DISABILITY BENEFITS: WHAT YOU REALLY NEED TO KNOW
You Must File a Timely Application. You
must apply for Social Security disability benefits within 5 years after
you stop working. Your insured status will expire, making a new claim
impossible for an impairment that began later. If there are gaps in your work history, you may have even
less time to file a new claim. Don't wait too long to file after you
stop working.
Denials Are Common But Almost Half of Them Can Be Won on Appeal. Around 70 percent of all disability claims will be denied. Social Security will tell you that you do not meet their rules to get benefits. A high percentage of these decisions are made in error and can be reversed and the claim paid with an appeal. An appeal has a fresh (and better trained) pair of eyes review the evidence in your case. Often, the new decision is better.
You Must Have Enough Quarters of Work. You become an insured person under the Social Security Act by working and paying FICA taxes. Most adults need 20 quarters of work to be covered. These 20 quarters generally must have been accumulated within the most recent 10 year period prior to filing a claim. Very young individuals might need less than 20 quarters of work.
Your Disabling Condition Must Last At Least 12 Months. Short term disability lasting less than 12 consecutive months is not covered by Social Security. You must have an impairment that has lasted, or can be reasonably expected to last at least 12 months. (Do NOT wait 12 months to file your claim).
You Cannot Be Working When You Apply. You may not be working at "substantial gainful activity" during the period you wish to receive disability benefits. In 2016, Social Security classifies substantial gainful activity as earnings/wages of at least $1,130 per month. In 2017, this amount will increase to $1,170 per month.
You Must Have Medical Treatment. Under Social Security regulations, a disabling impairment must be medically determinable. Medical records must be available to support the impairment. Medical treatment should be consistent and recent.
You Cannot Depend on a Social Security Doctor's Examination. Social Security may send you to a doctor with whom they contract to perform an examination. This exam will be brief and superficial. In our experience, these exams fail to help the claimant 90% of the time. Social Security will often use this exam to deny your claim.
You Need Support From Your Own Doctor. According to Social Security regulations, much weight will be given to opinions of your own treating doctor(s) under 20 CFR 404.1527. Your doctor should provide support and this includes more than just routine medical records. Try to get your doctor to provide you with a Medical Source Statement that lists your functional limitations, such as restrictions in sitting, standing, lifting, bending, kneeling, etc. Mental restrictions, such as concentration and memory, should also be documented.
You May Need To Be Examined By a Specialist. 20 CFR 404.1527 provides that extra consideration may be given to a doctor who is a specialist practicing in his/her field of medicine. For instance, if you have a bad back you may need an orthopedic specialist. For arthritis or fibromyalgia, you would need to consult a rheumatologist. A cardiologist may be helpful for heart related problems.
You Must File An Appeal Within 60 Days If You Are Denied. Only about 30 percent of applications are approved by Social Security at the initial level. The other 70 percent must be appealed. The 60 day deadline is absolute. If you do not appeal within the 60 days your claim dies and there is no appeal. Do not wait on medical evidence or anything else. File your appeal immediately, then work on whatever needs to be done to shore up the case. Appeal first, talk later. (A high percentage of denials are won on appeal).
Note: In Alabama, the appeal means requesting a hearing by an administrative law judge. In Tennessee, the first appeal is a request for reconsideration by the same state agency that denied your claim in the first place (usually a waste of time but required by the regulations; afterwards, you may request a hearing).
___________
For a free consultation regarding a Social Security disability application or appeal, please contact the Forsythe Firm in Huntsville at (256) 799-0297 or in Franklin, TN at (615) 732-6159. Free consultations and never a fee unless you win and get back payments.
Denials Are Common But Almost Half of Them Can Be Won on Appeal. Around 70 percent of all disability claims will be denied. Social Security will tell you that you do not meet their rules to get benefits. A high percentage of these decisions are made in error and can be reversed and the claim paid with an appeal. An appeal has a fresh (and better trained) pair of eyes review the evidence in your case. Often, the new decision is better.
You Must Have Enough Quarters of Work. You become an insured person under the Social Security Act by working and paying FICA taxes. Most adults need 20 quarters of work to be covered. These 20 quarters generally must have been accumulated within the most recent 10 year period prior to filing a claim. Very young individuals might need less than 20 quarters of work.
Your Disabling Condition Must Last At Least 12 Months. Short term disability lasting less than 12 consecutive months is not covered by Social Security. You must have an impairment that has lasted, or can be reasonably expected to last at least 12 months. (Do NOT wait 12 months to file your claim).
You Cannot Be Working When You Apply. You may not be working at "substantial gainful activity" during the period you wish to receive disability benefits. In 2016, Social Security classifies substantial gainful activity as earnings/wages of at least $1,130 per month. In 2017, this amount will increase to $1,170 per month.
You Must Have Medical Treatment. Under Social Security regulations, a disabling impairment must be medically determinable. Medical records must be available to support the impairment. Medical treatment should be consistent and recent.
You Cannot Depend on a Social Security Doctor's Examination. Social Security may send you to a doctor with whom they contract to perform an examination. This exam will be brief and superficial. In our experience, these exams fail to help the claimant 90% of the time. Social Security will often use this exam to deny your claim.
You Need Support From Your Own Doctor. According to Social Security regulations, much weight will be given to opinions of your own treating doctor(s) under 20 CFR 404.1527. Your doctor should provide support and this includes more than just routine medical records. Try to get your doctor to provide you with a Medical Source Statement that lists your functional limitations, such as restrictions in sitting, standing, lifting, bending, kneeling, etc. Mental restrictions, such as concentration and memory, should also be documented.
You May Need To Be Examined By a Specialist. 20 CFR 404.1527 provides that extra consideration may be given to a doctor who is a specialist practicing in his/her field of medicine. For instance, if you have a bad back you may need an orthopedic specialist. For arthritis or fibromyalgia, you would need to consult a rheumatologist. A cardiologist may be helpful for heart related problems.
You Must File An Appeal Within 60 Days If You Are Denied. Only about 30 percent of applications are approved by Social Security at the initial level. The other 70 percent must be appealed. The 60 day deadline is absolute. If you do not appeal within the 60 days your claim dies and there is no appeal. Do not wait on medical evidence or anything else. File your appeal immediately, then work on whatever needs to be done to shore up the case. Appeal first, talk later. (A high percentage of denials are won on appeal).
Note: In Alabama, the appeal means requesting a hearing by an administrative law judge. In Tennessee, the first appeal is a request for reconsideration by the same state agency that denied your claim in the first place (usually a waste of time but required by the regulations; afterwards, you may request a hearing).
___________
For a free consultation regarding a Social Security disability application or appeal, please contact the Forsythe Firm in Huntsville at (256) 799-0297 or in Franklin, TN at (615) 732-6159. Free consultations and never a fee unless you win and get back payments.
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