Demystifying

Demystifying, SSA, SSDI

How to File an Application for Disability

There are multiple ways to file an application for Social Security disability benefits. Here are a few options if you decide you want to get the disability process moving. When deciding to apply for disability it is important to know what needs to be submitted to the Social Security Administration for a medical determination to be made about your disabilities. If something is missed it can delay your application until all materials are received. Three documents are needed to complete an application. These documents include a disability report, benefit application, and authorization to disclose information to the Social Security Administration. All of these documents can be found online at the Social Security website. The disability report is the meat and potatoes of your disability claim. All of your medical providers’ contact information is needed as well as approximate dates of your first, last and any future appointments with these providers. The disability report also asks about your last 15 years worth of work history and any current medications you are taking related to your disabilities. In addition to the disability report you will need to complete a benefit application. This application requires more personal information about marriages, children and more details about the companies you have worked for. Once an applicant has completed the disability report and benefit application one more document is needed before Social Security can decide whether an applicant meets the medical requirements of being disabled. This document is the authorization to disclose information to the Social Security Administration. By printing and signing this document you are authorizing Social Security to collect your medical records so a medical determination can be made. Without all of these documents a valid Social Security Disability Insurance (SSDI) claim is not possible. If an applicant wishes to file a Supplemental Security Income (SSI) claim one more step is required. This involves calling Social Security to schedule an SSI phone interview. This is required to determine whether the applicant’s financial resources qualify them for this financial needs based program. The process to complete an initial application can be time consuming, but help is out there. Social Security legal representatives, such as Greeman Toomey PLLC, can handle the initial application for you and Social Security can also assist with the process.  

Demystifying, Legal News, SSA, SSDI

The Affordable Care Act and People With Disabilities

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.

Demystifying, SSA, SSDI

Ask a Case Manager: What information will I need to complete the Initial Application?

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.

Demystifying, General Info, SSA, SSDI

Reopening a Prior Application – How Far Back Can You Go?

Generally, a determination or decision that is made is final and binding if a timely request for review or appeal is not filed.  However, there are certain circumstances that allow for reopening and revising prior determinations and decisions.  The rules governing the circumstances for reopening are different for SSDI and SSI claims.  20 C.F.R. 404.988 sets forth the conditions for reopening SSDI claims.  A determination or decision may be reopened: Within 12 months of the date of the notice of the initial determination, for any reason; Within four years of the date of the notice of the initial determination if good cause is found 20 C.F.R. 404.989 notes good cause will be found if:  new and material evidence is furnished; a clerical error in the computation or recomputation of benefits was made; or the evidence that was considered in making the determination or decision clearly shows on its face that an error was made.  Further, there are additional less common circumstances that allow for reopening at any time in the following situations: claims involving fraud or similar fault; a person previously determined to be dead, and on whose earnings record your entitlement is based, is later found to be alive; or in circumstances when your claim was denied because you did not prove that a person died, and the death is later established. The regulations provide reopening may occur in the aforementioned scenarios.  For practical purposes, the most common reopening conditions are within 12 months for any reason and within four years if good cause is found.   As a practitioner it is important to request re-opening of prior determinations when filing an Appointment of Representative form for all new clients.  Further, prior applications more than 12 months old are most likely to be reopened during a hearing with an ALJ based on the condition of new and material evidence.  If a Medical Expert (ME) testifies during a hearing that the claimant’s condition meets or equals any of the Listing of Impairments, representatives should always inquire with the ME as to the onset.  Further, the existence of new and material evidence that further corroborates prior evidence may serve a basis for reopening. The rules governing the circumstances for reopening for SSI claims are set forth in 20 C.F.R. 416.1487 and 416.1488.  Again, reopening may occur within 12 months for any reason; however, reopening may only occur within 2 years if good cause is found.  The good cause provisions are set forth in 20 C.F.R. 416.1489 and are the same as the good cause provisions for SSDI claims. A similar mechanism to reach back and reopen prior claims is set forth in Social Security Ruling 91-5p.  However, the ruling technically does not reopen a prior application; rather it extends the time to request review.  Social Security Ruling 91-5p pertains if the claimant had good cause for missing the deadline to request review. This Ruling provides that if a claimant presents evidence that mental incapacity prevented her from requesting timely review of an administrative action, and the claimant had no one legally responsible for prosecuting the claim on her behalf at the time of the prior adverse action, SSA “will determine whether or not good cause exists for extending the time to request review.” SSR 91-5p. “The claimant will have established mental incapacity for the purpose of establishing good cause when the evidence establishes that he or she lacked the mental capacity to understand the procedures for requesting review.” In making the 91-5p determination, the following four factors must be considered: (1) inability to read or write; (2) lack of facility with the English language; (3) limited education; and (4) any mental or physical condition which limits the claimant’s ability to do things for him/herself.  In all cases, “[t]he adjudicator will resolve any reasonable doubt in favor of the claimant.” If it is determined, applying the proper criteria, that the claimant lacked the mental capacity to understand the procedures for requesting review, time limits are tolled “regardless of how much time has passed since the prior administrative action.”  In such cases, the adjudicator must “take the action which would have been appropriate had the claimant filed a timely request for review.”

Demystifying, Legal News, SSA, SSDI

Amputation and Social Security Disability

If an individual has two limbs amputated or one leg amputated at the hip, chances will be higher to obtain Social Security Disability benefits sooner rather than later and could be granted a presumptive disability right. There is a possibility for Social Security to approve someone for six months worth of presumptive disability checks if they are either missing two limbs or a leg from the hip down. Even if someone qualifies for presumptive disability, they can still be found totally disabled and eligible to continue receiving benefits. According to Social Security a person can be found disabled automatically if their amputation meets specific criteria set forth in Social Security’s official listing for amputations. Social Security does not take into account how you lost a limb, whether through an accident or diabetes. A person needs to meet one of the following criteria: amputation of both hands; amputation of one or both legs at or above the ankle; must not be able to walk effectively (“ineffective walking” generally means that you need to use both your hands for handling assistive devices, such as a walker, two canes or crutches, or a wheelchair); amputation of one hand and one leg at or above the ankle; amputation of one leg up to the hip (hip disarticulation), or pelvic amputation (hemipelvectomy). Of course there are many amputations that do not fit the criteria listed above. If you have an amputation that prevents you from working, such as an amputation of your dominant hand, you may still be eligible for disability benefits, even if your amputation does not exactly fit the listing criteria. If your work-related activities are limited because of your amputation, Social Security will assess your “residual functional capacity,” or “RFC.” Social Security will look at whether or not you can walk effectively on an artificial leg and whether you are capable of sedentary activities. If you have lower limb amputation, you may also be restricted in what kinds of surfaces you can safely walk on, as well as have restrictions around crawling, kneeling, climbing, bending at the knees, and activities that require good balance. For upper limb amputations, Social Security will look at your ability to grasp things, fine motor movements, typing and writing abilities, and your ability to lift objects. The RFC assessment is used by Social Security to determine what kind of work you are still capable of doing despite the limitations from your amputation.

Demystifying, SSA, SSDI

Alzheimer’s Disease and Disability Benefits for Early-Onset Alzheimer's Disease

In recent years, Social Security Administration has taken large steps towards recognizing the fact some types of medical conditions should qualify sufferers for disability benefits automatically, on account of the conditions being serious enough that those who have them fit the Social Security Administration definition of being disabled. Since 2008, the Compassionate Allowances program has allowed people with qualifying conditions to start receiving Social Security Disability benefits as early as three weeks after initially applying for disability. This is a considerable improvement over the months-long (and sometimes years-long) process of applying, re-applying and appealing which most people have to go through before being approved for Social Security Disability benefits. The Social Security Administration added early onset/younger-onset Alzheimer’s to the list of conditions under its Compassionate Allowance guidelines, giving those with the disease expedited access to Social Security Disability benefits. The Alzheimer’s Association, a longtime advocate for those with early onset Alzheimer’s, has played an integral role in this movement to reduce the length of disability decision process.  Alzheimer’s Disease is a complicated disability. Alzheimer’s is a brain disease that affects an individual’s memory, behavior, and thinking patterns. It is the most common form of dementia, accounting for about 50 to 70 percent of all dementia cases. The disease attacks the brain, and symptoms worsen progressively over time. When an individual suffers from Alzheimer’s Disease, certain types of nerve cells in different areas of the brain are destroyed. This results in a gradual decline in judgment, reasoning ability, verbal communication and cognitive skills. The exact symptoms and effects of Alzheimer’s Disease vary from individual to individual, but common symptoms include a loss of memory, disorientation, communication issues, reasoning problems, poor judgment, decision-making difficulties, and personality changes such as depression, mood swings, and distrust in others. Claimants applying for Social Security Disability Insurance benefits for Alzheimer’s are typically approved if symptoms are common to dementia episodes of decomposition in which there is an increase in signs and symptoms, accompanying a loss of functioning (this causes difficulties in performing everyday activities, inability to maintain social relationships, and inability to maintain concentration, persistence or pace when performing tasks); episodes requiring an increase in treatment or relocation to a less stressful situation and medical records proving a sudden significant increase in medication or the need for a more structured psychological support system. Episodes must be documented and there must be at least three episodes within one year (on average of one every four months, each lasting for at least two weeks. Each person’s situation is unique, so it is very important not to delay. When filing for Social Security Disability due to a diagnosis of early-onset Alzheimer’s Disease, you need to include as much medical documentation as possible. Medical records, documents, and written statements from your doctors supporting your diagnosis will be crucial to the success of your Social Security Disability claim.

Demystifying, Legal News, SSA, SSDI

Acting SSA Commissioner has a Tough Task Ahead

The departure of Michael Astrue Feb. 14 resulted in Carolyn W. Colvin becoming the acting commissioner of the Social Security Administration. Astrue’s stint as commissioner ended last month after a six-year term. Colvin, the previous deputy commissioner since being confirmed by the U.S. Senate Dec. 22, 2010, is said to blend compassion with toughness in her role, according to a FedInsider.com article. The article highlighted Colvin’s appointment by President Barack Obama and confirmation by the Senate as deputy commissioner. It remains unclear how long Colvin will serve as acting commissioner because Obama has yet to name a permanent successor to Astrue. Any potential nominee must be confirmed by the Senate before taking over as the new commissioner. Colvin said she is focused on fairness in making sure the “most vulnerable and most at-risk” receive the benefits they are entitled to, but has also worked on retrieving Social Security overpayments to recipients, something the Obama Administration has focused on. Colvin said her ultimate goal is the preservation of Social Security now and in the future. “I’m passionate about protecting this program so it will be there for all of us,” she said. It appears that Colvin is now taking over a thankless job. Last year the Social Security Board of Trustees announced that if nothing changes, Social Security will only be able to make partial payments to recipients beginning in 2033. To make matters worse, the chances of congress taking action at the 11th hour to avoid automatic federal spending cuts, a process known as sequestration, were slim to none as the deadline approached. The mandated cuts include a reduction of 5,000 Social Security employees. These equates to an 8.3 percent reduction of the 65,000 current employees working for Social Security, according to a U.S. Senate report. Social Security would also be forced to put all staff members on an un-paid six-week furlough while budget cuts are absorbed. Colvin has a tough task ahead of her holding down the fort until the next commissioner is named and confirmed.

Demystifying, SSA, SSDI

Proposed Reforms to Student Loan Debt Forgiveness Based on Disability

Earlier last week the Education Department proposed new rules to revamp its program for forgiving federal student loans of borrowers who become disabled. While the proposed reforms would not use Social Security disability findings as a basis for discharging loans – as many student borrowers’ advocates had hoped – they would streamline the application process and improve communication with borrowers. As of 2008, the standard for discharge of student loans is full disability for at least five years. Check out the full article here.  

Demystifying, SSA, SSDI

What is an RFC? (SSR 96-9p Part I)

An RFC is important at several stages of the 5 step sequential evaluation process, but let’s start with a definition. RFC stands for residual functional capacity, and is an individual’s maximum remaining ability to perform sustained work on a regular and continuing basis. In other words, what can the person do 8 hours a day, for 5 days a week? An RFC is assessed based on all the medical records in a case and is supposed to represent the most a claimant can do, both physically and mentally. A person’s RFC considers both exertional and non-exertional limitations. Exertional limitations have to do with physical strength and fall into one of seven categories: sitting, standing, walking, lifting, carrying, pushing, and pulling. Non-exertional limitations include any work-related limitation that is not covered by one of the exertional categories. Non-exertional limitations include: mental abilities, vision, hearing, speech, climbing, balancing, stooping, kneeling, crouching, crawling, reaching, handling, fingering, feeling, and environmental restrictions. If any exertional limitations are involved in a disability claim, then the RFC assessment must include an exertional classification of sedentary, light, medium, heavy, or very heavy work. As a person moves down the list of exertional classifications (for example, from heavy to medium) fewer jobs are available that fall within the person’s RFC. As a result, the lower the exertional classification, the better the claimant’s chances of being found disabled. Non-exertional limitations can also decrease the number of jobs that fall within a claimant’s RFC. For example, limitations in fingering and handling could exclude assembly jobs, while limitations in interacting with the public could exclude customer service jobs. In future blog posts we will look at RFCs in several different scenarios and examine how they might affect the outcome of case.

Demystifying, General Info, SSA, SSDI

Can I work and apply for Social Security disability at the same time?

Try going the better part of two years without the ability to earn a living and having no income to speak of. Many times this is exactly what someone who is going through the Social Security process is faced with. Because it can take a long time before an applicant is approved for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) most of those who apply experience financial distress. If you can’t work because of your disabilities how someone with no income would pay their rent and keep their utilities on is anyone’s guess. Fortunately, for those who are able to, Social Security will allow applicants to work on a part-time basis while they are going through the disability process and even after they are approved for disability benefits. It is important to know specific rules if you are working and applying for Social Security disability. It may seem like a contradiction for someone who is claiming to be disabled to go back to work or to continue working, but many people have no other choice. Working, especially on a part-time basis, does not necessarily mean you are not disabled. Many people have physical or mental health disabilities that prevent them from working at a full-time level, or what Social Security considers to be a Substantial Gainful Activity (SGA). In 2012 Social Security has set SGA at $1,010 gross income (before taxes) per month. Anyone who earns more than this through work-related activity runs the risk of disqualifying themselves from being eligible for SSDI. That means that Social Security will not even consider whether you are disabled because you do not meet the technical requirements of the program set forth by Social Security. Applicants who are applying for SSI face even stricter income limitations as all household income and most assets can disqualify someone from being eligible for SSI. It’s also important to know that even if you go back to work full-time, when going through the disability process, your case will probably not be dismissed unless you earn more than $1,010 (gross) per month for a continuous sixth-month period. Be sure to keep your legal representatives informed of your work activity, specifically your case manager, if you are a client of Greeman Toomey. If you show that you are attempting to work, but are unable to sustain that work because of your disabilities, it’s generally not a negative when it comes to the Social Security process.

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