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Social Security Disability benefits are designed to protect workers when the unexpected happens. Individuals who cannot work for at least a year because of a qualifying accident, injury, or illness may be eligible for compensation.
It’s reasonable to expect the government to uphold its promise to provide assistance when a medical condition impacts your ability to earn a living. After all, you have done your part by working for years and paying into the system.
But as many of our clients have discovered, the Social Security Disability process is complicated, and claims are often denied. An estimated 60% of all initial applicants are denied, usually because of minor administrative details.
A serious injury or illness is stressful enough without the added financial burden caused by lost income.
There are eight main reasons a social security disability claim may be denied. Knowing them can help applicants take necessary steps to ensure that their claim is not denied.
- The applicant makes too much money.While people can work and earn an income while on social security disability benefits, they can only earn a certain amount. When they make more than that amount, they will likely be denied benefits.
- The disability is not severe enough.Except for blindness, the disability must be severe enough to last for 12 months or result in a death.
- The Social Security Administration (SSA) cannot communicate with the applicant.This agency needs to communicate with applicants about paperwork, examinations, or other aspects of the application. If they cannot reach the applicant, and no representative has been named, social security disability benefits may be denied.
- The applicant refuses to cooperate with SSA demands.The SSA may request that applicants to see their own doctors, perhaps several times. They may also ask for additional information about the impairment, and expect the applicant to provide that information. If the applicant does not visit the SSA-chosen doctor to be examined, benefits may be denied.
- The applicant fails to follow treatment plans.While the SSA will make some exceptions for refusing to follow treatment plans, most must be followed by the applicant. If they are not, benefits can be denied.
- Drugs and/or alcohol are part of the disability.If the SSA would not find an applicant disabled if he or she stopped using drugs or alcohol, benefits may be denied.
- The applicant was convicted of a crime.If the applicant was committing a crime while injured, or is currently in prison, he or she cannot receive benefits.
- The applicant includes fraudulent information on the claim.When applicants are not honest on their applications and the SSA finds out, benefits can be denied.
In North Carolina, the appeals process begins with a Request for Reconsideration. The method to submit this request will be in the letter outlining the denial of benefits and the reasons for it.
Reconsideration can be a lengthy process, but in short, it is a complete review of the claim by medical consultants and examiners that were not part of the original decision.
When a request for reconsideration is denied, applicants can still appeall. The next step is to request a hearing with an administrative law judge (ALJ) within 60 days of the denial of reconsideration. Generally speaking, ALJs grant benefits to approximately half of the applicants who make it this far in the appeals process. When they do not, applicants can request that the Appeals Council review their case. The Appeals Council randomly selects cases for review and has the authority to grant, deny, or dismiss a request for review.
The Appeals Council is not likely to grant benefits to those that have been denied, particularly if they cannot find error with the ALJ’s decision. The chances of winning at this stage are only 2% to 3%.
When all other methods have been exhausted and benefits have still been denied, applicants can file a lawsuit in a U.S. district court. While there will not be a jury present in the courtroom, applicants are strongly advised to hire a lawyer if they have not already done so.
A Social Security Attorney in Wilmington can ensure all paperwork is filed properly, explain the process to the applicant, and give them the best chance of success.
The Social Security Administration (SSA) has two programs that provide benefits for individuals who meet their definition of “disabled.”
Supplemental security income (SSI) provides benefits for individuals who meet the medical criteria for disability and have limited to no assets or income. Generally, this means the claimant’s assets are valued at less than $2,000 for single applicants, and $3,000 for married couples.
How SSI Benefits Are Calculated
SSI benefits are calculated by subtracting the claimant’s countable income from the current SSI federal benefit rate. That number determines their monthly benefits. Benefits are typically paid out 60 days from the time a claim is approved. They only date back to the month after the claim is filed, regardless of when the disability occurred.
Government benefits paid to someone with a disability are not welfare. Social Security Disability Insurance (SSDI) is a program set up by the U.S. Congress to allow Americans to pay into an annuity that pays out if they become disabled and can no longer work. Unlike SSI, which is need-based aid, SSDI is based on work history.
Workers with a recognized, diagnosed disability will only qualify for monthly SSDI payments if they contributed to the SSDI program through payroll deduction or direct payment (if self-employed).
Although most American workers qualify for SSDI after suffering a permanent disability, the federal government has made the approval process difficult. In fact, more than half of all initial applicants are denied, usually because of minor administrative details.
How SSDI Benefits Are Calculated
Monthly SSDI is calculated based on the claimant’s average monthly earnings over the course of their working life. These payments may be reduced if the claimant is already receiving Workers’ Compensation or other disability benefits. SSDI payments also fluctuate annually according to cost-of-living changes.
There are medical and non-medical requirements for Social Security Disability.
First, you must have worked recently enough—and long enough—under Social Security to be eligible for benefits. Social Security work credits are based on your age, income, years of employment, and how many credits you accrued prior to when your disability began.
Now, let’s focus on the criteria for evaluating disability. Social Security defines disability slightly differently than other programs. To start, you must have a “qualifying disability” to receive benefits.
A qualifying disability means:
- Your medical condition prevents you from working and engaging in substantial gainful activity (SGA) which is work that provides a certain level of income.
- Your medical condition means you cannot do previous work, or adjust to other work—even with accommodations.
- Your medical condition has lasted or is expected to last for at least a year, or may result in death.
To make this evaluation, the SSA asks claimants 5 key questions:
- Do you work?
The claimant’s work must be SGA, earning the required average amount of income on a monthly basis. If you are employed but not performing SGA, your application will be forwarded to the Disability Determination Services (DDS) for a decision.
- Is your medical condition “severe?”
A qualifying medical condition must limit your ability to perform basic work tasks like standing, lifting, walking, or remembering, for at least 12 months.
- Is your medical condition included in the list of medical conditions?
The SSA maintains a list of impairments for each body system which are considered severe. Many of these impairments are permanent, and some result in death.
- Can you do the work you did previously with your medical condition?
If your impairment prevents you from doing any of your past work tasks, your claim moves on to question # 5.
- Can you perform any other type of work?
Before awarding Social Security Disability, the SSA inquires to find out if you can do other work despite your impairment. They consider your age, education, health history, and previous employment to make this assessment.
Even with these guidelines, there are exceptions, and the system is nuanced to some degree. Some claims can be expedited, particularly in cases with severe health conditions, or those with a statistically high probability of approval.
How Do We Prove Disability?
There are many medical conditions that can qualify an individual for Social Security Disability benefits as outlined in Social Security’s Blue Book. In addition to meeting the medical requirements outlined in this book, an applicant must also provide medical evidence from acceptable sources that prove that they are impaired.
As Social Security Disability attorneys, we use a wide range of documentation to support your claim. Typically, medical reports, diagnoses, labs and imaging tests no older than six months are preferred. The SSA only considers evidence from reputable healthcare providers, so be discerning when it comes to seeking medical care for your condition.
We also need to show SSA what your profession involves and why your condition prohibits you from completing your job duties. We work with you to provide a detailed list of your job responsibilities and provide supporting medical evidence to confirm your functional limitations.
Why Should I Hire a Social Security Disability Attorney?
As your designated advocate, your Rhine Law Firm attorney helps you navigate the claim process and advises you of your rights and responsibilities every step of the way.
Many—if not most—Social Security Disability claims are denied. The best way to avoid a denial is to ensure your claim is accurate and complete, based on the application checklist. Minor errors are enough to jeopardize your benefits.
As experienced disability attorneys representing clients in Wilmington and across North Carolina, we have a deep understanding of Social Security requirements and common challenges that arise.
If your claim is denied, we act quickly to file a compelling appeal before the deadline expires. If your claim is denied a second time, we can request an appeal hearing before an administrative law judge. Here, we provide evidence to show how your condition is permanently disabling.
From there, you can also pursue an additional appeal and even take your case to federal court. We believe America’s workers deserve disability compensation, and we’ll use every legal tool available to obtain it.
Every client’s situation is unique. A free, no-obligation case consultation is the best way to discuss your own legal matter. To learn more about applying for disability benefits and to get a Social Security Attorney from Wilmington on your side, call our firm today.
We are proud to serve the people of North Carolina.
Although our primary office location is in Wilmington, North Carolina we represent clients nationally and across the state of North Carolina. Some of the many areas we serve are listed below.
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