frequently asked questions – Social Security Disability Information
WHEN SHOULD I APPLY FOR BENEFITS?
You should apply for disability benefits if:
– You are not working, or you are working, but you are not earning over $1170.00 a month and:
– You have a physical and/or psychological condition which has prevented you from working for the last 12 months; or
– The doctor has told you the impairment will prevent you from working for over 12 months (even if it has not yet been a year); or
– Your impairment is expected to result in death.
HOW DO I APPLY FOR BENEFITS?
Make an appointment at Local Social Security Office: Call 1-800-772-1213. You can make an in-person appointment with the local Social Security office, or the local office will set up a telephone interview.
Apply Online: www.ssa.gov You may only apply for SSDI online. All other types of applications, including SSI, may be started with Social Security over the phone or in person.
WHAT IS THE APPEAL PROCESS?
1. Application – If you are denied you may file a Request for Reconsideration.
2. Request for Reconsideration – If you are denied you may file a Request for Hearing.
3. Hearing – If you are denied you may Request a Review of the Judge’s Decision by the Appeals Council.
4. Appeals Council – Your claim may be approved, sent back to the judge for another hearing, or denied.
5. Federal Court – If you are denied again by the Judge or Appeals Council you can file a lawsuit.
ALL APPEALS MUST BE FILED WITHIN 60 DAYS. IF YOU HAVE PASSED THIS DEADLINE, WE CAN STILL ASK SOCIAL SECURITY TO ALLOW A LATE FILING OF THE APPEAL.
WHAT IS THE SOCIAL SECURITY’S EVALUATION PROCESS?
This is the process that Social Security goes through to decide whether you are disabled.
Step One: Are you working at the SGA level?
If you have worked since claiming disability and the work constitutes substantial gainful activity (you are earning more than approximately $1170.00 per month for 2017 – this amount changes each year), you will be ineligible for disability benefits. There are some exceptions to this rule, depending on the type of work you are performing.
Step Two: Do you have a severe impairment?
You must have either a severe impairment or several impairments when combined would be severe. This step requires that you MUST suffer from substantial physical or mental problems rather than simple, minor problems. To be considered severe, the medical problems must significantly limit your ability to perform basic work activities such as sitting, standing, walking, lifting, or concentrating. Severity is a threshold issue and few claims are denied at this step.
Step Three: Do you meeting Social Security’s requirements to be “automatically” disabled?
SSA has determined certain diseases are per se disabling. These diseases are called the “Listings of Impairments.” Consequently, if you suffer from one of these conditions, SSA will award disability benefits. These conditions are very specific. There are criteria in the Listings of Impairments for 14 different body systems which affect the health of claimants. A review of the Listings for these disorders indicates the type of specificity required to establish that you meet the criteria for a listing. You can also be found disabled for a condition which does not exactly meet the criteria, but is so similar it equals a listing.
Before step four, SSA will determine the maximum level of work you can perform considering their exertional ability. This is referred to as “Residual Functional Capacity” (RFC), (i.e., your ability to sit, stand/walk, and lift). SSA will determine the maximum level of work you can perform, considering you physical impairments, as either sedentary, light, medium, or heavy work. Mental impairments have an RFC process as well.
Step Four: Can you go back to your prior work?
If, based on you RFC, you are able to perform any of the jobs which you performed on a full-time basis in the last 15 years, then you will be found not disabled.
Step Five: Can you perform any other kind of work?
If you cannot perform work which you have done in the last 15 years, then SSA determines whether there is any other work in the National Economy which you can do. Social Security considers your Residual Functional Capacity and your age, education, and work experience.
WHY AM I GETTING DENIED?
There are many reasons. Maybe you have not seen a doctor in a while, or Social Security did not obtain all of your medical records, or it has not yet been a year since you have been disabled. Below is an explanation of why some cases are denied and require a hearing.
For the initial and reconsideration levels:
1. Are you over 50 yrs old and have you performed a “sit-down” job in the past 15 years?
2. Are you under 50 yrs old?
If so, you have to prove that your functional capacity is “less than sedentary” (means you can’t even do a “sit down” job)
At the first two levels, Social Security only finds people have a functional capacity of less than sedentary in 6% of cases. – this makes it very difficult to get approved.
In order to be approved at the first two levels you usually have to either:
Meet medical criteria (very stringent)
Be over 50 yrs old AND have no past work that involved sitting AND you must be found not able to return to your past work. (more likely to get approved – but not guaranteed.)
Best chance of approval at a hearing:
– 66% of the time Judges find functional capacity is less than sedentary.
– The Judge was a lawyer.
– You get to tell the Judge things the medical records don’t.
– A “3rd set” of Social Security rules come into play.
– The Judge can make decisions “outside the box.”
– We give the Judge a medical summary.
– We win a majority of the time.
* Reviewers using the ALJ approach concluded that 48 percent of the cases should have received awards, while reviewers using the DDS approach concluded that only 13 percent of those same cases should have received awards.
OTHER FREQUENTLY ASKED QUESTIONS
What is the difference between SSDI and SSI?
SSDI (Social Security Disability Insurance) is paid to people who have worked and paid Social Security taxes. You must have worked and paid into Social Security at least 5 out of the last 10 years. Essentially this means you must be disabled prior to your date last insured or you are not eligible for SSDI. (the date is calculated by Social Security by considering how much you have paid into Social Security in the last 10 years) Usually Social Security documents you have received will tell us if this date is an issue. However, sometimes we discover this is in an issue later in the case and we will advise you accordingly upon our discovery if it is an issue.
Payment: The monthly payment depends on how much you paid in taxes. You can find out what your monthly benefit would be by calling 800-772-1213. You are eligible for payment 5 months after the date Social Security determines you are disabled. SSDI payments are retroactive 12 months from the date you applied for benefits. SSDI Retroactive benefits are paid in a lump sum amount.
Medicare: SSDI comes with Medicare. Medicare is effective 29 months after your disability date (24 months, plus the 5 month waiting period) Clark Cty Social Services should fill this “Medicare gap” and continue to provide you services until Medicare is effective. Medicare does not cover prescriptions.
SSI (Supplemental Security Income) pays benefits based on financial need, even if you have never worked, or if you have not worked enough. (If you are married and your spouse makes more than $900 a month or you have too many assets – retirement account, savings, etc – you may not be eligible for SSI)
Payment: The monthly payment for 2013 is $710.00 per month. Retroactive payments are generally paid in 3 increments over a 18 month period (every 6 months).
Retroactive payments could be reduced by 1/3 if someone has been providing your food and shelter (f this is the case, please ask us for a re-payment agreement), if you received rental assistance from Clark County Social Services, or if you had any earnings.
Medicaid: Medicaid is effective from the application date. (or disability date if after application date) Medicaid covers prescriptions.
After a favorable decision is issued how long will it take for benefits to be paid?
It takes about 60 days for current benefits to start being paid. From the date of the decision it can take from 60 – 180 days for all back benefits to be paid. Thus, all this takes a long time, much longer than it should. We will do everything in our power to facilitate your case, but we cannot force Social Security to process payments or decisions faster.
Do I need to get medical records or reports for my representative?
No. You don’t have to get any medical records or reports yourself. In fact, it’s better if you do not even try to get such things unless we ask you to. If you happen to get something such as a disability form completed by your doctor for an insurance company, etc., be sure to send me a copy.
What if I get a notice for a doctor’s appointment (a consultative examination) from Social Security?
You are required to attend the exam with the doctor. A failure to attend the exam will result in an automatic denial of your claim for benefits.
Will I have to fill out forms?
Yes. Usually Social Security will send you some forms to complete about recent medical treatment, what medications you’re taking, etc. Complete these forms as soon as possible after you get them.
What circumstances may change my case?
Report these changes to Social Security or your Representative immediately.
You see a new medical provider or go to the hospital;
There is a substantial change in your health (your condition worsens or you have a new diagnosis);
You change your address or phone number;
You receive documents or a phone call from Social Security;
If you return to work or are thinking about returning to work or school;
You start receiving any other types of benefits (VA, long term disability, workers compensation, etc.)
You get married or divorced; or