Social Security Disability

Why should I consult with a Social Security disability attorney?

Facing a debilitating injury or disease is an incredibly stressful experience. In addition to concern over your physical and mental health, you may be worried about your financial security and wonder if you will ever be able to return to work.

Falsani, Balmer, Peterson & Balmer helps disabled individuals recover any and all benefits to which they are entitled, including Social Security disability benefits. 

  • We can help you apply for Social Security disability benefits.

  • Protect your best interests.

  • Give you advice on dealing with the Social Security Administration.

  • Advocate for you at every opportunity.

  • We can serve as your trusted advisors throughout this overwhelming process.

  • Tell you how different benefits might affect each other.

  • Answer your questions about medical care, working while disabled, and other important issues relating to your disability claim.

Social Security Disability Claim FAQs

There are two main types of Social Security disability benefits. Social Security disability benefits (also known as RSDI, SSDI, or DIB) and Supplemental Security Income (also known as SSI) benefits are both federally-administered disability benefits payable pursuant to the Social Security Act. Both benefits require the claimant to be disabled, and both programs analyze disability the same way.

You can find out more about the two types of Social Security disability benefits online.

SSDI/RSDI/DIB BENEFITS

 SSDI benefits are based upon payroll deductions from work activity or as a result of contributions made by self-employed workers. This benefit program functions much like an insurance program with the employee earning “credits” through their payments into the program. Employees who have been paying into the program are still subject to a “date last insured,” which means that at some point, after a person has stopped getting paid for work, that person’s “insured” status will lapse. In other words, workers who have been paying into the Social Security program generally need to prove disability within so many years of when they stop working. These dates vary between people and depend on each person’s work history and pay. If too much time passes between the date that someone stops working and the beginning of that person’s disability, then that person may not receive SSDI benefits.

Being “insured” or having “insured status” for SSDI purposes has nothing to do with health/medical insurance. “Insured status” has to do with how much money you’ve put into the SSA system over the years, typically by your employer withholding money from your paycheck.

To have “insured status” for SSDI purposes, a person must have put money into the system in 20 of the previous 40 quarters.  A “quarter” is a 3-month period.  The quarters are January-March, April-June, July-September, and October-December.  If you earned the appropriate amount of money in a given quarter of a calendar year, then you establish a quarter of coverage.  Again, to have “insured status” for disability purposes, you must have put money into the system in 20 of the 40 quarters before the onset of your disability. Generally, if you have been working continuously for the last five (5) years or so, your insured status will probably last for another five (5) years if you stop working right now. People who have been off work already for a while or who have had sporadic income may have a harder time determining their date last insured.

You can usually find out your “date last insured” from your local Social Security field office. If you became disabled on or before that date, then you should file an application for SSDI benefits. If you became disabled after that date, then you may not qualify for SSDI benefits.

Disabled adults who became disabled on or before their “date last insured” generally qualify for SSDI benefits. An SSDI recipient’s spouse and/or children are also generally eligible for additional SSDI benefits. Disabled adults whose disability started before their 22nd birthday as well as spouses and children of disabled workers can also receive SSDI benefits.

 Some people who have qualified for SSDI may also qualify for SSI. It is a good idea to apply for both types of benefits just to be safe.

 SSI BENEFITS

 SSI pays benefits to people who are (a) disabled and (b) have minimal or no assets/resources.

An SSI recipient does not have to have ever worked or paid into the SSA system.

SSI benefits are similar to RSDI/SSDI benefits in that they are paid to disabled individuals but are available to people who have not worked at all (and so have not paid into the program) such as children. Disabled individuals can receive SSI benefits as long as they are disabled and their household (which generally includes spouses/partners, roommates, adult children, etc.) has limited resources.

Children (under 18) who are disabled can qualify for SSI benefits as well.

An SSI recipient’s spouse and/or children do not qualify for additional SSI benefits.

SSI recipients must follow the rules regarding resources or they risk being cut off and/or held responsible for an overpayment.

If you are found ineligible for SSI based upon your income/assets/resources, then you may still be eligible for SSDI which does not take those factors into account.

You may be denied SSI if your household has too much in assets/income/resources. There are many rules about how these figures are calculated, so if you do get denied, make sure you understand why. Even if you get denied SSI, you may still have an SSDI claim.

Many people have both an SSDI and SSI claim, and the only issue is whether they are disabled. A person can be eligible for BOTH SSDI and SSI if their SSDI rate is low (though this is rare).

The SSA usually decides your eligibility for SSDI and/or SSI at the beginning of your claim by determining your “date last insured” for SSDI (and whether you are claiming to have become disabled on or before that date) and your SSI financial eligibility (assets/income/resources in your household). You can get denied one or both of those benefits before the Social Security Administration (“SSA”) even gets to your medical conditions.

In addition to the “insured” and/or resource rules referenced above, a person must also meet the SSA’s definition of “disabled” in order to qualify for Social Security disability benefits.

The SSA’s definition of “disabled” is: an inability to sustain full-time competitive employment for at least 12 months due to one or more severe medical conditions.

The disabling medical condition(s) do not need to be permanent; many people receive Social Security disability benefits for a period before returning to full-time work.

The five (5) steps to qualifying for Social Security disability are:

Step 1: Is the claimant earning SGA?

The very first thing the SSA does when someone applies for Social Security disability benefits is decide whether that person has been earning “substantial gainful activity” (“SGA”) through work activity. SGA is work that involves significant physical and/or mental activity for which a person is paid. The SSA increases the SGA limits (one limit for blind people, one limit for non-blind people) each year. For 2022, the limit was $2260 per month for blind claimants and $1350 per month for non-blind claimants. This means that the definition of “disabled” in 2022 is someone whose medical conditions prevent them from earning at least $1350/month.

This also means that a person cannot qualify for SSDI benefits if they are still working and earning more than the SGA limit (net) per month. That can pose a financial stress for employees who need to stop working soon due to medical conditions but cannot afford to wait for a Social Security disability claim to be approved. There are, however, some steps to take to maximize the odds of a Social Security disability claim being approved sooner rather than later.

 If someone is working and earning at least SGA amounts, then the SSA will not even consider their medical conditions. If someone is earning more than SGA, then they are automatically not disabled as far as the SSA is concerned.

But, if a claimant is earning less than SGA levels, then the SSA goes to the next step.

Step 2: Does the claimant have one or more severe medical impairments?

 The next step requires the SSA to decide whether a claimant has at least one severe medical impairment. A severe medical impairment is a medical condition that significantly limits someone’s physical and/or mental ability to do basic work activities. Basic work activities include walking, standing, sitting, lifting, reaching, kneeling, balancing, using hand and foot controls, seeing, hearing, speaking, understanding, paying attention, using good judgment, responding appropriately to others, and dealing with changes in a routine work setting, amongst other activities.

Generally, a person who is receiving treatment for a medical condition has a severe impairment, especially if he/she has work restrictions from a medical provider.

If the SSA decides that a claimant has at least one severe medical impairment (which usually happens), then the SSA goes to the next step.

Step 3: Does the claimant meet or equal a listed impairment?

The SSA puts together a list of certain medical conditions that are generally so severe that a person who has that condition is automatically considered disabled by the SSA. This list is called the “listings” or “listed impairments” and are included in the Social Security regulations.

Qualifying for a listed impairment is usually difficult for a variety of reasons. Usually it’s because there is not enough support in the claimant’s medical records.

There are separate listed impairments for adults and children.

If the SSA finds that there is enough evidence to prove that a claimant meets or equals a listed impairment, then that person’s claim is granted. If not, the SSA goes to the next step.

Step 4: Can the claimant perform his/her “past relevant work?”

The next step requires the SSA to decide whether the claimant can perform his/her “past relevant work.” “Past relevant work” is any significant work done by the claimant during the 15 years prior to the date on which the claimant became disabled. Generally, past relevant work includes full-time jobs that the claimant did for long enough to earn at least one quarter of coverage.

In figuring out whether a claimant can do his/her past relevant work, the SSA will first decide what that person can and cannot do as a result of his/her medical conditions. That is called “residual functional capacity,” or “RFC.” The RFC is one of the most important parts of a disability claim. It is decided by reviewing what a claimant has said he/she has problems doing along with the medical evidence. The RFC will discuss how much a claimant can stand/sit/walk, lift/reach/kneel/crawl/etc., understand/remember/interact with others/etc., and so on.

Once the SSA makes a decision about a claimant’s RFC, then they will compare the claimant’s abilities to his/her past relevant work to see if the claimant could do any of those jobs.

If the SSA decides that a claimant can do more than what he/she feels they can do, then that usually leads to a denial. This is where you can help your claim by talking to your medical providers about what you can/cannot do because of your medical conditions.

If the SSA decides a claimant cannot do his/her past relevant work, then the SSA goes to the last step.

Step 5: Can the claimant perform any job that exists in significant numbers in the national economy?

This is where most Social Security disability claims are won or lost. A claimant’s physical and/or mental impairments, age, and educational and work history all go into this analysis.

There is a short cut to a claim being granted at this stage: the “grids.” The “grids” take into account a claimant’s age, educational background, work history, RFC, and transferable skills.

The SSA established the “grids” to acknowledge that the older a claimant gets, the harder it may be for him/her to learn a new job. So, once a claimant reaches age 50, they are more likely to qualify for Social Security disability benefits. They become even more likely to do so at ages 55 and then 60.

If the SSA concludes that you are “disabled” because of the “grids,” then your claim will be granted. Or, if the SSA decides that you could not work any job because of your limitations, then your claim will be granted.

The SSA does not care what you were doing or how much money you were making before you became disabled. If you can work as a greeter at Walmart, your disability claim will be denied.

You can apply for Social Security disability benefits in several ways:

Most people do not need an attorney to apply for Social Security disability benefits. The forms and questions generally look for information that only the claimant will know, so a lawyer couldn’t help you with that, anyhow. And, the SSA is usually happy to help claimants fill out the

forms and/or answer questions. Sometimes SSA personnel will fill out forms for you in a phone interview, send them to you, and have you sign them and return them.

You can apply for SSDI online, but you cannot apply for SSI online. The usual process is for a claimant to do an SSDI application and then say “yes” when asked whether they would also like to apply for SSI.

Here are some tips on applying for SSDI and/or SSI benefits:

  • Talk to your medical providers before you apply. Find out if they’re willing to fill out a form or write a note regarding your medical conditions and their impact on your ability to function. ***PLEASE NOTE: a statement from your doctor saying that you can’t work IS NOT helpful to your claim. Information about your abilities and/or limitations as a result of your symptoms IS helpful to your claim.
  • List ALL of your medical conditions, even if you consider them minor.
  • List any side effects from medications.
  • Be as accurate and detailed as possible.

You want to tell the SSA about ALL of your medical conditions, physical and mental, disabling and otherwise. For many people, this is simply one condition (for example, a back injury). Others may have multiple medical conditions which, when considered together, prevent an individual from working full time.

The SSA will want to know about all of the medical facilities where you have undergone treatment (doctors, hospitals, chiropractors, therapists, counselors, etc.), as well as a list of your prescription medications and any side effects. You will be asked to sign a release so that the SSA can obtain your medical records.

You may also have to provide the SSA with wage records/paystubs, tax information, marriage/death/birth certificates, and other types of documentation.

The SSA may send you to one or more “consultative examinations” (CE). It is very important that you attend those evaluations and participate as best you can. You will not be responsible for bringing any medical records or other evidence to that evaluation.

Social Security will also want a list of the jobs you have had over the past 15 years as well as the dates of your employment, wage info, and task descriptions. You can fill out a Work History Report to prepare this information.

The SSA will also want to know how your medical conditions affect your ability to function. You can fill out a Function Report to get this information organized.

The SSA can take anywhere from a few weeks to over a year to process an SSDI/SSI application. During that time, the following can happen:

  • The SSA collects your medical records and sometimes additional records (vocational, wage/personnel, school, etc.).
  • The SSA may contact your bank or former employer(s) for more information.
  • Sometimes the SSA will ask you to attend one or more consultative medical evaluations. You should attend these no matter what.

Sometimes your application just sits and is not being worked on at all which can be very frustrating.

If your claim is granted, the following things will take place (in no particular order):

  • You will get a copy of the decision from the SSA explaining that your claim was granted.
  • You will receive a letter that says “Notice of Award” across the top. This document is important and will tell you how much you will receive and when.
  • You will receive a phone call from your local SSA office about you, your household, address, etc.
  • You will get any back pay automatically deposited into your bank account (as long as you included your bank account info with your application). If you didn’t include your bank account information with your application, make sure to provide it to the SSA as soon as possible.

All taxpayers have a “primary insurance amount” (PIA). The PIA is the monthly benefit a claimant would receive at their full Social Security retirement age. It is also the amount of a claimant’s SSDI monthly benefit. You can find your PIA amount in your MySocialSecurity.gov account.

Your PIA amount depends upon how much money was paid into the Social Security system through Social Security taxes coming out of a person’s paychecks. The more money that is earned, the more money is paid in and the higher the PIA will be.

 SSDI WAITING PERIOD: SSDI claims do not allow for benefits for the first five (5) months of disability. So, if someone was found disabled on January 1, 2020, then they would not start receiving SSDI benefits until June 2020.

SSDI claims pay up to a year prior to the application date, regardless of how far back the disability onset date is. In other words, if a claimant wase found disabled on January 1, 2010, but he/she didn’t apply until January 1, 2013, then even though they are considered disabled as of January 1, 2010, their back pay will only go to January 1, 2012.

SSI disability claims will not go farther back than the month in which the application was submitted. So, even if a claimant alleges disability going back several years, benefits will only be paid beginning the month of the SSI application.

The monthly amount of SSI benefits is the same amount for all people no matter what. For 2022, it was $841 per person. Each year there is a cost of living increase for SSI.

If you receive a denial on your application, you generally have 60 days in which to file an (online) appeal. This initial appeal is called a “request for reconsideration.”

The letter will also say you can file a new application instead of appealing. But, filing a new application instead of appealing is generally a bad idea. If you intend on pursuing the claim, it is typically much better to appeal than to start over. And, if your “date last insured” has come and gone since you first applied, keep in mind that starting a new claim (instead of appealing) may mean you cannot qualify for SSDI benefits anymore.

If you decide to appeal, you can do it on your own, or you can hire an attorney to do it for you.

If you do it on your own, you can file a request for reconsideration online, in person at your local SSA office, or by filling out the appeal form and sending it to the SSA office that sent you the denial. Generally the SSA will ask for updated and new information about your medical conditions, medications, symptoms, limitations, and work activities since you submitted your application.

If you decide to hire an attorney to help you win your claim, don’t wait until the 60 days are almost up – contact an attorney right away.

Being denied does not mean you are not disabled. It just means that the SSA did not think there was enough evidence of your disability. If you strongly believe you are not able to work, then you should not give up.

Social Security law controls how much Social Security attorneys are paid. Right now, the law says that they can charge 25 percent of past-due benefits (“back pay”) up to a fee cap which is currently $6000.00.

Beginning with the first month of your claim (regardless of whether it’s the first time you’ve applied for benefits or you are trying to get reinstated on/continue benefits), every month that goes by is a month of “past due benefits” that will continue to add up until the claim is granted. Then the meter stops and the attorney can be paid 25% of the past due benefits (up to the cap).

Attorney fees have to be approved by the SSA.

You can find more information on paying an attorney representative in a Social Security claim here: https://www.ssa.gov/representation/fee_agreements.htm

If your initial application is denied, the appeal of that decision is called a “Request for Reconsideration.” The SSA can take anywhere from a few weeks to a year to process a request for reconsideration.

Sometimes the SSA will send you for one or more consultative medical evaluations (which, again, you should definitely attend) while they process your appeal. The SSA may also collect updated medical or other records.

However, most requests for reconsiderations are denied. You would then receive a letter telling you that your application had been denied again but that you have 60 days in which to file an appeal (a “request for hearing”). A “request for hearing” asks a judge to decide whether you are disabled.

Again, the SSA will offer you the opportunity to simply start over by filing a new application, but that’s usually still a bad idea for the same reasons.

It can take anywhere from 75 days to several years to have your application heard by a judge in a hearing. Each hearings office posts their average wait times online so you can check your local hearings office to see how long it has been taking for a claimant to get a hearing.

The SSA must get your permission to schedule you for a hearing less than 75 days from the date you requested a hearing. This is because it can be difficult to be ready for the hearing in that amount of time.

You will receive a Notice of Hearing at some point with the details of the hearing. It will include the date, time, and format (in person, telephone, or video) of the hearing as well as the issues that the judge will decide. It will also include the name of the judge.

Judges’ stats are also posted online so you can see how many claims your judge grants vs. denies.

DISCLAIMER: What follows is a general description of what can happen during a Social Security disability hearing. Many hearings do not go in this order, do not include all of these steps, and/or involve additional steps that are not described here.

Social Security hearings are conducted by an Administrative Law Judge. You should refer to the Administrative Law Judge as “your honor.” Most Administrative Law Judges are polite and sometimes even kind. But, they do not usually have much time which means they run hearings as quickly as they can.

At the beginning of the hearing, the Administrative Law Judge may:

  • Talk about how the hearing will go (who does what when, etc.);
  • Talk about the issues that the Administrative Law Judge has to decide;
  • Talk to the claimant’s representative/lawyer about the case; and/or
  • Resolve any loose ends regarding evidence, witnesses, etc.

Sometimes the Administrative Law Judge will ask the attorney representative to take a moment to make an opening statement. Some attorney representatives will have already submitted a written brief and so may not say anything at this point, instead choosing to “rely upon” their brief. Others will take the opportunity to summarize the case and/or tell the Administrative Law Judge why the claimant’s claim should be granted.

The Administrative Law Judge will “swear in” any witnesses that are expected to testify at the hearing. Witnesses generally include the claimant, the vocational expert, and the medical expert (if any). The judge will ask you to raise your hand and repeat an oath. Then you can put your hand down.

How long do hearings last?

Most Social Security hearings last 30-60 minutes. They are informal and take place over the phone, via videoconference, or in a room (not a courtroom).

Because these hearings do not last long and the Administrative Law Judges do not have much time, it is VERY IMPORTANT that you are on time for your hearing.

How should I dress?

Presentation is important. Dress neatly, cleanly, and comfortably in a manner that shows you take this proceeding seriously. Make sure your hair is neat and clean. Do not wear a hat or any offensive clothing. Do not chew gum or tobacco.

Who is at the hearing?

A hearing monitor (or “clerk”) will be present. The hearing monitor is responsible for making sure the technology is working and that the hearing is being accurately recorded.

A vocational expert is also usually “at” the hearing. The vocational expert will have some information about your educational and work backgrounds, but will not have met you before the hearing. The Administrative Law Judge usually asks the vocational expert about your work background as well as several “hypothetical questions” about what different versions of you could do depending on restrictions.

Sometimes one or more medical experts are at a hearing. They are typically hired by the SSA and will have reviewed your medical records beforehand. The Administrative Law Judge will ask the medical expert about your medical conditions, symptoms, records, and limitations.

Administrative Law Judges do not generally allow anyone other than the claimant and his/her attorney representative into the hearing. If you have a friend or family member, they will not be allowed to participate in the hearing unless/until they are called to testify as a witness, at which point the claimant will probably be asked to leave. This is called “sequestration” of the witnesses and the idea is generally to make sure the claimant and any witnesses are not giving each other “cues” or influencing how each other testifies.

What will I be asked at the hearing?

Most claimants are asked about the following:

  • Educational background (how much school was completed, did the claimant receive any special education services, did the claimant go to college, did the claimant get any special licenses or certificates, etc.).
  • Work history. Generally the claimant will be asked about full time jobs performed during the 15 years prior to the claimant being disabled.
  • Medical conditions, treatment, medications, side effects, and symptoms.
  • How medical conditions affect the claimant’s day to day functioning, such as how the claimant runs errands, buys groceries, does household chores, socializes, attends medical appointments, etc.
  • With whom does the claimant live; who does what around the house; etc.
  • Whether the claimant has any ongoing struggles with chemical dependency.
  • Whether the claimant has a valid driver’s license.

What do I say?

Here are some tips on giving testimony:

  • If you don’t know or don’t recall, say so. Do not force or make up an answer that you are unsure of.
  • It is very important that your answers are as truthful and accurate as possible. Mistakes, inaccuracies, or contradictions can all be used against you, so it is very important that you answer all questions carefully and accurately.
  • Tell the truth even if you think the truth will hurt your claim. Lying or even trying to “spin” a fact will reduce the value of your claim.
  • If you have a representative, he/she cannot answer for you or tell you what to say. They can’t even give you hints or pass you notes.
  • You should be prepared to talk about anything and everything, including subjects that may make you uncomfortable or upset.
  • Make sure you hear AND understand the questions. It is okay to ask for a question to be repeated or rephrased.
  • Respond to each question out loud so that your answer can be recorded.
  • Speak slowly and clearly so that everyone can understand.
  • Do not start answering a question before the whole question has been asked (even if you know what the question will be). The hearing recording needs to be as clear as possible.
  • Treat everyone with courtesy and respect. Doing so gives you a feeling of calm and dignity and will maximize your case value. While it is normal to feel frustrated or even angry, try to maintain your composure and be polite. Keep your temper. Testifying under oath is stressful to most people, but being angry or frightened makes it far more difficult to be accurate. If you feel you are losing control, ask for a break so you have some time to compose yourself.
  • Do not be combative or evasive. Do not make jokes or be sarcastic.
  • You can bring your cell phone, but please put it on silent and avoid looking at it. Do not record the proceeding on your own.
  • Speak naturally. It is not a test. All you will be asked about is what you know and what you remember. If you do not remember or know, then say so.
  • “Practicing” is not usually helpful because it can make your answers sound rehearsed.

Some Administrative Law Judges ask the claimant if he/she has anything else to add at the end of the hearing. This can be a good opportunity to clarify or correct something. Otherwise, the claimant can simply answer, “no thank you.”

The most important part of a hearing is the Administrative Law Judge deciding whether he/she believes you or not. That is why it is so important that you give honest, straightforward testimony, no matter what.

Administrative Law Judges make a lot of decisions, and their statistics (i.e. how often they rule in a claimant’s favor vs. against) are public record.

It is rare for the Administrative Law Judge to tell you what he/she has decided at the hearing. More often, you will have to wait several weeks if not months to receive the Administrative Law Judge’s decision in the mail.

If you lose your hearing, you have the right to an appeal, OR you can file a new application.

If you win your hearing, then your “claim” goes back to your local SSA office for handling. You can expect additional information from that office about next steps.

The SSA will send you many forms to complete and return (sometimes over and over). These forms can include Work History, Function Report, and other forms.

If you have already filled out the form, the SSA may just be looking for NEW or CHANGED information. If there have been no new information or changes, you can just write “nothing new” or “no changes.”

Sometimes the SSA wants the forms returned within ten (10) days of you receiving them (do not panic if you are a few days late). When you get a form from the SSA, please do your best to complete it and then send it back as soon as you can.  But, do not panic if you are late.

When communicating with the SSA, be very careful about details. Many claims have gone awry due to communication problems.

  • Do not mail something to the SSA without keeping a copy. If you do mail something, keep track of what you send and on what date. Then, make sure you call SSA to confirm they received it.
  • If you drop something off at a SSA office, ask for a receipt.
  • Keep track of the first names of all SSA employees with whom you speak.
  • For every conversation you have with an SSA employee, keep track of the date, time, and general content of the conversation.
  • Faxing to the SSA is best because you can prove that they received something.
  • If you have a change of address or telephone, inform the SSA right away and then call to confirm.

If you are getting ongoing medical care and you have a pending disability claim, you should:

  1. Go to all of your medical appointments (even your physical therapy appointments). If you miss a lot of medical appointments, make sure you have a good reason. The SSA will assume you aren’t that bad if you don’t need medical care.
  2. Tell your medical providers about ALL of your symptoms at EACH visit. This may seem like overkill, but if a medical provider does not mention a symptom or condition at a visit, the SSA will assume you are not having any problems with it at that point.
  3. Similarly, if you haven’t seen a medical provider for a medical condition for a while, the SSA will assume that it does not bother you and will not consider it as part of your claim. This may be unfair, but it is how the SSA thinks. So, even if the doctors told you there wasn’t anything to be done about something, you should still make sure your providers are documenting it in your charts as an ongoing problem.
  4. Do not lie to your medical providers. This should be obvious. But, don’t even exaggerate. And do not tell them that you are “good” when you are not, because they will write down “good” and then you may lose your disability claim.
  5. Follow through with all treatment recommendations. If you did not seek a recommended therapy or treatment or referral, the SSA will assume you didn’t need it. If it is a hardship for you to follow up on a recommendation, at least check in with us to make sure there isn’t anything we can do to help.
  6. Try to avoid talking to your medical providers about your disability claim; that can be misrepresented in the medical records.

If there has been any recommended treatment for you, please make sure you follow through on that. This can include stopping smoking, counseling, physical therapy, and other treatments that people sometimes do not want to do. SSA will hold any failure to follow prescribed treatment against you unless it is for “good cause” and good cause is pretty hard to prove.

You may wish to get a copy of your medical records and review them to make sure they are accurate. If you find any errors or inaccuracies, you should clarify with the SSA and also take steps to correct the errors or inaccuracies with your medical provider.

Medical records are typically the most important part of a Social Security disability claim. Your medical providers write things down that the SSA relies on as evidence of your claim. This can be a big problem for a lot of claimants, because most medical providers do not document their treatment of you with a disability claim in mind; instead, they will simply keep whatever records they need in order to provide you with good medical care. What is important in a Social Security disability claim isn’t always important for medical providers. As a result, there is frequently a good deal of inaccurate and/or missing information in medical records. Not everyone has had access to their records and so this can come as an unpleasant surprise.

You may get a denial or lose a hearing because of something in your medical records. Many Social Security disability denials are simply because of missing and/or inaccurate recordkeeping by medical providers.

That depends. As long as you would be disabled separate and apart from the chemical dependency problems, then you may still qualify for disability benefits. The SSA will have to determine whether your substance abuse issues are the main reason for your disability.

Achieving and maintaining sobriety is the best thing you can do for your disability claim. Keep track of dates of sobriety as well as relapses.

This is a very common complaint. But, be careful: saying things like this can actually hurt your claim. The government does not like having the reputation that people are receiving benefits when they shouldn’t, so they make it extra hard to qualify – which can be why perfectly legitimate Social Security claims are denied.

Also, it’s very hard to know exactly what someone is going through. So, even though you think you “know” what someone’s medical conditions are or are not, you really don’t. And, sometimes people seem like they’re doing better because they no longer have to use all of their strength to work an 8 hour day.

People struggling with chemical dependency cannot qualify for Social Security disability benefits on those grounds alone. They must also have a severe medical impairment that prevents them from working. If you know someone who is actively struggling with drugs or alcohol, you can rest assured that that is not the basis for their receipt of Social Security disability benefits. They may also be dealing with chronic pain, depression, anxiety, and numerous other medical conditions that can make it difficult to remain sober.

Not necessarily. Whether someone is “disabled” for purposes of a Social Security disability claim is something only a Social Security worker or judge can decide. It is technically a legal determination, not a medical decision.

So, while your doctor may be trying to help, it would be MORE helpful if your doctor could write a note about how your medical conditions affect your ability to function (i.e. what your limits are in standing, sitting, walking, kneeling, paying attention, using your hands, etc.) or what accommodations you would need (extra breaks, the option to sit down/lie down/rest during the day, immediate restroom access, etc.).

This is not true. SSA will ask about ALL of a claimant’s medical conditions – mental and physical, treated and untreated, old or new. Part of the application process will require you to tell the SSA about every single medical condition you have, even those that you consider minor. You will not be asked to choose your most disabling condition.

You can tell the SSA about your depression, but if you haven’t talked to a medical provider about it, then the SSA may not think it’s a big deal or even ignore it. This is a frequent problem with people who develop depression and/or anxiety (which is very common in disabled people) who do not talk to their medical providers about it.

If a medical condition is causing you problems, then you should at least get credit for it from the SSA, and the only way that will happen is if you talk to your medical providers.

If you have a claim for Social Security disability benefits pending, but you haven’t yet been approved (i.e. you haven’t heard back on your initial application, or you’ve filed an appeal and are waiting on that), then you can certainly opt to start collecting early on your Social Security retirement benefit (if it’s an option for you – i.e. if you reach the age at which you can start doing so). It is okay for you to be receiving Social Security retirement benefits (at the reduced rate, since you did not wait until you reached full retirement age) while you are waiting for your Social Security disability claim to go through.

If your Social Security disability claim eventually gets approved, the Social Security Administration (“SSA”) will convert your ongoing receipt of benefits to Social Security disability (instead of retirement) which you will continue to receive (all things being equal) until you reach your full retirement age at which point the benefits will convert back to Social Security retirement benefits (in name only, because the benefit amounts are probably the same).

The SSA will also go back and pay you the retroactive difference between your early Social Security retirement benefit amount (which is lower than what you would get if you’d waited until you qualified for the full retirement amount) and the full retirement benefit amount (which is generally the same or close to to your Social Security disability benefit amount) for each month in which you received that lower amount.

If your Social Security disability claim never gets approved, however, then you will be stuck with the lower amount forever.

Short answer: Yes.

Long answer: Yes, but be careful. You will become ineligible if you make too much money. If you plan on working while receiving SSDI benefits, there are a number of programs and rules that may apply (such as the “Ticket to Work” program). You cannot earn more than current SGA levels (currently $1350 per month), but you may get in trouble if you even get close to those amounts.

You should. If your claim is reviewed and there’s no evidence of ongoing medical treatment, you may be cut off from benefits.

SSDI recipients generally qualify for Medicare 24 months after SSDI benefits start.

Most SSI recipients can qualify for Medicaid the same month they are found eligible for SSI benefits.

Both programs are more complicated and you should generally direct questions to the SSA.

When the SSA claims they overpaid you, then they are attempting to recover an “overpayment.” If the SSA says you owe an overpayment, then there are two (2) issues: whether you really were overpaid, and if so, whether you should have to pay it back.

If you do not think you were overpaid, then you should appeal by filing a request for reconsideration on the overpayment. Include as much information as possible. If it has to do with wages, assets/income/resources, etc., then collect and provide as much documentation in your favor as possible. You should also write up a letter explaining why you do not think you owe an overpayment.

If you do not think you can or should have to pay it back, then you should file a “request for waiver of overpayment.” There are several reasons why you may not have to pay back an overpayment as long as it wasn’t your fault. Be as detailed as possible in the request for waiver and include supporting documentation as well as a letter of explanation if you can. An overpayment case usually involves a lot of “he said, she said,” which is why it’s so important to document all of your communications with the SSA.

This is called a “cessation” situation – where the SSA wants to stop your benefits because they think you are working too much and/or your medical condition(s) have improved.

WARNING: If you get a notice from the SSA saying they are going to stop your benefits, you usually have ten (10) days in which to request that they continue paying you benefits while you appeal the cut off. If you request ongoing benefits, but then lose your appeal, you usually have to pay all of it back.

If you request ongoing benefits, make sure you get that across to the SSA, because if they claim they never heard from you, then you may be out of luck.

If you do not feel you were earning too much money or have improved medically, then you should collect evidence in support of that position to present to the SSA.

  • Changes in address and telephone.
  • Marriages, divorces, and deaths in your household.
  • Job changes.
  • If you are on SSI:
    • Household wages, including yours – every month at least
    • Household changes including changes in roommates and rent/ownership
    • Other income/benefits – work comp, public disability, etc.

Yes. This is a secure way to check on various parts of your claim and benefits and also to get and submit information. Go to https://www.ssa.gov/myaccount/ and click on “create an account” to get started.

Technically, some people may qualify for both, but most Administrative Law Judges will deny Social Security disability benefits for any period during which someone also received unemployment benefits.

A doctor’s note saying someone cannot work is not very effective in a Social Security disability claim. See if your doctor will describe what your functional limitations are instead.

Veteran’s Administration disability percentages do not automatically transfer to the Social Security Administration and, while most Administrative Law Judges are interested in the issue, the percentage ratings will not count for much if the SSA does not also have the consultative examination reports that formed the basis for the VA disability percentages. Make a Freedom of Information Act request to get copies of the reports from your VA evaluations and then turn those in to the SSA.

Contact us for qualified legal representation.

If you have suffered a serious personal injury, deserve workers’ compensation benefits, need assistance with short- or long-term disability claims, or require help with the Social Security Disability claims process, Falsani, Balmer, Peterson & Balmer can serve as your trusted legal counsel. Schedule a free initial consultation with our qualified legal team and we will carefully evaluate your case and give you honest and expert legal advice.