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.
Friday, January 24, 2020
Thursday, January 23, 2020
"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.
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
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.
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
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
Wednesday, January 22, 2020
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:
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.
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.
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