Top 10 Things to know about your Social Security Disability Claim

1.    You Can Apply for Social Security Disability/SSI Through Three Main Avenues:

–    Phone Application – 1-800-772-1213
–    Online – www.ssa.gov
–    At your local social security office

2.    SSDI vs. SSI – Same Medical Standard of Disability, Different Programs for Qualification

SSDI or Social Security Disability Insurance is based off of your payments of social security taxes from working over a period of time. For every 1 year that you make $5,040 (as of 2016), you will earn “4 quarters of coverage.” To be able to apply for an SSDI claim, you must have at least 5 years of coverage within the last 10 years, therefore you must have 20 quarters of coverage within the last 10 years (20 quarters = 5 years)*
*There is a slightly different formulation of coverage for someone under 30 years of age.

SSI or Supplemental Security Income is for you if you don’t meet the above-referenced earnings requirements. Something to remember about the SSI program is before the Social Security Administration will even review your case medically under an “SSI application,” you must not have too much income in your household between you and your spouse. If there is too much income from you and your spouse, you may not even be able to qualify for a medical review of your SSI claim.

3.    What Happens if You’re Denied?
You have 60 days from a denial to appeal a medical denial from Social Security. It is not a good idea to wait to the last second to appeal.

4.    Can You get SSDI if You’re Off Work for 9 Months?

The standard for Social Security is that in order to be disabled, you must be disabled for 12 months or be expected to be disabled for 12 months or longer. For example, if you left your job 3 months ago due to cancer, even though it has not been 12 months yet, Social Security or SSA could still determine that it is reasonably expected for cancer to prevent you from working for 12 months (from when you left work originally), and therefore, that you could be found disabled without having been out of work for 12 months.

5.    You Were Told by Another Attorney that He/She Would Not Take Your Case Because You Won’t Win, Since You’re Under 50.  Should You Appeal Your Denial or Give Up?

The Short Answer: No you should not give up.
Why? Every social security case is different. While a large percentage of our clients are over 50, we have represented thousands of clients under 50 with a wide range of disabling conditions.  In our opinion, it would be unfair to automatically reject a potential client based on age — examining the actual medical file is crucial to a social security disability attorney’s understanding of what is the case’s strength.

6.    You Were Denied Because SSA said You Could do Other Work, Although You’re Over 50 and Have Been a Factory Worker for Over 20 Years.  What Should You do Now?

When someone is aged 50-54 they are considered “closely approaching advanced age,”  and when someone is 55 years and up they are considered “advanced age;” — the bottom line is that what kind of work you did is very important in a social security case when you are 50 years or older. There are many complicated variations of this general rule; our lawyers are well-versed and highly knowledgeable on the intricacies of the rule.

7.    What Considerations are Important to the SSA in its Determination Whether You’re Disabled and Eligible for Disability?

The SSA will consider your medical records, doctor’s statements, and hospital records. Additionally, it will consider statements from you and third parties that know you such as friends or family in determining your overall level of functioning.

8.    Why Isn’t Your Doctor’s Statement that You’re Disabled Enough to Get Disability?

This is because the SSA does not rely on blanket statements of disability by doctors without strong support for the statement in the treatment records.  SSA will look at the particular doctor’s statement, and it will then see if the statement matches up with the overall records you have with that doctor.  If the doctor’s statement is out of line with what he/she has said or treated you for in the past, the doctor’s statement will be given “less weight.” Also, the specialty of the doctor can make the statement stronger or weaker depending on the condition for which you are being treating:  (Example: a neurologist’s opinion on seizures in their patient is stronger than a neurologist’s opinion on a heart condition, if they are not trained in that specialty as well). Doubtless, this can be a frustrating experience for many claimants.

9.    Why Isn’t the Fact You Can’t Go Back to Your Past Job Enough to Get Disability?

This is because the SSA’s standard for disability is “total” – there are no percentages of disability with Social Security, you are either 100% disabled or not disabled. If someone is under 50, all jobs in the state, regional, or national economy must be eliminated. This can certainly be shown, but as in all cases, the medical evidence is the key.

10.    You Missed the Deadline to Appeal Your Denial, is There Anything You Can Do?

Maybe. And that’s a big maybe – depending on your language limitations or failure to deliver by the postal service, you may have good cause to file an appeal outside the deadline but this is not often granted without good reason.  You should consult an attorney immediately to determine whether you can appeal the decision or whether you should file another application.

Florida Court Rules that Florida Workers’ Compensation Law is Unconstitutional

Workers’ Compensation is based on the compromise that employees gain limited automatic benefits without proving fault in return for giving up their right to sue their employers in court. In Florida, and many other states, the legislature has slowly been eating away at the benefits Florida workers can get. One Florida court held this week that the legislature has gone too far in reducing the benefits available to Florida workers. As a result, the Court found that Florida workers are no longer getting enough to justify giving up their right to sue. This link to a story from Florida has more on the decision: http://www.bradenton.com/2014/08/13/5302285/miami-judge-declares-florida-workers.html

This decision is obviously limited to Florida. However, it should serve as a wake up call to Georgia legislators and business lobbyists that we can go to far in limiting the benefits available to Georgia workers. Since around 1992, there has been a trend of business lobbyists coming down to the legislature each legislative session and demanding more changes to the law to the advantage of employers. If they take too much, they risk breaking the compromise of the Workers’ Compensation system and they might face lawsuits over employee injuries. Hopefully, this decision will make the business lobby think twice about pushing for further changes to the Georgia Workers’ Compensation law. Right now, our law isn’t perfect, but we have not yet gone as far as Florida.

How Settling Your Workers’ Compensation Case Can Increase Your Social Security Disability Check

As I explained in a previous post, the Social Security Administration will reduce or offset your Social Security check if your Workers’ Compensation check and Social Security check combined are more than 80 percent of what you were making before you became disabled. However, settlement can sometimes reduce or even eliminate the offset. We can do this by telling the Social Security Administration that your settlement is meant to be divided over your entire lifetime. When you divide a lump sum settlement over your entire lifetime, it appears to be a much smaller amount. This may lead the Social Security Administration to increase your Social Security check. The advantage of doing this is that you can sometimes get a lump sum settlement and still receive close to the same amount monthly you received before you settled your case. However, this is not always the case. We would need to do a careful calculation to determine how settlement would affect your Social Security check.

For an example of how this works, let’s consider the client who was previously making $30,000 per year and is now getting $300 per week in workers’ compensation benefits. As we described in our prior post, this fictional client could only receive a total of $2000 per month in Social Security Disability Benefits and Workers’ Compensation benefits combined (this is 80 percent of $30,000 per year). In this scenario, the Worker’s Compensation benefits would reduce this client’s Social Security Disability benefit to a maximum of $700 per month. Now, suppose after expenses and fees, this same client settled his case for $150,000 and was 45 years old at the time of his settlement. That would give him a life expectancy of 35.4 years based on current life tables. The Social Security Administration will allow us to divide up the client’s portion of the settlement by his life expectancy. In this case, that would make the weekly amount appear to be $81.48 per week or $353.08 per month. As a result, this client could now receive up to $1646.92 in Social Security Disability benefits rather than the $700 he could receive before setting his case. That’s an increase of almost $950 per month in this client’s Social Security Disability benefit.

As the above shows, sometimes there are factors outside of the Workers’ Compensation case itself that will affect whether or not it’s a good decision to settle your case. Settling your case can allow you to have a lump sum and with an increased Social Security check, keep your monthly pay close to the same as it was before you settled your case. However, it differs from case to case and these calculations can be complicated. Also, the Social Security Administration requires specific language in your Workers’ Compensation settlement documents in order to take advantage of this trick.

If you think your Social Security check is getting reduced because of your Workers’ Compensation check, give us a call and we’ll help you calculate your offset and how a settlement would affect your offset.