How Does The Social Security Administration Determine Disability?

To receive benefits under the Social Security Disability program, you must have a physical or mental impairment (or a combination of impairments) severe enough to keep you from working fulltime in any regular paying job for at least one year or result in death. The test isn't whether or not you can return to your old job, and the test isn't whether or not you have been able to find a job lately. Rather, the test is whether you are capable of doing any job available in the national economy (even if this job involves different skills or pays less than your previous work). By using an extensive set of regulations, the Social Security Administration takes into account your medical condition, age, abilities, training, and work experience in deciding a case.

 The Five Step Evaluation that Social Security uses to determine if you are disabled is as follows:

 

 1. Are you working?

If you are working and earning more than the current Substantial Gainful Activity amount (currently $1,070.00 a month), you generally cannot be considered disabled.

 2. Is your condition severe?

Your impairment(s) must be expected to last one year or result in death and interfere with basic work related activities.

 3. Is your condition found in the list of disabling impairments?

Social Security maintains a list of impairments for each of the major body systems that are so severe they automatically entitle you to disability. If your condition is not on this list, Social Security has to decide if it is of equal severity to an impairment on this list. If it is, the claim is approved. If it is not, Social Security goes on to the next step. 

4. Can you do the work you did previously?

Does your impairment prevent you from doing any work that you performed in the last fifteen (15) years? If it does not, the claim will be denied. If it does, the claim will proceed to the fifth and final step of the evaluation.

5. Can you do any other type of work available in the national economy?

Social Security considers your age, education, past work experience, and transferable skills against the job demands of occupations as determined by the Department of Labor. If you cannot do any other kind of work, the claim will be approved. If you can, the claim will be denied.

Misconceptions About Social Security Disability Insurance and Supplemental Security Income Benefits

Cari and I have handled over 2,000 Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”) claims.  Throughout our years of practice, we have heard all kinds of misinformation and misconceptions about these benefit programs. Given how frequently we hear incorrect information about SSDI and SSI, we decided to do a blog debunking some of the frequent inaccurate statements we hear.

1.       “You have to be off of work for one year before you can file for benefits.”

 This statement is very inaccurate. You do not have to be off of work for 365 days before you can apply for benefits. You just have to be able to prove via medical and/or mental health evidence that your impairment (s) will prevent you from working for 365 or more, or that your impairment will result in death.

 If you have received a diagnosis and your doctor tells you that you will be out of work due to your impairment and medical treatment for a full year, you should put in your application for benefits immediately. Do no wait for your California State Disability to run out. You can file for both SSDI and State Disability simultaneously.

2.       “I have been denied benefits, so it makes no sense to appeal my claim.”

 The majority of people are denied at both the initial application level and again during the reconsideration stage regardless of the severity of the impairment. Applying for SSDI and SSI benefits is a game of frustration. Before giving up on your claim, you should consult an attorney if your doctor has indicated that you have a severe impairment that will prevent you from working for a year or more.

3.       “I am not looking for permanent benefits. I just want partial benefits.”

 The SSDI and SSI programs do not have a partial disability system. You are either found disabled or not disabled. Other areas of disability law like Worker’s Compensation and Veteran’s Service-Connection benefits, do break down disabilities into percentile scales. The Social Security Administration (“SSA”) does not quantify disabilities in this way, however. SSA will either find that you are disabled from all work or that you are capable of performing work in the national economy.

4.       “I can never return back to work if I collect SSDI/SSI benefits.”

 You can return to work if your condition improves. SSA simply requires that your impairment prevent you from working for a year. If you reach medical improvement after this 365 day period and can return to some type of work, you need to contact SSA and let them know that you are starting to work again. Depending on the level of income that you will be earning at your job, you may still qualify for benefits for a period of time.  The crucial thing is that you have to report to SSA that you are returning to work and provide them with a breakdown of your monthly gross income that you will be earning, so they can determine if you are still entitled to benefits.

5.       “People are getting rich off of SSDI/SSI benefits.”

 No one gets rich off of the SSDI or the SSI program. The average national SSDI payment for November 2013 is $1,129.65. The maximum Federal SSI payment that an individual can receive for 2013 is $710.00. No one receives a windfall from the SSA. People stand to earn a lot more money from working than from collecting SSDI or SSI benefits.

6.       “A lot of illegal immigrants are receiving SSDI/SSI benefits.”

 We hear this all the time and it is just not true. You cannot collect either SSDI or SSI benefits, unless you have legal Permanent Residence status in the United States. For any immigrant who came to the United States after 1996, you also had to have 40 credits of work performed in the United States to even qualify for SSI. Thus, immigrants who receive SSDI or SSI do so because they have contributed to the United States economy.

Got a question that you need answered? Please check out our website at www.westcoastdisability.com . We try to provide you with valuable information on our website that may help you navigate the Social Security Disability process. Also, feel free to shoot us an email at info@westcoastdisability.com or call us at (800) 459-3017.

Happy Thanksgiving!

West Coast Disability Law Group, LLP, wants to wish everyone a Happy Thanksgiving!

We recognize that dealing with chronic physical and mental health impairments is difficult every day of the year. However, we want to thank our clients for allowing us to lead them through the Social Security Disability process.

 We want to thank our clients' doctors, who take the time to help their patients any way they can, whether it be by sending us medical records or providing a supportive letter on a client’s behalf.

 We want to thank the Social Security employees who show empathy, respect and kindness to our clients, while doing all they can to make sure disability applications are processed properly.

 Lastly, we want to thank our staff, family and friends for all that they do for us every day of the year.

 Please have a happy and healthy holiday weekend!

 Warmest regards,

 Cari and Megan

Social Security Announces a Cost-Of-Living Adjustment for Beneficiaries

The Social Security Administration announced this week that the 63 million Americans receiving Social Security Retirement, Disability and Supplemental Security Income benefits will receive an increase of 1.5 percent in 2014. This Cost-Of-Living increase will take place on December 31, 2013, for Supplemental Security Income recipients. Social Security Retirement and Disability recipients will see the increase go into effect beginning in January 2014. This means that the average Social Security recipient will receive an increase payment of approximately $19 per month, making the average monthly payment $1,294.00 for Social Security recipients. The reason the Cost-Of-Living increase is so low this year is due to the fact that inflation has been low.

 Additionally, the maximum amount of earnings subject to Social Security tax will be increased from $113,700 to $117,000. This means that approximately 10 million people will pay higher taxes as a result of this increase in taxable maximum.

 This news happens to come the same week that 47 million Americans saw their Food Stamps cut by approximately 5%. This means that an average family of four, who traditionally received $668.00 per month, will now see their monthly check lessened by about $36.00.  The reason for this decrease is that the increase allotted in the Supplemental Nutrition Assistance Program from the stimulus package in 2009 has expired.

 Got a question that you need answered? Please check out our website at www.westcoastdisability.com . We try to provide you with valuable information on our website that may help you navigate the Social Security Disability process. Also, feel free to shoot us an email at info@westcoastdisability.com or call us at (800) 459-3017.

The Importance of Medical Records and Mental Health Records in Establishing Social Security Disability Insurance and Supplemental Security Income Claims

Now that the government has reopened and all branches of the Social Security Administration (“SSA”) are back in full swing, Cari and I wanted to discuss the importance of documenting your disability for Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”) purposes.  The bottom-line is that if the objective medical findings and clinical findings are not detailed and strong, it will be difficult to achieve SSDI/SSI benefits.

 

While SSA must consider an individual’s subjective complaints and credibility when assessing a claim, if an individual is not in consistent medical treatment with the appropriate medical provider, SSA will deny the claim. Think of it this way – the objective findings trump an individual’s subject complaints.

 

 SSA also has certain rules in terms of evidence it will consider. SSA only gives controlling weight to the opinions of certain medical providers. These acceptable medical providers include:  M.D.s, D.O.s, Ph.D.s, and Psy.D.s. SSA will not give controlling weight to the opinions of chiropractors, acupuncturists, nurses, physician assistants, social workers, or therapists. Thus, if you are not treating with the appropriate medical provider, you will want to get into treatment with a medical source that SSA deems “acceptable.”

 

You also want to make sure you are treating with the correct specialist for the impairment you are alleging. If you are claiming a psychiatric disability, you should be treating and receiving your medications from an actual psychiatrist, not a general practitioner, or an internist.

 

You also want to make sure your doctor is documenting all that you tell him/her in a clear and concise manner in the medical records. After all, if SSA cannot understand or read a doctor’s chart, it will be difficult for SSA to find an individual disabled.

 

Securing a narrative letter or a residual functioning capacity statement from your doctor can also be crucial. These documents in which a doctor lays out an individual’s impairments, symptoms, treatment, prognosis, and limitations can help SSA understand in a very simple summary why a claimant is unable to work. SSA will often have their paid consultative examiners complete these same reports. Since SSA is supposed to give more weight to the opinion of a treating doctor, than that of the opinion of their one-time consultative evaluators, the ability to secure opinion evidence from a treating provider will often make or break the claim.

 

Finally, if an individual does not have medical insurance and is not currently treating with a doctor, the chances of being awarded SSA benefits is slim to none. If you fall into this category, we recommend that you seek out treatment through County plans and facilities, or low-cost and free neighborhood clinics. Under the Federal government’s Health Care Reform, individuals who do not secure health insurance will soon be subject to financial penalties. Thus, we also recommend that you checkout the new exchanges set up by the Federal government to determine if you are eligible for any of their low-cost plans.

 

Got a question that you need answered? Please check out our website at www.westcoastdisability.com . We try to provide you with valuable information on our website that may help you navigate the Social Security Disability process. Also, feel free to shoot us an email at info@westcoastdisability.com or call us at (800) 459-3017.

How The Government Shutdown is Affecting the Social Security Administration

As you all are aware, the government shut down on October 1, 2013, due to Congress’ inability to come to a resolution on an appropriations bill. An agreement has not yet been reached.  What this means is that non-excepted government employees (approximately 800,000) have been furloughed and certain Federal agencies are operating with only staff members who are deemed essential.

The good news is that part of the Social Security Administration remains operational. Social Security Disability Insurance and Supplemental Security Income (“SSDI/SSI”) beneficiaries will continue to receive checks. Individuals can still apply for SSDI/SSI benefits. SSDI/SSI claims can still be appealed. Most other work at the local SSA offices will be suspended. This includes requesting a duplicate Social Security card.

Hearings that were previously scheduled at the Office of Disability Adjudication and Review (“ODAR”) will still take place if the Judge’s clerk was able to prepare the hearing file before the shutdown occurred. No other hearings will be scheduled, however, and no decisions or other correspondences will be written. The ODAR will be operating with a skeletal staff.

The Appeals Council will not be reviewing any cases at all.

For more informational on the government shutdown and how it affects SSA, please visit:

 http://www.ssa.gov/pressoffice/shutdown2013.pdf

Got a question that you need answered? Please check out our website at www.westcoastdisability.com . We try to provide you with valuable information on our website that may help you navigate the Social Security Disability process. Also, feel free to shoot us an email at info@westcoastdisability.com or call us at (800) 459-3017.

Can I Work and Collect Social Security Disability Insurance ("SSDI") or Supplemental Security Income ("SSI") Benefits?

Working and how it affects SSDI and/or SSI benefits is an extremely complicated matter. SSA affords people a limited opportunity to work, but people must pay close attention to the rules and regulations regarding work attempts, as the parameters are adjusted every year.

Currently, SSA does not consider an individual to be disabled if he/she can earn $1,040 per month. If an individual is blind, SSA will not consider the individual to be disabled if he/she can earn $1,740 per month. These figures reflect SSA’s current standards for 2013, but could likely change for 2014.

However, even if people are working under these above limits, they still could find themselves earning more than SSA allows. For instance, the maximum monthly rate that SSA pays in benefits for the SSI program in California for 2013 is $866.40. If an individual is blind, this amount is increased to a maximum rate of $921.40 in SSI benefits. These figures include the Federal rate of $710, as well as the State supplement of $156.40. Thus, if an individual receiving SSI is able to work and can achieve more than the 2013 SSI benefit rates, this individual may no longer qualify for the SSI program.

 On a different note, the SSDI program allows people to test their ability to work for a nine month period. It is called a Trial Work Period (“TWP”).  An individual is entitled to one TWP in his/her lifetime. A TWP allows an individual to attempt to work for a nine month period (does not have to be consecutive) over a 60-month rolling period. For 2013, any month that individual can earn $750 counts as a month that an individual performed services for the purpose of a TWP.  If an individual earns above $750 for over 9 months (even if it is not consecutive) in a rolling 60-month period, he/she would no longer be considered disabled. If the individual does not achieve nine months of earnings over the $750 level in a rolling 60-month period, he/she could still be considered to be under a disability.

 Regardless of whether you are a SSI or a SSDI recipient, an individual MUST notify SSA as soon as he/she returns to work. Failure to do so can amount to fraud and result in an overpayment. We suggest that you notify SSA by a certified letter, so you have physical proof that you are notifying SSA of a return to work. If you speak to a SSA employee about a work attempt, write down the name of the individual you spoke with and the employee’s phone extension in case you need to refer to it in the future.

 Additionally, if you have returned to work and know you should not be receiving benefits from SSA anymore, return any and all subsequent monthly checks to SSA. If you are registered for direct deposit and receive an improper deposit, do not spend the money and immediately notify SSA of their mistake. After all, SSA will eventually catch their error and ask you for the improper payments back.

 Got a question that you need answered? Please check out our website at www.westcoastdisability.com . We try to provide you with valuable information on our website that may help you navigate the Social Security Disability process. Also, feel free to shoot us an email at info@westcoastdisability.com or call us at (800) 459-3017.