Disability Secrets: February 2010 Archives

When Social Security Sends You to a Medical Exam, is There Anything Else They Need?

By Tim Moore on February 27, 2010 6:11 PM | Permalink Typically, when the social security administration sends you to a medical exam (known as a CE which stands for consultative examination), this signifies that the disability examiner working on your case: A) has received all your medical records from your various doctors, clinics, and hospitals B) has read and evaluated your medical records C) has reviewed your activities of daily living as reported by you and/or the third-party contact you listed when you initiated your claim D) has reviewed your work history to determine the types of jobs you have performed in your past relevant work history (the last 15 years) and E) has determined whether or not additional and/or more recent medical record documentation is needed before your claim can be decided. Usually, sending a claimant to an exam--whether it is a basic physical exam, a neurological consult, a psychological mental status exam, an IQ or memory test, or a full-fledged psychiatric evaluation--means that the examiner needs just that one "last thing" in the file before the case can be approved or denied. And that one last thing is typically "recent evidence". To be fair to social security disability and SSI applicants, social security requires that disability examiners have at least some recent documentation in hand before deciding the outcome of a case. This means having something in the file that is not older than 90 days. So, if a claimant hasn't been to a doctor in 90 days, or has never been treated for a particular condition (such as depression), there is a more-than-good chance that they will be sent to a CE, or consultative exam. After the exam, physical or mental, has been conducted (by an independent physician or psychologist), then the disability examiner will typically wait until the exam report has been received before deciding the claim. So, returning to the question, "When Social Security Sends You to a Medical Exam, is There Anything Else They Need?", the answer is that the examiner typically only needs the examination report in order to decide and close the case. However, there are instances in which further examination of the case will reveal, even after an examination report has been received, that additional information is needed, such as regarding the claimant's work history, medical history, or daily activities. Why might this be the case? In some cases, this is simply because the examiner's supervisor reviewed the file and determined that additional case development in one area or another was needed. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

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Social Security Denied Me but Didnât Have All Of My Medical Records (What should I Do?)

By Tim Moore on February 24, 2010 5:40 PM | Permalink Anyone who files for disability with Social Security and receives a notice of denial has the right to appeal that denial for any reason. In fact, Social Security sends instructions with regard to the appeal process in their denial notice. The appeal process begins with a reconsideration request appeal that must be filed within sixty-five days of the denial notice. This means the appeal actually has to be received at your local Social Security office by the sixty- fifth day. Currently, disability denial appeals can be completed either with paper forms or online. If you chose to use the online appeal process make sure that you complete the appeal and the disability report form online and return your signed medical release forms (copies of form SSA-827) to your local Social Security office. If your reconsideration appeal is denied as well, your next appeal will be a request for hearing before an administrative law judge. Once again, you have the same sixty-five day appeal period to get your disability hearing appeal submitted to, and received by, your local Social Security office. As to the development of a case and when a decision is made, Social Security disability examiners do not have to wait for all of an individualâs medical records to make a disability determination. They only have to have enough current medical information (medical information that is no more than ninety days old) to address the severity of an individualâs medical and/or mental impairments. Often, disability examiners have enough information to make a determination prior to receiving all medical treatment notes. If you feel that other medical records would have better evaluated the severity of your medical or mental impairment, it may not be a bad idea for you to obtain and include the missing medical treatment notes when you submit your request for reconsideration. Even if the notes do not make a decisional difference at the reconsideration appeal level (only about ten or fifteen percent of those who file reconsideration appeals win their disability benefits), it will be included in your disability case file when it moves to the administrative law judge disability hearing level. Now, in direct response to the question that begins this post, are there cases in which the disability examiner handling your claim does not have all of your medical records by the time a decision is made? Yes, this does happen. In some instances, either the disability examiner or the disability examiner's unit supervisor will make the determination that what is in the file is sufficient to render a decision. This will, of course, be more likely to occur if: A) one or more of the claimant's listed medical sources (a doctor or a hospital) has not provided their records, perhaps even after multiple attempts have been made to get the records. AND B) at least some of the medical record documentation that has been obtained is current (not older than 90 days). AND C) at least some of the medical record documentation in the file addresses each of the claimant's listed impairments (what the claimant included in their list of conditions when they filed their claim). Of course, if none of the medical records that have been gathered are "current", the chance is strong that the claimant will be sent to a consultative medical exam. And if none of the medical records that have been gathered address one or more of the claimant's conditions (either listed by the claimant, or discovered by the examiner during the evaluation of the claim), then the chance is also strong that the claimant will be sent to a consultative examination. Is it better for social security to wait until they (disability decision-makers) have all the medical records gathered before a decision is made on a case? Of course, without a doubt. But this ideal scenario doesn't always happen, usually for reasons beyond the disability examiner's control. There are, unfortunately, a great many doctors, clinics, and hospitals that are somewhat renowned for dragging their feet in complying with requests for records. This can be true when a case is being decided by a disability examiner, or when a case is being developed by a disability attorney prior to a hearing. In fact, it is not uncommon to make multiple requests for records, sometimes never actually getting them until considerably well after a hearing has been held. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

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Can I Buy A House With SSI and Social Security Benefits?

By Tim Moore on February 21, 2010 1:38 PM | Permalink Recently, this question (Can I Buy A House With SSI and Social Security Benefits?) was posted in a disability forum with the following response: âI am a realtor in Florida, $650.00 puts your annul income at $7800.00 a year, that is below the poverty rate. You will need some more income to qualify for a house. What about food, bills, and transportation?â It appears to that the respondent was only considering that the disability beneficiary had a combined Social Security and SSI benefit, or that they received only SSI. The person who responded seems to have been speaking strictly from a realtor point of view. They assumed that the disability beneficiary was going to have to get a mortgage to buy their home, however the realtor may not have considered that this individual could be entitled to Social Security disability benefits rather than SSI. Social Security benefits can be much higher than SSI disability benefits. Consequently, if the individualâs credit has not been ruined, as a result of having to "wait it out" through the disability approval process, they may qualify for a mortgage based upon the amount of their Social Security disability benefits. Additionally, the realtor who responded to this question may not have known that Social Security disability beneficiaries often receive very large disability back payments (especially if the individual was awarded disability benefits at an Administrative law judge hearing) that could help with the purchase of a house. Social Security does not prohibit an individual from using their disability benefits to buy a house, however SSI or concurrent SSI/SSD beneficiaries should be careful. SSI disability beneficiaries can own the home and land they live on, but other property may be counted as a resource (resources are SSA's term for "assets"). Resources can terminate an individualâs eligibility to receive SSI disability. Conversely, Social Security disability only beneficiaries have no resource limits, and the purchase of a home they do not live in would not affect their eligibility to Social Security disability benefits. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

Social Security Disability Posts and Pages

Social Security Disability Attorney Fees - How much is the Fee and When do you Pay?

By Tim Moore on February 17, 2010 12:41 AM | Permalink The fee for representation on a social security disability or SSI disability case is currently set at a maximum of $6000. How is the fee for representation paid to a disability attorney or a social security disability non-attorney claimant's representative? If you choose to be represented on your case, you will sign an SSA-1696 which will be submitted to the social security administration. This is the form designating a specific individual as your representative who, as was indicated, may be an attorney or a non-attorney. You will also sign a fee agreement. All fee agreements must be approved by the social security administration. But not all fee agreements are alike since some disability representatives will charge for certain incidental costs while other representatives will not (you should always read your fee agreement before signing it). All fee agreements, though, are alike in this sense: they specify what will be paid to the representative if and only if the case is won. Basically, it works like this. If the case is won, the representative is entitled to one-fourth of the claiman't back pay. However, there is a cap, or maximum limit, on the fee that a representative can be paid. And that maximum is $6000. Therefore, if a claimant receives $20,000 in disability back pay, the representative will be entitled to receive $5000, which is one-fourth of the back pay. If a claimant receives $24,000 in disability back pay, the representative will be entitled to receive $6000, which is one-fourth of the back pay as well. But, if a claimant receives, for example, $40,000 in disability back pay, the representative will still receive only $6000 because this is the maximum fee that can be paid on any case, regardless of the total back pay that a claimant is entitled tor receive. When is the fee for representation paid? After a case is won and only then. How is the fee paid to the representative? The social security administration will actually take care of the fee payment if the representative is a disability attorney attorney or a non-attorney claimant's representative who is eligible for fee withholding (meaning that SSA will send the fee payment amount, though this amount will be derived from the claimant's back pay). Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

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Do you have to be Disabled for a Year to get Social Security Disability Benefits?

By Tim Moore on February 14, 2010 10:18 PM | Permalink To be eligible to receive ongoing disability benefits from the social security administration, under either the SSD (social security disability) or SSI (supplemental security income) program, a person must have one or more physical or mental conditions that impose functional limitations severe enough to rule out the ability to work and earn a substantial and gainful income for at least one full year. The inability to earn income at the SGA, or substantial gainful activity level for at least 12 months is the test of severity for becoming eligible to draw SSD or SSI disability benefits each month. And, thus, individuals who are able to able to return to substantial and gainful work activity (such as those who are working at that level when they apply for disability or return to work at that level after they have filed an application for disability) will not be eligible to receive disability benefits. However, there are cases in which individuals who are not currently deemed disabled according to social security administration standards will be able to receive disability benefits for the period in which their condition would have been considered disabling. This period is known as a closed period. Social security disability claims examiners do not award closed periods. When they evaluate a claim, they award benefits only in cases where claimants satisfy the SSA definition of disability and in which claimants are not engaged in work activity at the substantial activity level. At hearings, however, administrative law judges routinely award benefit payouts for claimants whose conditions are not deemed to be currently disabling but were disabling at a point in the past. The fact that closed periods exist, of course, further illustrates the rationale for pursuing a case at least as far as the disability hearing level. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

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If a person Qualifies For Disability, will They also Qualify For Medicare?

By Tim Moore on February 11, 2010 11:47 PM | Permalink If an person qualifies for disability under the social security disability program (not SSI), they will be eligible to receive medicare benefits at a certain point in time. This point in time comes 24 months, or two years, after their month of entitlement. What is the date of entitlement and how does it relate to when you can get medicare benefits. Here's an example: 1. A person gets approved for disability in the social security disability program. 2. Based on the medical evidence, it is decided that their established date of onset is January 1st. This, the way the social security administration views it, is when their disability began. 3. Five months after this EOD, or established date of onset, is when they can begin receiving monthly disability benefit payments. This is because social security disability benefit recipients have a five month waiting period, meaning they have the first five months taken from them (think of it as being like an elimination period on a private disability insurance policy). 4. The individual would be eligible to receive monthly disability benefit checks in June, if their EOD was January 1. However, if their EOD was any day other than the first of January their five month waiting period would not begin until February and they would not get their disability benefit check until July. The five month waiting period is five full calendar months, so unless an individual becomes disabled on the first of the month, their waiting period begins the next month. 5. June would be their date of entitlement if they became disabled Jan 1. 6. The person would be eligible to have medicare benefits two years after this date. Now, obvious question: does everyone who qualifies for disability actually have to wait two years before their medicare kicks in? No, because in many cases the person will have filed their disability application a couple years or more in the past. Also, for the social security disability program (and not the SSI program), the individual may be eligible to receive disability benefits for up to 12 months before their disability application was even filed. These are called retroactive benefits and they can be awarded if the medical evidence proves that an early-enough onset date exists, which is why it is so important to do a good job of gathering medical records for a claim. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

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How are Social Security Disability and VA Disability Different?

By Tim Moore on February 8, 2010 2:20 PM | Permalink The Social Security disability and Veteranâs Administration disability programs do not use the same rules and guidelines to determine if an individual is disabled. The VA disability program is based upon a percentage of disability. Many veterans receive some type of disability benefits when they retire from the military and go on to work full time jobs. The performance of other work activity often has little or no bearing on the percentage of disability the VA gives a veteran. Social Security, on the other hand, is a total disability program that basically hinges on two factors: the severity of an individualâs disabling condition and how it affects the individualâs ability to perform substantial work activity. In fact, an individual can have a severe medical and/or mental condition and if the individual is still earning over the monthly Social Security substantial gainful activity amount without subsidy from their employer (special help given from the employer that enables the individual to work), they will still be denied without even being given a medical determination. Many individuals who receive VA disability believe they will automatically qualify for Social Security disability but, generally, this is not the case. Many veterans are still working full time jobs while receiving VA disability benefits. In truth, the Social Security disability process is more stringent than many long-term disability programs or VA disability. An individualâs impairment or impairments must prevent them from working at a substantial and gainful level and must significantly interfere with the performance of routine daily activities. Additionally, to qualify for disability, Social Security disability beneficiaries must meet or equal an impairment listing in the Social Security disability guide book, or they must be determined unable to perform their past work as well as unable to perform other types of work due to a medically determinable mental and/or medical impairment. If an individual's medical and/or mental impairment has rendered them unable to perform any of their past work activity and it prevents them from performing any other type of work, they may be approved through a medical vocational allowance (where a claimant is approved after their medical and work histories are both evaluated and the determination is made that they can neither return to their past work or perform any other type of work for which they might be suited based on their age, education, job skills, and functional capacity). The Social Security disability program is not a short-term or partial disability program; it is a total disability program. As such, it can be significantly harder to win Social Security disability than to be approved for VA disability, short-term disability programs, or long term disability. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

Social Security Disability Posts and Pages

Social Security Disability Claim Reviews

By Tim Moore on February 7, 2010 12:39 PM | Permalink Social Security performs two types of continuing disability reviews for beneficiaries who are entitled to disability benefits: medical and work continuing disability reviews (CDRs). Social Security can perform these continuing disability reviews simultaneously or separately. All disability claims are scheduled for continuing disability reviews using diary dates. Diary dates are simply another way to say "date for review". Generally diary dates are three or seven years (meaning the claim will be reviewed every 3 or 7 years) depending upon the age and likelihood for medical improvement. Sometimes there are diary dates of less than three years but never more than seven years. Medical reviews are performed to ensure that an individual receiving disability is still disabled and there has been no medical improvement in the intervening years since they were found disabled. This involves updating medical sources and work information, which implies, of course, that the benefit recipient will need to supply social security once again with a list of medical treatment sources. This information is sent to a state disability agency for review (in most states, the agency is referred to as DDS, or disability determination services, but may also be referred to as the bureau of disability determination, or the disability determination division). At this agency, as was the case when the claim was first evaluated years before, the case will be assigned to a disability examiner who will handle the processing of the review. If the examiner finds that there is no indication (work activity above SGA or indication improvement in medical records) of medical improvement the individual will continue to receive disability benefits. If an individual has worked during this time they may also receive what is referred to as a work continuing disability review. Work reviews can be done in conjunction with medical continuing disability reviews, or alone. All work activity has to be evaluated even if an individualâs disability claim has not reached its medical review diary date. "Work continuing disability review determinations" (a long phrase to be sure) can mean no change for a disability beneficiary...or it could mean their eligibility to receive disability benefits is suspended or even terminated. It should be no surprise that Social Security monitors disability beneficiary work activity closely, considering how important work activity is to the disability determination process. Put simply, work activity continues to be determining factor for disability eligibility long after the initial disability determination. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

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Lawyer for an SSD Claim, do I have to have one?

By Tim Moore on February 6, 2010 8:09 PM | Permalink I've written a number of pages regarding lawyers and SSD claims and here is a sampling of the more common questions claimants have regarding getting a lawyer for an SSD claim. 1. Do I have to have a lawyer? No, you are not required to have a lawyer at any step of the process. This includes the initial application, the reconsideration appeal, and even the request for hearing before an administrative law judge. The disability system operated by the social security administration does not even require you to have a lawyer at the appeals council (which reviews the decisions of administrative law judges) and at the federal district court level. Having said that...most individuals would be quite foolish to ever "go it alone" once their case has gone beyond the first appeal (the request for reconsideration) and is due to be heard at the second appeal appeal level (the request for hearing). This is simply due to basic common sense: 99 percent of all claimants will have no idea what the basic concepts are that involve a claim, such as A) the DLI (this is the date last insured and it is the attorney's job to prove that your disability began before this date so you can be eligible to receive SSD benefits), B) the AOD (this is the alleged onset

Disability Secrets: February 2010 Archives

Social Security Disability

Workers Compensation

When Social Security Sends You to a Medical Exam, is There Anything Else They Need?

Social Security Denied Me but Didnât Have All Of My Medical Records (What should I Do?)

Can I Buy A House With SSI and Social Security Benefits?

Social Security Disability Attorney Fees - How much is the Fee and When do you Pay?

Do you have to be Disabled for a Year to get Social Security Disability Benefits?

If a person Qualifies For Disability, will They also Qualify For Medicare?

How are Social Security Disability and VA Disability Different?

Social Security Disability Claim Reviews

Lawyer for an SSD Claim, do I have to have one?

Get Help - Have a Professional Review Your Case

Talk to a Social Security Disability Advocate

Talk to a Workers Compensation Attorney

Get Informed - Social Security Disability Information

Getting Started: Social Security Disability

Who is Eligible for Disability Benefits?

Disability Denials & Appeals

Workers Compensation Claims