Demystifying

After you’ve filed a Social Security Disability (SSD) or Supplemental Security Income (SSI) claim with the Social Security Administration (SSA) your local Social Security office will evaluate the non-medical and technical aspects of the claim. If you meet the technical requirements for one of the benefit programs your claim will be transferred to a state disability agency for a medical determination. In Minnesota and many other states the state agency is called Disability Determination Services (DDS). There is at least one DDS office per state used to evaluate the SSD and SSI claims. Each office has trained examiners that use the SSA’s rules to determine if the claimants meet the medical requirements for disability. Each of the DDS offices are federally funded. DDS is responsible for requesting and reviewing medical reports from the medical providers listed on your application. If the DDS examiner working on your claim decides that more information is necessary to make a determination, you will be asked to attend a consultative examination. These examinations are paid for by the SSA. The doctor at this examination will write up a report following your appointment and submit that report to DDS for review. The DDS office also sends out various questions for the claimant to complete. The most common questionnaires are the Work History Report and Function Report. The Work History Report asks for information regarding your employment history for the past fifteen years. The Function Report focuses on how your conditions affect your daily activities. There are other questionnaires that the examiner may feel are necessary for evaluating your claim. A few examples are the migraine, pain or seizure questionnaires. The examiner will then use your medical reports, consultative examination report (if requested), and the questionnaires you’ve completed to make a decision. The decision will be sent to your local Social Security office and then mailed off to you and, if you are being represented on your claim, to your representative. If your claim has been approved your local Social Security office will confirm you still meet the non-medical and technical requirements. If you meet these requirements the SSA will issue your benefits. If the DDS office denies your application you have 60 days to file an appeal. This appeal is called the Request for Reconsideration. DDS offices are also responsible for making the medical determination on your Request for Reconsideration. Your claim will be assigned a different examiner to review medical reports and any questionnaires you have completed. The new examiner also has the option to request you attend a Consultative Examination if more information is needed. For more information on DDS please click here.

If you just went through a hearing in front of a Social Security Administrative Law Judge, you may be wondering what was going on during the latter part of the hearing, when the Judge turned to the work expert and started listing off various activities like “crouching, crawling, kneeling” and the expert responded with a bunch of numbers and codes like “’669.687-018, svp 2.” What the heck is that all about? In a Social Security hearing, judges can call upon vocational experts to understand more about the kind of work that you may have done in the past, and whether or not any other jobs exist that could accommodate your medical limitations. First, the work (or, “vocational”) expert will talk to the judge about the kind of work that you’ve done in the past. You may have heard the term “PRW,” which stands for Prior Relevant Work. The question that the Judge needs to answer is not whether you want to go back to your prior job, or whether your prior job would hire you – rather, the question before the Judge is whether you would be able to perform your PRW on a full time, continuing basis, 8 hours per day, 5 days per week, in light of the limitations posed by your medical conditions. If the vocational expert determines that you are unable to go back to your PRW, the Judge will then proceed to ask the vocational expert whether there are any other jobs that you might be able to do, given your age and experience, the local economy, and the limitations posed by your medical conditions. The Judge does this by posing “hypothetical” individuals for the vocational expert to comment upon. Typically, the Judge will start with describing an individual who has some, but not all, of the limitations you are alleging. Next, they will describe one or two additional hypothetical individuals with additional limitations. The work expert is likely to identify many potential jobs for the first hypothetical individual, fewer jobs for the second hypothetical, and no jobs for the third hypothetical individual. Your attorney or representative (if you had one) may have posed additional hypothetical individuals for the work expert to discuss. Ultimately, it is up to the judge to determine which hypothetical individual he or she thinks you most resemble. If the judge finds medical support for the limitations described for the hypothetical individual for whom no jobs exist, you win your case. Having an attorney represent you at a hearing who is familiar with the acronyms and codes used by the work experts and the Judge, and who can elicit effective cross-examination of the work expert, can be very beneficial.

If you are filing for Social Security Disability (SSD) or Supplemental Security Income (SSI) and have been found disabled by the VA (Department of Veterans Affairs) it is in your best interest to advise the Social Security Administration (SSA) of the decision. While the requirements for proving disability for either SSD or SSI is different from VA disability, a disability rating from the VA may positively impact your claim. According to Social Security Ruling 06-03p, the decisions made by the VA or other organizations, and evidence used to make those decisions can provide insight regarding the severity of the claimant’s disabilities. But the ruling also states that these decisions are not binding on SSA.  Even though the decision isn’t binding, it is helpful for your claim to disclose the VA rating because it shows to SSA that another federal program finds that your conditions affect your ability to work or prevent you from working all together. With an SSD or SSI claim you are either found disabled or you’re not. With the VA you are given a percentage of disability. The higher the percentage the more disabled and less employable you become.  The percentage also translates into a higher monthly benefit. The VA will then determine whether your disability is service-connected or non-service connected. The service-connected designation is given to veterans who are disabled by an injury or illness that was incurred or aggravated during active military service. Non-service designated payments are for reserved for wartime veterans who are now unable to work.   If SSA does find that you are disabled your VA benefits may impact how much money you receive.  If you are eligible for SSD benefits and also receive service-connected VA disability there will be no offset for either benefit. However, if you receive non-service connected VA disability there will be an offset. If you are only eligible for SSI payments your total VA disability amount, either service-connected or non-service connected, will be deducted from each monthly check. For more information regarding VA benefits, check out their website at http://www.va.gov.

A frequent question that arises when a client is approved for either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits is whether the client has to pay taxes on Social Security disability payments. As is the case with many rules that impact Social Security disability claims the answer is: It depends. The general rule is that if your total income, including Social Security disability benefits, exceeds $25,000 a year for an individual or $32,000 a year for a married couple, you have to pay federal taxes on that income. If your only source of income is SSDI benefits, the risk of earning more than $25,000 per year is slim considering the average monthly SSDI benefit amount is $1,111. The risk of earning over $25,000 if you only receive SSI benefits is non-existent considering the maximum SSI benefit amount in 2012 was $698 per month. The federal tax implications will impact those who are receiving SSDI benefits and have other sources of substantial income. According to Social Security, having to pay taxes on benefits “usually happens only if you have other substantial income.” Types of such income include wages, self-employment income, earned interest and dividends. Even if a recipient is taxed on Social Security earnings the IRS has said that no one will pay federal income tax on more than 85 percent of Social Security benefits. The Social Security Administration has the authority to withhold federal taxes from your benefit, but no authority to withhold state taxes. Many states do not tax Social Security benefits, but you should check your state’s tax laws for more information. For more information about how Social Security determines whether federal taxes are owed on benefits visit: http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/493/~/paying-income-tax-on-social-security-benefits.  

In part 1, we learned the reasons why the SSA asks for a mass quantity of specific information (medical history, prescriptions, work history, significant dates in the work history), it’s time to figure out preparation. Before you go online, or start your phone or in person interview, make lists. The toughest part for an applicant, is remembering it on the spot. This is not a standardized test. Cheat sheets are not only welcome, they are encouraged. LIST 1: PLACES YOU HAVE RECEIVED HEALTHCARE TREATMENT: Classify each line item by facility (because facilities are more likely to have medical records than each individual doctor), and note address, phone number, doctor’s name (if you know it), first outpatient visit, most recent outpatient visit, next appointment, any ER visits, any medical tests (what test and when), and the date ranges of any inpatient stays. If you can’t remember exact dates, make your most educated guess (if you have to leave it at the month that is fine). The medical records the SSA retrieves will fill in some of those blanks. LIST 2: OTHER PLACES WITH MEDICAL RECORDS: In addition to healthcare facilities, often times medical records are kept at non-traditional sites. If you have been part of a personal injury claim, a worker’s compensation claim, a malpractice claim, or any other claim where your medical records are at issue, think of the name and contact information for your attorney’s office (if you had one) and write that down, as attorney offices often keep the medical records as part of the file. If you are receiving public welfare (food stamps, general assistance, medical assistance), write down the county or state department you are receiving those services from, and the contact for any social worker, if applicable. Also, if you saw a doctor in a prison, write down the name of the doctor, the contact for the facility, and the conditions being treated. If you had vocational rehabilitation, relevant medical treatment may be at the facility running the rehabilitation. If you have had health insurance, try to find that insurance card. Finally, think of anywhere else that’s not a medical facility that might have medical records, write down the contact info, and what you went to the facility for. It is not uncommon that thinking of these will cause people to expand on List 1. LIST 2: YOUR MEDICATIONS: Take a look at everything you are taking. Note what you are taking, who prescribed it (or if it is over the counter), and what it is for. LIST 3: YOUR WORK HISTORY: Make a list of all the job titles you have had over the past 15 years. Note the types of companies each job title was for. Then try to estimate the start date of each job (month and year) and the end date (month and year). Note the hours per day you averaged, and how many days per week, also your rate of pay. If you are not working when you file the application, you will need to know the exact date you stopped working (you can estimate it). If you stopped working for reasons other than your condition, you need to estimate the exact date your conditions became so bad so as to keep you from working. Whether or not you stopped working by the time you fill out the Adult Disability Report, if you had to make changes in your work to accommodate your conditions (changing hours, duties, asking for help, taking more breaks), then you need to estimate an exact date that began. Finally, think of someone in your life who knows you. This could be a spouse, another close family member, friend or neighbor, so long as they understand what you are going through. Note that person’s name, address and phone number (and let them know you are listing them). SSA will want the name of another contact person who they can ask about your condition. Preparation can help make the Adult Disability Report easier and a smoother process. Making cheat sheets can help an applicant recall everything he/she needs right on the spot. Take some time before you fill it out to get ready. It will make for a more complete Adult Disability Report, and a happier you when completing it.

Despite the several different ways of filling out an initial application for Social Security Disability and Supplemental Security Income (online, over the phone, in person at your local SSA office), there is no getting around the fact that the required Adult Disability Report makes it a long and arduous application. You will need to be able to recall every place you have sought medical treatment over the past 12 months: including every ER visit, every medical test, various outpatient appointments, every facility you have visited, all your medications you are taking, and the location of anywhere else that might have your medical records. You will also need to be able to recall all the jobs you have had for the past 15 years: including job title, company, hours worked per day, days worked per week, wage/salary and (in some cases) very specific duties. You will also need to recall the time period you graduated from your highest grade, and, where applicable, information regarding your most recent school in which you have had special education courses (including school name and dates of attendance). If you are an adult thinking about filling out an initial application and just read the above paragraph, take deep breath and count to ten. It can be easier than it looks, with the right mindset and preparation. Let’s start with understanding the reason why they ask for this information. In order to qualify for Social Security Disability Benefits and Supplemental Security Income, a person has to meet the medical requirements for being disabled. This is achieved through objective medical evidence, which is achieved most greatly through an applicant’s medical records. During the initial application process, it is up to the Social Security Administration to look for all the relevant medical records. This is why the Adult Disability Report asks everywhere an applicant has sought recent medical treatment, and medical treatment further back if it’s relevant. It asks about the date range for oldest to most recent visits to know the date range for medical records to look for. It asks about medical tests and ER visits, so they know to pay special attention to those when they appear in the records. It asks about workers compensation claims, whether the applicant is on public welfare, whether the applicant has seen a doctor in a prison or jail, whether the applicant has attended vocational rehabilitation, and whether there are medical records at an attorney’s office, so the SSA knows that there are other places with relevant medical records. It also asks about medications, so the SSA knows to look for those in the records, and to know that the applicant is treating for the conditions he/she is alleging. In addition, the work and education history becomes important here, as the applicant is alleging that the conditions prevent him/her from working 8 hours a day, 5 days a week. The SSA needs to know what kind of work the applicant has done in the past, to know how the conditions affect the applicant’s ability to do his/her job. The work and education history also show whether the applicant can perform other duties that their conditions don’t prevent them from doing. If an applicant spent his/her life as a standing assembly worker, loses their ability to stand for lengths of time, but can still sit, he/she may be still able do a sit down job, if the education and work history show skills necessary for sit down jobs. A specific piece (or pieces in some cases) of work history becomes especially important to the SSA. The Adult Disability Report will want to know the specific date an applicant stopped working (if the applicant stopped). If the applicant stopped working for reasons other than the alleged conditions, the SSA will want to know the date the alleged conditions became so bad so as to keep the applicant from working independent of those other reasons. If the applicant had to make changes to your work to accommodate his/her conditions (like taking more frequent breaks, requesting more help, changing duties or modifying hours or days worked), the SSA will want to know the specific date the applicant started these changes. These dates can be estimated, but the best educated guess is necessary, because the SSA uses this data to help determine when the start date for benefits, should the applicant win his/her claim. Essentially, the applicant’s job when filling out the Adult Disability Report is to point the SSA in the right direction to where the information is. At this stage, they will pull the records themselves, if they know what to look for, and where. The next step for the applicant is preparation. Look for that in Part II.

Being disabled and unable to work is difficult enough.  Being disabled, unable to work, being in debt and dealing with a particularly harassing debt collector is even worse.  People who are disabled and collecting Social Security Disability can rest assured on one important issue: in most cases, Social Security Disability payments are exempt from garnishment for debt collection. However, as noted here, not every debt collection agency cares about that particular aspect of the law.  This situation gets more difficult as more and more claimants are opting for direct deposit for their claim.  This will allow debt collectors to request the garnishment directly from the bank itself.  While banks are supposed to keep watch if the payments are coming from Social Security for Disability, not every bank is successful about policing every account receiving deposits from the Social Security Administration. It is important, that if you set up direct deposit for your claim, and are awarded Social Security Disability benefits, that you make it very clear to your bank which account is receiving those benefits.  This will make it easier for the bank to know which account cannot be subject to garnishment should a debt collector come after you.  If you are being harassed by a debt collector despite this, in a manner in violation of the law, then you should seek independent counsel to discuss your rights under the Fair Debt Collection Practices Act. If you are looking for assistance filing for Social Security Disability benefits, contact Greeman Toomey, PLLC at 877-332-3252.

What are The GRID Rules? The grid rules, formally called Medical-Vocational Guidelines, are a streamlined disability determination process and typically apply to individuals age 50 and over with physical limitations. In some cases, the grid rules are easy to explain and the facts easy to spot. In other cases, particularly when an individual is under 50 years old, performed past relevant work that was sedentary, or where there are primarily nonexertional limitations, it can be much more difficult to apply – and win under – the grid rules. The grid rules are set up as a chart. By applying the claimant’s age, educational level and past relevant work’s skill level, the chart indicates whether a finding of “disabled” or “not disabled” is warranted. How the Grid Rules Work To illustrate how the grid rules work, consider the following illustrations: In our first example, the claimant is 50 years old (closely approaching advanced age), graduated high school, and all of her past relevant work was in the unskilled medium to heavy labor field. Social Security has determined that this individual has the residual functional capacity to do sedentary work. (Or her doctor has completed a medical source statement indicating the client is limited to sedentary work.) Now if you look at the chart for sedentary work in the grid rules and you match up the columns you will see that under rule 201.12 an individual who is closely approaching advanced age, has a high school education, and unskilled past work the rule directs a decision of “disabled.” In the second example, the only difference will be that the claimant is 45 years old and therefore considered a younger individual. If you look again at the sedentary chart in the grid rules you will see under rule 201.27 that a younger individual with a high school education and unskilled past relevant work will direct a finding of “not disabled.” As a third example, we have the same 50 year old, graduated high school, and limited to sedentary, unskilled work. If her past work was performed at the sedentary and unskilled level, the grid rules would not apply as she would be able to perform her past work under that scenario. Skilled, Semiskilled Work and Transferable Skills You will notice some of these rules mention skilled and semiskilled work. Explaining what skilled and semiskilled work is, and whether or not these skills are transferable is difficult to quantify and explain, and is one of the reasons why Vocational Expert testimony is required at the hearing. If a claimant had past relevant work that was skilled or semiskilled then there is an issue as to whether or not these skills are transferable to other types of work within their physical limitations. If a claimant’s past work was unskilled, there is no issue of transferability because by definition unskilled work does not incorporate learned or acquired skills. Unskilled – work which needs little or no judgment to do simple duties that can be learned on the job in a short period of time (i.e. 30 days or less). This includes jobs in which the primary duties are handling, feeding and offbearing (that is placing or removing materials from machines which are automatic or operated by others), or machine tending, are generally unskilled since a person can usually learn to do them within 30 days and limited judgment is necessary. Semi skilled – work which needs some skills but does not require doing the more complex duties.  May require alertness and close attention to: watching machine processes; or inspecting, testing or otherwise looking for irregularities; or tending or guarding equipment, property, material, or persons against loss, damage or injury; or other types of activities which are similarly less complex than skilled work, but more complex than unskilled work. A job may be classified as semiskilled where coordination and dexterity are necessary, as when hands or feet must be moved quickly to do repetitive tasks. Skilled – work which requires qualifications in which a person uses judgment to determine the machine and manual operations to be performed in order to obtain the proper form, quality, or quantity of material to be produced. May require: laying out work, estimating quality, determining the suitability and needed quantities of materials, making precise measurements, reading blueprints or other specifications, making necessary computations or mechanical adjustments to control or regulate the work, or dealing with people, facts, or figures or abstract ideas at a high level of complexity. How SSA Classifies RFC Heavy Work – requires lifting no more than 100 pounds at a time with frequent lifting or carrying of objects weighing up to 50 pounds. Medium Work – Requires lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds. NOTE: Being able to frequently lift or carry objects weighing up to 25 pounds is often more critical than being able to lift up to 50 pounds at a time. Usually requires frequent stooping and crouching. Usually requires standing or walking, off and on, for a total of approximately 6 hours of an 8-hour workday. Light Work – Requires lifting no more than 20 pounds at a time with frequent lifting or carrying objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing or when it involves sitting most of the time with some pushing or pulling of arm or leg controls, e.g., mattress sewing machine operator. Usually involves (at least to some degree) grasping, holding, and turning objects, but does not require use of the fingers for fine activities to the extent required in much sedentary work. Usually requires standing or walking, off and on, for a total of approximately 6 hours of an 8-hour day. Sedentary – Requires lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files,

A Notice of Overpayment may be issued by the Social Security Administration (SSA) to Social Security Disability or Supplemental Security Income recipients when SSA realizes that they have paid you too much. Overpayments normally occur when SSA is not informed of a change in your financial situation. For example, you return to work or continue to receive auxiliary benefits after your children have moved out of the house.   Depending on when the overpayment is found, the amount can range anywhere from a few hundred dollars to several thousands of dollars. You have several options regarding what action you can take: ·      If you think that the Notice of Overpayment was issued by mistake you can file an appeal; ·      If you are unable to pay the overpayment back you may request a waiver from SSA; ·      You may also set up a payment plan to pay back the overpayment in several installments or have a deduction made from each of your monthly checks. Unfortunately, our office’s involvement will not impact or change the Notice of Overpayment. You must contact your SSA office to respond to the Notice. The contact information for your local SSA office will be given in the Notice of Overpayment.   For more information on SSA overpayments please view their website.