only), Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York, and Pennsylvania. In all other states, the first level of the appeals process is the reconsideration appeal (sometimes referred to as the “recon” appeal). Unfortunately, approval rates during this stage are quite dismal at only 10% to 15%. This is mostly due to the fact that these reconsiderations are sent back to the same state disability agency that originally denied your initial application. The good news is that even if your reconsideration appeal is denied, it is still a step in the right direction because then you can file a formal request for hearing before an administrative law judge. Hearing With An Administrative Law Judge The more you appeal, the greater your chances become of receiving benefits. At the hearing stage in the appeals process, things finally begin to look a bit more promising – with a national average approval rate of about 60%. There are several reasons that the odds are better for you at a hearing. For one thing, the judge presiding over the hearing may give more credence to the opinion of your treating physician. It is also the only stage in which the person making your disability determination actually gets to meet you in person, and the judge may be influenced by your symptoms, appearance, and testimony. There will also be more attention paid to your exertional and non-exertional limitations at this stage. This means that it is also a very good idea to hire legal representation before your hearing takes place. The Importance of Legal Representation Having appropriate legal representation can really help you win a claim at an ALJ hearing. While your lawyer can’t guarantee that you will be awarded benefits, he or she can guarantee that your case will be properly developed and prepared prior to your hearing date. A qualified social security attorney will also have a high level of familiarity and expertise with the relevant rules and regulations. They will know how to spot any errors in the SSA’s rationale for your denial, as well as which questions to ask your doctor and which types of medical documentation will be most worthwhile for your case. Disability attorneys generally get paid on contingency (i.e. only if you win), which means they also have an incentive to give your claim the best chance of winning. A social security disability lawyer’s fee is limited to 25% of the past-due benefits you are awarded, up to a maximum of $6,000. It’s important to note that the attorney will only be paid out of your past-due benefits – if no back-dated benefits are awarded the attorney will not receive a fee. (However, in some cases your disability lawyer may be able to submit a petition for payment.) Appealing an Appeal If your claim is still denied at the ALJ hearing, you can continue to appeal your denial. The next stage would be the Appeals Council, which has an approval rate of about 13%. If your claim is denied at that stage as well, you can still appeal the decision once again to federal court. National statistics indicate that approximately 40% of disability cases taken to the federal level are approved. So the important thing to keep in mind is that though appeals can be time-consuming, they are often your best chance for eventually receiving benefits. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"],After the long, confusing process of applying for Social Security disability benefits, it is understandably very frustrating to receive a denial. While the Social Security Administration (SSA) has no official policy to deny first-time applications, it is fairly easy to see why some people might think they do! Though the rate of denial varies from state to state, nationwide about 65% of all disability claims are denied on the first application. Receiving a denial does not necessarily mean you will never be able to receive benefits. You can always appeal the SSA’s decision – but you must do so within 60 days from the date of the denial notice! So if your application has been denied, the very first thing you should do is contact your local Social Security office to request an appeal. This will prompt the SSA to send you the necessary forms right away, so that you can get them completed and submitted prior to the deadline. Next, it’s important to take a close look at your denial so you can understand why you were denied in the first place. Look At Your Denial Notice If your initial application is denied, you’ll get a notice of denial from the SSA. This document will contain a brief description of your medical condition, the impairments that were considered, the medical and nonmedical records that were considered, and it will briefly explain the SSA’s reasoning for denying your claim. Some denial notices will also include Form SSA-4268: Explanation of Determination. This form states the technical rationale that the claims examiner used in making your disability determination. If your denial notice does not include this form, you can request it from the SSA so that you can review it. [native] Lack of Medical Evidence All applications for Social Security disability are evaluated on the basis of medical evidence – and the primary reason that applicants are denied is for failing to provide sufficient medical documentation to back up their claim. Even if your application included a consultative medical exam with a doctor hired by the SSA, those exams are generally quite brief and often shed little light on your actual disability determination. Instead, your disability examiner must rely on whatever medical evidence you have provided. Look at your file to determine if there are any areas where you need to provide additional medical documentation. If your medical records contain comments from your treating doctors about your disability, note whether the comments are clear and whether they support or hurt your case. For example, if your doctor uses the phrase “light work,” he or she may not know that the SSA has a specific definition of what type of work that entails. If your doctor’s statements makes it seem like you can do more physically than you actually can, you may need to speak with your doctor about writing a new letter for your appeal or filling out a residual functional capacity (RFC) form on your behalf. If your condition is listed in the SSA Blue Book, your appeal will need to specifically provide enough medical documentation to prove all the listed criteria in order to be approved. Understanding Residual Functional Capacity (RFC) If your condition doesn’t match a Blue Book impairment listing, your file will also include a discussion of your residual functional capacity (RFC). Your RFC is an assessment performed by your disability claims examiner with the help of a medical consultant from your state’s Disability Determination Services (DDS). Your RFC indicates what level of physical exertion the SSA thinks you are capable of performing and it is used to determine whether you can be expected to return to your prior job. For example, the SSA considers “light work” the ability to lift up to 20 pounds and perform a good deal of walking and standing or pushing and pulling controls. “Sedentary work” means you can lift no more than 10 pounds and that walking or standing should only be required occasionally. In addition to classifying your physical exertion ability, your RFC will also contain any other restrictions that would limit the jobs you would be able to do (for example, not being able to use your fingers or difficulty remembering instructions). Check your RFC to make sure that the assessment is accurate and corresponds with the information provided by your treating doctor. For example, if you have a physical RFC, did the medical consultant say your level of physical exertion (such as lifting, carrying, or walking) is higher than what your treating doctor says you can do? It’s also important to check what type of doctor evaluated your application – mental impairments should always be evaluated by a psychiatrist or psychologist and children’s claims about physical impairments should always be evaluated by a pediatrician. Medical-Vocational Grid Rules Using your RFC as a determination of your physical abilities, your claims examiner will have determined whether you are able to return to your prior job. If the examiner decides that you are unable to do so, the medical-vocational grid rules will be applied to determine whether you can be expected to learn how to do a new job. The grid rules take into consideration your RFC, your level of education, the skill level of your past work, whether any of the skills from your past work can be transferred to another job, and your age. It is generally easier for individuals older than 55 to qualify for a “medical-vocational allowance” under the grid rules. However, other important factors – such as the skill level of your past relevant work or the transferability of your skills – can also play a role in dictating whether your appeal will be approved. A disability lawyer can help you make sure these aspects are described accurately in your appeal. Disability Benefits May Still Be Possible Even if your application is denied the first time, it may still be possible for you to be granted disability benefits. However, it’s important to keep in mind that you’ll need to follow the official appeals process to get the SSA to reconsider your claim. The sooner you begin the appeals process, the sooner the SSA will be able to schedule a hearing, which will give you the best chance of a successful claim. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] When I was diagnosed with RA at the age of 25, I was right in the middle of law school and had not yet started my career. However, many people struggle with RA in the prime of their working years, and despite advanced treatments and laws to protect us in the workplace, not everyone with RA is able to continue working. This can be frustrating and disheartening, and can be made more so by the bureaucratic confusion surrounding the process of applying for disability benefits. Although I have no personal experience with this issue, I do have the hard-won research skills and ability to read code that comes with graduating from law school! And while I can’t offer any legal advice, I hope that this article can help explain some of the mystery behind applying for Social Security disability benefits. Social Security Disability Programs The Social Security Administration is the branch of the United States government that provides disability benefits to individuals who are out of work for at least a year due to long-term disability. If you have been diagnosed with rheumatoid arthritis (RA) and subsequently have been unable to continue working, there are two types of benefits for which you may qualify. While both of these programs require you to prove the extent of your disability, the other aspects of qualifying for each program differ greatly. The first program is Social Security Disability Insurance (SSDI). To qualify for SSDI benefits, you must have earned enough work credits during your recent work history. In most cases this means you must have worked for five of the past ten years. However, if you are not old enough to have a ten-year work history, you must have worked half of the time that you have been able to work since the age of 18. For example, if you are 24 years old you will be expected to have worked three of the past six years in order to qualify. [native] If you do not have enough work credits to qualify for SSDI benefits, you may still be able to qualify for the second program, which is called Supplemental Security Income (SSI). SSI is a needs-based program for low-income families. In addition to meeting the disability criteria, you must also meet certain income and asset restrictions. As of 2013, in order to qualify for SSI benefits you must earn no more than $710 per month as an individual or $1,066 per month as a couple. You must also have less than $2,000 in assets as an individual or $3,000 in assets as a couple. Qualifying for Social Security Disability With RA The Social Security Administration has a publication called the Blue Book that lists all of the medical conditions that may qualify an individual for disability benefits, along with the criteria that must be met. The easiest way to qualify for either of the above programs is to submit medical documentation to prove that your RA meets the criteria listed in the Blue Book. RA can be found in Section 14.09 of the Blue Book, under the heading “Inflammatory Arthritis.” In addition to providing proof of your diagnosis, the Blue Book requires you to be able to prove at least one of the following: (1) You suffer from persistent inflammation or deformity in one of your major weight-bearing joints, which results in the inability to move freely. (2) Your condition affects both of your arms and prevents you from performing everyday tasks. (3) Other organs are involved, causing at least two of the following symptoms: severe fatigue, fever, malaise, and/or involuntary weight loss. And/or (4) you suffer from repeated rheumatoid arthritis flare-ups with at least two of the following symptoms that cause limitations in your daily living activities: fever, fatigue, unexplained weight loss. Applying for Social Security Disability Benefits In order to apply for Social Security disability benefits, you can visit your local Social Security office in person or you can apply online. If you can provide medical evidence to show that your RA meets the requirements listed in Section 14.09 of the Blue Book, you will be much more likely to be approved for benefits during the initial stage of the application process. After you submit your application, you should expect a decision from the Social Security Administration within three to six months. If you are approved, your award letter will tell you when you can expect to begin receiving benefits. Appealing a Denied Claim If the Social Security Administration denies your original application, you may want to pursue a disability appeal. To do so you must file your appeal within 60 days of the date of your denial letter. At this point you should also consider retaining the services of a Social Security attorney, who can help you through each stage of the appeal process including your disability hearing. At the hearing your chances of receiving benefits will be greater than at any other point in the appeals process and statistics have shown that applicants with legal representation are more likely to be awarded benefits than those who try to represent themselves. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] ,

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