Demystifying

Social Security and Supplemental Security Income (SSI) payments generally are not payable for months that an individual is confined to a jail, prison or certain other public institutions for commission of a crime. A person is not automatically eligible for Social Security or SSI payments when being released from prison or jail. If you are receiving Social Security benefits and you have an outstanding arrest warrant for a crime that is a felony under the laws of the state in which you live, or a crime punishable by death or imprisonment for more than one year in states that do not classify crimes as felonies, you must notify Social Security immediately. An individual cannot receive disability benefits for any months in which there is an outstanding arrest warrant for a crime. If you are convicted of a crime, generally you are not entitled or paid for the months you are confined for a crime, however any family members who are eligible for benefits under your work will continue to receive those benefits. An individual must notify Social Security if you violate a condition of probation or parole under state or federal law. An individual cannot receive disability benefits for any months where a violation occurs while on probation or parole. Please note that if Social Security finds an individual has provided false information on purpose, benefits will be stopped. Be sure to have your claim number ready when you call Social Security to report any changes for faster,  more efficient service. If you receive benefits based on your own work, your claim number is the same as your Social Security number followed by the letters “HA.” If you receive benefits on someone else’s work, your claim number will be the other person’s Social Security number followed by a different letter. The award notice you received when your benefits started shows your claim number. You also should be prepared to give the date of the change, and, if different, the name of the person about whom the report is made.  

There are two types of partially favorable decisions. One is for a closed period of disability. The other is for an alternative disability onset date. A closed period of disability means the Administrative Law Judge finds that you are disabled for only a certain period of time. You will be paid benefits for this period, but you will not receive any ongoing benefits. A closed period is beneficial for claimants whose conditions have medically improved to resume working.  A Judge may also award a claimant benefits for a closed period of disability if something in their medical evidence refers to medical improvement. An alternate onset partially favorable decision indicates the Administrative Law Judge does find you disabled but does not think you were disabled as early as you originally alleged. The onset date of your disability will be related to evidence or fact(s) in your record, for example: when you stopped working, were diagnosed with a condition, or received medical treatment. In both cases after the decision is issued, the next step is the payment process. It takes up to 120 days from the date of the decision to receive the Notice of Award. The Notice of Award describes what backpay you will receive, as well as the attorney’s fees that your attorney is authorized to receive for his work on you case. It may take up to 90 days from the date of the award letter to receive your backpay. In the case of an alternate onset date decision, the Notice of Award will also indicate what your monthly ongoing benefits will be and when you can expect to receive them. If you are awarded for a closed period or alternate onset date and disagree with the decision, you do have the option to appeal; but there are some risks. Appeals go to the SSA Appeals Council. The Appeals Council could rule in your favor, but they can also put the whole issue of disability back on the table and potentially reverse the Administrative Law Judge’s favorable decision. At Greeman Toomey, we typically do not file appeals of these decisions or recommend that our client’s appeal. If you are awarded a closed period of disability and believe that you are still disabled, it may be in your best interest to forgo the appeal and instead file a new claim. If you choose not to appeal the Administrative Law Judge’s decision, it will be finalized. As a result, when you file a new claim there will be no risk of Social Security reversing the prior decision. If you have received a Notice of Decision – Partially Favorable and have any questions, please do not act until you contact our office at (612) 332-3252.

If you have been approved for Supplemental Security Income (SSI) benefits your claim will be reviewed periodically to determine if you still meet the Social Security Administration’s (SSA) criteria for disability. Your benefits will be continued if the SSA determines your conditions continue to prevent you from maintaining substantial gainful employment. The frequency of these medical reviews depends on what condition(s) you suffer from, the severity of the condition(s), and likelihood of the condition(s) improving. If your condition(s) is expected to improve, the SSA will review your claim within six to 18 months from when you were approved. If your condition(s) may possibly improve, you will be reviewed by the SSA within three years of starting your benefits. If your condition(s) are unlikely to improve, you will be reviewed by the SSA within five to seven years. The SSA will mail you a letter initiating the review.  The SSA will request medical reports from your providers and your claim will be evaluated by one of their disability examiners and doctors. If necessary, you will be asked to attend an appointment with a doctor selected by the SSA. If the SSA determines you still meet the disability criteria your benefits will continue. If it is determined that no longer meet the requirements you will be able to file an appeal of that decision. You may still be eligible to receive benefits while your appeal is pending. For more information on SSI medical reviews refer to the SSA’s article “What You Need To Know When You Get Supplemental Security Income (SSI).”

Sometimes a family can receive Disability Insurance Benefits (DIB) beyond the impaired person’s benefits. The unmarried children of a successful claimant can receive children’s benefits or auxiliary benefits.” There are three types of unmarried children who qualify for auxiliary benefits under 20 C.F.R. § 404.350: a child under the age of 18, an adult child who is disabled prior to age 22, and a child who is a full time student and is under 19. Eligible children include natural children, legally adopted children, and certain stepchildren, grandchildren, and equitably adopted children per 20 C.F.R. § 404.354. These auxiliary benefits are available when DIB payments are available – five months from the date of disability. Auxiliary benefits are subject to back payments in the same fashion as DIB back payments; you can receive back payments for benefits up to 12 months prior to the date o f the parent’s application for benefits per POMS GN 00204.030. Thus, even if the child does not meet the requirements to be an auxiliary beneficiary when benefits are awarded, the child can receive back payments to which they would have been entitled. At Greeman Toomey, we always remind and encourage our clients to file for auxiliary benefits when they are eligible so that our clients’ families receive all of the support to which they are entitled.

Interesting piece from Forbes magazine about the potential impact of the Affordable Care Act on people with disabilities.  The article makes the rather dubious claim that once the ACA is fully implemented, people with disabilities who are currently covered by Medicaid will leave the public health market in droves because they would not be ‘held back’ from working full time and/or finding insurance in the private market due to pre-existing health conditions.  However, it also points out that prior to the passage (and recent Supreme Court affirmation) of the ACA, persons with disabilities who had an interest in attempting to work more than part-time were loath to make an attempt for fear of losing their eligibility for SSI and Medicaid.

There are two portions to the Social Security Disability Initial Application. The first portion is called the Adult Disability Report (ADR) and the second portion is the Benefit Application. The ADR asks questions regarding your medical conditions, medical treatment, work background and education level. It is important to have a list prepared of all of your physical and mental health conditions that limit your ability to work. It is also helpful to prepare a list of the hospitals and clinics where you have been treated for these conditions. Social Security is most interested in your recent medical treatment. At Greeman Toomey, we ask our clients to prepare a list of places where they have received treatment in the past 12 months. We need the name and contact information of the facility, dates of treatment, and the name of the doctor that treated you. The ADR will also ask if you have had any medical tests performed at these facilities, and if you are being prescribed any medications. There may be other places that have additional medical records. These include public welfare offices, prisons or jails, other attorney’s offices, vocational rehabilitation centers, workers compensation, etc. If any of these sources are applicable to you, please collect the relevant contact information. The ADR asks for information regarding the applicant’s work background. The report asks about the jobs held in the past 15 years, or the five most recent jobs. Please prepare a list of your past employment. For each job, the reports asks for your job title, the type of business, start/end date, hours worked per week, and rate of pay. The ADR does not ask for much detail regarding each job, but you will later receive a Work History Report from the SSA Disability Determination Services office. The final questions on the ADR ask about your education history. Specifically, the highest level of schooling you’ve completed, along with any job or vocational training. Dates of completion for each level of education will also be requested. The ADR also asks if you have ever attended special education classes. The Benefit Application is typically the easier portion to complete and requires less advanced preparation. It goes into detail regarding your personal information. It asks what city and state you were born in, in addition to information about your children and spouses. The Benefit Application also asks about earnings in the current and previous year. This includes the names of employers and any self-employment income. Your case manager will be contacting you to complete the initial application either over the phone or in our office. To make the appointment go smoothly please prepare the required information. If you have any questions please do no hesitate to call our office at (612) 332-3252 or toll-free at (877) 332-3252.

Many people who filled out their own Adult Disability Reports at the outset of their claim will recall that it required them to list all the conditions limiting their ability to do work.  However, in many instances, people receive denials or fully favorable decisions based in whole or part on conditions other than what they alleged in their Adult Disability Report.  There is a common misconception amongst many claimants that Social Security is somehow limited in their analysis to only the conditions originally alleged.  This is not the case.   Social Security bases the majority of their decisions on the contents of the medical records, which, for people who are treating, provide a more comprehensive diagnoses listing than what most people put in their Adult Disability Reports.  The records also provide guidance as to the conditions’ severity and, in many cases, a pointed analysis as to the claimant’s ability to function as a result of these conditions.  Social Security has every right, and obligation, to analyze all the conditions that are present in the medical records that have caused or will cause the claimant a more than minimal limitation on his/her ability to work for a period of not less than 12 consecutive months.  This can and has resulted in decision letters that find the claimant disabled for reasons of x, y and z, when the claimant originally alleged a, b and c.  A claimant who originally alleged disability due to arthritis in knees and feet and make no mention of mental conditions, can be found disabled for reasons of Bi-Polar Disorder and Depression if the medical records bear out that those conditions are disabling for the claimant under Social Security’s rules.   The main benefit to the claimant is that this requires Social Security to analyze conditions that they may have certain difficulties talking about.  Many claimants are in situations where they suffer from several conditions that are disabling either singly or in combination, but as a result of the culture or environment for which they grew up, are ashamed of the conditions.  This can result in Adult Disability Reports with key conditions left off, as it is hard for a lot of people to talk about things like Schizophrenia, Crohn’s Disease, Traumatic Brain Injury or Learning Disabilities, despite the fact that these conditions are NOTHING to be ashamed of.  People often times fill out the Online Adult Disability Report when someone else is in the room, so they don’t feel comfortable listing it in front of the other person, or do the report by interview with a Social Security agent and don’t fully trust the agent.  However, in many of these cases, the claimant trusts their doctor, and is open and frank with that person.  Social Security’s system allows for claimant’s to receive a fair up or down vote based on ALL the conditions they are treating for.   The main drawback for many claimants to this approach is that if the medical records also contain ongoing drug and alcohol abuse, that will get analyzed alongside the other conditions present.  This means that a claimant cannot hide their abuse from Social Security by leaving it off the Disability Report.  Everything that has a material affect on the claimant’s ability to do work-like activities gets analyzed if it is present in the record, even drug or alcohol dependence.  Thus, if a claimant fails to mention drug and alcohol dependence in the Adult Disability Report, but the treatment records bear out that it is material to the claimant’s inability to work, Social Security can still use drug and alcohol abuse as a reason to deny a claimant. The notion that Social Security is bound to only analyze the conditions listed in the Adult Disability Report is incorrect.  The more accurate sentiment is that Social Security can and will analyze all conditions that the record indicates are causing more than a minimal affect on a person’s ability to do work, without regard as to whether it helps or hurts the claim.