QUICK DISABILITY DECISIONS AVAILABLE (FOR SOME)

Compassionate allowances permit Social Security to approve claims quickly (often in a week or less) for applicants suffering from one of 200 incurable diseases.

On December 6, 2012, Social Security Commissioner Michael Astrue met in the Hart Senate Office Building in Washington D.C. to announce reaching the milestone of 200 diseases that now qualify for a speedy compassionate allowance approval.

In order to qualify, an applicant must have one of the 200 illnesses on the list.  There are still many incurable and tragic diseases that are not on the list and thus do not qualify for the rapid award of benefits.  However, the program does provide very quick approval for thousands of applicants each year who suffer from one of the 200 conditions listed.

To see the complete list of diseases which qualify for a speedy compassionate allowance disability award, go to the following website:

 http://www.ssa.gov/pressoffice/pr/compassionate-allowances200conditions-pr.html

 

NOT COVERED BY SOCIAL SECURITY DISABILITY?

Social Security disability is an insurance plan mandated and paid for by the US Government under the Social Security Act.  Like any other insurance plan, it is funded by "premiums" or payments made to the Social Security Trust Funds.  In the case of disability insurance, it is paid for by FICA taxes.  The employee has taxes deducted from his/her wages, then the employer matches that tax and pays into the Social Security Disability Trust Fund.  

In order to have current disability insurance with Social Security, the worker must have worked long enough and paid enough FICA taxes to be insured.  The worker must have accumulated a sufficient number of "Quarters of Work" to be insured.  For most workers over age 40, the worker must have worked at least 4 out of the last 10 years to be covered.  Rules are different for very young workers.

Social Security disability insurance (SSDI) is often referred to as Title II (two).  SSDI does not require a claimant to be poor, have limited income or limited financial resources to be eligible for benefits.  There is no "means testing" as such.  Dependents may also be eligible for benefits under the primary worker's SSDI.  A disabled or blind widow or widower age 50 or over may qualify for benefits under the deceased spouse's SSDI.

If the claimant does not have sufficient Quarters of Work to be covered for Title II (SSDI), he is limited to filing for Supplemental Security Income or SSI, which is called Title XIV (16).  There are strict income and resource restrictions for SSI.  Therefore, SSI is often thought of as a type of "federal welfare."  Individuals as well as dependents may be eligible for SSI benefits, even if there is no coverage for SSDI or Title II.

In order to get SSDI or SSI benefits, the applicant must prove that he/she is blind or disabled under Social Security rules, which are very strict.  Most applications are denied and the claimant must appeal, have the claim reviewed more closely by an administrative law judge, and attend a hearing to get paid benefits.  A qualified representative can be of great assistance in obtaining a favorable result at these hearings.  And you cannot be charged a fee for representation until you win and collect your benefits.

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SOCIAL SECURITY vs. EMPLOYER'S DISABILITY PLAN

Social Security disability covers almost every worker in the United States.  It is mandated by federal law and paid for by taxes deducted from the workers' wages, matched by tax paid by the employer.  Therefore, Social Security disability (SSDI) is often the only disability benefit available to a worker who becomes unable to work before retirement age.

In some cases, employers may provide private disability insurance other than Social Security.  I highly recommend that workers enroll in employer sponsored disability plans whenever possible.  There are two big reasons:

1.  It is very difficult to be approved for Social Security disability.  The rules are very stringent and your disability may be covered by a private insurance plan even when it is not covered by Social Security.

2.  It takes a long time to get Social Security benefits approved. We see claims take up to 3 years or longer sometimes.  SSDI never covers the first 5 months of a disability.  And they never cover an impairment that doesn't last at least 12 straight months.  Private insurance plans can often start payments much quicker and may help out until Social Security can be approved (if it ever is).

Most private disability plans merely provide "stop gap" disability coverage until the disabled worker can obtain Social Security benefits.  But this can be very important.

The time to check on what kind of disability insurance you have (or don't have) is now--before you need it.  A good rule of thumb is:  You generally cannot buy insurance when you really need it. 
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THE FORSYTHE FIRM           
Huntsville, AL 35806
(256) 799-0297

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FIBROMYALGIA & DISABILITY BENEFITS

In July 2012 Social Security issued Ruling SSR 12-2p on fibromyalgia.  The gist of it is that fibromyalgia may be a medically determinable impairment and it can be the basis for a finding of disability.  

Social Security has instructed all its administrative law judges and other adjudicators to follow SSR 96-7p to evaluate a claimant's statement about symptoms and functional limitations.

This was kind of a milestone for sufferers of fibromyalgia.

For years, fibromyalgia was a little understood disorder and some Social Security judges did not consider it to be a "medically determinable impairment. Judges often ruled that disability could not be established merely on the basis of symptoms and that a medically determinable impairment must be deomonstrated by medical signs and laboratory findings.  There is no laboratory test for fibromyalgia.  It is usually diagnosed by exclusion of other disorders and by locating "tender points."  Many Social Security adjudicators simply did not believe that the disease existed - or if it did - it was not severe enough to cause disability.

Once a medically determinable Impairment (MDI) has been established by a physician (MD or DO), as required under SSR 06-3p, then SSA will look at evidence from any treating source, including those which are not "acceptable medical sources" (non-doctors). Evidence may also include statements by family, friends, former employers, teachers, etc. to establish daily limitations of function over time.  There still is no specific "listing" for fibromyalgia but it may equal another listing--such as 14.09D for inflammatory arthritis.

It is extremely important that the claimant provide Social Security with the full history of fibromyalgia symptoms and treatment over time.  The SSA acknowledges that it is a disease that can "wax and wane."

At last, a Social Security ruling provides judges and other adjudicators with a framework to find that "widespread pain and other symptoms associated with fibromyalgia, such as fatigue, may result in functional limitations that prevent a person from doing the full range of unskilled work.  Persons with fibromyalgia may also have non-exertional physical or mental limtiations because of pain or fatigue.

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Source:  Some of the information in this blog is from NOSSCR, Social Security Forum, Vol. 34, No. 7, July, 2012.

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MARVIN'S $60,000 DISABILITY MISTAKE

The Forsythe Firm in Huntsville represents persons who are unable to work needing SSDI benefits.

Marvin is a 54 year-old construction worker who has herniated cervical and lumbar discs and recently underwent a lumbar fusion surgery, which will not eliminate all his pain and symptoms. He applied for Social Security disability in late 2017 and was denied in April of 2018. Social Security agreed that Marvin* could not do construction work but stated that he "is able to do other jobs available in the national economy."

Marvin believed them. He looked for other work for months but couldn't find anything that he could do. In September of 2019, Marvin came to my office looking for help. Here is how I figure it:

1. Marvin is indeed disabled, in spite of what Social Security said in their letter.
2. Marvin almost certainly could've won his claim with back benefits if he had appealed within the time limit.
3. His 60 days for appeal has long ago expired - so his claim was now dead as a doornail.
4. Marvin's only choice, unfortunately, is to file a new claim and start over, which gives up the back benefits under his original claim.
5. Marvin's failure to file a timely appeal probably cost him $60,000 or more in benefits and will cause him to wait another 12 to 16 months before he can get a hearing on the new claim.

The moral of my story is very simple. When you get a rejection letter from Social Security, don't fool around. Appeal that decision within the 60 day time limit. Do not file a new claim without getting profesional advice.  Appeal the original claim. Do not wait until you get all your ducks in a row; appeal the denial within 60 days.  Figure it out later.  You'll have plenty of time. 

My office will help you with filing the appeal and also with putting together a case for the hearing judge. We charge no fee until your Social Security back pay arrives. At that point, Social Security will deduct our fee from your back pay, pay us, and put your money into your bank account. If you don't win or if you do not collect back pay, there is no fee for our service.  Local Social Security advocates - See our webpage here.

*Note: I never use clients' real names in my blogs. "Marvin" represents a typical case but a fictitious name is used to protect the real claimant's identity.

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SOCIAL SECURITY DISABILITY Q & A

Q.  Who makes the initial decision whether I am disabled or not?

A.  Social Security hands off that decision to a state agency known as the Disability Determination Service.

Q.  If my claim is denied what should I do?

A.  File a written request for a hearing within 60 days of the denial--if you live in Alabama.  If you live in Tennessee, file a written request for "Reconsideration," which is different than a hearing.  Procedures differ between Alabama and Tennessee but the 60 day rule applies in both states.

Q.  If I hire an attorney or representative, how is he or she paid?

A.  If you win the case, Social Security will withhold an approved fee out of your accrued back pay and pay the representative directly (assuming that the representative is qualified for direct payment of fees). If you don't win there is no fee.

Q.  What's the timetable for Social Security disability decisions?

A.  Times vary by location but here is the general time frames:  You will get an initial decision within 3 to 4 months of filing the application.  If you must appeal and have a hearing, it will take 12 months on average. Wait times for hearings vary from office to office with the national average being just over one year.  You will receive a notice of the judge's decision by mail usually within 6 to 8 weeks after the hearing. Payment is usually made within 60 days after notice of decision, barring any complications.  Be sure your banking information on file with Social Security is correct because payments will be made by direct deposit.  An error in your account or routing number can cause untold misery and delay.  Also, be sure Social Security has your correct mailing address.  Returned mail can delay payments, even if you are getting direct deposit.  The post office will not forward Social Security mail and when mail gets returned to Social Security, it can hold up things for a long time.

Q.  Can my attorney get my hearing expedited?

A.  Expedited hearings are available only in two extreme situations:  (1) Your condition is expected to result in death within one year, (2) you have a dire need.  Examples of "dire need" might be:  no food, inability to get urgent medical care, you are homeless or about to be evicted, etc.  Most situations do not qualify for expedited handling.

Send me a  confidential email to forsythefirm@gmail.com

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MENTAL DISORDERS AND SOCIAL SECURITY DISABILITY

Which of the following mental disorders can qualify for Social Security disability benefits?

• Anxiety
• Major Depressive Disorder
• Agoraphobia
• Post Traumatic Stress Disorder
• Paranoia
• Schizophrenia
• Bipolar Disorder
• Personality Disorders
• Panic Disorder
• General Anxiety Disorder

ANSWER:  All of the above, and more.

Social Security will recognize any mental disorder that can be medically documented and which is severe enough to cause major limitations in the ability to work.  The duration requirement is the same as for physical conditions; you must be unable to work (or expect to be unable to work) for 12 continuous months or more.

How Can We Help You Get Disability Benefits?


The Forsythe Firm specializes in obtaining Social Security disability benefits for adults who cannot work because of mental, emotional or psychological impairments.  While we also handle claims for physical impairments, we win a great many disability claims based on mental conditions.  There is no charge for our services unless you win your case and collect back pay.  Click this link for information on the Forsythe Firm in Huntsville.