MEDICAL & NON-MEDICAL RULES FOR DISABILITY (SSDI)

 

When you apply to receive a Social Security disability benefit (SSDI), you must meet both the medical and non-medical rules.

THE MEDICAL RULES. You must prove that you are totally unable to perform either previous work or any other full-time work which exists in the national economy. Social Security will require objective medical data from your doctor(s) to prove this.

THE NON-MEDICAL EVIDENCE. You must show that you are a US citizen or legal resident. You must show that you are not currently working at Substantial Gainful Activity (SGA). Most importantly, you will need to have the required number of work credits associated with your Social Security account. Generally, a claimant must have worked at least 5 years out of the most recent 10-year period to be covered.

Work credits earned more than 5 years ago may have expired, leaving you uninsured for Social Security disability benefits.

One of the services provided by disability attorneys is a review of your case to see if you meet the rules to get a benefit. Most attorneys/advocates perform this review free of any cost or obligation.

 

Seeing Social Security work credits expire, it is wise to apply without waiting. 

WHAT A DISABIITY JUDGE WILL CONSIDER

 

Social Security disability applications are denied every day. They then appear before an administrative law judge for trial. During a hearing, the judge will consider many factors in reaching a new decision.

What things will the judge consider? Here are some of them.

• Claimant's age
• Education
• Type of past work
• Medical records
• Longevity of work record
• Education
• Physical and mental limitations of function 
• Daily activity and social functioning
• Credibility of testimony 
• the Social Security Listings
• the grid rules (Medical-Vocational guidelines)
• testimony of the government's vocational witness

The judge will explore both written evidence/documents, claimant's explanations, and attorney's arguments. Often, the attorney can help guide the judge to the information he or she needs to approve the case.

In any event, the case must be thoroughly prepared before it goes to the judge for trial.

HOW TO FIX DISABILITY DENIALS

 

The Social Security Administration (SSA) recognizes that many disability claims are wrongfully denied. The agency has provided a means to correct wrongful denials. That method is the appeals process.

Many people think of an appeal as an extreme or unusual step that only occurs in a few instances. In reality almost three-quarters of disability decisions will need to be appealed. The appeal is common, not extraordinary.

The initial decision process with Social Security is flawed. The initial application process is a "weeding out" process, designed to eliminate claimants who don't really qualify for benefits. Unfortunately, a lot of well qualified claimants also get "weeded out" in the application process. So, appeals are a necessary part of most claims.

There are now two stages in the Social Security appeal process:

1. Reconsideration. You must ask for "Reconsideration" in writing and ask Social Security to review your claim. Your application will be denied again in around 9 out of 10 cases. But this is a required step before you may go further.
2. Hearing. The next step in the appeal process is a hearing before an Administrative Law Judge (ALJ). This is actually your best chance to be approved and paid.

WHAT IS THE DEADLINE FOR FILING AN APPEAL?

Anytime Social Security makes an unfavorable decision (denial), you must file an appeal within 60 days. You may add an additional 5 days for mailing paperwork. So, that gives you a firm and strictly enforced deadline of 65 days from the date of denial.

HOW LONG DOES AN APPEAL TAKE?

There is no set answer because each case is different. In Alabama the reconsideration process will take 3 or 4 months on average, but can take up to 6 months. If you are denied at reconsideration, you can usually get a hearing before an Administrative Law Judge within about 6 months.

If you receive a denial letter, just remember to appeal quickly. My firm recommends you file an appeal within 2 weeks of the denial. You certainly may need legal representation with the appeal. Data suggests that claimants with an experienced attorney/representative have a much higher success rate than unrepresented claimants. 

 

It's YOUR benefit, so go after it vigorously.

CAN YOU KEEP YOUR DISABILITY BENEFITS AFTER RETIREMENT AGE?

 

What happens to your Social Security disability (SSDI) benefits when you reach full retirement age? Do benefits stop, continue as is, or change?

When you reach your full retirement age with Social Security, your disability benefit will continue. The benefit automatically converts from a disability benefit to a retirement benefit. You don't have to do anything because the Social Security Administration does this for you.

Will your benefit amount change? No. You will receive the same amount as before. You really won't notice any difference. The check will still be sent to you from the US Treasury. Upon retirement age, your check will come out of the Retirement trust fund, not the Disability trust fund.

What is your full retirement age with Social Security? It depends on your birthday. If you were born between 1943 and 1954, your full retirement age is 66.

The retirement age increases if you were born later. For example:

If you were born in 1955 - Full retirement age is 66 + 2 months.

If you were born in 1956 - Full retirement age is 66 + 4 months.

When you are awarded SSDI (disability) benefits prior to your full retirement age, you actually receive your retirement benefit early. So, when you reach your full retirement age, the benefit amount does not change. (You are still eligible for annual Cost of Living Adjustments).

 

If you need help getting approved for disability benefits, contact the Forsythe Firm in Huntsville at (256) 799-0297. Social Security is all we do. We offer free consultations. 

YOUR DENIAL IS PROBABLY WRONG!

Roughly 4 out of 10 denials for disability benefits are just plain wrong.  They will be reversed and paid when they reach an administrative law judge.  The problem is, too many people fail to appeal.

If your disability claim was denied, what should you do?  Take the following steps immediately.  There's a 60 day deadline.

1.  File for Reconsideration.  This is the first appeal and it does not take you before a judge.  But it's the required first step.  Social Security will review their decision to see if they can approve your benefits.  (Most of the time they will not).

2.  File another Appeal and ask for a hearing.  This will take you before an administrative law judge for a personal hearing.  You will typically wait a few months for your hearing.  This gives you time to prepare.

3.  Consider Getting an Advocate or Representative.  The hearing is your absolute best chance to be approved.  It only happens once.  To have the best chance, get professional representation.  It won't cost you a cent unless two things happen:

• Your case is approved, and
• You receive back payments

You will be able to sit down with an advocate who understands Social Security disability and discuss your case with no cost, no obligation.  If you are comfortable with the advocate, you may hire him or her to represent you.  If not, you may talk to another one.  

I usually speak to potential new clients for a few minutes over the phone when they call my office.  Then, we may set up an in-the-office appointment here in Huntsville for a further consultation. The potential client has an opportunity to ask me questions, get detailed information, hear my view of the case, etc.  If we agree to work together, I get started on the case right away.

MISTAKES CAN HURT YOUR DISABILITY CLAIM

Everyone makes mistakes.  Making a mistake on your Social Security disability claim, however, can cost you tens of thousands of dollars and endless delay in getting benefits.

Here are some of the mistakes we see on disability claims that should be avoided at all costs:

1.  Missing Deadlines.  Social Security is a very slow system and we all get tired of waiting on them.  However, if you miss a deadline, the system can be very unforgiving.  For example, if you fail to file an appeal within the required deadline, your right to appeal dies and the denial becomes the final decision for that filing.

2.  Improper Forms.  There are more forms in a disability application than most people have ever dealt with in their entire lives.  The forms are confusing and complex.  Incorrect or incomplete forms become evidence in your case and follow you for months or years, even into the appeal process.  

3.  Not Asking Your Doctor for Help.  Your doctor can be very influential and a great ally.  Talk to him or her.  Ask if the doctor will support your disability claim.  A detailed Residual Functional Capacity report by the doctor can go a long way toward getting your application approved.

4.  Failure to Appeal.  Over 75 percent of disability applications are denied.  That's right, about 3 out of 4 will be denied.  Many of these denials are mistakes.  Mistakes get corrected in the appeal process.  Yet, we see individuals who give up without appealing their denials.  Most of the approved claims we see today are the result of the appeal process, not the application process.  By all means, appeal.

5.  Not Getting an Attorney/Advocate.  There are 2 powerful reasons why you should get an advocate:

A.  It costs you nothing unless you win.  

B.  Represented claimants are much more likely to win than those who are unrepresented.

GETTING DISABILITY BENEFITS IN ALABAMA REQUIRES A PLAN

Having a plan or strategy is very important to winning your Social Security disability appeal.

Judges have very limited time to spend on a case.  They are required to issue up to 700 decision a year, or over 50 per month.  One case may have thousands of pages of medical records and other documents to review.  Your attorney or representative can help the judge, and your chance of winning, by pointing out what the judge needs to know.

• Is this claimant insured for benefits?
• What kind of past work did the claimant do?
• Does he or she meet a Listing or grid rule?
• Are there any transferable skills?
• Does the medical record support the alleged onset date?  If so, where? 

These are things the judge must know to decide the claim. 

A good representative will read and analyze the medical records, which are the foundation of every case.  The important evidence will be pointed out to the judge.  Are there MRIs or imaging studies to prove the alleged impairments?  Where can they be found quickly?

Do any of the treating doctors provide an opinion on the claimant's ability to perform work-like activities?  How do these opinions limit the claimant's residual functional capacity?

Then we come to the claimant's testimony.  It's very important that the claimant has been prepared and knows what to expect--and how to answer.  The testimony should match up with what the doctors say in the records.

Award rates among Social Security judges are lower now than at any time in the past 30 years.  A lot of things have to line up and make sense for the judge.  

I always provide the judge with a pre-hearing brief.  That means that I give her a step-by-step view of the case and why the federal regulations allow benefits to be paid.  The brief condenses hundreds (or thousands) of pages of medical evidence into 3 or 4 pages that can be read in about five minutes.  So, I try to help the judge make efficient use of his/her time.

A lot of times I can answer difficult or technical questions for the judge.  This can also help to get a favorable decision out more quickly.  

It's risky to walk into a hearing and just hope for the best.  Those kind of hearings often don't go well for the claimant.  It's much better to have a legal roadmap of where you want to go and how to get there.  That's worth paying the attorney/representative a fee when your case is successful. 

So, talk to a representative early in the process.  I think most people who appoint me to represent them decide after just a few minutes that I can add value to their case.  I have to think so, too, or I won't take the case.  The best of all worlds is when the claimant and representative work well together as a team.
______________
Charles W. Forsythe
The Forsythe Firm
7027 Old Madison Pike NW, Site 108
Huntsville, AL 35806
"Across from Bridge Street"
CALL (256) 799-0297 

https://forsythefirm.wixsite.com/website