WHO ULTIMATELY DECIDES DISABILITY CASES?

Most Social Security disability cases are ultimately decided by a federal administrative law judge (ALJ).

   
A hearing, which lasts about one hour, considers your testimony, your attorney's arguments, the medical evidence, and the testimony of a vocational witness.

Specific factors which play a large part in the judge's decision include:

• Age of the claimant
• Education
• Past work experience (over the past 15 years only)
• Medical Evidence
• Residual Functional Capacity
• Transferable Skills from past work

I will discuss Residual Functional Capacity (RFC) here, since the other factors are self-explanatory.

RFC is the maximum that an individual can still do in terms of work-related activity.  In short, can much can the individual lift and carry?  How long can he/she stand, walk and sit?  How often can the claimant reach, bend, squat, kneel or balance?  In terms of the mental demands of work, what is the claimant's restrictions on understanding, remembering and carrying out simple instructions?  How much of the time will the individual be off task due to problems with concentration or focus?

How will these limitations affect the ability to perform jobs at the various exertion levels:  very heavy, heavy, medium, light and sedentary?  Will the claimant be able to perform skilled, semi-skilled or unskilled work?  How many jobs are there in the national economy that fits the claimant's Residual Functional Capacity?  (A question for the vocational expert).

From a practical point of view, most claims are decided on the claimant's ability to perform either light or sedentary level jobs at the unskilled level. 

There are so many technical issues that go into a Social Security disability appeal that I'm surprised that anyone would undertake this venture without representation. (I think many claimants do so because they don't know what they are getting into).

It is far from just telling your story to the judge.  It's more about proving that you meet all of the technical demands of Social Security's regulations.  

You need an understanding of medical evidence, grid rules, Social Security Listings, transferable skills and exertion levels--just to name a few things.  You will also need to know how to question (cross examine) the government's vocational expert.  If the expert gives unfavorable testimony, as they often do, it leaves your decision lingering in critical condition between life and death.  Asking the right questions can be the life-saver of your claim.

The judge who hears your case will require proof, not just a good story.










ADMINISTRATIVE LAW JUDGES CAN BE VERY SKEPTICAL!

ARDMORE DISABILITY - HOW TO GET APPROVED

ARDMORE, AL
ARDMORE, TN

What Is Social Security?

Social Security is a function of the federal (US) government.  It is a plan of mandatory federal disability insurance for workers, who pay into the Social Security fund by payroll deduction.  The withholding tax is called FICA for (Federal Insurance Contributions Act).  The law was passed in 1935 and is mandatory for most US workers.  Workers currently pay 7.65 percent of their pay into this trust fund and their employers match the contribution.  So for every dollar you earn, over 15 cents goes into the Social Security and Medicare trust fund. This funds the disability program.


What are the basic requirements to start disability benefits from the Social Security Administration?

1.  You have worked and paid into Social Security long enough and recently enough to have coverage.  Credits do expire over time.  Not everyone is covered for SSDI.

2.  You have a serious medically determinable impairment that (a) has lasted at least 12 straight months, (b) is expected to last at least 12 straight months, OR (c) is expected to end in death.

3.  You must have medical records of treatment that will establish the impairment's onset, severity, and duration.

WHAT ARE THE USUAL STEPS TO APPLY FOR BENEFITS?

• File a new application with the Social Security office.
• Wait 4 to 6 months for a decision.
• If denied (as many are), file an appeal within 60 days.
• Expect to go before an Administrative Law Judge (ALJ) for a hearing.
• Consider getting a specialist to assist with your appeal or hearing.

Claimants with professional representation are more likely to get benefits approved.  Honestly, Social Security will deny almost 80 percent of claims filed in 2020.  The appeal process is arduous and complicated.  However, if done correctly, the appeal can produce payment of benefits.

A professional representative cannot charge you a fee for his or her services until.....

A.  Your benefits have been approved, and also....

B.  You are paid past due or retroactive benefits.

Call (256) 799-0297 for a free disability consultation.

*During the COVID-19 crisis, our firm provides free telephone consultations for those who do not wish to visit our office.  If you do make an appointment to visit us, we will try to limit your exposure to others during your visit (as much as possible).  We currently only accept visits on in-person consultation by appointment, one person at a time, due to COVID-19 concerns.

ARDMORE AL DISABILITY ADVOCATES

Ardmore, AL and Ardmore, TN are served by the Forsythe Firm, helping Ardmore residents get the Social Security disability benefits they deserve.

Sure, you could go to an out of town firm and hire someone you will never meet.  But why not hire an expert who lives and works near your home?  

We offer:

1) Local appointments right here in north Alabama.

2)  Free consultations by phone or in person.

3)  Contingency Fee:  You pay us nothing up front, and never pay us a fee until your benefits are paid.

4)  One advocate who will stay with you and your case until it is resolved.

5)  The ability to reach your managing advocate with one phone call.  Yes, we will answer you call.  Yes, we do return calls if you miss us.  We'll be here for you!

Some things Ardmore residents should know about Social Security Disability Insurance (SSDI):

1.  Denials are very common and do not mean that you can't get a benefit.

2.  Most claims are approved in the appeal process, not by filing an application alone.

3.  Most claimants choose to get professional help when trying to get benefits.

4.  You cannot be charged a legal fee if unless you win your claim.  Any fee charged by your attorney/advocate must come out of your back pay.  No back pay, no fee.

5.  If you initial claim is denied, you only have 60 days to appeal.

CONTACT THE FORSYTHE FIRM AT (256) 799-0297.

EMAIL US AT forsythefirm@gmail.com

DISABILITY BENEFITS IN THE COVID CRISIS

It is still possible to be considered for new disability benefits, even during the 2020 COVID-19 crisis.  However, you must apply online or by phone.  Social Security offices are temporarily closed to the public.

The Forsythe Firm is offering free telephone consultations at no obligations.  We can help you decide if you may qualify, or give you advice on how to proceed with a claim or appeal.  (256) 799-0297.

THINGS A JUDGE WILL CONSIDER

Most people who apply for Social Security disability will wind up before a judge, who must decide if they qualify for benefits.  What type of things will the judge consider?

In addition to your medical record, there are several factors that judge will look into:

1.  Your Work Record.  Judges like to see claimants who have a long, steady work history.  This gives the claimant a great deal of credibility.

2.  Are Other Family Members on Disability?  Judges don't like to see a household where multiple members of the family are on disability benefits.

3.  Have You Tried to Keep Working?  Judges will ask how you have tried to stay in the workforce.  They want to know about medical treatment, physical therapy, rehabilitation or looking for an easier job that you may still be able to perform.

4.  What Are Your Hobbies and Recreational Activities?  You say you are not able to work, but how do you spend your time?  Do you go to ballgames, hunt, fish, travel or engage in other hobbies?  Do these recreational activities indicate inconsistency with the idea that you are disabled?

5.  Do You Have Unreported Wages?  Judges want to know if you have worked "under the table."  They usually view this as dishonesty because no FICA or federal tax were paid on these earnings.  Such work may also indicate that a person really isn't disabled, since they have been working.

THE REALITY TEST

When you apply for disability, Social Security will send you a  lot of forms.  These forms will ask you about every facet of your everyday life.  They take the answers on these forms very seriously.

When you complete your disability forms, have a relative or friend review them with you.  Do the Reality Test.  Are my answers really accurate?  Have I under-stated or exaggerated any of my answers?  Strive for absolute honesty.

Often, I interview claimants with a spouse present.  As the claimant is telling me what they can and cannot do, the spouse is very often incredulous.  Their expression says, "You certainly can't do that!" Or, "Are you kidding me?"

We tend to minimize our inabilities and downplay our limitations.  Our family members may notice our limitations more than we do.

When filling out Function Reports, address your worst days--not your best days.  If you can trim the grass two days out of an average week but you cannot do it five days out of the week, then you have a severe limitation. 


The reality test simply asks, "Is this a true reflection of what I can do, day in and day out?  

Keep in mind, too, that just because you can do something once or twice around the house, performing that same function on the job all day is a different matter.  Can you lift 10 pounds?  You say, "Sure, I can lift 10 pounds with no problem."  If I rephrase the question, Can you do a job all day that requires lifting 10 pounds? the answer might be totally different.


The same might be true with a simple thing like sitting.  Around the house you sit in a recliner and read or watch TV.  At work, however, you would sit in a much less comfortable chair with both feet on the floor, not elevated.  How long can you sit in those conditions?

Perform the reality test.  I also recommend having your spouse or family member review your answers.  He/she may look at what you have written and say, "Are you kidding me?"

SSI vs. SSDI: 2 VERY DIFFERENT PROGRAMS

The US Social Security Administration (SSA) operates two basic disability programs--which have some similarities and some differences.

SSDI

• Called "Title 2" because it was created under Title 2 of the Social Security Act.
• SSDI stands for Social Security Disability Insurance (Yes, it is insurance).
• Requires a claimant to have worked and paid FICA taxes for a number of years
• Poses no income or resource restrictions to get a benefit
• Requires that the claimant be medically disabled
• Has a 5-month waiting period (no benefits for the first 5 months of disability)
• Comes with Medicare after 29 months of continuous disability
• Requires a disability lasting at least 12 straight months or expected to end in death.
• Maximum 2020 benefit is $3,011 per month; the average benefit is $1,258 per month.

SSI

• Called Supplemental Security Income
• Also called "Title 16" because it's covered by Title XVI of the Act.
• Does not require any work history to qualify.
• Has severe income and resource restrictions.
• Requires that the claimant be medically disabled or at least age 65.
• Has no waiting period; benefits available the month after the application.
• Comes with Medicaid with no Medicaid waiting period.
• Requires a disability lasting at least 12 straight months or expected to end in death.
• Maximum 2020 benefit is $783 per month (non-blind) but may be less. 
• Living arrangements and household income affect eligibility and benefits.
• *benefits for a blind individual may be higher

You will hear a lot of people talking about getting "a Social Security disability check."  You never know if they are talking about SSDI or SSI.  

I hear people say, "He gets a disability check but he never worked a day in his life."  Of course, that's absolutely impossible with SSDI but could be possible under SSI.

Which do you want to apply for, SSDI or SSI?  

You want SSDI in most cases because it potentially has a much larger monthly benefit.  It also has no financial restrictions.  But if you can't qualify for SSDI because you didn't pay enough in FICA (withholding) taxes, you should try for SSI.  In some cases, a person can get both SSDI and SSI benefits.  This would occur in cases where the combined SSDI and SSI benefits do not exceed $783 per month.

The medical requirement to get SSDI and SSI is exactly the same.  The big differences are in the financial restrictions for SSI and the larger benefit possible under SSDI.