WHEN NO BENEFIT IS AVAILABLE FOR DISABLED PERSONS

Not everyone who is disabled can qualify for a Social Security benefit.  There are a number of possible reasons why a truly disabled individual would not be able to receive a benefit from Social Security.

One reason is that the individual may not have accumulated enough recent work credits to have insured status with Social Security.  Generally, most persons need 20 credits to be insured.  Those 20 credits must have been earned during the most recent 10 year period prior to filing a disability claim. That means that you should have worked at least 5 out of the last 10 years. (Younger workers may have different requirements).

Each worker has a DLI or date last insured.  Generally, a worker loses insured status with Social Security after about 4 years of no work activity, or after several years of sporadic work. The person might still file a claim for Supplemental Security Income (SSI) - but under SSI he or she must have limited financial resources and very limited household income.  (There are no resource restrictions for SSDI claims).

The other major reason we see disabled people failing to qualify for benefits is a lack of medical evidence. Many times, an individual who is disabled has no medical insurance.  Without the income from a job, they may be unable to go to the doctor and have expensive medical tests performed; therefore, they have no medical proof of their disability. There are two kinds of facts:  the facts you know and the facts you can prove.  Subjective complaints of pain or other symptoms will not prevail.  You must have proof.

Won't Social Security send you to one of their doctors?  The answer is, they might.  However, the chances of getting sufficient medical evidence from this type of consultative examination is very poor.  Consultative exams provided by Social Security are, at best, skimpy.  Usually they do not provide X-rays or other imaging studies, laboratory tests or any type of advanced diagnostic studies.  A doctor performs a brief examination, asks you a few questions and fills out a form.  More often than not, the doctor's examination will be used by Social Security to deny your claim.  Unless the doctor has X-ray vision, he or she probably won't find any severe disabling condition.  Also, a one-time examination is not a substitute for a long history of examinations and treatment by the claimant's own doctor.  It simply doesn't carry the same weight.

What can you do?
  1.  File a claim as soon as possible after you stop working-- while you still have insured status.  (This assumes you believe that you are disabled when you stop working, of course).
  2.  If you are having health issues, don't put off seeing a doctor while you still have health insurance.
  3. Try to see a specialist if you need one--and for heaven's sake, be sure you see a medical doctor.  Nurse practitioners are fine for many things but Social Security does not consider them to be "accepted medical sources" for purposes of evidence (20 CFR 404.1527). 

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