YOUR DISABILITY DECISION IS PROBABLY WRONG

There is a 50 percent chance Social Security made a mistake on your disability application.  

Here are some of the common "errors" or misjudgments that I see on SSDI claims in Alabama:

1.  They don't get all of the medical records.  

2.  They assign an overly optimistic job functional rating.  For example, they say you can do light work when you're really limited to sedentary work.

3.  They don't give enough weight to emotional or psychological impairments, such as anxiety, depression, panic attacks, etc.

4.  They ignore your doctor's opinion.  

5.  They assume that because you can do some activities of daily living that you can work.  I see denials that say something like:  "You are able to walk, shop for food, care for your child and do most activities.  Therefore, you are able to adjust to some types of work."

Activities around the house are different from activities at work.  For one thing, no one is making demands of you.  If you don't get enough done around the house, you aren't going to be fired.  For another, you can stop and rest from your household activities whenever you need; you cannot do that on the job.  If you wake one morning with a roaring migraine, you can stay in bed.  Not true if you're trying to hold down a job.

The appeals process is where mistakes get fixed.  It's important to talk to an attorney or disability advocate if your SSDI case gets denied. 

Almost half of SSDI denials are overturned and paid on appeal.

This assumes that you have adequate representation by someone who understands how to handle an appeal.

Therefore, the 3 most important things you can do when your claim is denied are:
1.  Appeal
2.  Appeal
3.  Appeal 

 

 

DISABILITY APPLICATIONS: THINGS TO DO

Applying for disability in Alabama?  Put these on your Things to Do list:

1.  Fill out the Function Report form carefully with emphasis on the everyday activities you now have trouble with.

2.  Fill out the Work History Report completely, not just the first page which lists your job titles and dates of employment.  The following pages which estimate your various job related activities are very important, especially if you are age 50 or over.

3.  Talk to your doctor.  Ask if he/she will provide a Residual Functional Capacity estimate for you.  If so, get it done and send it to Social Security very early in the process.  Keep a copy for your records.  This increases your odds of early approval more than anything else you can do.

4.  Attend any examinations Social Security schedules for you.  Arrive on early and be cooperative without trying to "sell" the doctor on the fact that you are disabled.  The doctor isn't the one making the decision. Take your medications or at least a list of them.

5.  Call your disability specialist at the Disability Determination Service about 3 weeks into the process to be sure they are getting your medical records.  If some doctors or providers are being slow about providing records, call the doctor's office and ask them to send in your records.

Remember that up to 80 percent of disability applications are denied, routinely.  This doesn't mean that you are not entitled to benefits; it means the system is very flawed and gets it wrong more often than not.  An appeal is the way the system corrects its mistakes, so appeal, appeal, appeal.

___________
The Forsythe Firm
Social Security Disability Counselors and Advocates
7027 Old Madison Pike, Suite 108
Huntsville, AL 3586
CALL US  (256) 799-0297

Email Us:  forsythefirm@gmail.com

https://forsythefirm.wixsite.com/website

APPLYING FOR SSDI IN ALABAMA

Alabama has thousands of new SSDI claims each year.  In 2020, about 80 percent of the disability applications will be denied and claimants must appear before a judge to be approved.

Appearing before a judge sounds like you've been accused of a crime.  And sometimes the process can make you feel that way.  It shouldn't.  

When you apply for SSDI in Alabama you are asking for insurance benefits that you have paid good money for over many years.  Roughly 15 percent of your earnings have gone to Social Security each week you have worked, year in and year out.  Now, you are asking Social Security to pay a benefit that they promised to pay when they forced you to sign up for their insurance (the day you began working)!

Why is getting your SSDI benefit not a straight forward, simple process?  For several reasons:

1.  You're dealing with the government; nothing is simple.
2.  The definition of "disability" is very, very strict.
3.  The program is short of personnel and over burdened.
4.  Paperwork is endless and confusing.
5.  Some people try to scam the system; no one is trusted.

So, what's the SSDI process like if you live in Alabama?  First, you file an application, which isn't as simple as it sounds.  Then, Social Security mails you a ton of additional forms to complete and return.  Then, they may send you for an examination by one of their doctors.  You will probably be denied.  Then, you file a request for "Reconsideration," which is a joke because 98 percent of these applications are also denied.  Next, you file another appeal and wait up to a year to get a hearing before an administrative law judge.

The administrative law judge will finally listen to your case, hear the arguments of your lawyer, and issue a new decision.  About 45 percent of claimants that go before a judge will receive benefits.  

At the Forsythe Firm, we try to simplify the SSDI process as much as possible and help our clients with forms, medical evidence and hearings.  We will go to the hearing with you and do everything we can to get you approved and paid.

Where do you start?  Why not call us for a free, no obligation consultation.  We can talk to you over the phone or set up an office consultation.  There's never a charge to speak with us and we will never ask you for money until after you have been approved.
___________
The Forsythe Firm
Social Security Disability Counselors
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
CALL (256) 799-0297

SOCIAL SECURITY JUSTICE

THOSE WHO EVENTUALLY WIN DISABILITY PAY....

"Those who eventually win disability benefits from Social Security are those who never ever, ever, ever give up...!

The usual course of disability cases these days is at least two denials, a hearing, and then perhaps--victory.

The initial Application results in denial about 75 percent of the time.  Appeal.

The "Reconsideration" process results in denial about 98 percent of the time in Alabama.  Appeal.

The Hearing will be successful about 45 percent of the time in Alabama.

Social Security depends on hearings by Administrative Law Judges to correct oversights and mistakes made by decision makers in the earlier processes.  If you fail to appeal, you are not giving the system the chance it needs to correct its faults and give you a just verdict.

I speak to hundreds of persons on the phone each month.  I am amazed at the folks who get denied then file a new application, get denied, then file a new application....  This doesn't give the system the chance it needs to correct itself in the appeal process.

If you have been denied Social Security disability benefits within the past 60 days, do yourself a huge favor:  call an experienced attorney or advocate and talk about appealing your case in the most favorable way possible.  It could be the best call of your entire life.  What's more, it will most likely be a free call - because you cannot be charged for this call.

WILL SOCIAL SECURITY KEEP CHECKING ON YOU?

Do you mean that Social Security will keep checking on me after I am approved, to be sure I am still disabled?

Yes, they most likely will.  It's called a Continuing Disability Review, or CDR.

How often you will be reviewed in the years ahead depends largely on two things:

1.  Do you have a medical condition which is likely to improve in the future?  If so, expect reviews.

2.  What is your age?  Individuals under age 60 will get reviewed more often than older individuals.

Some beneficiaries will be reviewed every 2 years.  Others may get checked every 3 or 4 years until they reach a certain age.  You will be notified when your disability case is being reviewed.

What does Social Security look for in a CDR?

They are checking to see whether you still meet the federal requirements to receive a disability benefit.  If you have made significant medical improvement and no longer meet the eligibility requirements, you will be notified that your benefit is going to stop. This decision is subject to appeal.  However, if you elect to continue receiving benefit checks during the appeal and you eventually lose the appeal, Social Security will want their money back.

How can you prepare for a Continuing Disability Review?

The best advice is to continue seeing your doctor regularly.  Keep taking your medications and following medical advice.  How often you visit your doctor is between you and your doctor.  The point is, don't start skipping doctor's appointments, stop treatment or drop off all your medications unless you are advised by your doctor.  Discontinuing medical treatment is often taken by Social Security to mean that you are much improved.  Whether this is true or not, you lose your evidence to prove continuing disability without doctor's treatment records.

What is the surest way to trigger a quick review?  Start working and reporting wages to Social Security.  Keep in mind that every dollar you earn must have FICA tax withheld by your employer.  Each quarter, or each month, your employer must report your wages and submit the FICA withholding to Social Security.  This automatically reports your earnings.  So, there's no such thing as working a legal job without it being reported.  While you may be allowed to work a minimal amount while you receive SSDI benefits, be careful to keep your earnings below the threshold you are allowed to make.  If not, a CDR will soon be coming your way.  And, even if you continue to medically disabled, earning too much in work-related income will still stop your check.

DISABILITY PAYMENTS FROM AN EMPLOYER

Some employers offer their workers group disability benefits at work.  It's a great thing to have.

First, understand that these employer sponsored disability benefits do not prevent a person from applying for Social Security disability.  

There are 3 tremendous benefits of having your own group disability program:

1.  Your employer's plan can begin paying you much quicker than Social Security.  Some people wait 6 months to 4 years to get SSDI started but the insurance company may start your pay in a month or so.  In short, you can probably get money from the insurance company while you wait months, or even years, to get Social Security.

2.  Your plan can pay you more than Social Security.  While most insurance plans reduce their benefits once Social Security disability starts to pay, they still might pay a benefit over and above the Social Security benefit.

3.  It is very likely that the definition of "disability" is more generous in the insurance company policy than it is with the Social Security Administration.  It is very possible that it will be easier to get approved by the insurance company than by Social Security.  

If you are fortunate enough to work for a company that offers a disability insurance policy, you should consider becoming enrolled or "covered" by it now, while you still can.

There's an old saying about insurance:  You can't buy it when you need it.

WHAT IS A 5 MONTH WAITING PERIOD FOR SSDI?

The term "waiting period" confuses many people.  The simple truth is, Social Security disability does not pay the first 5 months of disability under SSDI.

An insured person must wait 5 full months before receiving the first disability benefit check.

EXAMPLE:  Social Security finds Mr. Claimant to have become disabled as of 2/6/19.  His waiting period is taken up by the months March - July.  He will first be eligible for a benefit in August.

However, Social Security pays the August benefit the following month.  So, Mr. Claimant's first check will arrive in September.

Mr. Claimant will go from February 16, 2019 to September 2019 without a benefit check.  

This is why I encourage people to have at least six months of savings set aside.  Social Security will not send a check for at least 6 months, and that assumes everything goes smoothly and they approve the application right away (which seldom happens).  There is no "emergency fund" with Social Security, even if the mortgage is past due or the car is being repossessed.

If a disability strikes, it's important to file an application for benefits right away.  The process is slow to begin with and you can't afford to wait any longer than you must.

Can a lawyer or someone speed up your benefits?  No, unfortunately not, because if everything happens just like it is supposed to, it will take about 6 months.  If something goes wrong, let's say you get a denial, it can take much longer.

I recommend each individual who is working talk to a banker or financial adviser.  Determine how much savings should be set aside each week or each month to accumulate enough savings for emergencies, such as sudden disability.

Saving is tough and requires a lot of discipline.  Most of us aren't good at it.  Start with a little and set it aside every payday.

TECHNICAL MATTERS THAT KILL CLAIMS

Sometimes technical matters prevent disability claims from being paid.  These are matter-of-fact, objective facts that render a claim ineligible for SSDI or SSI benefits.

What are some of these technical problems?

1.  You don't have enough work credits to be covered by SSDI.  In short, you haven't worked and paid enough into Social Security to be covered by the disability program; you are uninsured.  If you haven't worked recently, the problem may be that your work was too long ago and your work credits have expired.  

2.  You waited too long to file an appeal.  In most cases, only 60 days are allowed for filing an appeal on a denied application.  If you wait too long, an administrative law judge will dismiss the appeal because of an untimely filing.

3.  You are still working at substantial gainful activity on the date you allege disability.  In 2020, earnings of at least $1,260 per month will disqualify an individual from getting benefits because of work.  In 2019, that amount was $1,240 per month.

4.  Your disabling impairment does not meet the duration requirement; that is, your condition isn't expected to last at least 12 straight months OR to end in death.  Social Security does not cover short term disabilities which last fewer than 12 consecutive months.

If you feel a mistake has been made in your denial, the way to fix it is to file an immediate appeal.  If your work credits are involved, you may be able to check your work credits through the Social Security office.

No matter how many times you call Social Security and discuss your problem with your denied claim, the only sure way to protect your rights under the claim is by filing a formal, written appeal within 60 days of the denial.

Never let 60 days pass without filing an appeal.  When in doubt, appeal first and discuss later.

BEFORE APPLYING FOR SSDi: 3 THINGS TO DO

It may be time for you to apply for Social Security Disability benefits (SSDI).  The government may pay you a monthly benefit for the disability which prevents you from working.

There are 3 things you should do before applying for disability:

1.  Check Your Earnings History.  Most individuals need at least five years of recent work history (within the past ten years) to be eligible for SSDI.  If you don't have the required work history, your benefits are at risk even before you apply.

2.  Talk to Your Doctor.  You will need strong medical evidence to support your claim that you're unable to work.  Your doctor can help you by placing detailed information in your medical charts.  Each time you go to the doctor, tell him or her that you are thinking of filing for disability and tell them why.

3.  Check with a Social Security Disability Attorney.  You may or may not decide to hire an attorney/representative right now.  However, the information you can gather with a free phone call may be invaluable and help you avoid costly and time killing mistakes. Be sure to choose a representative who is knowledgeable and experienced in Social Security disability; not everyone is.

JUDGE'S QUESTIONS AT YOUR HEARING

A disability hearing is a fact finding venture designed to help the administrative law judge make a fair, new decision on your request for benefits, which has been denied previously.

The judge's questions will focus on 5 areas:

1.  Personal Information
2.  Work History
3.  Medical History
4.  Medical Treatment
5.  Daily Activities

As for daily activities, here are some things the judge will probably ask:

• How do you spend an average day?
• Do you have any hobbies?
• Are you able to dress and bathe yourself?
• Do you prepare your own meals?  If not, who does?
• Do you take care of your child(ren)?
• Can you shop?   Clean your house or apartment?  Do your laundry?
• Are you able to climb stairs?
• How long can you sit?  Stand?  Walk?
• Any problem with kneeling or stooping?
• Do you drive?
• Have you taken an out of town vacation in the last 2 years?  Where?
• Do you smoke or drink?
• Have you ever used any street drugs or recreational drugs?
• Are you able to read and do simple adding and subtracting?  Make change?
• Have you looked for any work since your last job?  Why not?

Keep in mind that the judge usually knows the answers to questions before he asks.  It is absolutely imperative that you answer truthfully and without evasion.  

One of the most important things you can achieve at your hearing is to come across with credibility.  That is, the judge feels that he can believe what you have said.

EARLY RETIREMENT BENEFITS AND SSDI

If you are at least age 62 you can receive early retirement benefits from Social Security and also apply for disability or SSDI.

However, you will receive reduced retirement benefits prior to your full retirement age.  For persons born between 1950 and 1955, full retirement age is 66.  That means you can receive retirement benefits with no reduction when you reach 66.  Reduced benefits are available beginning at age 62.

Can a person who is at least age 62 receive early retirement benefits and apply for disability at the same time?  Yes.  You can apply for disability benefits any time before reaching your full retirement age.  You can receive your early retirement benefit while a decision is being made on your disability application.

If your disability application is approved, your monthly benefit will be increased to the amount of your full retirement benefit, starting with the onset date of disability.  This may involve some back pay.

If your disability application is denied (never approved), you will continue to receive the reduced early retirement benefit for the remainder of your life.  You may receive periodic cost of living increases.  When you reach your full retirement age, however, your benefit will not increase because you began taking it early, so the reduced benefit is "locked in."

In summary, receiving an early retirement benefit really has no impact on a Social Security disability application.  The disability application will be processed just like it would if you were not getting early retirement benefits.

There is no disability benefit available after you reach full retirement age because you are already receiving the maximum benefit.

YOUR HEARING: SOME STATEMENTS TO AVOID

 Most disability applications are denied and the claimant must wait a year or longer to get a hearing before a judge.  At the hearing, you will be asked a lot of questions.  It is in your best interest to answer truthfully, give details, avoid rambling or getting off subject and be as specific as possible.

Unless, you are asked, there are some topics that you shold avoid altogether:

• You live in a region where no jobs are available at this time.
• You have family members who are currently receiving disability payments.
• You can't get to work because you don't have transportation or can't drive.
• You have a criminal background
• You have failed to follow the instructions or orders given by your doctor
• You have failed to take the medication prescribed by your doctor
• You haven't really tried to get recent medical treatment.
• You have had problems with alcohol or drugs
• You quit your most recent job for a non-medical, non-disability reason.
•  You believe there are some jobs you could do if you could only find one.
• You are more entitled to a benefit than many other people who are getting one.

The judge will want you to speak in terms of how your medical condition prevents the ability to do work related functions.  How does your condition keep you from sitting, standing, walking, lifting, paying attention, using your arms, feet or hands, etc.

It is not necessary for you to address your conditions in medical or diagnostic terms.  The judge has your medical records and knows all of your conditions and diagnoses.  Don't bother to tell the judge that you have spinal stenosis, degenerative disc disease or type 2 diabetes, for example.  Talk about how your conditions affects your ability to do things you would have to do at work:  stand, walk, lift and carry, reach above your head, or stoop/bend.

One of the things your attorney will do for you is meet with you in advance of the hearing and prepare you to testify.  That way, you go into the hearing knowing what to expect.



 

4 THINGS SOCIAL SECURITY CONSIDERS

According to the federal regulations, there are 4 things that Social Security must consider when determining whether a person is disabled under their rules:

1.  RESIDUAL FUNCTIONAL CAPACITY (RFC):  What is the maximum that a person is able to do in terms of work-like activity or function?  This is based on medical evidence. The most restrictive RFC is sedentary work.

2.  PAST RELEVANT WORK (PRW):  What full-time work has the claimant performed in the past 15 years.  This is especially important to claimants who are at least 50 years old.  SSA will consider skill level and exertion level of all past relevant work.  If a person has done skilled work or sedentary work, it may make approval more difficult.

3.  AGE:  The most difficult age category for approval is "younger individuals," those who are below age 50.  Social Security assumes that persons under age 50 can more easily adapt to new or different kinds of work.  Ages 50 - 54 fall "in between" in a category of "Approaching Advanced Age."  Claimants age 55 and over are in the "Advanced Age" category, which gives them the greater advantage of the medical-vocational guidelines or "grid rules," as they're sometimes called.

4.  EDUCATION:  Social Security will consider how much education a claimant has and how it effects the ability to work.  Generally, the more education a person has, the more likely he/she will be to adapt to new types of work.

So, the "perfect" claimant (if there is such a person) would have an RFC limited to sedentary work, would have past work at the heavy or very heavy RFC, would be at least age 55 and have a limited education.

On the other hand, the most difficult case would involve a person under age 50, who can perform medium to heavy work, has an advanced education, and who has performed sedentary, highly skilled past work (with transferable skills).

Of course, almost nobody meets all of the favorable characteristics.  Most claimants will meet one or two of them, not all 4.  Some claimants don't meet any of the 4. 

What's the best advice for someone thinking about Social Security disability?  It's best to talk to a Social Security attorney or representative to get a free case evaluation. That can give a pretty good idea of the odds of meeting the basic requirements.  There is never a charge for this service. 

WHAT "DISABILITY" MEANS TO SOCIAL SECURITY

In reality, the term "disabled" doesn't mean anything to the Social Security Administration.  It's a term used by individuals, doctors and lawyers but not used by Social Security, as surprising as this may sound.

Everyone who files a claim with Social Security believes they are "disabled."  This doesn't mean that they will qualify for a benefit.

So, what is important to decision makers at Social Security?  

They want to know whether a person has the capacity to perform any type of full time work which is available in the United States economy.  For individuals under age 50, this usually means "Can you perform even a simple, unskilled minimum wage, sedentary job on a full-time basis?  If so, they won't pay benefits.

Here are some common things that do not qualify for benefits:

• I am working but I'm not really "able" to be working.
• I can't perform my past work, but I can do other work.
• Nobody will hire me.
• There are no jobs available where I live.
• I can't live on the minimum wage job I could get.

Federal regulations require that a claimant meet very specific requirements to get a benefit.  Social Security requires proof in a form acceptable to them.

In fact, benefits are getting more difficult to get with every passing year.  Award rates have fallen by about 20 percent since 2010 and will probably continue to fall in the future.

One of the best services a disability attorney or representative can perform is to evaluate a case to see if the basic requirements are met.  Our office will perform this evaluation free of charge.  

ARE YOU DISABLED? CHECKLIST

Is it possible that you meet the requirements for Social Security disability checks?  This checklist may give you a better idea:

___ Are you now unable to work due to a medical condition?

___ You are not currently working.

___ Have you been/will you be off work 12 mos. or more?

___ Are you receiving current medical treatment?

___ Are you under full retirement age (66 for most people)?

___ Have you worked at least 5 out of the past 10 years?

Of course, answering these questions does not guarantee anyone that they will be approved for disability.  However, if you answered all of these questions in the affirmative, you may meet the basic requirements and should explore a claim further.

"CAN MY DOCTOR PUT ME ON DISABILITY"?

Doctors do not have the power to put a person on disability benefits.  The decision as to who is disabled is reserved to the Commissioner of Social Security; this decision is usually made by administrative law judges.

However, your doctor does play a couple of vital roles in the consideration process:

1.  Your doctor provides medical records which establishes your diagnoses, symptoms and treatments.  Doctor's records can establish that you have a medically determinable impairment.

2.  Your doctor may provide an opinion regarding how your symptoms limit your ability to perform work related activities.  This opinion, in turn, may help Social Security to decide that you are disabled.

The final decision about whether a person is entitled to benefits, however, rests with Social Security, not with the doctor.

It is always best for the doctor to address functional limitations, not an opinion as to whether a patient is disabled or "able to work."  

I always try to get a treating physician to render an opinion on such things as how long an individual can sit/stand/walk,  how much he/she can lift and carry, and if there are restrictions on the use of hands, etc.  It may also be useful to get an opinion on how often a person will need a break during an 8-hour workday or whether a person is impaired at understanding or carrying out simple instructions.  There are quite a few other limitations I will ask the doctor about and they are very specific.

WHICH IS BETTER: SSDI OR SSI?

SSDI, or "Social Security Disability Insurance," insures workers who become disabled and lose their income prematurely (before retirement age).  

SSI, or "Supplemental Security Income" is not an insurance program; instead, it is an assistance program for aged or disabled individuals who have very little income or financial resources and need help meeting minimum living expenses.

SSDI usually has the higher monthly benefit.  It pays a monthly benefit based on the recipient's lifetime earnings, up to a maximum of $3,011 per month.  The average benefit in 2020 is around $1,250.  Also, there are no limits to income or financial resources to receive SSDI.  Therefore, I consider this to be the stronger, better of the two programs if an individual can qualify.  SSDI does require a claimant to have worked enough and accumulated a sufficient number of work credits to be covered or insured.  Individuals who haven't worked in several years may not be covered or "insured" for SSDI benefits.

SSI pays a maximum benefit of $783 per month.  This benefit can be reduced by other income, savings, certain other financial assets or even living arrangements.

The medical requirements for SSI and SSDI are the same:  a person must be unable to work based on a severe medical impairment that is going to last at least 12 straight months.  As mentioned, SSI imposes certain additional financial requirements or limitations.

SSDI comes with Medicare coverage after 29 months of continuous disability.  SSDI comes with Medicaid, which is effective almost immediately (no waiting period).

Thus, the two programs are different and are structured to serve different recipients.

If an individual has the work history to support it, I recommend filing for SSDI.  An application for SSI may also be considered in some circumstances.
_________
The Forsythe Firm
7027 Old Madison Pike NW
Suite 108
Huntsville, AL 35806

Call Us:  (256) 799-0297

SOCIAL SECURITY JUSTICE 

DO I GET MEDICARE OR MEDICAID?

When a person qualifies for a disability benefit through the Social Security Administration, it comes with either Medicare or Medicaid coverage.  Which one depends on the type of claim.

Medicare comes with Social Security Disability Insurance (SSDI).  This is the normal program where a worker has paid into Social Security over the years through payroll deduction.  There is a 29-month waiting period for Medicare to begin.  That is, it starts 29 months after the onset of disability.  For example, if a person is found to have become disabled on June 1, 2019, Medicare begins 29 months later (regardless of how long it took to get the case settled).

Medicaid comes with Supplemental Security Income (SSI), a different type of program.  SSI is a needs based program for aged or disabled persons who have restricted incomes and financial resources.  There is no waiting period for Medicaid. Coverage begins the next month following an approved application.  For example, Mr. Claimant filed an application for SSI in February, claiming disability as of February 10th.  The application was approved in May.  Medicare would be retroactive to March (the month after the application was filed).

In some cases, a claimant may get both SSDI and SSI benefits.  In these situations, the individual may get both Medicare and Medicaid.  This would be possible when a claimant has very low income, gets a very small SSDI benefit, and qualifies for a supplemental SSI payment.

DISABILITY ONSET DATE

The Disability Onset Date (DOD) is the date that the claimant has met the evidentiary requirements to prove "disability" as defined by the Social Security law.

This date is important for two reasons.  One, if the onset date is after the claimant's 50th birthday, Medical-Vocational Guidelines may mandate a finding of disability and payment of benefits.

Second, if the DOD is after the claimant's "Date Last Insured," the claimant is not insured by Social Security and is not entitled to a benefit no matter how disabled.

Another reason for accurately establishing the Disability Onset Date is that it directly affects when Social Security begins to pay benefits.  Earlier DODs get larger back pay checks and earlier access to Medicare health insurance.

To avoid confusing my readers, I will tell you that Social Security uses other names for the Date of Disability, including:

AOD:  Alleged Onset Date - the date the claimant alleges to have become disabled; however, this date has not been proven yet.

EOD:  Established Onset Date - the date Social Security has accepted as the office date the disability began.  In other words, the date which has been proven.

So, in any disability application or hearing, there are two major points to prove:  One, that the claimant meets the rules for disability and, two, the date on which the claimant first met the rules.
_________
The Forsythe Firm
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
CALL (256) 799-0297

WHAT IS SSDI?

SSDI stands for Social Security Disability Insurance. Since 1956, the US government has required most workers to contribute to a mandatory disability insurance plan administered by the Social Security Administration (SSA).

 Workers contribute approximately 7.65% of their income (listed as FICA tax on your pay stub) and employers match that amount.  The money goes into a trust account under each worker's Social Security number. A worker must accumulate a certain number of "quarters of coverage" based on payroll deductions to be covered by Social Security (SSDI). Then, if a disability occurs, the worker can apply for disability benefits.  If the worker can meet the strict medical definition of "disability," benefits will be paid.

The problem is, relatively few people meet that definition.  It may take months or years to convince Social Security that you are "disabled" according to their rules, even if you are.
What Are Basic Medical Requirements for Disability?  

Assuming a person has worked long enough and recently enough to be covered, here are the basic rules for getting SSDI benefits:

• has at least 1 severe impairment that is medically determinable (provable)

• the impairment will last a minimum of 12 consecutive months 

• the impairment is severe enough that the claimant has stopped working full-time and is not expected to go back to work for at least 12 months (called the "duration requirement").

Typically, in Alabama, a claimant must file an application followed by 2 appeals to get benefits started.  It is rare to get approved simply by filing the application.

Most people end up hiring an attorney to help them through the complicated appeals process.  Those who eventually get paid are those who "stay the course" and follow the appeals process as far as it takes.

ALABAMA APPLICATION STAGES & APPROVAL ODDS

Alabama has a prescribed order in which disability applications and appeals must be filed.  Part of the strategy to win is simply to file the correct application and stay the course.  

Here are the prescribed actions to file, and our estimate of the "chances" of success at each stage, based on average numbers:

1.  File a New Application

File a new application and wait 90 to 120 days for an initial decision.  On average, your odds of being approved at this first stage are less than 30 percent (3 out of 10).  The majority of claims are denied.  The proper next step is to file an appeal, which is to ask for Reconsideration.

2.  Appeal and Ask for Reconsideration

You ask for Reconsideration by filing a written appeal.  This takes your case back before the state's Disability Determination Service (DDS) for a second look.  They basically check over their work to see if the denial was correct.  They deny again in almost 98 percent of cases.  So, what does "Reconsideration" accomplish?  It sets you up for the next appeal, which takes your cases before an administrative law judge (ALJ).

3.  Appeal and Ask for a Hearing

This appeal is a request for a hearing before an administrative law judge (ALJ).  If your case is properly prepared and you are represented by a good lawyer, your odds at the hearing level are the best of anywhere in the entire process:  about 45 percent, based on averages.  It can take several months to get before a judge; however, the best advice is to stay the course and follow the appeal process.

4.  Appeal to the Appeals Council (AC)

While many people consider the hearing before the ALJ to be the "last appeal," this is actually not the case.  If the ALJ gives you an unfavorable decision, you may appeal to the Appeals Council.  The AC will refuse to review about 80 percent of appeals, leaving the ALJ's decision standing.  However, in about 13 percent of cases, the AC will remand the case back to the administrative law judge for a new hearing.  This occurs when the Appeals Council feels there is some technical issue of law that the ALJ needs to consider or more fully develop.

5.  Federal District Court Appeal 

This is a level of appeal only used by about 1 percent of all claimants.  But if the Appeals Council does not provide a favorable decision, you may file a suit against the Commissioner of Social Security in federal district court in your state.  You must have the assistance of an attorney for this.  As stated, 99 percent of Social Security cases never reach this level.

A Word About Deadlines for Appeal

The normal deadline for filing any appeal in a Social Security case is 60 days, plus 5 days for mailing time, making a total of 65 days.  There are exceptions; however, any appeal should be filed within this strict deadline.  If you wait too long, an appeal will not be possible.

DISABLED VETERANS AND SSDI BENEFITS

According to the United States Census Bureau, almost 3.8 million US Veterans currently experience some form of disability. Of these, around 1.1 million have a VA disability rating of 70% or higher, meaning their condition prevents them from working.

During their years of military service, personnel paid into the Social Security disability insurance program (SSDI).  Therefore, SSDI benefits may be available in addition to VA benefits.

VA benefits provide monthly payments based on the degree of disability, from 10 percent to 100 percent.  However, Social Security or SSDI pays a benefit to individuals who are totally unable to work.

SSDI must be applied for separately; it does not automatically come with VA benefits.  The process is quite different.

Once approved, however, SSDI may add a substantial amount of money to the veteran's monthly disability benefit.  In some cases, the SSDI benefit may be as much as the VA benefit, if not more.

Here is a question we often get:  "Will receiving SSDI benefits reduce or delay my VA benefit in any way?"  The answer is no.  SSDI benefits are strictly in addition to any VA or military benefit, whether retirement or disability.

Veterans who have a VA disability rating of 70 or higher should immediately apply for SSDI benefits.  If denied, the decision should be appealed within 60 days because many SSDI cases must be appealed before they can be paid.  It's just the way the system works.

The Forsythe Firm provides free case evaluations and consultations, with no obligation. 

Although VA benefits are designed to provide monthly supplements in proportion to your disability, some veterans with severe conditions require extra assistance. In this case, Social Security disability benefits may be an option. Veterans can qualify for both VA benefits and Social Security disability insurance (SSDI).

Continue below to learn how you may qualify for SSDI while receiving VA benefits.

WHAT IT TAKES TO GET DISABILITY BENEFITS

The following are required before you can be approved for disability benefits.

SEVERE IMPAIRMENT - 

This is a medical condition which is severe enough to case a loss of function in at least one area of work related activity.

DURATION REQUIREMENT

You must have at least one severe impairment which has lasted, or is expected to last at least 12 straight months OR is expected to end in death.

INABILITY TO WORK

For persons under age 50, you must be unable to perform any type of full time work; this includes an entry level, unskilled minimum wage job at the sedentary level.

3 THINGS TO HELP YOU GET SSDI BENEFITS

While getting Social Security disability benefits is never going to be easy, here are 3 things you can do to increase your chances for approval.

1.  Update Your Medical Information 

Social Security always bases their decisions primarily on what is contained in your medical records.  When completing your application, be sure to list and provide the full address for every doctor, clinic, hospital, psychologist or other medical provider you have seen for any long-term medical condition.  Social Security obtains medical records only from the medical providers you list on the application.  If you omit a doctor, hospital or other provider, the records are not obtained.  

2.  Have Your Doctor List Specific Restrictions

Most doctors use a standard form for recording patient information.  There are 4 categories on most of the reporting forms that doctors use:

• Complaints
• Examination
• Diagnosis
• Treatment

There is no space on most doctor's forms to note restrictions of daily activities or limitations in work related activities.  In short, the doctor usually will not make a record of what you can and cannot do functionally.  For example, he or she will not state that you cannot lift more than 10 pounds, reach overhead or stand more than 1 hour at a time.  It takes an effort on the patient's part to get this information into the doctor's records.  But this is exactly the type of information Social Security wants when deciding whether you qualify for disability benefits.

If your records do not contain restrictions, you may ask your doctor to list your restrictions by providing a Medical Source Statement (form) or a Residual Functional Capacity opinion (form).

3.  Hire a Laywer 

In 2012, the Social Security Advisory Board found that people who hired an attorney to help them with their initial application were more likely to be awarded benefits.  A Government Accounting Office study in 2003 determined that people represented by an attorney at their hearing were more likely to win their case.  It just makes sense that a professional who is trained in Social Security regulations and who has handled hundreds of hearings can be expected to add value to a hearing.  Of course, having an attorney or representative never guarantees the outcome of an application or a hearing.  But you are looking at increased odds, not guarantees.

3 SETS OF DISABILITY RULES BASED ON AGE

How difficult is it to get Social Security disability?  That depends to a large degree on age.  As I've mentioned in earlier posts, Social Security has 3 sets of rules, based on the claimant's age.  While age is the big factor, they also consider the following additional factors:

• past work experience, including
• transferable skills
• education
•  residual functional capacity (level of exertion you can do)

While the medical-vocational rules or "grid rules" are complex, here is the gist of what they will direct.

Ages 18-49.  The grid rules do not apply to these "younger individuals."  It doesn't matter whether these claimants can perform any of their past relevant work or not.  Even if they cannot perform any past work, they must be unable to perform "any other work," which includes sedentary, simple, unskilled, entry level or minimum wage jobs.  In other words, if a younger claimant cannot do any past job but can change to a very simple, entry level job as a copy machine operator, a finding of "not disabled" will be entered.  In short, there must be no job in the US economy that this person is capable of performing.

Ages 50 - 54.  This is a borderline age category called "Closely Approaching Advanced Age."  If a claimant has less than a high school education, no work history or only a history of unskilled work, and is limited to Sedentary exertion, the grids find him disabled.  However, this same individual, if able to perform work at the Light exertion level will be found not disabled, as long as he can communicate in English.

Ages 55 or Above.  Generally, if this individual is unable to perform any of his/her past relevant work, a finding of disabled will be entered.  In short, an older claimant is not expected to adapt to new work and, if required to do so, will be judged disabled.  

I have simplified the grid rules tremendously here in order to give a very general idea of how they work.  You should consult with a disability attorney about your case to see exactly how the rules may apply to your particular circumstances.  Every case is different because no two sets of facts are exactly the same.

IS IT TIME TO FILE FOR DISABILITY?

Filing for disability benefits is a last resort.  An individual should file for disability when it becomes evident that they are either never going to be able to work again or that they will be unable to work for at least 12 straight months.  When I speak of "work," I'm using the term to mean a full-time job of around 40 hours per week.

Unfortunately, there come times in our lives when we know it's time to file for disability benefits.  Some of those times or events include:

• You have a major health crisis which will prevent you from working for a year or more: 

• Your doctor tells you that it's time to file for disability.

• The doctor has diagnosed you with a terminal condition.

• Your doctor states you have reached "maximum medical improvement" and you still can't work any job.

• You have tried easier jobs but have not been able to sustain even lighter work.

• You can't think of an easy, sedentary unskilled job that you could perform 40 hours a week.  (Not "find" this type of job, "perform" this type of job).

I'd be remiss if I didn't say that there are really 3 sets of rules for Social Security disability.  One set is for younger individuals ages 18 - 49.  One set is for individuals ages 50 - 54.  The final set of rules applies to persons ages 55 and over.

18 - 49     You must prove that you are unable to perform                      even unskilled, sedentary, minimum wage jobs.

50 - 54      You probably must prove the same standard above; however, some claimants may only have to prove that they can't perform any of their past work.

55+           You need to prove that you cannot perform any of the jobs you've held within the past 15 year-period.

ADDING NEW EVIDENCE FOR DISABILITY

Many people make the mistake of not adding new evidence as they wait for their disability hearing.  

Some claimants believe that once they file their appeal, all they need to do is wait until the hearing date arrives.  Actually, there is a lot more that must be done.

A claimant who is seeing a doctor or other healthcare provider on a regular basis is accumulating medical evidence constantly.  Each time you see a doctor, you have created new medical evidence.  This evidence needs to be submitted to the Social Security decision maker.  

New evidence can and should be submitted right up until the hearing date to keep the file up to date.  Failure to do so may result in a denied claim or a postponed hearing while the judge waits to get the new evidence.

If You Are Represented

If you are represented, your attorney or representative is responsible for updating your medical evidence.  Notify your representative each time you see a new or different doctor/provider, have a major diagnostic test, such as MRI--have surgery or are hospitalized.  Your representative can only order records you make him aware of.  

If You Are Unrepresented

If you are unrepresented, you must keep your medical file updated yourself.  Don't depend on Social Security to do so.  You should take the following steps:

• Notify the Office of Hearings Operations (OHO) of each new doctor or provider, along with dates of consultation.
• Notify the OHO of any hospitalization, surgery, or major diagnostic testing, such as X-rays, MRI or CT scans.
• Tell the OHO if you are diagnosed with any new conditions after you filed your last update.

In short, you must keep Social Security advised of how your medical condition and treatment is changing so they can keep your medical records updated.  They order records only from the doctors/providers you tell them about.  They have no way to "automatically" update your medical records.

______________

The Forsythe Firm

Representing Social Security Claimants in Alabama

7027 Old Madison Pike, Suite 108

Huntsville, AL 35806

CALL US:   (256) 799-0297

Email me:  forsythefirm@gmail.com

WEBSITE: SOCIAL SECURITY JUSTICE