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.