Disability Secrets: May 2010 Archives

What determines social security disability decisions?

By Tim Moore on May 31, 2010 4:24 PM | Permalink The stock answer to this question is that your medical records determine what decision you will receive on your application for disability benefits. And, yes, medical record documentation--including admission and discharge summaries, office notes, lab reports, imaging studies, and even statements from treating physicians--is used to determine your level of functional capacity and, conversely, how limited your mental and physical functionality currently is. However, functionality, i.e. what you can still do within the range of normal daily activities, is just part of the disability determination process. The entire reason social security looks at medical records to determine a claimant's residual functional capacity is to measure this rating of function against the claimant's work history. Why? To see if they can still work, either at a job they've done before, or at some other job they've never done...but might, at least on paper, be able to do. So, in answer to the question, what is it that determines social security disability decisions? One way to answer to answer the question is to say: Whether or not the claimant can still work while earning what the social security administration refers to as a substantial and gainful income. To illustrate this, I should point out that disability examiners who work on social security disability and SSI disability claims devote a fair amount of their case processing time to going over the work history information supplied by claimants at the time of application and then attempting to classify these jobs by matching them against listings in a separate reference source. The whole point of this, of course, is for the disability examiner to get an idea of what the claimant's past work demanded of them because their current condition may not allow them to work under such demands. The disability examiner also attempts to get an idea of the claimant's level of work skills to see if, in conjunction with the claimant's age and education and functional restrictions, the claimant can possibly do some type of work they've never done before...assuming that they don't have the ability to do their old work. As you can clearly see, the individuals who make decisions on disability claims (judges at the hearing level and examiners at the levels preceding this) are actively looking to see if a claimant's disability application or appeal can be denied because...they can still work. What implications does the social security administration's focus on work activity and the possibility of a claimant returning to work activity have for how a case is handled? One is this: claimants who are initially filing should do their very best to supply detailed information about their work history. Doing so will help facilitate the accurate categorization of their past work and skill levels (though it won't necessarily guarantee it). However, work activity issues and how they influence the outcome of a case will typically be best addressed at the time of a disability hearing if a claimant has able representation. Why? Because though disability claimants are permitted to review their case files prior to a hearing, few if any will be able to discern whether or not their past work was properly classified and, accordingly, the effect this had on the perception of their job skills. A good representative, on the other hand, can look over the prior decisions that were made and sometimes find glaring errors on the part of the prior decision-makers. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

Social Security Disability Posts and Pages

Should You Give up on Your Disability Claim if you Miss your Appeal Deadline?

By Tim Moore on May 28, 2010 11:04 PM | Permalink This was covered in a recent conversation in a forum in which an individual advised another to go forward with her case even though she had appealed after the deadline. It was good advice, of course. The social security administration gives you sixty days, plus an additional five days for mailing time, to send in a mailed disability appeal. And if your appeal arrives in an untimely fashion, you may have to begin again with a new application for disability. However, even if this is the case, there are certainly a couple of things to consider. First of all, you may be able to demonstrate that you had what is known as "good cause" for filing a disability appeal past the deadline. If you have--or get--a disability attorney or representative, they can enlighten you on what is (and is not) a valid good cause reason for filing late. But good cause tends to equate with common sense. For example, were you ill and not able to respond to your notice of denial? The second thing to consider, of course, is this. Missing an appeal deadline and not having good cause might mean having to start all over, effectively losing months of time in the process. But giving up on a social security disability or SSI disability claim is far worse. Simply because the statistics are very clear on one matter: those who do not give up and pursue their claims at least as far as the level of a disability hearing have a better chance of winning disability benefits than losing. And I should point out that representation on a claim tends to dramatically reduce instances of late appeals. This is for a couple of reasons. One, the disability attorney or non-attorney representative handling the case has every incentive to mail in a timely appeal. And, second, once the social security administration is aware that you have representation, they are obligated to send copies of all correspondence that is sent to you to them as well. Which makes it much harder to miss a notice of denial, and, subsequently, be late on the filing of an appeal. Note: it's still a good habit, even though your representative should get a copy of everything social security mails out, to, nonetheless, notify your attorney after you get a notice of denial, or any other type of notice. There are many instances in which social security fails to notify either the claimant or the attorney that a case has been denied and it is simply best to ensure that both you and your representative are on the same page. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

Social Security Disability Posts and Pages

How Disabling Does a Condition Have to be to Collect Social Security Disability?

By Tim Moore on May 25, 2010 10:14 AM | Permalink I came across this statement in a disability forum and thought it would be good to clarify how disabling a condition must be for a person to have Social Security disability benefits, and also how work activity affects potential disability eligibility. The person in the forum stated, âWork is getting harder and harder for me and I am wondering about collecting disability, but if I am not eligible to get it I don't want to waste my time applying.â Basically this statement is asking two questions: 1) How disabling does a medical condition have to be for Social Security disability? 2) How much work can an individual perform and still be eligible for disability benefits? Let answer the first question. How disabling does a medical condition have to be for Social Security disability? Social Security considers any medically determinable mental or physical impairment to be disabling if-- A) It has prevented an individual from performing substantial gainful activity (SGA) for twelve months; or B) Is expected to prevent the performance of SGA level work activity for twelve continuous months; or C) Is expected to result in the death. For the purposes of a Social Security disability determination, SGA is a monthly earnings amount that is considered to equate with substantial work activity. Basically, if you can work and earn at least this amount, then the social security administration does not consider you to be disabled. If you have a severe physical or mental impairment and cannot work, or you can work but cannot earn at least the SGA amount, then social security will likely approve you for disability benefits. Usually, the SGA monthly limit increases every year by a small amount. And Social Security really is not so interested in specific conditions that a person might have, but, rather, just that the condition (or conditions) have prevented the person from engaging in substantial work activity. Which brings us to the second question: How does much work can an individual perform and still be eligible for disability benefits? Basically, if a person is working and earning over the SGA monthly earning limit, it does not matter how severe their medical and/or mental impairment is; their disability claim will be denied for the performance of SGA prior to being sent for a medical determination. Translation: if you apply for disability benefits with the social security administration at the same time that you are working and earning at least the SGA monthly earnings amount, your case will not be transferred to a disability examiner to be evaluated (meaning your medical records will never be looked at). You will essentially receive an rapid denial from the social security office based on the fact that your level of work activity--according to the definition of disability used by the social security administration--makes you ineligible to receive disability benefits. To reiterate, Social Security bases its medical determinations not so much on whether a person has an impairment or set of impairments, but, instead, on whether the individual's condition makes it impossible for them to work and earn at least a certain amount of income each month (which is SGA). In other words, potential applicants may find it is a waste of their time filing for Social Security disability if they are still working and earning over the SGA amount. However, work activity, by itself does not make it impossible to apply for disability. It all depends on how much a person is earning at the time they file a claim. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

Social Security Disability Posts and Pages

Does Social Security Need To Know About All Of My Jobs?

By Tim Moore on May 20, 2010 3:46 AM | Permalink The simple answer to this question is yes, social security should be informed about all of your jobs if you are filing a disability claim with the social security administration. Social Security reviews an individualâs job history for fifteen years previous to the date that they filed for disability. Which means if it is 2015, Social Security will review all relevant jobs back to 2000. Relevant jobs for Social Security purposes are jobs that lasted three months or more and in which the claimant earned wages that were considered to be substantial gainful activity, or, as it is more commonly known, SGA. SGA is a monthly earnings amount that Social Security considers to be substantial work activity (self supporting). Anyone who files a disability application will have their disability claim denied prior to having any kind of medical determination done if they are performing SGA-level work activity. Social Security reviews all past relevant work activity as part of the five-step sequential disability evaluation. It is very important for a disability applicant to give thorough information about any job that they have performed in the past and individuals should describe their job as they performed it. This is because the disability examiner who processes the case must be able to determine that an individual is unable to perform any of their past relevant work. If that's not the case, they have to deny the disability claim on the basis that the claimant can perform a past job. (Note: it is the experience of many disability examiners that disability applicants often tend to minimize the requirements of their jobs which can obviously disadvantage them. So, in other words, don't do this) If the disability examiner determines that an individual has a residual functional capacity that is too restrictive to perform any of their past work, they must then evaluate the person's ability to perform, or be trained to perform, other types of work, given their limitations and job skills. If an individual has a severely restricted residual functional capacity and it has been determined that they cannot do any of their past work and have no transferable skills that would enable them to transition into another job, they will most likely be approved for Social Security disability. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

Social Security Disability Posts and Pages

How Does Social Security Look For Medical Records?

By Tim Moore on May 16, 2010 6:25 PM | Permalink Social Security does not go on a random search to look for medical records for a disability applicant, nor does social security have a means of automatically identifying where a person has been seen for medical treatment. It is actually the disability applicantâs responsibility to provide Social Security with a detailed list of their treating physicians, treatment dates, medications, testing, as well as their work activity for the past fifteen years, at their initial disability interview. Note: Claimants who chose to file a Social Security disability claim online with Social Security (currently, individuals filing for disability are unable to file for SSI online, though that may change in the future) must also complete their disability report form online. Either way, the medical treatment sources (doctors, hospitals, clinics) listed by the applicant at the time of application will be asked to provide a copy of the applicantâs medical records to Social Security. Basically, it works like this: after a disability claim is taken at a local social security field office, the claim is transmitted to the state disability agency that works on making the disability determination. Some may be surprised to learn this, but the "social security office" is not actually involved in this process; they simply take the claim and then forward it to the state agency which, depending on the state, may be known as disability determination services (DDS), or the the disability determination unit or division, or the bureau of disability determination. Once the claim is at the state agency, it is then assigned to a disability examiner, a type of specialist who will review the claimant's medical history and work history in order to render a determination on the SSD or SSI disability claim. One of the very first things the examiner will do, of course, is electronically generate letters requesting medical records from each medical treatment source listed by the claimant. Typically, this will be done by the examiner on the very first day that they have the case simply because the wait for medical records represents the single largest holdup for a case. Note: Though it can sometimes make sense for a claimant to obtain their own records and submit them when they file a claim (in order to save processing time on a case), Social Security does pay medical providers for medical records. So if it is a financial hardship for an applicant to get their records, they should allow Social Security to request and pay for the medical records. Once an applicant's medical records are obtained, social security may or may not have enough medical information to make a disability determination. Social Security would like to have a twelve-month medical history as well as current medical information (medical treatment notes within the past ninety days) to make their determination. However, disability examiners are only required to have a current medical status of an individualâs alleged medical and/or mental impairment (s) to make their decision. Consequently, individualâs who have no medical treatment information (or their treatment information is considered non-current) may find themselves attending one or more consultative examinations with a physician hired by Social Security to provide current medical information. These consultative examinations are often short cursory examinations that are just intended to give the disability examiner a bare amount of medical information for their decision. While these examinations are good for the disability examiner (in the sense that the examination report may allow the examiner to get the case closed and off their desk), they are rarely good indicators of an individualâs true residual functional capacity (what an individual is able to do in spite of the limitations of their disability) and generally lead to a denial of disability benefits to the applicant. To that end, an individual who is considering filing for disability with Social Security should not depend upon Social Security consultative examinations to win their disability benefits. It is almost always best to have his or her own medical treatment information that is provided by a physician who actually treats the applicant...versus someone who is just paid to perform a quick exam for a disability decision. If at all possible, try to have current medical information even if it is an emergency room visit at the local hospital, because it is still more objective than an examination provided by Social Security. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

Social Security Disability Posts and Pages

Can You Collect Social Security Disability At The Same Time As Workerâs Compensation?

By Tim Moore on May 9, 2010 8:37 AM | Permalink If you are approved for Social Security disability there is nothing barring you from receiving workerâs compensation. Workerâs compensation entitlement is based upon the fact that you have some kind of work related impairment that has prevented you from working at your usual job and, as such, does not interfere with you collecting your Social Security benefit. However, there are some restrictions involved with receiving Social Security disability benefits simultaneously with workerâs compensation benefits. Social Security does not pay a full disability benefit amount to individuals who are receiving workerâs compensation benefits. Workerâs compensation benefits cause an individualâs Social Security disability benefits to be offset (lessened). Perhaps the reasoning for this has been that Social Security and workerâs compensation benefits are both government funded disability benefits and it would be unfair to pay a person who is already receiving a federally funded disability benefit the full amount of another federally funded benefit. However, this is not likely if you consider the fact that there is no offset involved when a person is receiving both social security disability and VA disability benefits. It really does not matter why Social Security offsets their disability benefit. Suffice it to say that if you receive weekly workerâs compensation benefits there is a very good chance that your Social Security disability benefits will be greatly reduced. If your workerâs compensation claim is going to be settled, your workerâs compensation attorney should include a âclincher statement or statementâ that prorates your workerâs compensation settlement weekly over the course of your lifetime to reduce the affect it has on the amount of Social Security disability benefits you can receive. If your representative does not prorate your workerâs compensation settlement, your Social Security will continue to be offset by the weekly amount until the settlement amount is recouped. This could mean that an individual would receive a very small amount of Social Security monthly benefits for years after they have settled their workerâs compensation claim. So be very careful when settling your workerâs compensation claim if you are receiving Social Security disability. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections

Social Security Disability Posts and Pages

Social Security Disability, Light and Sedentary Work, and Mental Limitations

By Tim Moore on May 3, 2010 9:47 PM | Permalink Social Security vocational guidelines define work activity as medium, light, or sedentary. These work activity levels are defined as follows: 1) Sedentary work means that you are able to sit for up to 6 hours in an 8 hour day, and lift up to 10 lbs. occasionally during a day; 2) Light work means that you can stand and walk for up to 6 hours in an 8 hour day, lift 10 lbs. frequently and 20 lbs. occasionally; 3) Medium work means that you can stand and walk for up to 6 hours in an 8 hour day, lift 25 lbs. frequently and 50 lbs. occasionally. The vocational grid can only be used to evaluate disability claims that involve physical impairments and is essential to all disability determinations that involve physical impairments. This does not mean that an individualâs mental impairments are not considered in addition to one or more physical impairments if an individual has both mental and physical conditions that limit their ability to work. The following information is just a sample of the sedentary vocational grid rules: Rule 201.01 ----------- Age:55+ Education:Limited or less Work Skills:Unskilled or none Equals finding of: Disabled Rule 201.02 ----------- Age:55+ Education:Limited or less Work Skills:Skilled or semi-skilled, Skills not transferable Equals finding of: Disabled Rule 201.03 ----------- Age:55+ Education:Limited or less Work Skills:Skilled or semi-skilled, Skills transferable Equals finding of:Not Disabled Rule 201.04 ----------- Age:55+ Education:HS grad or more Work Skills:Unskilled or none Equals finding of:Disabled According to the example above, it is evident that an individualâs age, education, work skills, and the transferability of work skills are important to determining when an individual--who does not meet or equal an impairment listing--is disabled. It is difficult for an individual who is capable of a full range of sedentary or light work to be found disabled if they are under the age of 55 or even older, especially if they performed a sedentary or light jobs. Disability examiners have to prove that a claimant is unable to perform their least exertional work. However if their least exertional work is sedentary or light work, it can be difficult to receive a medical vocational allowance, especially for those individuals who have completed high school or more, and worked in skilled jobs that have transferable skills. So how can an individual with an education of high school or above, with a history of light or sedentary job requirements, and work skills that could be considered transferable be approved for disability benefits? Well, there are factors that might negate the transferability of job skills for an individual. For instance, even with a history of skilled work, having some degree of mental limitation can get you out of your past work, basically rendering your job skills non-transferable to other work activity. If you suffer from depression or some other mental condition that causes you to be unable to concentrate, come to work on a regular basis, or causes memory problems that make it difficult for you to complete tasks, it could very well get you approved for disability if social security decides that you have a sedentary or light residual functional capacity rating for your physical condition. Return to the homepage for:Social Security Disability Secrets Social Security Disability Resource Sections