Patience is key
Most Social Security Disability claims are denied upon the first application. Claims that are approved on the initial application are often referred to as “compassionate allowance” cases, where the applicant has a catastrophic and hopeless new condition, such as Lou Gehrig’s Disease, kidney failure, or Stage 4 cancer. These are “no doubt” situations where the condition is permanent and will only worsen.
Now and again, a seemingly run-of-the-mill case gets fast approval. For instance, someone over 55 who has worked in construction their whole life, with a strong work record, and some significant new injury prevents them from working, such as a herniated disk on which the surgery has failed.
The initial application can be made at a local Social Security office, by mail, telephone, or online. It can take up to six months for your initial application to be approved or denied. www.ssa.gov is the website where one can apply for benefits.
What happens when you get denied?
If denied, one can appeal and ask for a reconsideration, which takes about six months. If that reconsideration is denied, one can appeal the matter to a live hearing before a Social Security Disability Judge, which can take 14 months to two years. This entire process (filing, reconsideration, and hearing before a judge) can take about three years, and you still might be denied.
If you win your appeal, you will get “back payments” for Social Security Disability dating back to your application date. Lawyers who take disability cases get paid because the law allows them a 25% fee on the past due disability owed, capped at $7600.00.
The disability must be severe
If the applicant is currently engaged in “substantial gainful activity,” the application is denied.
The next hurdle is the disability must be severe.
Can the applicant perform the job they were doing before the disability? If so, they are denied.
Can the applicant perform any work in the economy? If the answer is yes, you will not get disability.
Could the person work in a toll booth for the Kansas Turnpike? Could the person be a clerk at a convenience store? Judges who decide these cases try to think of any job that the person could do.
Often the person could do such a job for a short while, but if one needs to take 15-minute breaks every hour, that would disqualify them from holding that job. Or if the person needs to sit or stand a certain length of time, that can disqualify them for a job that seems easy unless the employer will accommodate the work requirements.
No benefits are paid for a partial disability or a short-term disability
The disability must last a year, be expected to last a year, or be expected to result in death. In short, you must be unable to work—any job. For instance, if a man who built cabinets for 40 years has a completely disabled right hand, he cannot build cabinets anymore, but he could work as a clerk at a convenience store, etc. In other words, the issue is not whether you can do your current job but any job.
What about mental disabilities?
It is easier to prove physical disabilities in court through medical records. Nearly 1/3 of disability cases involve musculoskeletal system and connection disorders. These disabilities can be seen on an X-Ray or CT scan.
Mental disabilities are harder to prove. Medical records showing the disorder’s length and progressively worse nature are helpful. However, some hereditary mental conditions, such as schizophrenia or bipolar, are easier to prove.
If you are not currently receiving treatment for the condition, your chances of getting disability are slim. Disability judges will think if you are not getting treatment for the disability, it must not be that bad or that perhaps treatment could improve the situation.
The key is to be currently under treatment for the disabling condition; for the doctor to say you aren’t going to get any better, and for the doctor to say that the condition prevents you from working any job.
You can apply for Social Security Disability without a lawyer. Many hire a lawyer to pursue the appeal to an Administrative Law Judge. The key is to be prepared. When you meet with a lawyer or a Social Security Representative, have the medical records handy which show that you are under treatment for the disabling condition and why it keeps you from working.
For the Social Security Disability cases where you claim an injury that has worsened over the years, claimants generally need to make 15 years of medical records available. If you have a sudden catastrophic illness (generally an SSI case), medical records are not needed going back 15 years.
72% of Social Security Disability recipients are in the 50-66 age range, and only 28% are under 50. If you are under 50, the odds are against you. Many times, if you are getting close to the age at which you qualify for Social Security income, the denials of Social Security Disability don’t get reversed until you are close to 62.
What is the difference between SSDI and SSI Disability?
SSDI disability means you are disabled and have made enough payments into the Social Security fund by payroll in the workforce to qualify you for benefits. SSI is when one has a severe disability but has not paid into the system sufficiently; for instance, an 18-year-old who has never held a job and paid into the system but has a severe disability. SSI is based on pure need. SSDI requires disability, plus the person has paid into Social Security as a worker for a sufficient number of quarters.
It is rare for one to get social security disability on an initial application. An appeal process can take years. Many are denied, then apply a second or third time and eventually get the disability. It is a tedious, time-consuming process. Most folks who get SSD get about $1250 a month.
The bottom line is the disability must be severe, and you must be unable to do nearly any job available in the economy.
Marty wrote this article in his capacity as Director of Legal Services at GraceMed and the original article is at gracemed.org