Top Reasons Why SSDI Claims Are Rejected

What should I do if my disability application is rejected?

For those who have severe ongoing disabilities that render them unable to work, the Social Security Disability Insurance Program (SSDI) provides much-needed benefits; however, nearly two-thirds of disability applications are rejected. Let’s take a look at the leading reasons benefit claims are rejected.

Insufficient Work Credits

The Social Security Administration considers a number of factors when determining benefit eligibility, including the applicant’s age, the number years worked – and paid into the social security system, and when you became disabled. You must have worked for a certain amount of time to qualify. Generally, you must have 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. If you have not acquired the needed credits, your application will be rejected.

Too Much Income

There is a limit on the amount of income you earn from to be eligible for benefits. If you exceed this amount you are considered to be engaging in “substantial gainful activity” and therefore ineligible for benefits. Currently, the amount is $1,130 for disabled applicants and $1,820 for blind applicants. 

You Medical Condition is Not Considered a Disability

In order to qualify for disability benefits, you must have an impairment that is expected to last a year or result in death, and your condition must be on the SSA’s list of impairments. If your condition is not listed, you will need to provide additional details about your condition and possibly undergo a special examination with an SSA approved physician. 

You Are Fit to Perform Other Work

If the SSA determines that you a capable of performing a different but related job, your application will be rejected. It is necessary for you to demonstrate that the severity of your condition makes you unable to perform any kind of work-related activity. 

Application Errors and Omissions

Applying for benefits can be a difficult process and requires a significant amount of documentation about your work history, your income, medical history, other benefit applications. In particular, you must provide details about your medical condition or injury, the doctors, hospitals or clinics that treated you as well as test results, treatments, and medicines that have been prescribed.

The Takeaway

If your application is denied, you can appeal the decision, but this requires an extra effort to ensure that all the documentation is in order. Because of the facts that applying for benefits is a difficult process and nearly two-thirds of applications are denied, you are well advised to engage the services of an experienced disability attorney.

Social Security Disability Benefits: Separating Truth from Fiction

How much of what I’ve heard about SSDI is actually true?

Many people who have become disabled wonder if they are qualified to receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) and whether it is worth applying for benefits. The best person to answer this and other related questions is a thoroughly knowledgeable disability attorney. Here is a list of fact-checking replies to some of the myths you may have heard. Of course, it is essential that you actually meet with a lawyer who specializes in the field to explore your unique situation and personal options.

Not many people actually become disabled during their working years

Actually, according to the Social Security Administration, one in every four 20-year-old workers will become disabled before they arrive at retirement age.

I’ve heard that the rate of denial of claims is so high that I shouldn’t even bother applying

Although there is a high rate of denial, approximately 33 percent of those who apply for benefits receive them the first time around. In addition, many more applicants receive relief on appeal, particularly when they have the support of a capable lawyer.

I’ve been told that if I receive SSDI I will be receiving an income similar to what I earned while working

This is a blatant falsehood unless you were grossly underpaid at your last job. As of 2015, the Social Security benefit paid an average monthly benefit of about $1100 per month or about $13,000 annually. This payment is meant to help you meet basic living needs, but for most people it will barely cover housing costs.

I understand that once I begin receiving benefits I will not be able to work anymore

In fact you can return to work while collecting SSDI benefits. Your attorney will be able to guide you through the process of testing your work capabilities during a 9 month trial period.

If my doctor affirms that I’m disabled, I will definitely qualify for benefits, right?

No. The SSDI decision is legal rather than medical, though if you are applying for benefits your treating physician will have to provide the government with detailed information about your health.

Once I’m awarded SSDI benefits, I will have them for the rest of my life

Not necessarily. Your medical condition will be periodically reviewed. Your first review will be 6 to 18 months after the date you became disabled. Depending upon whether your condition is expected to improve, future reviews may occur once every 3 to 7 years.

Now that I’m unable to work, if I apply for benefits quickly, I will receive payments promptly.

Don’t kid yourself. The Social Security Department, like other government agencies, is cumbersome and bureaucratic, so don’t expect that a check will be in the mail any time soon. Processing usually takes up to 6 months, but SSDI payments will be retroactive to the date of your disability onset.

Fast-Track Review of SSDI Claims

Does my medical condition qualify for a fast track disability review?

While Social Security Disability Insurance is designed to provide benefits to those who are unable to work, the system is plagued by delays and inefficiencies. However, the Social Security Administration has procedures in place to fast track review certain cases. Let’s take a brief look at some of these programs.

Quick Disability Determinations (QDD)

This process utilizes a predictive model to screen initial applications and analyze specific elements of data. Cases selected for QDD processing are forwarded to a Disability Determination Services (DDS) within 24 hours of receipt. By sorting through vast electronic files, this process helps to quickly identify cases that have readily available medical evidence and are highly likely to receive a favorable determination.

Compassionate Allowances Program (CAL)

This program has been in place since 2008 that helps claim examiners identify over 100 diseases (a number of cancers and other medical conditions) based on the claimants allegations alone. CAL relies on sophisticated software to target illnesses that normally qualify under the SSA’s Blue Book listing of impairments. This program differs from QDD in that it only requires minimal, but sufficient, medical information that trained professionals rely on when determining this evidence confirms a medical diagnosis. In these cases, decisions can be made in a matter of weeks, rather than months or years.

Terminal Illness (TERI) cases

This program is designed to expedite applications of individuals who have untreatable impairments – those which cannot be reversed and are expected to result in death. There are specific protocols in place to label, flag and continuously monitor these cases to ensure fast processing. In addition these claims must be supported by a credible claim from the applicant, a friend, family member, personal physician or other medical source. At the same time, these cases can also be identified during DDS processing. Qualifying claims include diagnoses such as amyotrophic later sclerosis (ALS), any stage IV malignancy, small cell or throat cell lung cancer, or a statement that the claimant is receiving in-patient hospice care.

Other Fast Track SSDI Cases

The SSA also fast tracks processing of disability claims for Military Service Casualty Cases (MSCC). This process, in conjunctions with the Veterans Administration (VA) and the Department of Defense (DOD) is designed for members of the military who were seriously injured while on active duty on or after October 1, 2001. To qualify, military personnel must be unable to do substantial work due to their physical or mental medical condition(s) that must have lasted or be expected to last at least one year, or is expected to result in death.

Lastly, there is also a fast track process for Presumptive Disability (PD) and Presumptive Blindness (PB) cases that provide claimants with payments in advance of a formal DDS determination if there is a high degree of probability of approval.

The Takeaway

Even though wait times and delays continue to grow, and are even longer for disability appeals, fast track processes are specifically designed for people with serious health conditions. It has been reported that about 6.9  percent of claims (or more than 181,000) received fast-track status in fiscal year 2015. The best way to navigate the SSA and ensure your application is put on the fast track is to engage the services of an experienced disability benefits attorney.

Lawmakers Propose Emergency Payments for Social Security Beneficiaries

How can I qualify for Supplemental Security Income benefits?

Led by Sens. Patty Murray (D-WA) and Charles Schumer (D-NY), congressional lawmakers are proposing a one-time emergency payment in the amount of $581 for over 65 million individuals who currently receive retirement benefits and Supplemental Security Income (SSI).

The payments are designed to assist these recipients who were denied a cost of living adjustment in 2016. Those receiving retirement benefits who are slated to receive $5 per month in the coming year increasing the average monthly payment from $1,355 to $1,3660. Recipients of SSI were set to receive a mere $2 monthly increase in the maximum federal benefit to $735. The scheduled cost of living adjustments are tied to the Consumer Price Index, but these minor increases are considered to be “woefully inadequate” and do not help vulnerable seniors keep pace with the risings costs of daily life.

SSI at a Glance

The Social Security Administration pays Supplemental Security Income benefits to individuals with limited income and financial resources who are age 65 or older, disabled or blind. Children who are blind or disabled may also be eligible for these benefits. Unlike retirement benefits, SSI is not based on one’s prior work history, although it is means tested.

In addition, SSI beneficiaries may also be able to obtain medical assistance through the Medicaid program to cover the cost of hospital stays, doctor bills, prescription drugs and other healthcare costs. Further, many states also offer separate supplemental benefits to SSI recipients, some of whom may also be eligible for food assistance.

The SAVE Benefits Act

While Senate Democrats initially floated the plan last year, the Seniors and Veterans Emergency (SAVE) Benefits Act failed to pass. The measure was first introduced by Sen. Elizabeth Warren (D-MA), who tied the 3.9 percent increase to that of raises that many business executives reportedly received.

This would not be the first time Capitol Hill lawmakers approved such a measure as Social Security recipients received a one-time $250 payment back in 2009 – when Democrats had control of both houses of Congress. The proposed additional $581 would be the equivalent of three-months groceries for most seniors and would also help to cover out of pocket expenses for prescription drugs, according to Sen. Schumer.

Whether  Democratic leaders in the Senate are successful in making this proposal part of the post-election agenda remains to be seen. Nonetheless, qualifying for Supplemental Security Income and navigating the Social Security Administration system can be complicated. By engaging the services of an experienced Social Security benefits attorney, you can obtain the benefits you deserve.

New Criteria for Evaluating Mental Disorders

What mental disorders qualify for social security disability benefits?

The Social Security Administration announced new rules in September concerning the criteria the agency will use to evaluate disability claims related to mental disorders. The new rules, slated to take effect on January 17, 2017, are said to be the most extensive changes to this criteria in more than 30 years. In devising the new rule, the SSA considered public comments to its proposed rule released earlier this year.

More importantly, the agency relied on the input from disability policy experts, SSA lawyers and judges, as well as the expertise of psychiatric professionals. The administration also worked closely with a variety of people who have direct interest or involvement in benefit programs for those with mental disorders, particularly disability beneficiaries and their families. In sum, the new medical criteria is being aligned with the mental health professions standards set forth in its Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).

“We are committed to updating our regulations to reflect up-to-date standards and practices used in the health care community,” said Carolyn W. Colvin, the Acting Commissioner of Social Security.

Mental Impairments at a Glance

Currently, the SSA has an official list of impairments (the so-called “blue book”) that contain medical conditions considered to be inherently disabling such as schizophrenia, autistic disorders, anxiety, depression, bipolar disorder, mental retardation and substance abuse disorders. This requires a disability examiner to make a determination if an applicant’s symptoms of a cognitive, mental or emotional disorder meets the criteria  listed in the blue book.

The SSA has taken this action to update its criteria for evaluating intellectual disability as many of these individuals have significant problems functioning and do not have daily practical and social skills. The agency will now rely on new diagnostic and functional criteria, along with IQ test scores, in order to more expediently identify those who may qualify for disability benefits.

The Takeaway

In the end, qualifying for disability benefits should become less complicated for people with mental disorders. These individuals are particularly vulnerable, and it is critical to ensure that they get the benefits, service and support they need, and deserve.

Nonetheless, navigating the social security system can be a daunting challenge, and many applicants are met with long delays or are subsequently denied. For this reason, if you are trying to obtain disability benefits for a loved one suffering with a mental disorder, you are well advised to engage the services of an experienced disability benefits attorney.

New Study Suggests Social Security Administration Fails to Properly Explain Benefits

Earlier this year, the Government Accountability Office (GAO) conducted a study of the Social Security Administration (SSA); namely, its practices while working with soon-to-be beneficiaries. Overall, the GAO concluded that the SSA can – and should – do a much better job ensuring beneficiaries fully understand the ramifications of their decisions – which, up until now, have blindly cost thousands of enrollees millions of dollars in lost income.

The study focuses primarily on retirement benefits through the SSA. However, the clear issues are those that can impact any number of enrollees, including those receiving disability benefits and Supplemental Security Income (SSI). Overall, the GAO reviewed a number of surveys, academic reports and interviews with both agency representatives and beneficiaries to conclude that the information supplied to SSA customers is incomplete, unclear and sometimes misleading. Concerning retirement benefits, the GAO found that SSA employees were failing to fully explain the penalties awaiting those opting to retire prior to 65 – which could result in a substantial loss of income in the long-term.

One important takeaway from the study was to always seek information from higher-ups before accepting the advice at face value. A Tier-1 customer service representative is usually the first representative a person meets when arriving at the SSA office or calling on the phone. However, Tier-2 representatives may be summoned at the request of the customer, and will have a more highly-specialized knowledge of the particular benefits question at issue. Unfortunately, the GAO also determined that nationwide budget cuts within the SSA will mean longer wait times for most folks, thereby adding to the already mounting frustration.

Contact a Social Security disability attorney today!

If you would like assistance with your Social Security issue, please do not hesitate to contact Roeschke Law, PLLC today: 1-800-975-1866. 

Disability Benefits for Individuals with PTSD

Am I eligible for SSDI if I am suffering from post traumatic stress disorder?

Have you been involved in a traumatic event? Are you plagued by feelings of hopelessness, guilt or shame? Do you have difficulty concentrating or remembering things? Are you angry and irritable? Do you have trouble sleeping or experience excessive anxiety or fear?

If you answered yes to these questions, you may be suffering from post traumatic stress disorder (PTSD). If these symptoms are interfering with your everyday life, you should medical attention. Certainly, most individuals who survive a traumatic event suffer a certain amount of shock or fear, but those with severe symptoms will get worse without treatment: often a combination of medication and counseling. Those who are unable to work due to PTSD may also be eligible for social security disability benefits. 

SSDI and PTSD

In order to obtain disability benefits for PTSD, it is necessary to satisfy the criteria listed in the Social Security Administration’s Blue Book. This means that there must be medically documented evidence of one of the these symptoms:

  • Repeated, disturbing memories of a trauma that result in severe distress
  • Long lasting anxiety
  • Irrational fear of a particular object or place that makes one avoid it
  • Frequent panic attacks occurring once a week or more
  • Persistent obsessions and compulsions

In addition, it is necessary to demonstrate that these symptoms cause significant limitations in at least two areas: daily living, social functioning, or concentration, persistence, or pace. Alternatively, the symptoms must leave an individually totally incapable of functioning independently outside of the home.

On the other hand, those who do not meet the above-listed requirements may still be eligible for benefits though a “medical vocational allowance.” This is a specific approval that takes into account an applicant’s work history, age, education and “Residual Functional Capacity.” This refers to the amount of activity an individual is capable of performing despite his or her impairments.

Medical Evidence of PTSD

As with any disability claim, it is necessary to provide medical evidence of PTSD and any other impairments related to the traumatic event. This evidence includes records of inpatient or outpatient psychiatric treatment and counseling and therapy notes. In some cases, it may also be helpful for a medical provider to submit an RFC form. 

The Takeaway

In the end, there is a growing awareness of the debilitating effects of PTSD, and those who are suffering with this disorder may obtain relief with proper medical treatment. For those who meet the SSA’s criteria, disability benefits are also available. Nonetheless, submitting an application is a complicated process that requires the advice and counsel of an experienced disability benefits attorney

Be Careful Who You Trust With Your Social Security Info

When I see news stories about con artists preying upon people that rely on Social Security to get by, it makes me so angry. People living on Social Security Disability Insurance, Supplemental Security Income, or who have retired and are collecting Social Security, don’t need any additional trouble in their life. Yet they seem to always be the people that wind up getting swindled.

I recently saw a story about a worker at the Phoenix Rescue Mission who was sentenced to 3 1/2 years in prison for stealing Social Security benefits from the homeless people living at the shelter. He had access to all the personal information of the residents, and was the person who handled all the mail going in and out of the facility, so he took advantage of his situation to steal over $61,000 in Social Security benefits.

As someone who spends my time helping people apply for benefits, this is so frustrating. There are way too many people out there who are getting scammed by the very people that are supposed to be helping them.

Here are a few tips that I hope will help people avoid being scammed by people they are supposed to be getting help from:

Consider going digital.

The homeless men who were taken advantage of had their benefits checks physically stolen by the person who handled all the mail at the facility where they were living. This could happen to anyone who has their mail taken care of by someone else, or who does not get their mail out of their box soon after it is delivered.

One way to prevent your benefits from being physically stolen is to set up direct deposit. With direct deposit, the government puts your benefit money directly in your bank account instead of sending you a physical check.

Don’t give your Social Security number to everyone that asks for it.

Did your dentist ask for your Social Security number the last time you went in for a cleaning? A lot of dentists do this so they can use it as a patient tracking number instead of setting up their own numbering system. And I don’t mean to pick on dentists, they are not the only businesses that do this, a lot of companies rely on Social Security numbers for client tracking.

Identity thieves have noticed this, and have started stealing Social Security numbers from these companies by hacking into their computer systems, digging through their trash, or bribing their employees to share your data with them.

So, the next time a business (or anyone) asks for your Social Security number, don’t automatically give it to them. Ask them why they need it, and what will happen if you don’t give it to them. If they don’t actually need it, don’t give it to them.

If you think something is amiss, notify the authorities right away.

If your Social Security card is lost or stolen, or you suspect that someone has stolen your identity, contact the Social Security Administration, and if applicable, your bank, immediately. You may even want to contact the police depending on the situation.

Be careful who you trust to work on your behalf.

Finally, don’t trust everyone that offers to help you. As someone that has dedicated their life to helping people navigate the Social Security system, nothing makes me angrier than seeing people be taken advantage of by people that are supposed to be helping them. If you have questions about someone who is offering to help you with your Social Security benefits, and you aren’t sure if it is a scam or not, please contact me and I will do what I can to help you.

Understanding the Intersection Between Child Support and Benefits for Children

Is your child receiving Supplemental Security Income (SSI)? Are you considering seeking SSI for your child due to his or her health and financial needs? If so, it is important to understand the delicate intersection of child support and eligibility for benefits – as child support payments are considered the child’s income and can greatly impact (or eliminate) the extent of the child’s eligibility for assistance.

Supplemental security income is available for children who are deemed to be blind or disabled – as well as meet certain household income criteria to demonstrate financial need. If you are receiving child support and hoping to also qualify your child for SSI benefits, keep in mind that the Social Security Administration (SSA) will count two-thirds of the payment amount as “unearned income.” After the first $20.00 in child support, any amount beyond that will count dollar-for-dollar against the child’s SSI eligibility.

It is also important to address the scenario in which a child has actually reached the age of adulthood, but is still receiving child support payments under a court order. When this occurs, the one-third exemption does not apply, and the SSA counts 100 percent of the child support payment as unearned income.

In some families, child support recipients opt to retain the monthly support payments in a trust or interest-bearing account for the benefit of the child when he or she reaches adulthood. In an SSI situation, however, this would count as an “asset” belonging to the child – and eligibility would be adjusted accordingly.

One way to help avoid this unfortunate result – particularly if a child is receiving Medicaid coverage as well – is to work with an experienced attorney to set up a special needs trust. In this scenario, the trust is actually the “owner” of the assets – as opposed to the child – and the child can avoid the unnecessary result of losing eligibility for SSI benefits as a result of his or her legal right to receive child support from a non-custodial parent.

Contact an experienced Social Security attorney today!

To learn more about the process involved in obtaining and maintaining benefits for children, please contact Roeschke Law today: 1-800-975-1866. 

Disabled and Proud

How are attitudes about disability changing and why?

Like so many other types of individual differences, disabilities are gradually becoming accepted as one of the ways of being human. If society can now accept and give rights in the workplace and on the home front to women, blacks, Hispanics, the LGBT community, immigrants of varying ethnicities, surely it is time for people with disabilities to be embroidered into the fabric of our culture as well. It is no longer enough to welcome those who are “different” (as if any of us is not!) to participate in society, it is necessary to bestow the same honors upon them as other minority groups, particularly because the people with disabilities are the largest minority group in the United States.

If you are disabled, whether physically, psychiatrically, because of a learning disability, because of a congenital defect, as a result of aging, injury, trauma or disease, you are entitled to all the same rights and privileges as everyone else. Beyond that, you are entitled to the accommodations necessary to put you on as level a playing field as possible with the rest of the population. If you run into problems applying for or being awarded the disability benefits you deserve in Arizona, you should promptly contact an energetic and experienced Social Security Disability attorney to fight vigorously for your rights.

Disabled Population is Large and Growing Larger

The Centers for Disease Control and Prevention estimate that one in five adults in the United States is living with a disability. The National Organization on Disability says there are 56 million disabled people in this country. As a matter of fact, as more categories of psychiatric, neurological, and learning disabilities are discovered, the percentage of people who fit into the disabled categories continue to grow.

Accentuating the Positive

Just as most of us have come to accept slogans like “Black is Beautiful,” and “We’re Here, We’re Queer, Get Used to It!” as worthy of respect and helpful in ridding ourselves of racism and sexism in all their forms, it is clearly time for us to embrace the rights of the disabled community, in all its various manifestations, to express identity pride. Those in wheelchairs, those who use walkers or rollators, have cochlear implants, prosthetic limbs or service dogs or breathing devices, those with Down syndrome or short stature, autism or schizophrenia or bipolar disorder — all are as human as the rest of us. They all have as much right to be proud of their accomplishments and to live their lives free from discrimination in schools, in the workplace, at sporting events, in playgrounds, in restaurants, in theatres and on public transportation as do we all.

Getting Used to the Idea of Disability as a Normal Part of Life

While most of us will never change our skin color or gender, we will all spend some portion of our lives being disabled. As Rosemarie Garland-Thomson recently wrote in The New York Times, “We just might be better off preparing for disability than fleeing from it.”

If you are disabled, you may have questions concerning qualifications for Social Security Benefits or you may require assistance in applying for SSDI or SSI, appealing a denial of benefits, or requesting a hearing. If you find yourself in any of these situations, you should consult with a knowledgeable attorney who specializes in disability law.