The Primary Reason for the Long Time Period

Probably the most asked question that SSDI attorneys hear concerns whether the SSDI claim will be approved, followed by the question of how long it will take. While close to half of all SSDI claims are approved, unfortunately, as described above, the time period for this approval is lengthy, forcing applicants to attempt to survive without income.

At its root, the increase in applications is the primary cause of the time delay. As a result of the aging of the population, more and more applications are made by persons who have experienced age-related disabilities. Additionally, as SSDI benefits become more well-known, more applicants, even those in their prime working years, have been submitting applications, including applications with little support or unjustified claims. While anyone with enough work history is free to file an SSDI application, applications based on unsupported disabilities do tend to clog up the system, taking away SSA examiners from reducing the current backlog of SSDI applications.

Further complicating the situation is the Congressional underfunding of the SSA. While applications have been increasing, due to financial constraints, the SSA budget has been relatively unchanged, and staff levels are well below what is necessary to process the increased number of applications. It should be noted that this is not an issue exclusive to the SSA, as other government agencies have been forced to operate with less, as a result of fiscal cautiousness.

It should also be noted that, contrary to popular belief, the SSA does not purposely delay applications, or deny applications, solely in an effort to save money. The financial underfunding discussed above is limited to staffing issues and not to the payout money.

Strategies in Response

There are a few strategies that individuals can use to attempt to clear the backlog of SSDI applications. Initially, contacting federal representatives and asking them to support legislation that will provide additional monies for staffing the SSA, as well as to audit the SSA to ensure that it and its employees are working as efficiently as possible, can be done easily.

However, probably the most effective strategy, in light of the current financial environment, both at the SSA and throughout the country, is to secure the services of an experienced SSDI attorney to help shepherd an application through the SSA. While using an attorney cannot guarantee that an application will be addressed quicker, their services can help to ensure that any errors or omissions are reduced or eliminated, potentially reducing any delay that could hinder the progress of a successful application.

Get Help

If you have filed (or are considering filing) a claim for SSDI benefits, contact the experienced SSDI benefits legal team at Farrell Disability Law as soon as possible. Our training and experience in negotiating the SSDI process is not only important to have on your side, but can aid in reducing the time delay between filing and approval. Additionally, our skill can help ensure that your application has the best chance for success. Contact our Jacksonville office today.

Resource:

social-services/castor-calls-review-tampa-social-security-disability-claims-office/

Overview of Disability Evaluation Methods

An SSDI application is examined in two ways. First, the condition causing the disability is examined to see if it fits within a predetermined list of impairments maintained by the SSA. Second, if the condition does not fit within this list, a further examination is conducted to ascertain whether the applicant’s residual functional capacity to maintain regular employment is severely impaired due to the impairment’s effects. In other words, the SSA examines whether the impairment is so severe that basic work functions, such as walking, sitting, or retaining information, become nearly impossible to perform on a regular basis. As mentioned above, the main focus is on the first option – the SSA’s Listing of Impairments.

The Listing of Impairments

The Listing of Impairments is published by the SSA, which provides a list of impairments that the SSA has predetermined to be worthy of SSDI benefits, as the severity is so extreme disability is presumed. Within each impairment is a summary of the symptoms an applicant must have to qualify as meeting the Listing requirements. Currently, the Listings are divided into the following sections, each of which contain various impairments:

• Musculoskeletal Problems;
• Special Senses and Speech Impairments;
• Respiratory-Related Problems;
• Cardiovascular Issues;
• Digestive Impairments;
• Genito-Urinary Impairments;
• Hematological Disorders;
• Skin Disorders;
• Endocrine Disorders;
• Congenital Disorders Which Affect Multiple Systems;
• Neurological Impairments;
• Mental Disorders
• Malignant Neoplastic Diseases; and
• Immune System Disorders.

Beyond the specific criteria and symptoms that an applicant must meet for each impairment, additional specific clinical and laboratory tests are often required to make an evaluation. If the applicant is able to prove the existence of these symptoms, and provide the required tests, the applicant will typically be approved for SSDI benefits. Since experienced disability attorneys are very familiar with the Listings, it is a good idea to engage his/her services to help navigate through the SSDI process, and to have him/her work with one’s physician so that all relevant medical evidence is submitted to the SSA.

Get Help

Obtaining SSDI benefits can be frustrating, but you don’t have to go it alone. The legal team at Farrell Disability Law have years of experience navigating the SSDI application process, and having them on your side will be advantageous to your application, and reduce your frustration. Contact the Jacksonville office today to schedule an appointment.

Resources:

ktvz.com/news/wyden-cheers-move-to-cut-social-security-disability-backlog/720362443

SSA View of Autoimmune Disorders

Autoimmune conditions create chronic inflammation in the body that leads to disability and dysfunction as otherwise healthy systems and tissues are attacked and broken down. These conditions can manifest in a number of different ways, and over 40 different types are currently recognized by the medical community. However, the SSA only officially recognizes a handful of these disorders, which means the average examiner will be unfamiliar with all but the most common types of autoimmune disorders, such as lupus, rheumatoid arthritis or multiple sclerosis. This reality means the examiner is unlikely to understand enough about a specific disorder to fully understand and evaluate the medical evidence. Also, even among the more well-known disorders, the complexity of these conditions makes it difficult for examiners to fully grasp how doctors analyze and identify these conditions, especially as technology and medical research advances. The result is a denial of benefits, especially in the early stages, which requires appealing for a disability hearing in front of Administrative Law Judge. At this point, an experienced disability attorney can present the proper arguments and ask the appropriate medical questions of experts to give a claimant a good chance of being approved.

Showing Disability

Disability is established by either producing evidence that a claimant fits within the listing criteria in the SSA’s blue book, or showing his/her residual functional capacity or ability to hold down regular employment is severely impaired due to the condition’s effects. In effect, the condition must be so severe that basic work functions, like walking, sitting or retaining information, become nearly impossible to perform on a regular basis. In the context of autoimmune disorders, this can be tricky if the effects of the condition wax and wane. Having an experienced disability insurance attorney to show an inability to perform work on a regular and continuing basis, not just isolated points in time, is key to overcoming this potential obstacle. Turning to the types of evidence needed to show disability in a specific example, lupus, a systemic condition, information related to a person’s physical, mental and sensory abilities must be provided. For the physical component, lupus sufferers often experience fatigue, chest pain, headaches and shortness of breath, which would impact physical exertion. For mental limitations, lupus frequently triggers memory problems, anxiety, depression and difficulty concentrating, all factors that would inhibit effectively performing daily job tasks. Finally, those with lupus commonly have sensory problems that manifest as blurry vision, photosensitivity and seizures, all of which restrict working in any meaningful or safe capacity.

Get Help

Qualifying for SSDI benefits should be a simple and easy process, but in reality, receiving approval is frequently long and complex. Farrell Disability Law understands your frustrations with this process, and will work to get you the money you deserve. Contact us for a free consultation.

Resource:

nytimes.com/2018/01/10/opinion/in-my-chronic-illness-i-found-a-deeper-meaning.html

SSA View of Rare Diseases

The SSA only awards disability benefits for conditions that create a permanent and total inability to work for at least one year, or when a disease is likely to result in death. Establishing a condition as totally disabling is generally accomplished in one of two ways. First, by meeting the criteria for a listing in the SSA Listings of Impairments, which if done, means the claimant is considered to be suffering from a severe condition that not expected to improve, and is more likely to progressively worsen. In fact, a diagnosis of certain conditions, such as Lou Gehrig’s Disease (ALS), is always accepted as disabling without the need for the presentation of further medical evidence. The Compassionate Allowance program is another component that is sometimes applicable to those with a rare disease. This program significantly expedites the approval process for certain recognized severe conditions, and reduces processing time from months or years to weeks. An experienced disability insurance attorney can help with compiling a claim that will trigger consideration under this program, as well as submit a new condition for inclusion.

Alternatively, a claimant can qualify under a vocational medical allowance, which looks at a person’s residual functional capacity to perform different types of work. The difficulty facing individuals with a rare disease is often obtaining a medically determinable diagnosis, as not all disabling conditions have been fully identified and named, and symptoms may take years to accurately diagnose.

Potential Issues with Qualification

Proving a rare disease is more than just a collection of unexplainable symptoms is the largest challenge these individuals frequently confront. The SSA will expect to see a verifiable and confirmed diagnosis of some type of impairment (assuming the disease does not fall into the group automatically considered disabling based upon an official diagnosis alone) through physical exams, lab work and/or imaging. Daily symptoms and limitations are relevant for determining what type and amount of work a claimant could tolerate, but the symptoms must relate to a medically-determinable impairment that would reasonably be expected to produce them. Additionally, this complication often manifests as a claimant bouncing around a large group of physicians looking for an answer to his/her condition, which the SSA could interpret as evidence the claimant is exaggerating or creating symptoms solely to obtain benefits. An experienced disability insurance attorney will know how to address this possible bias, and draft a disability claim that minimizes the likelihood the SSA would question the veracity of the reported symptoms/condition.

Get Legal Advice

SSDI benefits are something you work years to accumulate, and should be accessible in a time of need for any American. Farrell Disability Law understands the frustration of navigating the SSDI process, and knows how to effectively fight to get you the money you deserve. Contact the Jacksonville law firm for a free consultation.

Resource:

ssa.gov/planners/disability/dqualify.html

SSA Review Process

The SSA is required to review each SSDI benefit recipient’s level of disability, called a Continuing Disability Review, every certain number of years, depending upon the expected likelihood of improvement. If the SSA determines a recipient’s condition has improved to the point where he/she can return to work, benefits will be terminated. The frequency of these reviews are as follows:

• if improvement is expected, review occurs within six to eighteen months;
• if improvement is possible, review occurs after three years; and
• if improvement is not expected, reviews are after seven years.

While these reviews are mandatory, passing them is much less rigorous than the process to gain benefits in the first place.

In addition, if a recipient returns to work or school full-time, or earns $1,180 or more per month, (for 2018), the SSA will terminate benefits, though terminated recipients are given a three-month grace period (the month termination is communicated to the recipients, plus two more) before benefits cease. Further, certain events can trigger a review outside the normal schedule, including if a new treatment for a person’s disabling condition is now available or if the SSA received reports a recipient is not following treatment protocol.

Appealing Termination

When an SSDI benefit recipient receives notice of a termination of benefits, he/she does have some recourse, and can appeal the decision. If the appeal is submitted within 10 days of receiving notice, benefits will continue until the appeals process is concluded. Otherwise, recipients have 60 days to appeal the termination, though benefits will stop after the grace period passes. If benefits continue while the appeal is pending, and the individual later loses benefits for good, he/she may be asked to repay some or all of the money received during this time. The first step in the appeals process typically involves a review by a representative at the State disability determination office, and advances to a hearing in front of a disability hearing officer if the first review supports termination. If termination is still upheld after the hearing with the disability officer, the case may be appealed to an Administrative Law Judge (ALJ). Beyond this stage, an appeal to the Appeals Council and with the federal courts are also possible, but harder to win. Through the ALJ stage, new medical evidence and arguments against termination may be offered for consideration, and given the importance of retaining this support, working with an experienced disability insurance is critical to obtaining a satisfactory outcome.

Talk to a Disability Insurance Attorney

Facing the termination of SSDI benefits is a scary and financially devastating situation that requires quick action and the focused attention of an experienced disability insurance attorney to avoid the loss of this benefit. Farrell Disability Law know the obstacles you must overcome, and can put their more than 20 years of experience to work on keeping benefits you earned and deserve. Contact the Jacksonville law firm for a free consultation.

Resource:

santafenewmexican.com/news/local_news/woman-struggling-to-make-mortgage-payment/article_ee8f7bee-5451-5241-a1c1-af7e5db228f2.html

Improvement to Condition Due to Medication or Other Factors

Once benefits are awarded, the issue with medications is no longer the severity of side effects, but whether the drug improves a person’s condition to the point that a return to work is possible. As new drug therapies become available, SSDI recipients could see their benefits go away if a particular medication sufficiently alleviates their symptoms so that work is now feasible. An improvement in a person’s medical condition is the most common reason disability benefits are cut-off, and the SSA performs periodic assessments, typically every three to seven years, of an SSDI recipient’s continued disability. The stoppage of medical treatment is one of the first things the SSA will evaluate, and it assumes it means a person is no longer disabled. Unfortunately, this stance does not account for those who give up on pursuing treatment for complicated conditions, or those unable to afford effective treatment.

Earning Too Much Income

For 2017, SSDI recipients are permitted to earn some income, up to $1,170 a month, but if someone returns to work full-time or for an extended period, the SSA will view this as engaging in a “substantial gainful activity (SGA).” A finding of SGA by the SSA means a person is no longer eligible for benefits because he/she is not considered disabled. The SSA does offer a work program for disability benefit recipients so these individuals can determine if working is possible without losing benefits, but this only lasts for a specified period of time (nine months), although participation does exempt someone from a medical review of disability during the trial period.

Additionally, income received from pensions, alimony and public assistance, such as free housing, would also count towards a person’s monthly income, and could render him/her ineligible for disability benefits if it exceeds the allowable maximum.

Talk to a Disability Insurance Attorney

Getting and keeping disability benefits is a critical issue for anyone dealing with a disabling condition or impairment. If you have concerns about obtaining or retaining benefits, talk to a disability insurance attorney as soon as possible. Strict deadlines to appeal the denial or termination of benefits must be satisfied to avoid filing a brand-new application for benefits. Farrell Disability Law has years of experience getting the benefits clients deserve, and is available to help you with your disability claim. If you live in Jacksonville, Orange Park, Middleburg or the surrounding areas, contact us for a free consultation.

Resources:

thv11.com/news/local/patients-fear-medical-marijuana-card-could-cost-them-their-social-security-benefits-11-listens/453909122

choosework.net/about/work-incentives/index.html

What Is a Disability under SSA Regulations?

The SSA has a very strict definition of disability that does not provide partial or temporary benefits for someone experiencing a short-term disability. Instead, the SSA requires all recipients be completely unable to perform any type of work, and this disability must be expected to last at least one year or lead to death. The SSA limits the definition of disability in this way because it is assumed the disabled have other financial resources to access, such as workers’ compensation, savings and investments.

Disability Under the Listing of Impairments

When the SSA evaluates an SSDI application, the examiners look for medical evidence that the applicant suffers from a disease or condition that severely impacts his/her ability to work. To make it easier to identify which diseases and conditions produce acute effects, the SSA has a list of conditions, the Listing of Impairments, that are automatically considered disabling. Thus, if a person has a diagnosis of a medical condition listed on the SSA’s directory of disabling impairments, and the diagnosis is supported by sufficient medical evidence, the applicant should be approved for benefits.

Disability According to Functional Limitations

However, if an applicant has a severe condition, although not at the level required under the Listing of Impairments, the SSA then turns to an analysis of whether the applicant can perform previous work. If not, then the SSA assesses whether the applicant can perform other types of work. Specifically, determining whether an applicant can work is largely based on the functional limitations the impairment creates. The SSA will look at an applicant’s work history for the past 15 years, and decide if the applicant can perform the work in the same manner as before the onset of the disability. If the answer is no, the SSA will then examine the applicant’s capacity to transition to other types of work, based on education, work experience and age. The SSA’s ultimate decision in many cases is greatly influenced by the information contained in the residual functioning capacity form. This form is filled out by the applicant’s treating physician, and contains the physician’s assessment of the applicant’s physical and mental limitations, including how severe they are and if improvement is possible over time with the correct treatment. Gathering the necessary medical evidence is crucial to getting an SSDI application approved, and disability attorney who specialize in SSDI claims are in the best position to get an applicant this result.

Get Help

Getting approval for SSDI benefits is rarely easy or quick, but a disability attorney can take the guesswork out of what you need to do to succeed and navigate the complicated SSDI application process. Farrell Disability Law understands how crucial SSDI benefits are to your financial stability and will work to get you the money you deserve. If you live in Jacksonville, Callahan, Fernandina Beach or the surrounding area, contact the office for a free consultation.

Resources:

washingtonpost.com/business/economy/trump-to-propose-big-cuts-to-safety-net-in-new-budget-this-week/2017/05/21/62c01f44-3e34-11e7-adba-394ee67a7582_story.html?utm_term=.eff2a925204b

ssa.gov/planners/disability/dqualify4.html

What Could Lead to a Loss of Benefits

The most common reason offered for the termination of benefits is that the claimant is no longer considered to be disabled. The definition of disability under private disability insurance policies is entirely dependent on the language in the contract, which means the insurance company has a lot of control over how the word “disability” is interpreted. Often, after long-term disability is approved but before the coverage is set to expire, the company will reevaluate the claimant and decide he/she no longer meets the definition of disabled.

For SSDI, the definition of disability relates to a person’s ability to work, and in order to bring a successful disability claim, the person must be:

• unable to perform past work; and
• unable to adjust to other work due to limitations created by a medical condition.

Furthermore, the disability must be expected to last for at least one year or lead to death.

Thus, being awarded benefits by one entity does not guarantee approval by the other since the standards for disability are not necessarily the same. Once awarded, the recipients of SSDI benefits can have their benefits terminated if the disabling condition improves to the point he/she no longer qualifies as disabled. The Social Security Administration (SSA) reviews disability recipients on a periodic basis to determine if they still qualify as disabled, though the review is usually less stringent than the one used to initially qualify. More often, benefits terminate if a claimant returns to work, and the SSA decides the person is engaging in substantial gainful activity (SGA). Earnings above the monthly limit of $1,170 are considered SGA, except during a trial work period, and disqualify a person from SSDI benefits. Further, the SSA may decide a person who earns less than $1,170 per month is still capable of engaging in SGA based on the individual’s job duties.

Responding to a Termination Letter

When an insurance company decides to terminate a policyholder’s disability benefits, there is a specific procedure it must follow in order for the termination to be legal. If the procedure is not followed, the individual denied benefits has the right to file a lawsuit seeking reinstatement. One recent example of a lawsuit filed for the wrongful termination of disability benefits comes from a woman in Miami who claimed the company did not review her case in good faith and failed to provide a reason for the termination decision. Federal law requires all employer-sponsored disability insurance carriers to give claimants prompt and detailed explanations about why benefits were terminated, as well as how the claimant may fix his/her claim by submitting additional evidence. Importantly, insurance companies must evaluate disability claims in good faith, which means they must give a doctor’s opinion sufficient consideration in the overall decision. Failure to follow these guidelines could lead a court to reinstate benefits.

If an SSDI recipient receives notice the SSA is terminating benefits following a continuing disability review (CDR), the individual has the right to file an appeal and request a hearing with an official from the State disability determination office. An appeal must be filed within 10 days to keep receiving benefits during the appeal, and an appeal of this type should be handled by an experienced disability attorney to greatly reduce the possibility of permanently losing benefits.

Get Help from a Skilled Attorney

Appealing a notice of the termination of disability benefits is a situation with significant long-term ramifications, and should be handled by a disability insurance attorney to give you the greatest chance of prevailing. Farrell Disability Law represents disabled clients seeking insurance benefits in Jacksonville, Bryceville, Middleburg and the surrounding areas. Contact us today for a free consultation.

Resource:

ssa.gov/planners/disability/dqualify4.html

Reporting

Under SSA regulations, specified changes to a recipient’s financial situation or legal status must be immediately reported to avoid possible penalties. These changes include:

• returning to work;
• collecting disability benefits from other sources;
• collecting a pension; or
• getting married or divorced.

Returning to work directly affects a person’s income, and SSDI has strict income limits for all recipients. Thus, any changes in income must be reported so the SSA can assess whether the person still qualifies for benefits. The SSA does have a trial work program for SSDI recipients that allow them to work for a nine-month period during which they can assess if employment is feasible. Benefits continue through the trial period, and the SSA will cover some expenses for items needed to get to work or do the job, such as wheelchairs or walkers.

Applying for or collecting disability benefits from other sources, such as workers’ compensation or private disability insurance policies, also affects the person’s income and must be reported as a result. For workers’ compensation or other public disability benefits in particular, recipients are only permitted to collect up to 80 percent of their average earnings prior to the onset of the disability. Pensions, just like the other changes noted above, can also affect income. Pensions that are of particular concern to the SSA are those from jobs that did not pay social security taxes. Common examples of pensions of this type include: federal civil service positions, positions with foreign governments, and some State pension programs.

Finally, any changes to marital status must be reported, especially if the person is receiving SSDI benefits through a spouse’s earnings and/or work history.

Effect on Benefits

Any of the changes described above could result in the reduction or elimination of a recipient’s SSDI benefits. A big component of SSDI benefits is the income cap imposed on all recipients.  Non-blind recipients’ monthly earnings cannot exceed $1,170 for 2017, except during the trial work period. If income exceeds this amount, the SSA views these individuals as no longer disabled and discontinues benefits. Disability payments from other sources can result in a reduction of the SSDI benefits depending on the amount received, especially if workers’ compensation is involved. The same is true for pensions. Determining if an individual continues to qualify for SSDI benefits following marriage or divorce can be somewhat complicated, and a disability attorney should be consulted if this is a concern.

Consequences for Not Reporting

Not reporting these changes can lead to overpayment and the imposition of penalties. Any overpayment of benefits must be repaid, even if the money is already spent. Failure to repay this money could cause a complete suspension of benefits. In addition, failure to report can result in penalties that reduce monthly benefits by $25 to $100. If the SSA decides the information was deliberately withheld, benefits will be suspended for at least six months.

Talk to a Disability Insurance Attorney

If you live in Florida or South Georgia and are in need of an attorney experienced in disability insurance benefits, contact Farrell Disability Law about taking your case. They understand the frustration of being denied benefits, and will fight to get you the money you deserve. Contact us for a free consultation.

Resources:

ssa.gov/pubs/EN-05-10003.pdf

ssa.gov/disability/Documents/T2%20Reporting%20%20Disability%20doc%20final.pdf

Listing of Impairments

SSDI regulations require an applicant to prove he/she is totally and permanently disabled in order to receive monthly benefits. Total and permanent disability means the person suffers from a physical or mental impairment that will prevent the person from working for at least a year or result in death. The analysis of whether an applicant meets this definition of disability starts with determining whether there is a diagnosis of a condition listed in the SSDI Listing of Impairments.  The Listing of Impairments (“Listings”) lists all the disorders approved by the SSA as worthy of receiving SSDI benefits as well as the specific limitations each disorder must produce to qualify for benefits under SSA standards. The Listings are organized by disease type and the corresponding location on a person’s body. Having a diagnosis of a listed condition can make qualifying for SSDI much easier, depending on the known progressions of the disease, and some conditions only require a confirmed diagnosis to be awarded benefits. However, if a specific condition is not listed or a particular applicant does meet the listing requirements, the SSA examiner will assess whether the person’s impairments are equivalent to similar listing in severity. New conditions are added on a regular basis, and are updated on SSA’s website as necessary.

Compassionate Allowance

As noted above, some disorders are considered so severe that a diagnosis is enough to qualify for benefits. For these individuals, the SSA has an expedited evaluation process so they can start to receive benefits sooner, in a matter of weeks instead of months or years. The Compassionate Allowances program has pre-selected conditions that automatically qualify for benefits, such as Huntington’s Disease and pancreatic cancer. These conditions were selected based on severity and the ability to quickly confirm their presence through objective medical evidence. SSA automatically screens for these conditions are part of the disability process. In addition to having a recognized disorder, the applicant needs to have a sufficient work history and not make too much money. Outside of these standard requirements, he/she will qualify for benefits.

Talk to a Disability Attorney

If you are unable to work because of a disability, find out if you qualify for SSDI benefits. These benefits are potentially available for anyone who paid into the Social Security System, and should not be overlooked when a disabling condition is an issue. The application and approval process for these benefits is complicated and overwhelming, but an experienced disability attorney, like those at Farrell Disability Law, can help you navigate this sometimes daunting procedure. We serve clients throughout Florida and South Georgia; contact us today to learn how we can help you.

Resources:

ssa.gov/compassionateallowances/

ssa.gov/disability/professionals/bluebook/AdultListings.htm