Talk the Walk

I left a few things hanging with my last blog. Not sure where to start, I am going to run with a comment that was left on my last blog about disability. *Note: My experience relates only to Social Security Disability. I am not an attorney and my experience may not be typical.

Social Security Disability Insurance (SSDI) can be a very frustrating process. There was a LOT I did not understand about the entire process, even though I thought I did. I’m not an expert by any means, but I figure it can’t hurt to share my mistakes and lessons.

My myth-understandings:

•     You have to wait until you have been unable to work for 12 months before filing. WRONG

      When I first looked into SSDI, I read that your condition must have lasted or be expected to last for at least 12 months. I, being blonde and girl, interpreted this to mean I could not file until I had been unable to work as a result of my injury for 12 months. What it really means is that your medical records must indicate your disability must be expected to last at least 12 months. If you are told the day you are diagnosed that your condition is expected to prevent you from working for at least 12 months, file online when you get home J

•      You can’t work at all in the process before/during filing or after approval.  WRONG

      The Social Security Administration (SSA) doesn’t care if you work so long as you do not make over what SSA calls earning Substantial Gainful Activity (SGA). For 2014-15, that amount is $1090 per month. So if you are able to work part time, do so without worrying about your SSDI claim/benefits.

•      If your doctor hasn’t released you to return to work, you qualify.  WRONG

       Just because your doctor hasn’t ‘released’ you for work doesn’t mean you meet a listing requirement.  While you may not have a release to return to work, it may simply be because your physician feels you need more time to heal and that eventually, all will be okay.  The Social Security Administration has what is known as a “blue book” that, in some measure of clarity (although not much), lists which diagnoses qualify for SSDI.  The diagnoses listed often need no additional requirements other than it will prevent you from SGA for 12 months or longer.  There must also be documentation to confirm the diagnosis.  Typically, this documentation needs to state the condition is “severe”. 

•      If you qualify for a ‘permanent’ handicapped placard/license plate, you qualify for SSDI.  WRONG

        These are two distinct departments: placards/license plates are determined by your state; SSDI is governed by Social Security Administration (SSA), which is a federal agency.  Each determines your level of disability a bit differently than the other.  While the physician certification required by your state to obtain a placard may be of assistance with an SSDI application, it does not equate an SSDI approval.  Along those same lines, SSA utilizes adjudicators assigned to each state to determine eligibility for SSDI. 

•      In order to get approved for SSDI, you NEED to have a lawyer.  WRONG

       If you are 50 (or over) AND meet a qualifying listing requirement, you may be able to be approved on your initial application.  Anyone can file an initial application online.  More information and a link to application can be found here: https://secure.ssa.gov/iClaim/dib.  Once the initial application is filed, it can take several months to hear anything.  Printing your application and submitting as many medical records as possible along with your application to your local SSA office may reduce the length of time it takes to receive a response.  If your initial application is denied, you have a few choices:
               1) You can file your own appeal
               2) You can hire an attorney to file your appeal
               3) You can re-file at a later date
               4) You can give up
If your application is approved, you can expect to get a letter outlining what conditions qualified you and how far back your condition prevented you from SGA, as well as what your monthly amount will be, when you will get that amount each month and how much back pay you will receive (and when you will get that). 

•      If you hire a lawyer, they will get 1/3 of the amount.  WRONG

       The SSA governs how much your lawyer will receive.  As of this writing, that amount is 25% of the past-due benefits you are due to receive, up to $6,000.  Note: this ONLY applies to back pay.  For example: You’re awarded $2,000 in monthly benefits and $10,000 in back pay benefits.  Your lawyer will receive $2,500, which is 25% of your back pay.  If however, you are awarded $30,000 in back pay, your lawyer will received $6,000, which is the maximum payment, NOT the $7,500 that would be 25%.  Your lawyer is not entitled to current monthly benefits.

•      Once you are approved for SSDI, it will continue for life.  WRONG

       The obvious truth is if your condition improves, you no longer qualify.  However, this may not be as simple as you have had more treatment/therapy/surgery/et. and you are able to improve your function or that your physician has released you to return to work.  Often, in fact most often, SSA will have scheduled re-determinations.  Usually this is done within 5-7 years of your initial approval.   SSA can (and sometimes does) perform a determination and decide you CAN perform SGA, even though you and your healthcare team determine you cannot.  In those instances, you should review your options based on the same format as if you received an initial denial.

•      You are in this alone.  WRONG

   There are many websites and forums that can offer assistance/advice/support through the application/determination process.  Seek them out.  Unfortunately, I found them too late to help much in my process, but my favorite one is http://ssdfacts.com/

I filed my initial claim online.  I did not include any medical records but I did list as many providers as I thought were of importance (note: anyone who has provided care from the Date of Onset {DOI} IS of importance, include them).  I fell under the first assumption and did not file until I had not been able to work for 12 months.  I also relocated to another state just prior to filing my claim, as a result, I was not under current medical care so there was a lapse in my treatment.

A few weeks after I had submitted my claim, I received a form from SSA regarding my work history.  I filled that out and faxed it in.  I recommend faxing because you have a date and time proving you submitted the documents as well as confirmation they were received.

A few weeks later, I received a call from my adjudicator.  He asked me a few questions about my abilities but mostly about my medical care.  Since I was between providers, he suggested the possibility of being evaluated by one of the Disability Determination Service’s (DDS) physicians.  Nice gentleman, but he was determining my qualifications for something that would offer some sense of financial security.  I was not referred to a DDS physician and a few weeks later I received a denial.

Between my initial application, the call from the adjudicator and my denial, I found appropriate medical care.  With that in mind and my denial in hand, I contacted an attorney.  I collected as many records as I could (I discovered SSA did not contact/collect records from one of my providers) and met with the lawyer who filed an appeal (in my state, it is known as a ‘reconsideration’) and I waited again.

It was a few weeks before I received a phone call from another adjudicator.  This one was more focused on my ability to perform daily tasks as well as my ability to ambulate and work.  Since my physician had prescribed a walker and my daughter was doing all the housework, errands and driving, the adjudicator made a decision on my claim quickly.  I received a call from my lawyer notifying me my case was closed but he did not know if it was approved or denied.  Two days later, my back pay was deposited in my checking account.

A few more suggestions:
               Sign up on the Social Security website.  Even if you aren’t filing for disability, you can gain access to your social security earnings record.  If you are filing, you can keep an eye on your claim.  This will also allow you to set up a direct deposit account (which I strongly suggest).

If you have any questions or additional experiences, please comment below. 

Good luck to all who are filing!

***NOTE: This is my own experience and based on knowledge I investigated on my own.  This should NOT be taken as legal advice.  I am not an attorney and have no legal background.  I am not responsible for any errors in legalities within this post.  File claims at your own risk with or without an attorney.

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