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Disability Questions

WHEN IS A PERSON CONSIDERED DISABLED FOR SOCIAL SECURITY DISABILITY?

  • For Social Security Disability purposes, to be considered disabled a person must have an impairment, either medical, psychological, or psychiatric in nature. The disabled person's impairment must also meet the definition of disability which essentially states that the impairment must be severe enough that it keeps the person from working, and earning above a certain amount, for at least twelve months.

    In detail, what does this really mean, as far as the Social Security Administration is concerned?

    First, a person's medical records must indicate the presence of an impairment, or several impairments, either physical or mental in nature.

    Second, the impairment must be severe enough that it prevents a disabled individual from working, or, if they continue to work, prevents the person from earning more than $900.00 each month. This amount is referred to by the social security administration as SGA, or substantial gainful activity. It is important to note that this amount is before taxes.

    Third, the impairment must last at least twelve calendar months, or be projected to last that long.
  • Therefore, applicants for Social Security Disability should realize the following:
    1. A claimant may fit the definition of disability and be considered eligible for Social Security Disability on the basis of one impairment, or on the basis of several impairments. But the condition must be severe enough to significantly affect the ability to work. This means the impairment must last at least twelve months, or be expected to last that long. It also means that while "back conditions" usually fall into the severe category, "wrist and ankle sprains" seldom qualify as severe disabling conditions.
    2. A disabled individual may be working when they apply for Social Security Disability, and may continue to work even after they have been approved---as long as they do not earn more than the SGA amount. The SGA amount changes periodically, but currently it is $900.00 per month. It is important to remember this is a gross income amount, i.e. before taxes have been deducted.
    3. A person earning more than the SGA amount who applies for Social Security Disability or ssi benefits will, essentially, be denied the same day without having their impairments or medical records even considered. This is referred to as a "technical denial".
  • The specific answer to Question One, however, is this: in the eyes of the Social Security Disability program, a person is considered disabled when:
    1. They have a severe impairment that has lasted, or will last, twelve months.
    2. They are unable to perform work (work they have done in the past) while earning in excess of $900.00 per month.
    3. They are unable to perform other types of work, typically work related to their past work (for example, a car mechanic might be expected to switch to motorcycle engine repair if the job duties are similar enough).
  • When a Claimant passes this litmus test, they are considered disabled and eligible for Social Security Disability benefits.

WHEN SHOULD YOU APPLY FOR SOCIAL SECURITY DISABILITY OR SSI

  • Social Security Disability cases can drag on for a very long time. In fact, it is not at all uncommon for an initial application to exceed the 90-120 days commonly "estimated" by the social security administration and take as long as 6 to 8 months to complete. Of course, if an initial claim for disability benefits is denied (and such claims generally are, with the denial rate typically hovering around seventy percent), going through the appeals process will become necessary.

    From start to finish, the disability application process, coupled with the appeals process (the first two levels of appeal are the Request for Reconsideration and the Request for Hearing before an Administrative Law Judge), can easily take up to three years to finish.

    Given these conditions, claimants for social security disability or ssi benefits often find themselves in great financial distress prior to the time of a disability hearing. When should you apply for social security disability?

    The answer is this: if you believe you are disabled and unable to work, and also believe you may qualify for disability benefits through the social security administration, you should minimize the waiting time by filing a social security disability or ssi application as soon as you are eligible.

    Most Claimants will be eligible to file a disability application the day after they stop working or the day after their earnings drop below $900.00 per month. That is when you should apply for social security disability or ssi.

    It is at this point that an individual should contact the local social security office and request a disability application and, possibly, consider seeking representation.

HOW TO APPLY FOR SOCIAL SECURITY DISABILITY

  • To apply for social security disability benefits simply contact your local Social Security Office.

    There are currently three methods available to potential claimants:A) filing for disability online, B) calling the social security office to set up an appointment to apply, and C) walking into the social security office without an appointment.

    To get things started and apply for disability benefits, calling is generally the best option since applying online can leave out what is sometimes essential face-to-face communication, and walk-in visits to the social security office can mean hours of waiting before one is seen.

    In either of the two cases, though, an applicant will usually be given an appointment to be interviewed at a later date and time---therefore calling ahead to apply will generally be less problematic and less frustrating.

    After an appointment to apply for disability benefits has been made, a claimant will either be interviewed in-person at the local office, or, more conveniently, over the phone.

    These are essentially the basics of how to initiate an application for disability benefits with the social security administration, i.e. how to apply for the benefits you need in light of your medical problems.

    Claimants who need very basic assistance in completing their paperwork and are represented, of course, may refer such matters to their attorney or non attorney representative.

    Note: additional information regarding how to apply for disability and how to appeal denials can be found in the overview, "how to", and questions sections.

HOW DOES SOCIAL SECURITY MAKE DECISIONS ON DISABILITY CASES?

  • A number of things guide decisions on social security disability and ssi benefit claims, but, ultimately, the approvals & denials made by SSA are based solely on medical evidence.

    After an application for Social Security Disability or ssi benefits is taken at the social security office and sent to DDS (Disability Determination Services), the first thing the DDS examiner will do with a case is request the medical records.

    For this reason, then, it is very important to list every medical treatment source on the application, along with phone numbers and addresses. This is true even for doctor's offices and hospitals that have rendered minimal treatment for a patient.

    In essence, it is impossible for benefits to be awarded on a case without the presence of supporting medical records. For example, even if a personal physician supplies a statement supporting a case, this statement will hold no no weight whatsoever---without the medical records to substantiate the statement.

    Additionally, the records obtained by the disability examiner must also include recent treatment (at least within the last two months). Even for a case that represents itself as a "winner", recent evidence must exist to substantiate the claim for disability. If it does not exist, the decision rendered will be a denial.

    When a Claimant (or a claimant's representative or attorney) does not properly list every treatment source on an disability application or ssd or ssi appeal, the effect can be dramatic. A case can literally be slowed down for weeks or months as a result or, worse, be decided without crucial evidence being reviewed. Typically, this results in a denial. Cases that are properly represented, of course, stand a much better chance of avoiding such scenarios and eventually being won.

HOW LONG DOES IT TAKE TO GET A DECISION FOR SOCIAL SECURITY DISABILITY?

  • The question of how long it takes to get a decision on a Social Security Disability or ssi benefit claim...is a vexing one. And vexing for several reasons.

    First of all, in many parts of the country, the Social Security initial application and appeals process is getting longer. Why is this occurring? Part of the reason is most likely due to a steep rise in disability claims, which may be a factor of the changing economy and/or the fact that the population is aging.

    The other "vexing" reason is simpler to understand, particulary if you have applied for benefits, or appealed a denial on such a claim:

    Disability claimants usually, at some point in the process, experience tough financial circumstances as a result of having zero income while they wait for their case to be resolved.

    To answer the question, though, Social Security Disability and ssi cases can be won in as little as 30 days, or take as long as two years for benefits to be awarded. There is simply no way to predict how long a case will take because unlike other programs (Dept of Social Services, for instance), the federal disability program does not have deadlines for applications or appeals.

    On average, though, a decision for an Initial Claim takes 3-4 months, and a Reconsideration about as long, though it is not unheard of for a case to be decided much sooner or much later.

    Claimants whose Social Security Disability (or ssi) cases are denied at the Reconsideration level (the first appeal after the denial of the inital claim) will have to wait for a hearing to be scheduled before an Administrative Law Judge.

    This routinely takes 6 months or longer (and in some parts of the country, the wait, incredibly enough, is as long as 18 months), but, ultimately, this depends on the number of cases pending at the Hearing Office, which varies considerably by geographic area.

    Note: read the overview and tips sections to learn how a case can potentially be speeded along faster, hopefully toward a benefit award.

WHAT TO DO IF A SOCIAL SECURITY DISABILITY OR SSI CASE IS DENIED

  • If you are denied on your Social Security Disability or ssi benefit claim, you should request an appeal immediately, within the 60 day deadline. In some cases, you should do this yourself personally even if you have representation, simply to have the appeal request "officially" on record.

    Amazingly, most disability claims that are denied are not appealed. Claimants either give up on the process, or file an untimely appeal, or---mistakenly---file a brand new claim.

    A failure to appeal timely or filing a brand new claim will have the same end result: a loss of all appeal rights and starting over at the very beginning, with a new Social Security Disability or ssi application. This result is unfortunate for at least two reasons.

    First, it is by going through the social security disability appeals process (as opposed to making a new application) that a claimant has the best chance of winning a claim and being awarded benefits.

    Second, filing a new application, either because someone thought that was a good idea or because they missed the appeal deadline...is simply a waste of valuable time. Subsequent applications for disability will likely be denied for the same reasons as the first application.

    In either case, missing an appeal deadline, or starting a new application instead of appealing a denial...are situations to be avoided because they waste a significant amount of time.

    Again, if your Social Security disability or ssi claim is denied, IMMEDIATELY contact the social security office (and your attorney, or non attorney representative, if you have one) and request an appeal.

Questions in our Social Security Disability Information Guide

Social Security Disability Information

Who can get Social Security disability benefits?

How do I meet the earnings requirement for benefits?

When should I apply and what information do I need?

Who decides if I am disabled?

When and how can I appeal?

What happens when my claim is approved?

Can my family get benefits?

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