Author name: patrick@greemantoomey.com

There are several reasons why so many Social Security disability applications are denied. When it comes to medical eligibility the main reason is that the SSA has strict eligibility requirements, and many applicants do not meet these requirements. For example, to be eligible for SSDI, you must have a disability that is expected to last at least 12 months or result in death, and you must have worked and paid Social Security taxes for a certain number of years. Social Security also uses stringent medical analysis to deny claims. The process is also a long one, as Social Security remains understaffed and underfunded. A decision on an initial application for disability benefits can take up to six months, sometimes longer before a decision is made and most of that time the claim is denied, and an appeal is needed. If an initial claim is denied it is not the end of the claim, but an appeal will need to be filed. Below is an explanation of the different appeals that can be filed based on the level of the denied claim. The Four Levels of Social Security Disability Appeals If your Social Security disability claim is denied, you have the right to appeal the decision. There are four levels of appeal: Reconsideration: At this stage, your case will be reviewed by a different SSA examiner than the one who reviewed your initial application. Administrative Law Judge (ALJ) Hearing: If your claim is denied after reconsideration, you can request a hearing before an ALJ. The hearing is usually held within 75 miles of your home and is an opportunity for you to present evidence and argue your case. Appeals Council Review: If your claim is denied after the ALJ hearing, you can request that the SSA Appeals Council review your case. The Appeals Council can either overturn the ALJ’s decision, send your case back for another hearing, or uphold the decision. Federal Court: If your claim is denied at the Appeals Council level, you can file a lawsuit in federal court. If you are interested in a free consultation about applying for Social Security disability benefits, please contact Greeman Toomey PLLC at 877-332-3252

Most Social Security disability claims are denied at the initial application phase and even a higher percentage are denied at the first appeal stage of the process. Most of these claims are denied for a variety of common reasons that claimants should be aware of before applying for benefits to give claimants the best opportunity to be successful with their claim. Below we look at the most common reasons a disability claim is denied. Technical Denial A technical denial is a denial based on eligibility criteria that has nothing to do with medical evidence in a case and is sometimes call a “non-medical denial.” A claimant can receive a technical denial for different reasons including too much work-related income or non-work-related income for Supplemental Security Income (SSI) claims. A technical denial can also be issued if a claimant has not worked long enough and more recently enough to be eligible for Social Security Disability Insurance (SSDI) benefits. Technical denials are typically not appealed unless Social Security has made miscalculations on a claimant’s work history or their income and assets. Medical Denial Cases are often denied because Social Security determines that there is not sufficient medical evidence to support a finding of disability. An unfavorable medical decision will typically include language indicating a claimant’s condition is not considered disabling and not severe enough or the condition is severe, but not expected to last at least 12 months as Social Security requires. It is important to send all available medical evidence to the Social Security Administration to help enable them to make an informed decision and to appeal medical denials if you feel your condition is disabling.

The Ticket to Work program is a voluntary employment program offered by the Social Security Administration (SSA) in the United States. It is designed to assist individuals who are receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits in transitioning to employment or increasing their earnings through part-time work. Here are some key points about the Ticket to Work Program: Eligibility: Individuals who receive SSDI or SSI benefits due to a disability are generally eligible for the Ticket to Work program. It provides an opportunity for recipients to explore employment options, receive vocational rehabilitation services, and potentially reduce their reliance on disability benefits. Free Services: The program offers a range of free support services, such as career counseling, job training, job placement assistance, and ongoing employment support. These services are provided by various employment networks or state vocational rehabilitation agencies that participate in the program. Trial Work Period: The Ticket to Work program includes a Trial Work Period (TWP) during which individuals can test their ability to work while still receiving their full disability benefits. During the TWP, individuals can earn an unlimited amount of income for up to nine months without jeopardizing their benefits. Extended Period of Eligibility: After completing the TWP, individuals enter an Extended Period of Eligibility (EPE) that lasts for 36 months. During the EPE, individuals can continue to receive disability benefits for any month in which their earnings fall below the substantial gainful activity (SGA) level. In 2023, the SGA level is $1,470 per month for non-blind individuals and $2,460 per month for blind individuals. Continued Medicare or Medicaid Coverage: The Ticket to Work program also allows individuals to maintain their Medicare or Medicaid coverage while they explore employment opportunities and increase their earnings. This ensures that individuals have continued access to necessary healthcare services.

Receiving a notice in the mail that you owe money is not something anyone looks forward to and this includes when Social Security informs a Social Security disability beneficiary that they received too much money and now are required to pay back an overpayment. Many times, a claimant receives an overpayment notice because of no fault of their own. Social Security makes mistakes, and this can include benefit amounts. Social Security takes many things into account when calculating payments and sometimes sends a beneficiary too much money they are not entitled to. So, what do you do when Social Security notifies a beneficiary they were overpaid, and Social Security wants its money back? Each person’s situation is different, but there are steps a beneficiary can take to combat an overpayment. If a beneficiary can’t afford to return the overpayment the beneficiary can ask Social Security to waive the overpayment. If Social Security agrees the beneficiary will not have to return the overpayment. There are other options as well. A beneficiary can ask Social Security to reduce the amount of the overpayment to make it more affordable. Another option is to appeal the overpayment notice if a beneficiary believes the overpayment is a mistake. When a beneficiary receives notice of an overpayment the agency will typically ask the beneficiary to return the overpaid funds within 30 days. A beneficiary should not delay in acting on an overpayment matter.

Most Social Security disability claimants will need a hearing before an Administrative Law Judge (ALJ) to decide whether they medically qualify for benefits. The hearing will include the ALJ, the claimant and the claimant’s attorney or representative, but will also include a Vocational Expert (VE). A VE is an individual whose education and training is relied upon to provide opinions at a Social Security disability hearing on a claimant’s ability to work in certain fields and to provide labor market analysis. Testimony from the VE is considered when an ALJ issues a decision on a case. During the hearing an ALJ is likely to ask the VE about the claimant’s ability to work based on the claimant’s age, work history, and educational level and what types of limitations the claimant may face in the workforce. Types of jobs the claimant can or can’t perform will likely be discussed by the VE. IF a claimant has an attorney or representative on a case the representative will also be allowed to question the VE on behalf of the claimant. Once the hearing is concluded the ALJ will use testimony from the VE along with all the medical evidence provided in determining whether the claimant is disabled and eligible for benefits. A written decision by the ALJ will be issued to the claimant. A fully favorable decision or a partially favorable decision issued by the ALJ results in the claimant being awarded benefits. An unfavorable decision issued by the judge will not entitle a claimant to disability benefits, but if the claimant believes the ALJ made the wrong decision an appeal of the unfavorable decision is also an option.

During the start of the COVID-19 pandemic in March of 2020 businesses and government agencies had to figure out different ways to provide service to the public. Naturally delays in customer service were inevitable, but a recent report from Social Security’s Inspector General’s office identifies the areas where Disability Determination Services (DDS) struggled in continuing to process claims. The DDS state agencies make medical determinations on Social Security disability claims prior the hearing phase of the process. Below is what Social Security found. CEs – The number of CEs performed during the pandemic decreased, as SSA suspended in-person CEs for a period of time. Once DDSs resumed in-person CEs, they still had issues scheduling CEs because for example, (1) not all CE providers returned to conducting CEs and (2) claimants refused to attend in-person CEs because of fear of exposure to COVID-19. DDS Staffing and Training – About 4,000 DDS employees resigned or retired during the pandemic, but DDSs hired 4,305 employees during this same time. However, it takes a newly hired disability examiner an average of 2 years to become proficient at processing most initial claim workloads. Telework and Communication with Claimants – During the pandemic, most DDS employees teleworked, so the DDSs needed to adjust to how they processed certain workloads. SSA provided the DDSs with basic cellular telephones to communicate with claimants, but claimants were wary of answering the calls as the telephones’ caller identification did not show the incoming call was from a state agency. Policies and Procedures – During the pandemic, SSA updated policies and procedures on how the DDS should operate. The updates included combined instructions with the field office, which confused some DDS employees about what pertained specifically to DDS processes.

Medical evidence is crucial to a disability determination for a Social Security disability claim for both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Each claimant who files a disability claim is responsible for providing medical evidence showing the claimant has at least one impairment that limits the ability to work and the severity of the impairment. The Social Security Administration will assist the claimant to get medical evidence from the claimant’s own medical sources who have evaluated, examined, or treated the claimant for the impairment. Claimants who provide SSA with timely, accurate, and complete information and evidence can help accelerate the processing of claims. Below are examples of the information Social Security needs to evaluate the existence of an impairment and the severity of that impairment. Existence of an impairment By law, SSA needs specific medical evidence to establish that a claimant has an impairment. Social Security regulations require “objective medical evidence” from an “acceptable medical source” to establish that a claimant has a medically determinable impairment.  The regulations define these terms. Severity Once the existence of an impairment is established, SSA considers all evidence from all medical and nonmedical sources to assess the extent to which a claimant’s impairment(s) affects his or her ability to function in a work setting; or in the case of a child, the ability to function compared to that of children the same age who do not have impairments.  Nonmedical sources include, but are not limited to the claimant, educational personnel, public and private social welfare agency personnel, family members, caregivers, friends, neighbors, employers, and clergy.

We realize it may be a stretch for ordinary people to want to keep up with the comings and goings of the Social Security Administration, but sometimes circumstances permit where someone does want to follow the latest news regarding the agency due to a possible retirement or disability interest. This blog is an ongoing piecemeal of recent stories that have involved Social Security. Some are tidbits and some are important things that should be known in the world of retirement or disability and others are just interesting stories and nothing more. Less People Collecting Social Security Disability These Days The Center for Retirement Research at Boston College recently issued a study on the factors that have led to less people collecting Social Security disability benefits than just a few years ago. Since 2015 the number of individuals collecting Social Security Disability Insurance (SSDI) benefits dropped compared to the previous two decades and the trend is continuing. Below are some key points from the conducted study and gives some insight as to why less people are receiving disability benefits than there used to be. This drop was caused by a wave of terminations, as beneficiaries aged into the Old-Age and Survivors Insurance (OASI) program, combined with a steep decline in the incidence rate (the number of new DI awards relative to the insured population). Yet, the forces driving down the incidence rate remain poorly understood. Prior studies suggest that three factors could have played a role: 1) a strong economy following the Great Recession; 2) demographic shifts due to population aging and the decline in manufacturing; and 3) policy changes at the Social Security Administration (SSA). Using data provided by the SSA’s Office of Disability Programs, this study examines how each of these factors contributed to the drop in the incidence rate. The paper found that: A strong economy accounted for about half of the drop in the incidence rate. Policy changes – specifically the retraining of Administrative Law Judges – also accounted for about half the drop. Population aging put slight upward pressure on the incidence rate. In terms of the total number on the disability rolls, the impact of aging on terminations far exceeds its impact on new awards. The policy implications are: The time may have come to somewhat rebalance the goals of DI from encouraging labor force participation to protecting vulnerable people. Congress may want to consider merging the DI and OASI trust funds.

A common question many people have when they are considering applying for Social Security disability benefits is “do I qualify?” The question is focused on medical impairments a potential disability claimant suffers from. Social Security does maintain a listing of impairments that can be considered for disability purposes, but even if a condition someone suffers from may not be on that list it does not mean you “don’t qualify,” but rather that a condition must prevent a claimant from working fulltime based on severity. Understanding how Social Security considers impairments is especially valuable in understanding your claim. Below are some finer points of how Social Security will look at your impairments. The Listing of Impairments: The SSA maintains a comprehensive list of medical conditions, known as the “Listing of Impairments” or the “Blue Book.” These conditions are considered severe enough to automatically qualify individuals for SSDI benefits if they meet the specific criteria outlined in the Blue Book. The Blue Book consists of two parts: Part A covers adult impairments, while Part B covers impairments in children. Qualifying for SSDI Through Medical Evidence: Even if a medical condition is not listed in the Blue Book, individuals can still qualify for SSDI if they can provide sufficient medical evidence to demonstrate that their condition meets the SSA’s requirements for disability. This evidence may include medical records, diagnostic tests, treatment history, physician statements, and functional assessments. Common Medical Conditions that Qualify for SSDI: Several medical conditions commonly qualify individuals for SSDI in Minnesota. These include, but are not limited to a. Musculoskeletal disorders, such as severe back injuries, spinal disorders, and joint disorders that significantly limit mobility and function. b. Cardiovascular conditions, including congestive heart failure, chronic heart disease, and severe coronary artery disease. c. Neurological disorders, such as multiple sclerosis, epilepsy, Parkinson’s disease, and traumatic brain injuries. d. Mental health disorders, including severe depression, bipolar disorder, schizophrenia, and post-traumatic stress disorder (PTSD). e. Immune system disorders, such as HIV/AIDS, lupus, rheumatoid arthritis, and certain types of cancer. f. Respiratory disorders, including chronic obstructive pulmonary disease (COPD), asthma, and cystic fibrosis. g. Endocrine disorders, such as diabetes mellitus, thyroid disorders, and adrenal gland disorders, chronic kidney disease  and other renal impairments.

To qualify for Social Security Disability Insurance benefits, generally you must have worked and paid into Social Security for at least five years within the past ten years. According to Social Security rules, a claimant must meet specific medical requirements to qualify for Social Security disability benefits. These can include a developmental disability, long-term disability, a mental health diagnosis or any other limiting medical condition that limits a claimant’s ability to work. To receive SSDI payments, the applicant must show evidence that their disabling condition will last for at least twelve months or result in death. Getting started on a disability claim can be difficult if you don’t know where to start. Below are some details of how to begin a disability claim. Options To File The SSA provides three ways to apply for disability: You can go online and fill out the application, visit your local Social Security office and fill it out with a Social Security representative, or do it over the phone. You can apply for SSDI online at www.ssa.gov/pgm/disability.htm. In-person. If you want to apply for SSI or SSDI in person, visit your local SSA field office. The employees there can help you with the paperwork and explain the forms, but they cannot give legal advice. Go to the SSA’s website to find your local field office in Minnesota. By telephone. You can apply for SSI or SSDI by phone. If your field office is too distant or if you have a disability preventing travel, this may be a better solution for you. You can call 800-772-1213 and apply by phone, or if you are deaf or hearing impaired, call 800-325-0778.