Medical Evidence

Medical evidence forms the heart of any SSDI claim, and applications based on mental illness are no different. However, impairments due to these conditions are particularly hard for examiners to evaluate because they often operate cyclically, leaving the sufferer with periods of stability followed by times of acute dysfunction. With mental health claims, in particular, the medical records should include an assessment of an individual’s ability to engage in normal daily activities and/or a reduced ability to keep up with them to show he/she is incapable of working. Evaluations of issues, such as the ability to concentrate, learn and retain information, and capacity to work with others will be crucial information to the success of an SSDI claim. However, the most important type of medical evidence for mental health disability claims relates to episodes of decompensation.

Decompensation

Decompensation is the decline of an individual’s ability to function at a normal level, which is indicative of an inability to work. Basically, if someone has repeated and extended episodes of mental health issues that impair his/her capacity to adequately function in a job, an employer is likely to terminate, and finding a new job may not be feasible. A lack of decompensation evidence does not doom an SSDI claim. All medical evidence is considered during the examiner’s assessment, and most individuals with mental illnesses have additional conditions that contribute to their overall ability to work, such as spinal deterioration and depression.

Listed Conditions

Some mental illnesses are known to involve repeated and increasingly severe periods of acute psychic dysfunction, and are consequently listed as officially recognized impairments. The SSA considers these conditions to be inherently debilitating, rendering a sufferer unable to work. An examiner looks for medical evidence of the symptoms associated with a particular mental illness to determine if a claimant meets the necessary criteria. Some of the conditions accepted as disabling by the SSA include:

• Schizophrenia;
• Bipolar disorder;
• Autism;
• Anxiety; and
• PTSD.

Contact a Disability Insurance Attorney

If you are suffering from a disabling condition, the income provided by SSDI benefits can mean the difference between having necessary medication and a place to live or being out on the street. Given how important SSDI benefits are, a disability insurance attorney should be consulted about filing a claim to give you the best possibility of success. Farrell Disability Law helps clients throughout Florida or South Georgia get the benefits they need and deserve. Contact the office today for a free consultation.

Resources:

ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm#12_13

nami.org/Learn-More/Mental-Health-Conditions

One of the biggest issues concerning most disabled individuals, after finding adequate medical care, is figuring out how to financially support themselves. Social Security Disability Insurance (SSDI) is the avenue many take to obtain regular income. This option is available to individuals who worked in the past, but now find themselves unable to do so due to a mental or physical impairment. The application process to apply for disability benefits is fairly involved, and application can take days to complete depending on how extensive one’s work and/or medical history is. Consequently, when a letter denying disability benefits comes in the mail, the disabled applicant is often devastated. Thankfully, this is not the only opportunity someone has to make a disability claim. Anyone denied SSDI has the right to appeal, and the appeals process has many intermediate steps before a denial of disability benefits becomes final. Given that the approval rate for disability claims during the initial application stage is only 35 percent, the majority of those seeking SSDI will need to appeal. Thus, understanding the appeals process is very important to the successful award of disability benefits.

The Initial Application Review

While disability benefit eligibility is ultimately decided by the Social Security Administration (SSA), SSDI applications in Florida are funneled through the Florida Division of Disability Determinations, where an individual’s medical eligibility for benefits is decided. Assessments of non-medical eligibility (work history, for example) are made by the SSA. The processing time for this stage of an application is typically three to six months.

Reconsideration

Reconsideration is the first step in the appeals process, and must be requested within 60 days of a receiving a denial of SSDI benefits. If this 60-day window is missed, a new application must be filed. Reconsideration involves a review of an applicant’s file by a new examiner, but the same rules for determining whether to approve benefits apply, so approval at this stage is unlikely unless something was left off the initial application or new medical evidence is available for submission. Thus, any updates on a person’s medical condition, treatment or diagnosis should be forwarded to the SSA to give an applicant the best chance of success at this stage.

Administrative Law Judge Hearing

A hearing before an administrative law judge (ALJ) is the next step in the appeals process, and the one where an applicant is most likely to receive an approval of benefits. Again, a person has 60 days from the time a denial by the reconsideration examiner is received to request a hearing. Examiners affiliated with the SSA no longer have control over a decision, and an ALJ is permitted to make a determination based on evidence or testimony presented at a hearing. Having an attorney at this stage of the appeals process is very important to an approval of benefits by an ALJ, because the lawyer will know the types of evidence to submit, and the most effective way to present an applicant’s claim. Note that it is not uncommon for it to take over a year to a year and a half for a hearing to be scheduled.

Appeals Counsel

If a claim is still denied, the next step is to appeal to the SSA Appeals Council. Success at this stage is low because the Council only reviews whether the ALJ correctly applied the law. The Council does not review the substance of the disability claim itself. Typically, it takes six months to two years to receive a decision, and if the Council does think error occurred, it will refer the claim back to the ALJ.

Petition in Federal Court

The final step in the disability appeals process is to file a petition in federal court. At this stage, a lawyer is almost certainly needed if not already retained. The decision is entirely based on a brief filed with the court and in some cases, oral arguments before the judge. New evidence, testimony or documentation is not permitted. Federal courts are currently backlogged, and it can take well over a year for a decision to be made.

Work with a Disability Insurance Lawyer

The claim process for SSDI benefits can easily become overwhelming for an applicant, but an experienced disability insurance attorney can provide the guidance and expertise needed to get the benefits you deserve. Farrell Disability Law helps clients throughout Florida and South Georgia get the money they need. Contact us for a free consultation.

Resource:

floridahealth.gov/programs-and-services/people-with-disabilities/disability-determinations/index.html

Working or having a job is often more than just a source of steady income. Being employed brings a sense of purpose and structure to a person’s day and life, and a big hole is left behind for many that find themselves un- or underemployed. While unemployment numbers have decreased from their height about 8 years ago, substantial layoffs are still commonly reported in the news. Involuntary employment will always be difficult to accept, but the emotional and financial instability of this situation is compounded when the unemployment is due to a disability that impacts a person’s ability to work. Everyone is at risk of developing a serious condition that requires curtailing or stopping work. Disability insurance exists to supplement the financial loss of these circumstances, and the most well-known form in this country is the Social Security Disability Insurance (SSDI) program offered by the federal government. SSDI turned 60 this year, and offers government benefits to adults with physical or mental impairments that prevent them from maintaining self-supporting employment. Without this assistance, many disabled individuals would not have enough money to provide for necessities, such as food and housing. Consequently, understanding the process to qualify for this benefit is crucial to anyone facing a debilitating health condition.

Pre-Application Requirements

Before a person is eligible to apply for SSDI, a few prerequisites must first occur. First, the applicant must be unable to work because of a medical condition that is expected to last at least 12 months or cause death. Second, the applicant must have enough work history to earn a sufficient number of work credits, which is calculated by the age at which the applicant became disabled. Thus, the older a person is when disability occurs, the more credits are needed to qualify for SSDI. Credits are earned based on a person’s annual salary or self-employment income, and typically, a person earns four credits a year. Applicants generally need 40 credits, with 20 earned in the past 10 years to qualify. Younger workers may qualify with fewer credits.

Applying

The Social Security Administration now allows applicants to apply for disability online. The application is very extensive, and requires a lot of detailed information to complete. It is not uncommon for applicants to receive assistance with completing the forms, which can easily take hours to complete, depending on the complexity of a person’s work and medical histories. Completing an application requires gathering a lot of information, so applicants typically have some prep work to do prior to initiating the application process. Examples of the type of information requested on an application include:

• work history for the previous 15 years starting from the time the medical condition developed that affects the applicant’s ability to work. This work history also includes a description of the duties at each job so the evaluators can assess the physical and mental stressors the applicant would experience if he/she returned to work; and
• a list of all doctors, hospitals and clinics that treated the applicant for the debilitating medical condition, including an account of all tests performed and medications prescribed.

Appeals

One important point to know about this process is that each step takes a considerable amount of time, and patience is needed to get through it. An applicant does have the right to appeal a denial of benefits. However, there are many layers to the SSDI appeals process, and it is best to hire a disability insurance attorney to handle this aspect of the application procedure to give an applicant the best chance of getting approved.

Contact a Florida Disability Law Attorney

Seeking disability benefits from the government is a trying process, but an attorney experienced in this area can take away some of the unavoidable stress. At Farrell Disability Law, representing clients throughout Florida, we understand how essential this money is, and will fight to get you approved at the earliest possible stage. Contact the office for a free consultation.

Resource:

ssa.gov/pubs/EN-05-10029.pdf