Thursday, August 8, 2019

WHAT IS A 'PARTIALLY FAVORABLE' DECISION?

If you are found eligible for any Social Security benefit, you have been judged to be totally disabled.  Social Security does not pay any benefit for a partial disability.  

However, Social Security may issue two types of favorable decisions on a disability claim:

Fully Favorable means you are getting everything you asked for in your application.  This means that Social Security agrees with you concerning the date of onset.  They find that you became disabled on the same date that you say.  They will pay benefits back to that date.

Partially Favorable means that you have been found disabled, but some aspect of the application has been disputed and changed by Social Security.  This nearly always means that the onset date of your disability is found to be later than stated in your application.  Thus, you get a monthly benefit but the amount of your back pay may be less than you wanted.  You also may have to wait longer to get Medicare coverage due to the waiting period.

Let me say that in both cases, you have a total disability, not a partial disability.  Social Security will not pay any benefit unless they find the claimant to be totally disabled.  There is no such thing as a partial disability.  It is the DECISION which can be partially favorable, not the disability.

It is the claimant's responsibility to prove the date on which the disability began.  This is done by submitting medical evidence that shows a severe impairment as of the "alleged onset date," the date that the claimant claims the disability began.  If the claimant fails to prove the onset date, Social Security may change the date, thus not paying the claim as far back as hoped.  This reduces the amount of back pay.  Obviously, if you receive 2 years of back pay it will be more than if you only receive 1 year.

So, proving the date that disability began (the "onset date") determines how far back in time the claim can be paid.

There are usually two factors that may mess up your alleged onset date:

1.  You worked after the alleged onset date.  For example, you claim to have become unable to work on July 1, 2018 but worked until September, 2018.  The fact that you worked invalidates the alleged onset date.  (*In 2019, work related earnings of at least $1,220 per month will disallow any disability payments for the months you worked at that amount).

2.  You did not have adequate medical treatment back to July 1, 2018; therefore, there are no medical records to prove that you were disabled that far back.  Even if you stopped working by July 1, 2018, for example, but did not get any medical treatment--it will be difficult to prove disability back that far.

As an advocate, one of the things I try to do is take the onset date back as far as the law permits. In most cases, I am able to get my clients back pay.  
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