Demystifying

The most asked question by anyone who has ever gone through the Social Security disability process has to be “why does it take so long?” In reality, it’s an easy question to answer, but not as easily accepted. Most of the people who apply and are awarded benefits for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) face an approximate wait time of up to two years, depending on what part of the country they live in, before claims are ultimately decided. The main reason for this is that the majority of SSDI and SSI applicants have to appear at a hearing before an Administrative Law Judge before benefits are awarded because Social Security denied them on two previous attempts to acquire benefits. The Office of Disability Adjudication and Review (ODAR) in Minneapolis, the Social Security office that schedules and administers hearings, has up to 10,000 cases on any given day that are waiting to be scheduled for a hearing. The number of cases waiting to be scheduled for a hearing in other jurisdictions varies. Because there are this many cases waiting to be scheduled in Minneapolis it takes 12 to 15 months before a hearing will be held because there not enough judges to hear all the requests for hearings in a timely manner. Other jurisdictions face wait times between 8 and 20 months for hearings. If you are someone who is waiting 12 to 15 months for a hearing that means you have already been denied SSDI or SSI on two previous occasions, which results in you having spent up to 10 months on this process before you even have chance to request a hearing. With this knowledge it’s easy to see why Social Security disability cases can drag on. It is true that not everyone who applies for SSDI or SSI have to go to a hearing before they are approved. About 25 percent of applicants are approved on initial application and another 10 percent or so are approved after their first appeal. Even if you are approved at one of these two levels the process can still take several months. You may know someone who didn’t have to wait a long time before they were approved, but these people are the exception to the rule. If you have to go to a hearing before an Administrative Law Judge for your SSDI or SSI case, you have a lot of company. This link explains the appeals and hearing process.

As a case manager, I am always glad to hear when one of our client’s gets selected for the Virtual Screening Unit (VSU). This can potentially speed up the processing time of your claim and get the benefits you deserve in your hands faster. The VSU is a program developed by the Social Security Administration (SSA) to reduce the backlog of claims waiting for a hearing. Claims selected by the VSU are claims currently waiting for a hearing at one of the SSA Offices of Disability Adjudication and Review (ODAR). If your claim is selected by the VSU, an attorney adjudicator will review your file in an effort to determine if a fully favorable decision can be issued without having a hearing. A fully favorable decision means that SSA agrees that you are disabled and agrees to the exact date that you alleged onset of your disability. At Greeman Toomey, if one of our client’s receives a VSU notice, we update their file immediately. You will receive a phone call from one of the members of our medical records staff to confirm we have requested records from all the appropriate medical sources. Once received we will submit all of these records to the attorney adjudicator the at the VSU. We would also want to make contact with your supportive doctors. If you are treating with a doctor for your physical or mental health conditions and believe that doctor would be supportive of your claim, we have a special form we will ask them to complete regarding your conditions, restrictions and limitations. Also if you have any supportive documents in your possession that have not already been submitted to SSA please provide our office with copies. After reviewing the information submitted, the attorney adjudicator may try to make a decision within the next 7-14 days. Sometimes the adjudicator may need some clarification regarding your medical information. An example would be when a specific condition was diagnosed or a treatment plan was prescribed. The adjudicator may also request additional information regarding your past relevant work, such as a job description or confirming whether previous employment was full time or part-time. If a fully favorable decision cannot be issued, your claim will be sent back to the appropriate ODAR office. Claims returned to the ODAR office go back in line in their original order, not causing any delay in the scheduling of your upcoming hearing. Should you have any questions please feel free to contact your case manager at (612) 332-3252 or toll free at (877) 332-3252.

A prior blog post entitled “Medically Equaling Analysis at Step Three of the Sequential Process” discussed the importance of having an updated opinion from a Medical Expert. If additional medical evidence obtained after the State agency physician reviewed the claim suggests that a medical equivalence may be reasonable, an Administrative Law Judge (ALJ) must obtain an updated medical opinion from a Medical Expert. This requirement may be satisfied by either having a Medical Expert present during a hearing to testify, or by obtaining his or her opinion through interrogatories (i.e., a set of written questions). HALLEX I-2-5-44 outlines what an ALJ must do when the ALJ receives a Medical Expert’s response to his or her interrogatories. When the ALJ receives a Medical Expert’s response to his or her interrogatories, the ALJ must: Provide a copy of the response to the claimant and the representative and notify them of the right to comment, submit further relevant evidence, propose additional interrogatories to the ME, and request a supplemental hearing with opportunity to question the ME at the supplemental hearing. If the claimant requests a supplemental hearing, the ALJ must grant the request, unless the ALJ receives additional documentary evidence that supports a fully favorable decision. Questioning a Medical Expert is an essential part of a Social Security disability attorney’s job. Therefore, understanding the procedures and rules surrounding Medical Expert interrogatories is imperative.

Due to the high volumes of Social Security Disability claims waiting for a hearing by an Administrative Law Judge, the average wait time is between 12-15 months. This can be financially straining for many people pursuing disability claims. Clients frequently ask me if there is any way to speed up this process. The Social Security Administration (SSA) Office of Disability Adjudication and Review (ODAR) will expedite a claim if the claimant is in “dire need.” SSA classifies this as the inability to obtain food, medicine or shelter. In order to request an expedited hearing, please provide a written letter explaining your current financial situation. It is also important to show documentation, such as an eviction or foreclosure notice, to verify your financial need. Utility disconnect or shut-off notice are other examples of helpful documentation. It is very important to show proof of your hardship or SSA may not grant this request. If your request is granted it does not mean that your hearing will take place immediately but rather when the ODAR office is able to fit your claim into their schedule. ODAR offices are typically scheduling hearings two to three months in advance. Successful requests for expedited hearings may speed up the process by several months, potentially alleviating the financial difficulties experienced while awaiting your hearing. For more detailed information regarding this process, click here. (Section B, number 4).

If you work, Social Security may deduct your Impairment Related Work Expenses (IRWE) from the amount of earnings they use to figure your SSI benefit.  This means that Social Security will not reduce your SSI benefit as much because they will not count all of your earnings. IRWE may include out-of-pocket expenses for: (1) medical items  – such as medicine, medical supplies, medical devices, service animals, bandages, and syringes; (2) medical services  – such as counseling, doctors visits, and some attendant care services; and (3) transportation and modifications to your home, car, or van to allow you to work.  Normally, public transportation is not an IRWE. The expense must not be reimbursed by any other source (such as Medicare, Medicaid, or a private insurance carrier) and must be related to your disabling impairment(s) and needed in order for you to work.  Generally, it does not matter if you also need the item or service for daily living.  For example, the cost of a wheelchair usually can be deducted from the earnings Social Security might count even though the wheelchair is used for both daily living and work. Generally, you must be working in the month you pay for an IRWE. However in certain situations, Social Security can deduct IRWE amounts for expenses you pay before you start or after you stop work. Here’s a link to a table listing examples of deductible and non-deductible IRWE:    http://www.ssa.gov/redbook/eng/ssdi-and-ssi-employments-supports.htm#3

Many people receiving Social Security Disability Insurance Benefits became disabled due to a work-place injury or had private disability insurance. It is not unusual for a claimant to be eligible for many types of disability-based benefits, but these various benefits affect one another and can limit how much a claimant can receive. The SSA utilizes relatively straight forward rules when determining whether other benefits affect a claimant’s monthly DIB payment. If a person is receiving DIB payments and other disability payments, the SSA may reduce the DIB benefit if the total DIB payments and other disability payments are greater than eighty percent (80%) of the person’s average earnings. For example, eighty percent of Bob’s average earnings of $5,000 a month would be $4,000 a month. If Bob was receiving $2,000 a month in DIB payments and $2,500 a month in worker’s compensation payments, then Bob’s total monthly benefits income would be $4,500 – which is $500 over eighty percent of his average earnings. The SSA would reduce Bob’s DIB payment to $1,500 a month so that his total monthly benefits equal $4,000. Not all benefits are included when calculating a person’s total monthly benefits income. Veterans Administration benefits, Supplemental Security Income, and some state or local government benefits are generally not included.  Also, worker’s compensation settlements can affect DIB back payments if the settlement and the back payments cover the same period.

We discussed Global Assessment of Functioning (GAF) scores and how they may be helpful in your Social Security disability claim. But why are GAF scores in particular helpful? GAF scores serve two purposes. First, they summarize your mental health status. Mental health conditions can vary wildly from person to person; two people with identical diagnoses may have significant differences in severity. A GAF score succinctly describes the severity of your mental health conditions at the time of evaluation in a manner that can be easily understood. Second, GAF scores provide a snapshot of your condition in time. Your psychiatrist, psychologist or other mental health provider will often give you a GAF score each time you have an appointment. If this is done over several visits or more, your mental health can be examined to see if it is increasing or decreasing in severity due to things like medication changes, outside circumstances, or other forces. This can be helpful to your claim by showing Social Security that your mental health problems are severe, and have persisted despite attempts at treatment. As it is with many other aspects of the Social Security process, explaining the significance of GAF scores to Social Security can be complex and difficult. Having the assistance of an experienced advocate like the attorneys at Greeman Toomey can help develop the record and, consequently, your claim. Contact us at 1-877-332-3252 or at www.greemantoomey.com today.

On this blog we’ve covered the 5 step sequential evaluation process , which is the method Social Security uses to determine if a claimant is disabled. We’ve also discussed how a person can be successfully found disabled by equaling a Listing. However, the most direct way to be found disabled is to meet a Listing of Impairments. The Listings (there is both an adult Listing and a child Listing) are just what they sound like: a list of medical conditions that, in Social Security’s judgment, are so severe that merely meeting the criteria is enough to find a claimant disabled. To “meet” a Listing means that Social Security does not even get into what a claimant’s physical and/or mental limitations are; a person with a condition contained in the Listing who is not currently working is presumed to be unable to work on a full-time basis. There are a variety of sections in the Listing of Impairments, covering a wide range of both physical and mental health conditions. Some listings are very straightforward, requiring only a test or examination (see, e.g., section 3.02 (requiring an FEV1 level below a certain threshold depending on the claimant’s height)) or a certain number of events (see, e.g., section 11.02A (requiring seizures with loss of consciousness more frequently than once per month despite at least three months of prescribed treatment)). Other sections of the Listing are more opinion-based, such as an opinion by a medical professional about the severity of the condition’s impact (see, e.g., section 12.04B (requiring marked difficulties or restrictions in activities of daily living, social functioning, or concentration, persistence or pace)). Whether your condition is opinion-based or based on your medical evidence alone, having a Social Security disability attorney like those at Greeman Toomey PLLC can assist you in analyzing your situation and presenting your strongest case to Social Security.