Most of us know someone who draws Social Security disability, or someone who should qualify. The reality, though, is that SSDI is getting tougher to obtain. Paid claims dropped nearly 10 percent last year, and the national award rate from judges is the lowest in 40 years.
Legal guidance in this area can mean the difference in an award for a deserving claimant. What follows is an extremely simplified guide to the disability process:
• How do I apply? The easiest way is to call or contact Social Security and simply say you are applying for disability. An intake worker will conduct a phone interview and ask why you can’t work, when you last worked, what type of work you did, and get information about your doctors and medicines. You will need to sign medical releases for all your medical providers, and likely provide other paperwork.
• Who determines whether I qualify? Social Security farms out initial cases to disability determination services, most of which are state agencies. An agency worker reviews your application and medical records. If you fall squarely – that is, perfectly – within a specified medical listing, you qualify. However, these medical listings criteria are very hard to meet. Virtually all claims are rejected at this initial level.
• What type of disability qualifies? Sad to say, it’s complicated. Most people must prove they have an impairment(s) that prevents them from doing any work available in the national economy on a regular and sustained basis. For example, if you can sit at a desk and monitor security screens or work as a telemarketer, then you may not qualify for disability. On the other hand, if an MRI shows you have a herniated disc in your back that is clearly displacing a nerve and is non-surgical, you may automatically qualify under the medical listings. Thus, very good medical proof must support your claim.
• What if I receive an initial rejection? The next step is to call or contact Social Security to ask for a reconsideration. This MUST be done within 60 days of your rejection. You might also want to at least contact an attorney at this point. Most cases are rejected simply because the claimant’s medical records don’t meet the proof standard required by the SSA. An attorney should be able to advise you on the proof that needs to be in your medical records – or even that you have little or no chance of winning your case.
• After reconsideration, what if I still do not qualify? Within 60 days of denial, you must ask for a hearing before an Administrative Law Judge (ALJ). This is the step where you should think seriously about retaining an attorney. Gather all your medical records so the attorney can review them. The attorney can tell you more specifically why you were rejected, and can advise you on the medical proof you will need to submit in order to win.
• How long before an ALJ rules on my claim? Sadly, it can take quite a while. Even though ALJs do their best to clear their crowded dockets, it is not unusual to wait 12 to 18 months. You may be able to get a hearing more quickly if you work with an attorney to bring your medical proof up to snuff.
• Will I go broke hiring a lawyer? Probably not. Attorney fees for an SSDI case are capped at 25 percent of past-due benefits, at a maximum of $6,000.00. Benefits from the time of the award into the future are not subject to an attorney fee. However, an attorney may require you to bear the added cost of medical records or obtaining medical reports that meet the proof standard.
• If I win disability, can I obtain Medicare before age 65? Yes, but probably not automatically. There is a minimum 9-month waiting period (and sometimes longer) for Medicare benefits.
As can be seen, the disability process is a maze. Yet, deserving claimants can win and do qualify. Like many things in life, a little help in the process can make a tremendous difference.
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