DISABILITY: WHAT YOUR DOCTOR CAN AND CANNOT DO

I see a lot of misinformation about the role of doctors in the disability process.  I just read a post on the internet that said a note from your doctor can help you get disability benefits.  That's not entirely wrong but it is misleading.

A "note" from the doctor indicates a short or simple statement.  This generally is not admitted as evidence by Social Security judges.  Statements like, "This patient cannot work," or "This patient is totally disabled" are totally useless.  Why?  They don't explain in detail WHY the patient is disabled.  Social Security loves, loves detail and hates it when doctors draw conclusions.

What doctors may provide is a very detailed statement of your residual functional capacity (RFC).  The form I use has 6 pages of questions.  It asks the doctor to estimate the patient's function:  things like, sitting, standing, walking, lifting, stooping, kneeling, reaching, handling....etc.

I don't mean this to disparage doctors.  But most doctors don't know how detailed their statements need to be.  Social Security has very particular rules and it needs very precise and detailed functional information.  That's why we use forms and discourage letters or "notes" from doctors.

Of course, doctors will be asked to provide the patient's routine medical records.  But medical records alone are often not sufficient to prove disability.  And no medical record contains a residual functional capacity.

So, a note from your doctor won't do much good unless it uses Social Security's standards for determining disability.  And, again, doctors are not permitted to draw conclusions about who is disabled and who is not.

If a doctor writes:  "Mr. Claimant is limited to lifting no more than 5 pounds occasionally, is limited to sitting no longer than 30 minutes at one time or not more than 3 hours per 8-hour day.  He can stand only about 15 minutes at one time and  is limited to standing no more than 2 hours in an 8-hour workday.  He will be off task more than 20 percent of a workday due to back pain and probably will be absent at least 4 days per month."  Social Security may use this information to conclude that Mr. Claimant cannot work full-time at any exertion level and find him to be disabled. But that conclusion must be made by Social Security, not by the doctor.

One final thought:  Your doctor probably does not have a Residual Functional Capacity (RFC) form in his/her office.  You probably need to obtain this form from your attorney or representative, not from your doctor.  If you go to the doctor's office asking for a Residual Functional Capacity statement, the doctor may not know what you need.  I recommend that you get the form from your attorney, then take the form to your doctor and request that it be filled out.

WHAT KIND OF INCOME AFFECTS MY SOCIAL SECURITY DISABILITY BENEFIT?

Income from inheritance, pensions, retirement funds or court settlements will generally not affect Social Security disability (SSDI) benefits because SSDI is not a needs based or income based program.

In short, your eligibility for SSDI is not restricted by your income, as long as it is not earned income produced by your work (wages, salary, tips, commissions, self-employment income, etc.).

The only type of income to worry about if you are receiving SSDI (also called Title 2) is income from working.--whether working for yourself or someone else.  It's really not the income that is a problem, it's the work.  By working, you simply prove that you are not disabled according to Social Security's rules.

One word of clarification:  Social Security also operates a program known as SSI or Supplemental Security income, which is needs based and income restricted.  Almost any type of income can affect eligibility for SSI. So, be certain what type of benefit you are receiving before relying on any information on this site.  SSI requirements are very different from SSDI requirements.

ONE SINGLE KEY TO SOCIAL SECURITY DISABILITY

The single biggest secret to Social Security disability is:  Never resign yourself to failure.  Keep on until you get approved.  The appeal process is your friend, especially if you know how to use it.

Many people apply and get denied.  In fact, 67 percent of all applications nationwide are denied.  In Alabama, the denial rate is even higher.

By the time a person has completed all the forms, questionnaires and inquiries--they may be just too tired or frustrated to continue.  If you allow this to happen to you, Social Security has won.  Don't let them.

Steps to take if you were denied SSDI benefits within the past 60 days:

1.  Ask for Reconsideration in writing.  You may do this online.  Expect this to be denied, too because there is a 97 percent denial rate at Recon.

2.  When Reconsideration fails, appeal again.  Ask for a hearing before an administrative law judge.  This is your best chance.  Just be sure that your case is well prepared and all medical evidence is submitted prior to your hearing date.

3.  Consider appointing an attorney or non-attorney specialist in Social Security to help with your appeal.  They will not charge you anything unless you win.

The claimants who WIN with Social Security disability are the ones who don't give up.  They move their claim UP the chain of command until someone gives them a fair hearing.  Again, preparation and good medical evidence are a must!  P.S.  filing a new claim over and over will not help.  You need to be in the appeals process, not starting over with a new claim.

IMPORTANT:  There is a strict limit of 60 days to appeal any unfavorable decision.

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The Forsythe Firm

Social Security Representation

7027 Old Madison Pike    Suite 108

Huntsville, AL 35806

CALL (256) 799-0297

SHORT TERM DISABILITY, LONG TERM DISABILITY, AND SOCIAL SECURITY

I bet you don't think much about disability.  Yet, 1 out of 4 persons will become disabled before they retire.  So, there's a good chance you and your family will find yourselves out of work, out of income, and with all the regular expenses still pressing down on you.

No problem, there's always Social Security, right?

Well, not exactly.  

Social Security disability (SSDI) doesn't pay the first 5 months of disability due to the waiting period.

On top of that, Social Security is very difficult to get--and takes a long time to get approved.  It's a bureaucratic nightmare.  Some people wait 2 years or longer to get a check and some never get one.  The rules to qualify for Social Security disability are the hardest of any disability program in the world.

So, let's talk about other types of private disability insurance that could tide you over, at least until you get Social Security.

SHORT TERM DISABILITY (STD)

Short Term Disability (STD) insurance is usually provided by your employer.  Not all employers offer it, but many do.  If your employer pays all the cost of STD premiums, you may not even be aware that you have it.  Depending on the policy your employer has purchased, STD may pay up to two-thirds of your salary if you become disabled.  These payments may continue for 3 to 6 months, depending on the terms of the policy.  

Some things to be aware of with Short Term Disability at work:

• You usually must apply for benefits and get your doctor to submit forms
• STD is often easier (and faster) to get started than Social Security.
• STD is sold by private insurance companies, usually to businesses, to cover their employees.  Many insurance companies sell it.
• Receiving STD will not hinder Social Security claims and will not make you ineligible for SSDI.

LONG TERM DISABILITY (LTD)

Long-Term disability is also sold by private insurance companies to employers who want to protect their employees.  LTD kicks in when Short Term Disability has maxed out (usually after 3 to 6 months).  Long term disability may be a bit harder to qualify for than STD was.  However, most LTD benefits are easier to get than Social Security disability (SSDI).  Some employers may only offer STD and not LTD.  Others may have both STD and LTD.  

Some points to consider about Long Term Disability (LTD) at work:    (These are general statements and may not apply to everyone.  See Disclaimer below).

• Coverage may be offered free by your employer or you may have to request enrollment and contribute to the cost to be covered.
• You generally cannot enroll in LTD after a disability strikes.  (You must get it before you need it, like all insurance).
• Each employer has a policy from the insurance company which spells out coverage terms and conditions.
• Most LTD policies require the worker to file for Social Security Disability (SSDI) benefits as soon as LTD benefits start to pay.
• You, the disabled employee, are responsible for filing for SSDI and your LTD company will generally require you to appeal a denial by Social Security in order to keep STD payments.
• You may hire your own advocate or attorney to represent you with Social Security; you don't have to us the insurance company's lawyer.
• If you eventually get Social Security benefits (SSDI), your LTD company will usually reduce its payments by the amount of the SSDI award.
• Getting LTD payments will NOT interfere with your ability to receive SSDI benefits.
• Be careful about voluntarily giving up any LTD benefits, even after you start getting an SSDI benefit.  
• Obligations of the LTD company may not completely end when you get approved for Social Security disability.  They may still owe you payments, depending on your policy's terms.

SOCIAL SECURITY DISABILITY (SSDI)

Social Security Disability Insurance (SSDI) is a government program provided by the 1935 Social Security Act. (The disability provision wasn't added until 1956).  It is paid for by a payroll withholding tax called FICA.  Individuals become covered under SSDI by working and contributing FICA taxes from their paychecks.  You must work a certain amount of time to earn enough work credits to be covered.  Generally, a person must have worked at least 5 years out of the most recent 10 -year period.  Young workers may need fewer work credits. Individuals who have not worked recently may not be covered by Social Security disability. Find out by calling your local Social Security office.  By the way, Social Security calls their disability plan "Title 2" because it's covered under Title 2 of the Social Security Act.

General Requirements to Get SSDI:  (1) You have earned enough work credits to be covered by Title 2.  (2) You have not yet reached full retirement age.  (3)  You have a medically determinable impairment which has lasted at least 12 consecutive months, is medically expected to last at least 12 straight months, OR will end in death.  (4) You are not currently working at substantial gainful activity.

Even though you may feel that you are disabled and qualify for SSDI, Social Security will often dispute your claim.  Approximately 70 percent of all SSDI claims will be denied on the initial application.  The proper response is to file an appeal right away.  Also, there is a 5-month waiting period for SSDI, meaning that Social Security will not pay the first 5 full months of an SSDI claim, starting with the date of disability onset.  For example:  If Social Security agrees that you became disabled on March 12th, your waiting period will run from April through August.  You would not be eligible for a payment until September.  Since payments are one month in the arrears, the September payment would arrive in October.  So, if everything goes well with Social Security, you're on your own for almost 7 months!  That's if you get approved as quickly as the law allows and no appeal is required.

If your SSDI claim requires an appeal, it can take an additional 12 months or more.  So, you can see why Short Term Disability and/or Long Term Disability from another source could be very, very helpful while you wait on the painfully slow Social Security process.

DISCLAIMERS

The Forsythe Firm does not give legal advice concerning insurance policies, companies or insurance matters.

We are not licensed insurance agents.

Statements herein are general in nature and are not to be taken as legal advice in any situation.

We have obviously not read your STD or LTD policy and our general statements may or may not apply to all policies or plans of insurance, including yours.

Your or your employer's  insurance policy/contract governs all benefits, terms, payments, qualifications and stipulations. Get a copy and read it carefully.

SOCIAL SECURITY WIDOWS OR SURVIVORS BENEFITS

SOCIAL SECURITY MAY PROVIDE FINANCIAL SUPPORT FOR A SURVIVING DIVORCED SPOUSE

If your ex-spouse dies and you were married at least 10 years you may be eligible for Social Security survivor’s payments on your ex-spouse's earnings record. Basically, Social Security treats you like a widow or widower if you were in a marriage for at least 10 years.. This reflects the reality that the economic circumstances of any marriage that lasts at least a decade probably will have a financial impact on the standards of living for the rest of the spouses’ lives.

ELIGIBILITY

To determine eligibility for benefits under an ex-spouse's work record,, the Social Security Administration (SSA) applies a formula. SSA considers how many work credits the deceased worker earned as well as the deceased’s spouse's age at time of death.

If a surviving divorced spouse cares for a biological or adopted child of their deceased ex-spouse, and that child is either disabled or under age 16,  they may be eligible even if the marriage lasted less than 10 years.

My firm recently represented a widow in just this type of situation.  She had been married more than 10 years, her husband had passed away a couple of  years ago, and the woman herself (over 50) is unable to work.  She had applied for Social Security survivor's benefits but was denied, which happens all too often.  She came to my office in desperation, wandering how she was going to survive financially with no Social Security support.  It became apparent to me that she had been unjustly denied survivor's benefits.  I filed a petition for appeal and the case wound up before a federal administrative law judge.  During a one-hour hearing, the judge found that my client was eligible for Social Security survivor's benefits based on her deceased husband's work record.  The judge not only allowed monthly payments to begin, but also approved retroactive pay back to the date of the original claim.

I fear that many women, especially, find themselves in this situation after the death of a spouse.  They have not worked sufficiently to get benefits under their own work record.  Their spouse supported the family until his death.  When the woman applies for Social Security disability, she is told that she doesn't have enough work credits for SSDI or Title 2. Or, She may be told that she is not disabled "according to the rules of the Social Security Administration."  In either event, her benefits are denied.

This is time to get competent representation and take the case higher up the chain of command to a judge.  This can easily be done with no upfront cost.

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The Forsythe Firm

7027 Old Madison Pike - Suite 108

Huntsville, AL 35806

Consultations by phone or by appointment only

(256) 799-0297

I LIVE IN HUNTSVILLE AND NEED DISABILITY BENEFITS. GUESS WHO I FOUND WHO COULD HELP?

Consider hiring an attorney on a contingency basis to help get your Social Security disability started.  There is no upfront cost and you may never pay an attorney's fee.  Let me explain how a "contingency fee" works.

A contingency fee only comes due when a certain contingency occurs.  In this case, the fee is contingent upon getting your disability approved and paid.  If this happens, you will pay a fee.  If it doesn't, you will not owe a fee.

Social Security adds one other stipulation to their contingency fee:  There must be back-pay or retroactive payments before a fee becomes due.  So, if there is no back-pay payable on your case, you still don't owe a legal fee.

This may sound to good to be true.  It isn't.  The US government protects Social Security claimants and beneficiaries when it comes to fees that can be charged on a disability claim.  In most cases, there can be no money charged up front and the amount of any eventual fee is limited by the government.

So, if you need disability payments but have been denied (or just don't know how to start), call one of the specialists in the Huntsville area for help.

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Sponsored by:

The Forsythe Firm

7027 Old Madison Pike - Suite 108

Huntsville, AL 35806

PH (256) 799-0297

TOGETHER WE GET YOUR SOCIAL SECURITY DISABILITY BENEFITS!

Like most government programs, Social Security can be difficult to deal with.  There are applications you don't understand, questions you don't know how to answer, and procedures that are baffling and frustrating.  Often, the result of all this confusion is denial of your benefits.

We know how to take your denial letter and take it up the chain of command.  Over half of these denials can be overturned and won on appeal.

But to win you need a plan, a legal strategy--and an understanding of the reason you were denied in the first place.

When you bring your case to the Forsythe Firm, here is what will happen:

1.  We listen to your story over the phone and find out where you are in the disability process.

2.  We bring you into our Huntsville office (if needed) to gather information we need to fight for you.

3.  Our advocate will file whatever forms and paperwork that may be need to get your case reconsidered or appealed.

4.  Our office begins the work of getting new and stronger evidence to support your case.

5.  We get your case before a federal Administrative Law Judge (ALJ) for a new decision.

6.  We help direct your case to one of the payment processing centers for payment, including back pay that may be due.

Wow!  How Much Does All This Cost?

• You pay nothing upfront, no fee, no deposit, nothing.
• If your case wins, you still owe us nothing unless we collect back pay for you.
• If there is back pay, Social Security will approve and pay a small percentage of the back pay to cover our fee.

Call the Forsythe Firm at (256) 799-0297