Frequently Asked Questions about Social Security Disability Insurance
Common questions clients have about the endless confusing maze also known as Social Security Disability Insurance. If you'd like access to more free information on this topic (and there's a lot more) please don't hesitate to visit our website at https://www.ltlegalteam.com/faqs/
How do I know if I qualify as disabled?Social Security defines a disability as having a condition severe enough to prevent one from working and earning a livable income (as defined by the federal government). There are several criteria to be met:
First, your condition must be severe. This is measured somewhat subjectively. A severe impairment is one that interferes with an individual's activities of daily living, and often makes one unable to engage in work activity.
In children severity is measured by how the condition affects their ability to engage in "age-appropriate activities." This is typically assessed by psychological testing, a review of the child's schoolwork and progress reports, and upon conversations with their school instructors. Teacher questionnaires also offer insight as they document the child's ability to perform age-related activities such as schoolwork and studying, as well as social functioning, concentration, attention, and persistence.
Second, a condition must last at least 12 consecutive months. If the condition resolves before one year, the claimant will receive a durational denial.
Third, a condition must be physically or mentally limiting, so much to the extent that it eliminates the claimant's ability to return to any jobs held in the last 15 years. The condition must also be severe enough that the claimant cannot be expected to use their education and work skills to do another type of other work. Many claims are denied on the basis that the claimant can return to a previous job or do another job they haven't done before. It is extremely important for claimants and their attorneys to understand this part of the process, and they must examine all avenues as to the transferability of their work skills and all possible methods of achieving a substantial gainful living.
How exactly does Social Security assess somebody's ability to work?In reviewing a claimant's ability to work, Social Security will evaluate a claimant's medical records and then rate the claimant's limitations in performing the physical and mental functions of their last job or jobs they have held in the last 15 years. They will also research other similar jobs that utilize a claimant's education and training history.
All claimants are rated for their Residual Functional Capacity (RFC), which defines their ability to function in certain ways. One example is a rating of "sedentary," which means a claimant can perform work that requires minimal exertion and is performed while sitting. There are also ratings for light, medium, heavy, and very heavy work.
Social Security may also rate a claimant for a mental RFC, which examines things like a claimant's ability to concentrate, their ability to learn and recall information, and their ability to interact in social settings and deal appropriately with coworkers and supervisors.
The physical and mental RFC ratings are assessed and then compared to a claimant's previous job requirements to determine whether a claimant can return to that job. If a claimant is deemed as unable to return to their last job, then the RFC rating will then be compared to other jobs for which a claimant may qualify for, based on their education and work history.
Note - medical records are extremely important here, as they will form the basis of any argument supporting a claimant's inability to return to work. It is also very valuable to get a Qualified Support Statement from a treating physician to state a relationship between an injury and an inability to perform certain types of work. These are routinely gathered by attorneys when pursuing disability claims, and they carry weight with administrative law judges should the claim go to the appeals process.
What medical information (and non-medical information) will Social Security seek to obtain?During the initial disability claim interview, a claims representative at a local social security office will obtain a claimant's medical information, including the names of any treating physicians, clinics, hospitals, and other medical providers. They will also gather dates of treatment.
The claims representative will also gather information about your work history over the last 15 years. This will include the name of your employer(s), their address, phone number, the specific dates you worked there, your job title, and details of your position and the types of work you performed. This will also of course include your rate of pay.
Other non-medical information they will gather is your proof of citizenship, your date of birth, and marriage status.
What timeline should I expect for the disability application process?As you probably imagined, there is no set-in-stone timeline for the disability application process. It depends on several factors, such as how many times a claimant has gone through the disability application process. There is no guarantee of a claimant being approved on their first claim.
The initial claim takes anywhere from 30 to 90 days to elicit a decision. Should your initial claim application be denied (most are), then you have 60 days to file an appeal of your denial. This appeals process typically takes about 60 days. Should this appeal for reconsideration be denied, the claimant can appeal again by requesting a disability hearing with an administrative law judge.
This step is often the longest and most frustrating one due to long backlogs. It can often take over a year to get a hearing, but it is well worth it for most claimants. Nationally, about 65% of claims that are appealed to administrative law judges are granted.
There is also an expedited process for claimants that have terminal conditions (TERI process). These claims are typically processed in less than 30 days.
Another expedited process is the Quick Disability Determination (QDD). Claims are placed here if it is determined that it will most likely result in approval for benefits. This is often used for extreme cases that exhibit overwhelming substantiated evidence of injuries.
The Compassionate Allowances process identifies disability claims involving conditions that always meet Social Security's list of impairments. This process is also used mostly in cases exhibiting overwhelming evidence and multiple impairments.
What are my chances of approval for a disability claim?Nationwide, about 35-40% of all disability claims are approved after the initial application.
For those claims that undergo a reconsideration appeal (request for reconsideration), only about 15% of appeals are granted. This is mostly because reconsideration appeals are handled by the same agencies that made the initial denial.
Claims that are appealed a second time to an administrative judge are approved about 65% of the time nationwide.
How can I speed up the disability application process?First off: be prepared for the application before it even starts. Disability examiners will seek information regarding a claimant's work history, medical history, and activities of daily living. Be prepared to provide this information by accumulating documentation and logging relevant information. List out all sources of medical treatment, including all doctors, all facilities, all diagnosed conditions, and all symptoms.
Be sure to provide addresses for treatment sources so that the disability examiner can retrieve these records. Remember that if you leave any tasks like this up to the disability examiner, it will only prolong your application process.
When providing your work history, go back 15 years prior to the onset of your disability. Include your job titles, job descriptions, the dates worked, and your rate of pay.
Always gather your medical records yourself. If you leave it up to Social Security to do this, they will take weeks or even months to do this. This is because as a third-party, Social Security has to deal with privacy laws and third-party medical record companies that operate extremely slowly. They may also have difficulty locating facilities. It is not uncommon for them to take 2-3 months to do this, when it is almost always substantially faster for a patient to retrieve their own records. Any delay in acquiring records is a delay in your entire case, as disability examiners cannot evaluate your case until all records in.
Get records that go back to the beginning of your disability. The farther back you go for records, the better chance you have in making a successful claim for back pay.
When gathering medical records, always remember that Social Security does not consider chiropractors to be acceptable medical sources.
Make sure all your records are current. The Social Security Administration will not declare you disabled unless some records are recent, AKA no older than 90 days.
Make sure you medical records include pain symptoms so that the disability examiner can take that into consideration in assessing your residual functional capacity. If pain limits your RFC it can be considered as part of your disability and affect the outcome of your claim. Pain will be considered only if it is supported by substantial recorded evidence. Make sure your initial application mentions pain as well.
Never minimize your levels of pain. Keep this in mind when talking to your doctors or discussing your case with a disability examiner. Many people feel embarrassed about admitting pain and try to tough it out instead. Doing this will only hurt your case, as hiding pain will only be used against you, since you want your pain to be recorded in your medical records. Be sure to mention every way that you are affected by pain - whether it is discomfort sitting in a chair at work or if it is painful to bend over to clean things in your house.
How does Social Security assess my ability to work?Social Security will only grant disability benefits if a claimant is unable to earn a "substantial, gainful employment," meaning earnings of $1,170 or more (in 2017) per month (for non-blind individuals). The disability examiner will look at your most recent jobs performed in the last 15 years and will attempt to match your work history with jobs listed in a "dictionary of occupational titles (DOT)." They will attempt to match jobs not only based on titles but on the required skills, exertional requirements, and the duties performed.
Should the examiner find that 1. Your condition is severe enough to last a year and 2. Your condition limits you from engaging in substantial gainful employment, they will next consider whether your limitations prevent you from going back to your last job, or any other previous jobs held in the last 15 years. To deny you disability benefits, Social Security only has to find that you are capable of going back to ONE of the jobs you held in the last 15 years.
It is extremely important to be as specific as possible about your previous jobs. Don't leave any guesswork to the representatives reviewing your claim. Also remember to give the exertional requirements of each job - especially physically exertion. Social Security classifies work abilities in exertional categories - sedentary, light, medium, heavy, and very heavy. Always mention how much weight (if any) you were required to carry, and/or other physical requirements of the job.
Why was my claim for Social Security Disability denied?Denials are issued simply because in the eyes of the disability examiner (or appeals processer) the claimant failed to prove that they were unable to work at a substantial and gainful level, and that they were unable to do so for at least one full year. Along these same lines, the examiner thinks that the claimant's residual functional capacity does not preclude them from going back to their old job.
Remember that in order to qualify for disability your condition must be:
o Severe enough to make it impossible to work at a substantial and gainful level;
o Severe enough to last one year.
"Working at a substantial and gainful level" includes your last job, any jobs that you held in the last 15 years (what Social Security considers to be relevant past work), and any other jobs that your skills and training may qualify you, as long as your age and restrictions don't disqualify you.
Another somewhat common reason for denial is that the claimant returned to their work (where they presumably earn a substantial and gainful wage) while the disability application or appeal was pending. It goes without saying that if a claimant returns to work while the application is pending, there is no hope that the examiner will find them "unable to return to work."
What's the difference between Supplemental Security Income (SSI) vs Social Security Disability (SSD)SSI Disability claimants are not entitled to retroactive disability benefits. SSI's entitlement dates begins on the date they filed their application, and is not retroactive.
SSI Disability is not subject to any waiting period like SSD is. For SSI, it doesn't matter when you were approved for benefits, as one will receive disability benefits back to the date they filed their claim.
SSD is always subject to the five month waiting period (although many claimants don't effectively have to undergo the waiting period since it takes typically over 5 months anyway to get a hearing, with the filing of appeals, etc.)
Should a claimant be approved on initial claim, they will be more likely to undergo the five month waiting period since they didn't have to wait through appeals, etc.