WHY SOCIAL SECURITY DISABILITY IS SO CONFUSING

"Social Security is one of the most convoluted systems I have ever encountered in my life!"

This was a remark by one of my clients who had just won a hard-fought battle to get Social Security disability benefits.  I think his reaction isn't unusual.  Most people come away with this feeling.

Why is Social Security so bewildering?

For one reason, it's based on federal laws and regulations which are largely written by lawyers for lawyers.  

For another, it uses its own unique language and mysterious abbreviations.  Alleged Onset Date (AOD), Established Onset Date (EOD), Date Last Insured (DLI), Primary Insurance Amount (PIA), Substantial Gainful Activity (SGA), Grid Rules, Listings, etc.

Also, it uses mathematical and actuarial science to come with who is covered, who is disabled, how much they can receive, and when they can begin receiving it.

My best advice to someone trying to get disability benefits from the government is:  TAKE SOMEONE WITH YOU WHO UNDERSTANDS THE SYSTEM AND SPEAKS THE LANGUAGE.

 

A judge once told an unrepresented claimant:  "Go find somebody who speaks my language, then come back."

I've represented claimants for years and I've seen hundreds of hearings where winning or losing depends on asking the right questions, providing the right information or handling a small technical detail.

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The Forsythe Firm

7207 Old Madison Pike, Suite 108

Huntsville, AL 35806

CALL US:  (256) 799-0297

Email Us:   forsythefirm@gmail.com

"Yes, we'll answer your question for free."

SSDI BENEFITS: IT'S NOT "SMALL POTATOES"

If you qualify for the maximum Social Security Disability (SSDI) benefit, you could receive a check for over $3,000 per month.  This may continue for as long as you are disabled.  It's not "small potatoes" any more.

SSDI BENEFITS - NOT SMALL POTATOES

Like every other government program, SSDI has rigorous requirements that must be met. Here are the general requirements:

1.  You cannot be working currently at substantial gainful activity (SGA), which is defined in 2020 as earning at least $1,260 in work related wages, commisisons, salary or self-employment.

2.  You must at least one severe impairment that has lasted for at least consecutive12 months, is medically expected to last for at least 12 straight months, OR is expected to result in death.

3.  You must be unable to perform any of your past relevant jobs (any of the full-time jobs you have held in the past 15 years).

4.  If you are under age 50, you must show that you are unable to perform any other full-time job which exists in the national economy.

I might add that "proof" must be in the form of objective medical evidence from a licensed physician or psychiatrist who has treated you and knows your medical or psychiatric condition.

You also must meet Social Security's "insured status."  Normally, this means that you have worked enough, and worked recently enough, to be covered by Social Security disability.  The general rule is that you must have worked at least 5 years out of the most recent 10 year period.  You earn coverage under SSDI by working and paying into Social Security through payroll taxes.  If you haven't worked in a long time, you may not be covered.

Finally, the road to approval is frustrating, disappointing and difficult.  Most claimants hire an attorney or advocate to help them prove their disability and get their checks started.  It is usually necessary to attend a hearing before an administrative law judge before your claim is approved.  It is also normal for claims to be denied at least twice before they are finally approved.  So, SSDI is not a quick or easy road to riches.  However, it can be a path to financial survival and even security for a person who has worked and paid into the system for years and now needs to receive benefits from it.

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THE FORSYTHE FIRM

7027 Old Madison Pike, Suite 108

Huntsville, AL 35806

CALL US:   (256) 799-0297

Email Us with Questions:  forsythefirm@gmail.com

https://forsythefirm.wixsite.com/website

  

CAN YOU GET SOCIAL SECURITY DISABILITY AND RETIREMENT BENEFITS AT THE SAME TIME?

Getting Social Security disability and retirement benefits at the same time?

A beneficiary may get either retirement OR disability benefits, but not both.

It is possible to apply for both retirement and disability benefits at the same time, however.  

I can best explain with with an example. Let's take the case of an imaginary person, whom I will call Leon.

Leon is 62 years old.  He is old enough to receive a reduced retirement benefit, so he applies and receives his benefit of $1,380 per month.  He feels that he is also disabled.  So, while he is receiving his retirement benefit, he files a disability application, which is approved 12 months later.

When Leon's disability application is approved, his payments are increased to his full retirement amount of $1,830 per month, even though he is only 63 years old.  His reduced retirement benefit is increased because he will now get a disability benefit--which is not reduced because Leon isn't yet of full retirement age.

Basically, when a person is approved for disability benefits, Social Security pays him or her their full retirement benefit early.  At the full retirement age of 66 or 67, the benefit does not increase; however, it will then be called a retirement benefit because of the beneficiary's age, and the check will come from the Retirement Trust Fund, not the Disability Trust Fund.  The amount doesn't change, except for annual cost of living adjustments (COLA).

An early retirement benefit at age 62 is easy.  You get it just by applying for it.  Disability benefits are usually much harder; you have to fight for those.

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The Forsythe Firm

7027 Old Madison Pike, Suite 108

Huntsville, AL 35806

"Across from Bridge Street"

Call us:  (256) 799-0297

Email Us:  forsythefirm@gmail.com

SOCIAL SECURITY JUSTICE (WEBSITE)

WHAT SOCIAL SECURITY ALWAYS KNOWS ABOUT YOU

When you attend a Social Security hearing, there is a lot of information they already know about you.  For example:

Your Past Wages:  Just before the hearing, the judge will order a wage query that explains all of your past earnings--from the time of your first job--right up until the day you quit work.  If you worked a part-time job after you applied for disability, this will also show up.

The Kind of Work You Did in the Past:  The judge will be able to see each of your past jobs, the employer's names, addresses, and a detail of your wages.  

Unemployment Benefits:  A check will be made with the state to see whether you received unemployment benefits, and if so--when, how long and how much.  

Other Income:  If you received pay for sick leave or vacation time or cashed out a 401K, it will show up on your earnings history and must be explained.

Each of Your Medical Records:  Medical records show more than you may think.  In addition to your medical complaints, treatment and symptoms, your doctors' records may show such things as:

• Whether you smoke and how much
• Where you work
• Whether you drink and how much
• Trips or vacations you have taken
• Whether you gamble or not
• Your height and weight
• Any illicit or illegal drug or alcohol abuse
• Over use or abuse of prescription medications
• Failure to comply with treatment
• Personal or family problems you mentioned to your doctor
• Whether you have a valid driver's license
• Sick leave days or personal leave you have taken
• Who you live with
• Anything else your doctor knows about you

With this wealth of information, Social Security judges know a great deal about you before your hearing begins.  Therefore, it is foolhardy to misrepresent anything. 

 

Keep in mind:  Your doctor may put anything you tell him/her in your medical chart.  It becomes part of your medical record.  For example, you say to your doctor:  "My back hurts because I helped a friend put a new roof on his barn last week."  You wouldn't think that becomes part of the medical record, but it may.  

___________________

The Forsythe Firm

7207 Old Madison Pike NW, Suite 108, Huntsville, AL 35806

"Across from Bridge Street

CALL US  (256) 799-0297

Email Us:  forsythefirm@gmail.com

SOCIAL SECURITY JUSTICE (WEBSITE)

EXPLAIN "QUARTERS OF COVERAGE" TO ME PLEASE

A Quarter of Coverage is the basic unit for determining whether a worker is insured for disability under the Social Security Act. Not every American is covered by Social Security disability, only workers who have paid enough into the system, usually through payroll deductions.

In 2022, worker may earn 1 quarter of coverage for any calendar quarter in which qualifying wages of at least $1,510 were paid.  This number will increase slightly for 2023.

So, if an individual earned at least $1,510 in any calendar quarter in 2022, he or she is given credit for 1 Quarter of Coverage (QC).  If the worker earned at least $1,510 in all 4 calendar quarters of 2022, he/she would earn 4 Quarters of Coverage for the year.

Most workers require 20 quarters of coverage to be insured for Social Security disability purposes.  These quarters also must fall into a certain time period.  Generally, you need 20 quarters of coverage out of the last 10 years.  (Older quarters of coverage "fall off" after a period of time).

The usual rule for Quarters of Coverage is: You must have worked at least 5 years out of the most recent 10-year period.  There are exceptions for very young workers, who have different rules.

What does it mean if you don't have enough Quarters of Coverage and are not insured for SSDI?  It means that you cannot file a new claim for disability because you are not an insured person.  It would be like trying to file a claim for a car accident with an insurance company that never issued you a policy.  Or filing a claim with an insurance company whose policy expired prior to the date of the accident. Note:  If you can prove that your disability began before your Date Last Insured, you may still recover a benefit.

How can you know for sure whether you are insured by Social Security for a disability?  Simply call your local Social Security office and ask two questions:

Question 1:  When is my Date Last Insured (DLI) for Title 2?

Question 2:  What is my PIA?

The Date Last Insured (DLI) is the expiration date for your Social Security disability insurance coverage or SSDI.  For example, if your DLI is 12/31/20, you must prove that you were disabled prior to 12/31/20 to be covered.

The PIA stands for Primary Insurance Amount.  This is the approximate amount of your monthly disability benefit if you should become disabled today.

Please note:  The DLI refers to the last date you may file a NEW disability claim.  It has nothing to do with benefits you are already receiving.  Those benefits will continue until you become able to return to work or reach full retirement age.  Upon reaching full retirement age, the benefit will convert from disability payments to retirement payments.  The amount will not change and you won't notice any difference.

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THE FORSYTHE FIRM
Social Security Counselors
7027 Old Madison Pike, Suite 108
Directly Across from Bridge Street
Huntsville, AL 35806

Call Us:  (256) 799-0297 or (256) 503-8151

Email Us:  forsythefirm@gmail.com

SOCIAL SECURITY JUSTICE (WEBSITE)

SOCIAL SECURITY DISABILITY MYTHS

There are many urban legends or myths about Social Security disability.

Many of these myths are told with such convicting fervor that you would swear that they are true.

Often, they come in the form of personal testimonials about a friend, a neighbor, a co-worker or even a relative.  

Here are a few of the myths about Social Security disability, most of which cannot possibly be true:

Number One (My Favorite):  "He never worked a day in his life and he gets a big Social Security disability check."

THE TRUTH:  You aren't even covered for Social Security disability unless you have worked at least 5 years out of the most recent 10 years and accumulated the minimum Quarters of Coverage.  A person who never worked cannot possibly get SSDI benefits, no matter how sick he/she may be.  Note:  Supplemental Security Income (SSI) is a different matter because it is based on financial need, like welfare, not work.  But it is not Social Security Disability.

Number Two:  "My neighbor (or my uncle, cousin or someone) isn't disabled at all....but he gets a big disability check from Social Security."  

THE TRUTH:  It's very difficult to tell whether someone is disabled just by looking at them.  I'm afraid we may misjudge this in many cases.  It's hard enough to get SSDI benefits even if you are disabled.  Now, I admit the system isn't perfect, and mistakes do get made, but it's very rare for a totally able bodied (and able minded) person to get SSDI benefits.

Number Three:  "Everyone in the United States is Covered by Social Security disability."

THE TRUTH:  Only workers are covered.  SSDI stands for "Social Security Disability Insurance."  Like all other insurance, it must be purchased and paid for.  Workers pay for it by having FICA tax withheld from their payroll checks.  A worker must pay into SSDI for the minimum number of quarters before he/she is covered for disability insurance.  An uninsured person who has not paid enough into Social Security has no benefit.

The Social Security Tax, called FICA, stands for Federal Insurance Contribution Act.  This tax is required to be withheld from every worker's paycheck.  The withholding is matched by the employer and the tax goes into the Social Security Trust Fund under the worker's name and Social Security Number.  This is what pays for the disability benefit.  When a person stops working, the FICA tax is no longer collected and within a few years the Social Security disability insurance ceases to exist.  So, not everyone is covered for disability by Social Security.

Number Four:  "I am not totally disabled but I can get a partial disability benefit."

THE TRUTH:  Social Security does not pay for partial disability; there is no such thing.  A claimant is either disabled or not disabled.  There is no in-between.  Some agencies, like the Veterans Administration, do offer a partial benefit.  But Social Security does not.

Number 5:  "All I have to do is tell the judge a convincing story and my benefit will be approved."

THE TRUTH:  Judges do not pay benefits based on convincing stories.  They pay benefits based on objective medical evidence that supports the claimant's testimony.  And very specific federal regulations must be met.  There are basically only 3 ways to be approved for disability benefits: 

(1) Meet or equal a published Listing.
(2) Meet a medical-vocational guideline (if you are 50 years of age or older)
(3) Prove that you are not able to perform any type of full-time work based on your age, education, past work experience and residual functional capacity.

Unless the claimant can meet one of these 3 conditions, Social Security disability benefits will not be paid.  The process is long and tedious and any haphazard approach will likely result in denial.  Winning cases are designed by someone who knows Social Security regulations and law and knows how to put the case together.

Need help with the confusing Social Security process?  Call an experienced attorney/advocate such as The Forsythe Firm in Huntsville.  (256) 7990-0297.  There's never a fee unless you win and recover back payments.

 

SOME THINGS GET YOUR DISABILITY DENIED AUTOMATICALLY

There are several things that can get your Social Security disability claim denied on technical grounds without your medical condition or disability ever being considered.

What are some of those things?

1.  You haven't worked enough and recently enough to have insured status with Social Security.  For SSDI eligibility, a person must have worked about 5 years out of the most recent 10 years.  Technically, he/she must have earned at least 20 quarters of work credits out of the past 40 quarters.  If not, there is no coverage for disability, regardless of how sick or severely impaired a claimant might be.

2.  You are working at substantial gainful activity (SGA), which generally means working a full-time job.  You cannot claim SSDI benefits while you are working at SGA levels, regardless of how severe your medical impairment is.  Simply said, a person cannot work and get SSDI benefits at the same time.  In 2022 an individual is considered working at SGA level if earning wages of at least $1,350 per month before tax. In 2023, a claimant must be earning less than $1,470 per month (before tax).

3.  Your impairment doesn't meet the duration requirement. The medical condition must be severe and must meet 1 of the following requirements:

• Has lasted for at least 12 straight months; OR
• Is expected to last at least 12 straight months, OR
• Is expected to result in death.

Even severe medical conditions which don't meet the 12 month duration rule will not be considered because Social Security pays no short-term benefit.

4.  There is no period of 12 consecutive months that you were not working at substantial gainful activity.  This is really part of the duration requirement.  Even though you believe you were disabled, you can't win a claim if you can't find at least a continuous 12-month period during which you were not working at SGA level.

These are the 4 most common reasons for "technical" denials without consideration of any other facts.

It's a great idea to consult with an attorney or advocate who has experience with Social Security claims.  Friends, family members or co-workers all mean well with their advice.  But most of the time, they are not knowledgeable about Social Security's rules and requirements.

In our office, we constantly hear about a friend, a neighbor or a family member who "never worked a day in his life," but supposedly gets a big Social Security disability check.  In most cases, these stories cannot be true, based on the federal regulations of Social Security.  Unfortunately, reliance on these stories can lead the claimant to take the wrong actions and harm their chance of getting a benefit.

If you will call us, we will listen to your situation and give you a free case evaluation, based on what the regulations really say.  Free and at no obligation.  If we represent you, you never pay us a fee unless you win your case AND collect past due benefits (back pay).
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The Forsythe Firm
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806

Call Us:  (256) 799-0297

Email Us:  forsythefirm@gmail.com

CHECK OUT OUR WEBSITE

WHAT YOUR DISABILITY CASE WILL BOIL DOWN TO

Social Security denies benefits for one reason:  "You are not disabled according to our rules."  This is what the denial always says.

In fact, this decision is made based on two facts.  Nearly all cases boil down to these two things:

1.  Are you able to perform any of your past work?  If you are age 50 or over, this is perhaps the most crucial question of all.  

2.  Can you perform any other full-time work, even sedentary unskilled jobs?  If you are under age 50, this may be the most important question of the entire case.  If you are found able to perform any full-time work, your benefits will be denied.

Social Security will sift through a lot of evidence to reach conclusions to these two questions.  As the claimant, you or your attorney must address the following items to win:

• Provide a detailed description of all your past work, going back a full 15 years.  You must describe the kind of work, along with how much sitting, standing, walking, lifting, bending, crouching, crawling, reaching, handling, etc. each job involved.

• Produce medical evidence that shows severe symptoms which will not permit you to perform any of your past relevant jobs.  If possible, your doctor should complete a residual functional capacity (RFC) report for you.

• If you are under age 55, you should produce evidence that there are no other jobs in the US economy that you would be medically able to perform on a full-time basis.  Here again, your doctor may help with an RFC report.

Many claimants make the mistake of arguing the wrong points.  The following are examples of things that Social Security will NOT consider, and these things do not help your case at all:

• No one will hire me.
• I can't find any of those jobs; I've looked.
• I couldn't possibly live on those wages?
• All of those jobs have moved to Mexico.
• When I apply for a job, they say I'm a liability.

Social Security considers your physical and mental ability to work, not whether you can find work.  Remember, it's a disability insurance program, not an unemployment program.

Most claims ultimately come down to the quality of medical evidence that is submitted.  Social Security's rules require clear and convincing evidence of severe, chronic medical problems that make you unable to meet the physical and/or mental demands of full-time work.

Talk to your attorney or representative about your medical evidence.  He or she best knows how strong your case is, based on the evidence available.

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The Forsythe Firm

7027 Old Madison Pike, Suite 108

Huntsville, AL 35806

Call Us:  (256) 799-0297

Email Us:  forsythefirm@gmail.com