Applications for Social Security disability benefits have surged to all-time highs in recent years, driven in part by an increase in claims involving chronic pain and emotional difficulties.
Approvals also have soared, but don’t expect it to be easy to get money out of the program if you become disabled. Approximately two-thirds of initial claims are rejected, forcing most applicants to endure a lengthy and complex multilevel appeals process.
What you need to know if you or your loved one makes a Social Security disability claim…
To find out whether your major health problem qualifies for Social Security disability benefits, click the “Disability” tab at SSA.gov…select “Disability Publications” from the “Learn About Disability Benefits” menu…then scan down to find the “Blue Book” listing. It contains the SSA’s Listing of Impairments, which provides details about qualifying conditions. You might have to consult with your doctor to determine if your disability meets the criteria.
You generally will be eligible only if you have a health problem that is expected to prevent you from working in your current line of work (or any other line of work that you have been in over the past 15 years) for at least one year…and/or you have a terminal condition. There’s no such thing as a partial disability benefit—if you’re fit enough to work part-time, your application will be denied. Do not apply while you still are working with the intention of quitting if your application is approved—if you’re working, your application will be denied.
Your skill set and age are factors as well. Your application will be denied if your work history suggests that you have the skills to perform a less physically demanding job that your disability does not prevent you from doing. (Applicants over age 50 are less likely than those under age 50 to be required to seek employment in a new profession that still is within their abilities.)
ESTABLISHING YOUR DISABILITY
If your disability is something like chronic pain that is difficult to prove, the judge who rules on your application will be evaluating not just your medical records but also your credibility. To be seen as credible…
Provide consistent answers. You will be asked the same questions time and again throughout this process. How far can you walk without pain? How much can you lift? How often does the pain occur? The more consistent your answers, the more you will be believed.
Provide answers consistent with information in government databases. Don’t claim that you haven’t been able to drive for months if you just registered a new vehicle. Don’t claim that you haven’t been able to walk more than a few steps without pain for months if you recently renewed a hunting license.
Admit to some abilities. Applicants who claim that they can’t make a move without agonizing pain tend to be viewed with greater skepticism than those who concede that they still can do some things and/or that the pain is worse some days than others.
Encourage your doctors to include your description of your pain and limitations in your medical file before you apply for benefits. Doctors don’t always write such things in their notes—but they usually will if the patient explains that it could help him/her make a disability claim.
Watch for back and leg pain traps during consulting exams. If the judge asks you to see a doctor other than your own to confirm your back or leg pain, expect this doctor to watch you with a very critical eye—including before and after the exam.
Example: The doctor (or a nurse) might observe you climbing up onto the examining table before the exam or getting into your car after the exam and note if your movements don’t seem as restricted as you claim.
HIRE A REPRESENTATIVE
You can hire a representative to help you with your Social Security disability claim. This might be an attorney specializing in Social Security disability or a nonattorney Social Security disability advocate. Either is fine—experience with the Social Security disability system is what matters most, not a law degree.
Your local SSA office might be able to provide a list of representatives in your area or point you to a local organization that can. Otherwise, search on the Web for the name of your state or city, plus the terms “Social Security,” “disability” and “representative.”
It’s probably worth hiring a representative at the start of the application process if your disability is something difficult to prove such as chronic pain or emotional issues. If your disability is obvious to anyone who has access to your medical records, it might be worth initially working without a representative to avoid paying a fee. You still can hire a representative later if your initial application and first appeal are denied.
Choose someone who at a minimum has handled several dozen cases over multiple years. Also, a qualified, experienced representative should have one or more paralegals or assistants.
By law, representatives can charge only $6,000 or 25% of the retroactive benefits you receive (that is, 25% of the initial benefits check covering the months from the onset of your disability until your benefits are approved), whichever is less. You should not be asked to pay this fee in advance, nor should you have to pay if your application is denied.
Ask the representative about expenses, too. They shouldn’t amount to more than a few hundred dollars. The only significant cost should be the acquisition of your medical records—don’t work with a representative who passes along the cost of basic office expenses or paralegal help.
HOW TO APPLY (AND APPEAL)
There are two separate Social Security disability programs…
Social Security Disability Income (SSDI) benefits are calculated much like Social Security retirement benefits—the size of your monthly check is based on your earnings history. The average monthly benefit is between $1,100 and $1,200. Spouses, ex-spouses, widows and/or minor children can qualify as well. The benefits are automatically converted to retirement benefits when you reach “full” retirement age.
Supplemental Security Income (SSI) benefits are more like welfare. This program is for disabled people who have limited work histories and very limited assets—less than $2,000 ($3,000 for married couples) excluding a home, car and a few other assets. Someone can qualify for both SSDI and SSI benefits at the same time, but the SSDI income will count as income in SSI calculations, so this is likely only if the SSDI benefits are quite low. The current SSI benefit is $710 per month.
How to apply for disability benefits: In person often is the best option, particularly if your disability will be apparent to the Social Security employee with whom you meet.
Phone usually is not the best option to apply for benefits, although calling the Social Security Administration (SSA) at 800-772-1213 can make sense if you have a serious health problem but still are trying to work. Explain your situation, and say that you would like to learn more about Social Security disability in case you decide to apply later. The employee you speak with should complete a form about your call. If you later apply for benefits, having this in your file will help you establish that you’ve been struggling with the health problem for some time.
Online applications are best avoided. The judge who rules on your application might conclude that your ability to fill out a form online means that you’re healthy enough to do “sedentary work,” which requires mainly sitting in a chair and using a computer—especially if you also have an active Facebook account or some other significant Internet presence. If you’re younger than age 50, the ability to do sedentary work likely will render you ineligible for benefits. If you’re age 50 or older, the ability to do sedentary work likely will render you ineligible for benefits if you have done sedentary work before or have the education and training to do it.
How to appeal if your initial application is denied: Pay special attention to appeal deadlines mentioned on the denial notice—miss one, and you might have to begin the whole process again. The denial notice should provide directions about how to appeal…or click “Disability” on the SSA.gov Web site, then select “Appeal Our Recent Medical Decision” for instructions.