Clients frequently ask what the most common mistakes people make when they apply for Social Security disability and how they can avoid them are. The two most frequently-seen mistakes are failing to appeal an unfavorable decision and failing to obtain appropriate medical care.
File An Appeal if You Were Denied
Many people apply for Social Security benefits and receive an unfavorable decision after 3 to 4 months. After a claimant receives the unfavorable decision, there is a 60-day time limit to appeal. However, many people with disabling impairments do not appeal that decision. The claimant can request a reconsideration if denied on the initial application. If a claimant is denied on reconsideration, they can request a hearing. All it takes is filing a written statement with Social Security stating that the claimant disagrees with the decision because they are disabled, and that will suffice to move the claim to the next level of appeal. Unless there is "good cause," however, if the claimant fails to appeal an unfavorable decision within 60 days, then that claim is closed, and, in the best case, the claimant would have to re-file from the beginning, causing lost time and benefits. In the worst case, the claimant may only be able to re-file if the date last insured has passed in Title II claims or if the claimant has acquired too many countable resources in Title XVI claims.
Seek treatment, even if you don't think you need it.
Another common problem made is failing to obtain appropriate medical care. Most areas of the state have some form of a low-cost or free clinic that provides some form of health care. Social Security is aware of this fact. When a claimant does not obtain medical care, even if they lack insurance, Social Security might conclude that their impairments are not severe enough to warrant treatment. Many claimants become frustrated that they suffer from a chronic condition and do not feel that doctor visits help them, so they stop going. This can be a mistake for their health and their claim. Those with chronic medical conditions are usually the ones who most need regular visits with their physician. And the medical records generated from doctor visits make up a vital part of a person's claim for Social Security disability. If there are few records, there is little evidence to support the claim.
When a claimant timely appeals their decision and regularly sees a doctor for treatment, that person has successfully avoided two of the most common problems when applying for Social Security benefits.
Constructive Actions You Could Take
Few Social Security Disability (SSD) cases lack complications. Setbacks are part of the process, from outright claim denials to lengthy appeals. Unfortunately, they cause constant stress, which can further harm your compromised health. The better you can handle inevitable setbacks, the better outcomes you'll enjoy for your legal case and your health.
Expect Setbacks
A shocking 65 percent of SSD claims face initial denial. Many more people need help to obtain the evidence they need to win appeals. With such tough odds, the saying "Expect the worst and hope for the best" definitely applies.
Focus on the Big Picture
An immediate victory would be incredible, but that's different for many people. With SSD applications, it's all about persistence. You stand a strong chance of success if you work diligently with your attorney, but you can kiss benefits goodbye if you throw in the towel at this early stage.
Emphasize Next Steps
Stop worrying about your previous inability to secure SSD benefits; shift your focus to the road ahead. First, meet with your attorney to discuss a viable backup plan. Then, write a brief to-do list based on that plan, and tackle at least one task each day. If nothing else, prompt action will prevent you from ruminating on your latest SSD failure.
Determine a Plan B
You're dead set on securing SSD benefits, but what if that doesn't happen? You'll feel far more confident if you plan for the worst-case scenario. Outline the likely impacts of repeated claim denials, and draft a step-by-step plan for getting by even if you never achieve the benefits you deserve.
Advocating For Yourself Assertively as a Patient—Do's and Don'ts
You may spend far too much time in clinics and hospitals as a patient with a chronic health condition. Nobody will hold your hand as you seek proper care; it's up to you to advocate assertively on your behalf. The following do's and don'ts should help you navigate medical endeavors more efficiently:
Do: Gather and Organize All Medical Records
From seeking a second opinion to disputing claim denials, documentation is essential. Collect all lab tests and diagnostic reports, and be prepared to present them when necessary.
Don't: Rely on the Advice of Just One Medical Expert
Medical professionals are far from infallible. If your gut tells you to seek a second opinion, don't hesitate to visit another physician or specialist. That different opinion could save your life.
Do: Ask Specific Questions About Symptoms and Treatment
Be honest about your symptoms and response to treatment. Speak up for yourself, and ask your primary care physician or specialist about all the options available, including those that don't require extensive physical therapy or surgery.
Don't: Arrive at an Appointment Without an Outline
Make the most of every minute by developing an outline and note page ahead of time. This should include every issue you intend to address with your physician.
Do: Take Advantage of Patient Technology
Online portals and smartphone apps make it easier to access much-needed information. If you suffer from limited mobility or struggle to discuss issues with your physician in person, advocate for yourself online.
Don't: Rely Exclusively on Patient Technology
Technology can make life as a patient easier, but it should be different from face-to-face appointments. Don't rely on an app to get you through severe physical suffering; schedule an appointment as soon as possible.
You can advocate for yourself when seeking treatment, but you don't have to in court; that's your lawyer's job.
The right attorney can make all the difference as you file for Social Security disability or appeal denied claims. Keep the following considerations in mind as you prepare for a productive consultation with your lawyer:
Pay Attention to What Has Your Attention About Your Case
If a burning concern about paperwork wakes you up at night, write down what's bothering you. Suppose you have insight into your lower back symptoms while in the shower; jot it down as soon as you dry off. Get in the habit of recording productive thoughts when you have them and then circle back to process them later. This process will make communication with your lawyer more efficient – fewer email strings and long voicemail messages. It should also give you insight into your symptoms and what relieves them.
Get As Organized As You Can Before You Meet with Your Lawyer
The Social Security Administration demands ample documentation of your condition. To prove eligibility for disability benefits, bring the following to your consultation:
Don't Exaggerate
Your Social Security disability attorney's chief goal is to help you secure the benefits you deserve while reducing the potential for a complicated appeals process. To accomplish this end, your attorney needs an honest picture. How are you suffering? What's your course of treatment? It can be tempting to exaggerate or downplay your symptoms, but this could lead to a smaller award than you deserve or an outright denial of your claim.
Be Responsive
Ideally, your attorney will get back to you promptly when you call or email. However, the attorney-client relationship goes both ways. Return calls and emails promptly to expedite the legal process.
Like many federal programs, Social Security Disability has many rules and regulations governing its administration. Knowing how the Social Security Administration calculates Social Security Disability (SSD) benefits can save you time and stress if you need to apply.
Understanding Eligibility
The government uses the amount you have worked and the nature of your disability to determine SSD eligibility. If you are eligible for benefits, the government decides your monthly payments by your average lifetime earnings since the time of your disability. Typical payments range from $700 to $1,700 each month. The government may reduce your payments if you receive disability benefits from other sources.
Calculating SSD Payments
The Social Security Administration uses a complex formula to calculate each individual's benefits. Every case is unique, and so is the amount of money you may receive. The office bases the formula for your benefits on how much you have paid into the Social Security system. The payroll taxes that the government deducts are called "covered earnings."
The Social Security Office calls your average covered earnings over a set period your average indexed monthly earnings (AIME). Then, the SSA applies a formula of fixed percentages to your AIME based on your income. This determines your primary insurance amount (PIA) – the amount you receive in Social Security benefits before retirement age.
To stay on top of your covered earnings history, check your Social Security Statement, which the SSA sends out every five years. The SSA's website also allows you to check your statement online. This is valuable information if you need to file for SSD benefits later.
Reduced Payments
Disability payments that you receive from private insurance companies for long-term disability will not have an impact on your SSD benefits. However, suppose you also receive government-regulated benefits such as worker's compensation or temporary disability from the state. In that case, you will not receive more than 80% of the average amount you earned before your disability from the combined benefits. In addition, the benefits you receive from Supplemental Security Income (SSI) and the VA will not affect your SSD benefits.
According to the Social Security Administration, studies show that a 20-year-old worker has a three-in-ten chance of becoming disabled before reaching retirement age. When a person suffers from a debilitating mental or physical disability, they may be eligible to receive Social Security Disability benefits from the government.
The Social Security Administration pays disability benefits under two different programs:
• Social Security Disability Insurance (SSDI) - Based on prior work for which Social Security Taxes were paid.
• Supplemental Security Income (SSI) - Based on financial need. Children, as well as adults, may be able to collect disability benefits.
Unfortunately, meeting Social Security's definition of disability benefits is often challenging. That's where you could use the help of an experienced SSDI attorney, like the ones at SWS Accident & Injury Lawyers.
Our attorneys are thoroughly familiar with both programs and can work with you to help get you the benefits you deserve and desperately need. We have successfully represented hundreds of claimants, helping them obtain Social Security benefits after previously being denied.
We all know what "disability" means, but this term has a specific definition in the context of the Social Security disability program and the Supplemental Security Income (SSI) program. A person with a "disability" has the inability "to engage in any substantial gainful activity by reason of any physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. 423 (d)(1)(A) and 1382c(a)(3)(A).
"Substantial gainful activity" is another specific term defined by Social Security, and we will discuss this in our next blog. However, the big takeaway from the definition of disability is this: it deals with a severe health condition that interferes significantly with one's ability to work and must last or be expected to last 12 continuous months. This is why Social Security requires so much paperwork about a claimant's physical and mental abilities; it must decide how those abilities affect the claimant's functioning in a work setting.
Social Security Disability (SSD) exists to assist individuals who have paid into the Social Security system when they can no longer work.
In general, you need to have worked in a job where the government deducted Social Security taxes from your pay; and you must have a medical circumstance that meets the Social Security Administration's definition of a disability.
Social Security defines "disability" somewhat differently than other entitlement programs. The system only pays for total disability; individuals are not eligible for partial or short-term disability. This fact distinguishes SSD from similar programs like worker's compensation. The government considers someone disabled if they meet all of the following criteria:
• The individual is unable to work as they previously did;
• The Social Security Administration (SSA) determines that the individual is unable to adjust to different work due to their medical condition;
• The individual's disability has lasted (or is expected to last) for one year or more, or physicians expect the individual to die soon.
The SSA uses a strict definition of disability; this is why many Social Security Disability claims are denied. The Georgia SSD department approves about 30% of the claims that come through its office.
The amount a person has worked and paid into the Social Security system is the other factor determining who is eligible for Social Security Disability benefits. Every year you work, you earn Social Security credits based on your yearly wages or income from self-employment.
The number of credits you earn will vary yearly, but four credits each year is the maximum. To qualify for Social Security Disability benefits, you generally need 40 credits, 20 of which should be earned in the last ten (10) years of your employment.
Although the government created SSD benefits for those who have spent their lives working, it is possible to qualify for them at a younger age. For example, if you become disabled before age 24, you can be eligible for benefits if you earned six Social Security credits in the three years leading to your disability.
There is a list of approved diagnoses that will make you eligible for benefits, but that isn't a promise. Some conditions that may qualify an individual for Social Security benefits include:
• Depression/anxiety
• Blindness
• Arthritis
• Heart disease
• Paralysis
• Orthopedic injuries
• Diabetes
• Neurological disorders
Again, getting a diagnosis from this list does not guarantee the benefits you seek, but if you keep good records and submit appropriate paperwork, you are well on your way. You might be wondering if it is possible to expedite the process, but there are very few ways to rush the SSD process. If your conditions are more severe, look into the qualifications for the Compassionate Allowances Program. It is one of the only ways the government will expedite your SSDI case.
Following a lengthy application process, you may wait weeks, even months, to hear back about Social Security Disability benefits. During that time, your bills could pile up quickly, especially if your disability leaves you unable to hold down full-time work. However, suppose your condition is unusually severe. In that case, you may be eligible for expedited approval via the Compassionate Allowances Program, which provides prompt assistance for those with serious (often terminal) medical conditions.
The Compassionate Allowances Program maintains a list of over 200 conditions that qualify for expedited disability benefits. These include:
The process of proving eligibility for the Compassionate Allowances Program is surprisingly simple, although it varies somewhat based on the applicant's condition. More evidence is always better, especially as hospitals and clinics can sometimes be slow to respond to inquiries. Biopsy reports, discharge summaries, and physician letters are helpful and can pave the path to quicker acceptance.
Typically, it takes several months to determine whether an individual is eligible for Social Security benefits. With the Compassionate Allowances Program, this decision is made in a matter of days. Unfortunately, the usual SSDI waiting period applies after approval or denial is granted. Established by federal law, this five-month waiting period cannot be waived, even for those accepted through the Compassionate Allowances Program.
The Compassionate Allowances Program can spell the difference between months of suffering and prompt financial relief. If your suffering is severe, and you cannot afford to wait for a disability determination, this program may be your best option.
Medical evidence is an integral component of any bid for disability benefits. When you file a disability claim, you are responsible for providing ample evidence of your condition and how it impacts your day-to-day life. This evidence must come from reliable sources who have treated your condition.
Tracking your condition can be tricky, but thankfully, you have many resources at your disposal. The Social Security Administration can help you obtain the necessary information if you provide permission, or you can turn to a Social Security disability lawyer for help. Keep the following considerations in mind as you track your condition:
According to the Social Security Administration, accepted sources of disability evidence include:
Additionally, the SSA may request copies of reports from clinics, hospitals, or even social workers. These reports may include the following:
Your personal records of your symptoms will not be enough — you need feedback from licensed medical professionals. However, healthcare professionals will likely advise you to keep a detailed history of the symptoms you experience. Whenever an incident related to your impairment occurs, please take note of what happened, when it happened, and how much pain it caused. Avoid exaggerating or minimizing your condition, as this could lead to claim denial. Careful tracking of symptoms is essential for representative payees, who must record medical incidents and associated expenses.
The right Social Security attorney can help you locate the medical records and documents needed to support your claim. Look to Smith, Wallis & Scott, LLP for assistance filing for disability benefits and appealing denied claims.
Suppose your significant other, parent, sibling, or friend desperately needs Social Security Disability Insurance or Supplemental Security Income, but cannot apply for those benefits or follow through with the approval process. Now, it's up to you to secure the disability benefits your loved one requires. Keeping reading to learn more about this big responsibility:
Your loved one may be unable to communicate the full extent of their suffering. Be careful not to underestimate the pain this person is experiencing. Carefully observe what the disability applicant can and cannot do as a result of their condition, and be prepared to report on these observations.
The Social Security Administration appoints a representative payee to manage benefits on behalf of those who are too ill to do so themselves. The payee's job is to use the awarded benefits to pay for necessary care and save benefits that are not needed. The payee must also keep a clear record of these expenses and savings. The Social Security Administration recommends that payees act not only in the financial interests of the beneficiary, but also take an active role in that person's life.
If you already have power of attorney, you'll still need to apply to be your loved one's representative payee. The application process is simple, but it typically occurs in person. Complete form SSA-11, and be prepared to show documents that prove your identity.
As a representative payee, you can positively impact your loved one's life. Take your duties seriously — you are the integral link between your loved one and the care they desperately need.
There is no such thing as too much support for Social Security Disability Insurance recipients and their valued caregivers. From FAQs and blogs to YouTube videos, everything helps. So take some time to browse the valuable resources highlighted below—you’ll be glad you did!
Social Security Disability: Frequently Asked Questions
The official FAQ page of the Social Security Administration answers common questions about retirement benefits, returning to work, Compassionate Allowances, and more.
The Faces and Facts of Social Security
The SSA maintains a blog that provides a wealth of information on the everyday applications of the disability system. The articles contained therein cover everything from the pioneers of Social Security to the role of mental health in disability claims.
A Day in the Life of a Caregiver
Do you feel as if your efforts as a caregiver are rarely recognized? Then, watch this YouTube video from AARP, and share it via social media to let your loved ones in on your caregiving struggles and triumphs. The video captures what it’s like to care for a disabled individual.
Kalispell’s SSDI YouTube Videos
YouTube user Kalispell has ample experience with the SSDI program. Her channel details the complications of applying for SSDI and life after approval, including why she continues to work and how she coordinates her schedule to make the most of her benefits.
How to Live on Disability Even If You Are Broke
SSDI benefits are typically modest; many claimants receive less than $1,000 per month. This detailed article from Confined to Success offers excellent insight into budgeting for SSDI recipients. You’ll learn to stretch each dollar further and pursue greater financial security.
Fantastic Resources For People on Social Security Disability and Their Caretakers: Part 1
Since its founding during the Great Depression, the Social Security Disability Insurance program has made life more bearable for millions of Americans who would otherwise face crippling poverty or a complete lack of independence.
Unfortunately, if you’re injured or disabled, the difficulties don’t stop upon approval of your SSDI claim. Whether you receive benefits or care for a loved one on SSDI, you can use continual help and support, which you’ll find with these valuable resources:
Ticket to Work Program
Are you interested in returning to work but worried about losing your benefits? Then, join the Social Security Administration’s Ticket to Work Program, a free and voluntary opportunity for SSDI and SSI beneficiaries. You can safely explore various work options while enjoying protection from continuing medical disability reviews. Visit the program overview at the SSA’s website to learn more.
NAIDW’s Social Security Disability Support
Sometimes, when your disability gets you down, all you need is a little encouragement from somebody who has been in your position. That’s precisely what you’ll find at the Social Security Disability Support forum maintained by the National Association of Injured and Disabled Workers (NAIDW). Stop by the chat room or check out the links posted by the site’s administrator.
Telling Our Disability Stories: The ATC Podcast
If you ever feel alone due to disability, listen to the ATC Podcast for an instant sense of belonging. The program features heartening stories from individuals with disabilities.
Can I Get Paid…As a Caregiver?
This AARP guide provides extensive insight into the role of caregivers and the potential for receiving compensation. In addition, it offers a valuable reminder of the importance of taking care of your financial and emotional health as you also care for loved ones with disabilities.
Living Well and Getting What You Need With a Slimmed-Down Budget [for Social Security Disability Claimants]
A reduced disposable income may prevent you from previous pursuits. Still, with careful budgeting and a better spending assessment, you can live a full and rewarding life on a minimal income. In a two-part series, we’ll explore life on a slimmed-down budget.
Budgeting 101
Before you can live your best life on a slimmed-down budget, you need to know just how slim it is—and where you have room to cut back.
Budgeting doesn’t come naturally for most of us. In a 2015 Bankrate.com survey, 82 percent of Americans claimed to keep a budget—but most of their methods were suspect. Mental budgets won’t cut it, nor will scrawling numbers on an old receipt. Thankfully, a variety of smartphone apps and online budgeting systems make things easier to manage. For some, however, pencil and paper suffice.
Begin by taking stock of all fixed income and expenditures. These could include Social Security benefits, income from a part-time job, rent, or student loan payments.
Finally, estimate variable costs. These include food, entertainment, and transportation. After you’ve constructed your initial budget, continue tracking these expenses to determine the accuracy of your original estimates.
Choose Goals and Assign Costs
Outline your financial and personal goals, and determine where they overlap. Next, highlight your top aspirations and estimate their cost. For example, a frugal beach vacation might cost you $1,000 for lodging, flight, and food. Now that you’ve established your budget, you can determine how many months it will take to save up for this goal while maintaining your current income.
Determining How You Want to Spend Your Budget: Spending on Things or Experiences?
Ample research indicates that people derive far more satisfaction when they spend their money on experiences rather than material objects. You may have little cash available for either, but some of life’s most exciting experiences are surprisingly affordable. So when tempted to splurge on items you previously would have deemed essential, think carefully: do you actually need these material goods? How long will you enjoy them, or how soon will they collect dust in the closet?
Read These Books While Pursuing Your Social Security Disability Benefits Case
Chronic illness and injury sufferers complain nearly as much about boredom as they do about the physical symptoms of their maladies. Social Security Disability Insurance (SSDI) benefits may be appreciated, but it’s tough to replace that sense of purpose that accompanies a regular workday. Instead of sitting at home and feeling sorry for yourself, tackle this reading list:
David and Goliath: Underdogs, Misfits, and the Art of Battling Giants — Malcolm Gladwell
Whenever you feel defeated, grab this inspiring ode to the underdog, which reexamines stereotypes about advantage and disadvantage.
Not Broken: Making the Transition to Living With Physical Disability — Andrea M. Orsini
Don’t let disability define you. “Not Broken” features valuable strategies for handling the mental, emotional, and social challenges associated with physical impairments. This valuable read will help you reclaim your personal power and momentum.
At Home: A Short History of Private Life — Bill Bryson
Sitting at home isn’t so bad, as you’ll discover while paging through one of Bill Bryson’s most underrated works. You’ll learn more about the common household items you take for granted.
Gilead — Marilynne Robinson
The deserved recipient of a Pulitzer Prize, “Gilead” tells the somber tale of Reverend John Ames, a small-town pastor with a devastating heart condition. The book demonstrates why faith is an integral component of daily life, even (or especially) for those dealing with terminal illness.
Life Without Limits: Inspiration for a Ridiculously Good Life — Nick Vujicic
You won’t feel bad about your malady after reading “Life Without Limits.” Written by a man who lacks limbs, the book shows how anybody can lead an extraordinary life, regardless of disability.
If you need a social security disability lawyer in Georgia, call SWS Accident & Injury Lawyers today at 770-214-2500 for a free consultation.
Social Security disability benefits allow you to make ends meet, but just barely. Unfortunately, if the Social Security Administration (SSA) claims that your payments are too high, you may suffer garnished tax returns or even be forced to write a check for the overpaid amount.
What Causes Overpayment?
Several circumstances prompt higher SSI or SSDI compensation than anticipated. Examples include:
What Happens If My Payment Is Too High?
If the Social Security Administration discovers that you’ve received benefits beyond what you’re entitled, you may receive notice, along with a request for repayment within one month. The message may also include a plan for withholding future disability payments and the date on which the proposed withdrawal will begin.
What If You Don’t Think You Received Excessive Compensation?
If you feel you were paid correctly, request a reconsideration within ten days of hearing from the SSA. If you believe, however, you were overpaid but not due to any wrongdoing on your part, request a waiver. If granted, this will allow you to avoid repayment. First, however, you must demonstrate that you were not at fault, and that paying the SSA back would cause severe financial hardship. Be prepared to submit bills indicating that your monthly expenses approach or exceed your income. Consider seeking feedback from the SSA on the criteria used to determine whether you received more benefits than warranted.
What If Your Request Is Denied?
You have the right to appeal denial of your waiver request. However, if the SSA continues to insist that you were overpaid, withholdings from your monthly benefits payments may occur. If you no longer receive benefits, you can petition for monthly payments. Your overpayment may also be withheld from your federal tax return.
If your application for Social Security Disability Insurance (SSDI) gets denied, don’t despair. Only about one-quarter of applicants in Georgia receive SSDI approval on their initial application. You may file a Request for Reconsideration – also known as the first appeal – to overturn the Social Security Administration’s denial of your claim. The reconsideration request must be filed within 60 days of the initial claim’s denial, but the sooner it is filed, the better. Miss this deadline, and you must start the entire application process from square one.
Only about 12 percent of reconsideration requests are approved in Georgia, but there are a few ways you can boost these long odds in your favor – for instance, you can hire a qualified SSDI lawyer to guide and advise you.
Request for Reconsideration
The Request for Reconsideration is the first appeal a denied claimant may file in Georgia. It is conducted the same way as your first application, except that another disability examiner and physician evaluate your case.
Refuting Denial
You can get a copy of your claim file from the Social Security Administration (SSA) and review it. While the SSA will not necessarily release all of the doctor’s reports, your lawyer should be able to get this information. If you and your attorney believe the reasons for the denial are in error, you can refute them for the Request for Reconsideration.
New Material
Provide relevant new material to your reconsideration request. For instance: updates about your doctor’s visits, medication, and new treatments.
Look over your initial application carefully, and ensure you did not leave out any pertinent information regarding your medical condition or work history. An unintentional omission could have made the difference in the original denial, and it could affect the Request for Reconsideration.
Another Step
It can take eight or nine months for a reconsideration decision. However, if your Request for Reconsideration is denied, there are more steps you can take. For example, the next phase could involve an appearance before an Administrative Law Judge (ALJ).
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