Before submitting a disability claim to the Social Security
Administration (SSA), it is very important to understand how a
determination is made on your case. Realizing there are key fundamental
aspects to every disability submission is critical to whether or not a
person will be successful.
While there are many sub-parts to these categories and the issues can become quite complex, this should provide a basic understanding to help you navigate the SSA disability system.
Determine Whether or Not You Are Legally Disabled:
First, it is important to understand how SSA determines legal disability. In order to be disabled because of a mental or physical condition, one must not be able to do the work he or she did before and is unable to adjust to some other type of work. Further, this impairment must be expected to last for at least one year or result in death.
Again, as stated above, this definition can become more complex as you start considering your condition, but what is most important is to ask yourself:
If you can affirmatively answer "no" to the first two questions and "yes" to the third, then you are likely well on your way to at least having a credible claim.
Determine What Type of Benefits I Need:
If you have successfully passed the first hurdle, then understanding your own financial situation and your work history is very important at this stage. Here, you need to determine whether you are eligible for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) or both. Because this part of determining whether you are legally disabled and what benefits you may qualify for is terribly complicated, SSA provides step-by-step instructions on their website and a benefits calculator to make this easier.
Remember this, SSI is based on need.
Once again, there are many requirements in order to qualify, but you must be determined to be disabled and not make more than $721.00 per month for an individual and no more than $1,082.00 for couples. However, please understand there are exceptions here, such as SSA may only count some of your income towards your limit, and you also may be able to set aside some of your income if you are enrolled in the PASS (Plan to Achieve Self Support) program, or if you receive state supplements.
Basically, if you can remember or understand nothing more about SSI, understand that it is intended for those with very low income and those who have little or no liquid assets.
Social Security Disability Insurance (SSDI) is based on the amount of work credits you have earned.
There are different requirements for various age groups, but generally you need 40 credits, 20 of which were earned in the last 10 years before you stopped working. Again, this is very complicated to many people, but you earn credits by working. SSA determines that $1,200 equals one credit and a person is allowed a maximum of up to four credits per year.
Therefore, in determining the amount of income your household brings in each month and the amount of assets you have on hand and the amount of time you have worked, will determine whether you qualify for either SSI or SSDI benefits or both.
Criteria That is Used to Determine Whether You Are Disabled:
Finally, you need to understand how Social Security is going to determine whether your physical or mental condition keeps you from working.
If you don't take anything else from this article, it is important that you understand the importance of documenting your condition. Social Security states explicitly on its own website that medical evidence is the "cornerstone" of a disability determination. Every person who files for disability is responsible for providing medical evidence showing that he or she has an impairment and the severity of that impairment. While SSA does help claimants with collecting their medical records, ultimately it is up to the person filing for disability to see that SSA can make a determination with an adequate amount of medical evidence.
Therefore, as you go to the doctor, make it a point to tell your physician you are attempting to file a claim for disability. Ask your doctor to not just write shorthand about your condition, but to spell it out in his or her notes because those will be reviewed. SSA understands you have a physical or mental condition, but your doctor stating you are disabled is not sufficient. That is a legal determination that is made by SSA and not your doctor. He or she needs to explain that you cannot sit for long periods of time, walk more than 20 yards before sitting to rest, get along with others, follow directions, etc. This is what helps SSA determine whether or not you are disabled.
Social Security will also look at other evidence to determine if you are disabled. This "other evidence" helps to show the extent of the individual's condition and his or her ability to work in a business setting. Such evidence may be allowed to come from spouses, employers, friends, other family, etc.
If Social Security is not content with your medical records or has a difficult time obtaining them, then you may be asked to go through a Consultative Examination. This may be done by your own doctor or through one SSA designates. Here, there will be a report made about your condition and any results the physician feels is relevant for SSA to make a determination.
Lastly, you need to consider what evidence you have in regards to your condition which shows that you are unable to work. Social Security here will look at a number of factors such as:
Here, probably the most important thing is that you continue to see a doctor, even if it is only once every six months. Many people often find it difficult to keep up with their treatment because they are no longer working. They can no longer afford private care because they no longer have insurance. However, if you truly are disabled, it is imperative to stay under the care of a physician, even if it falls under indigent care.
Further, you must always be a good patient and do as your physician prescribes. Social Security will usually not consider your case if you can't even follow instructions from you own doctor in trying to better your condition. Remember, medical evidence is the cornerstone to making a determination as to whether you are disabled. A note from your physician stating that you are not following his recommendations will assuredly make it that much more difficult to be successful in your claim.
While there are many sub-parts to these categories and the issues can become quite complex, this should provide a basic understanding to help you navigate the SSA disability system.
Determine Whether or Not You Are Legally Disabled:
First, it is important to understand how SSA determines legal disability. In order to be disabled because of a mental or physical condition, one must not be able to do the work he or she did before and is unable to adjust to some other type of work. Further, this impairment must be expected to last for at least one year or result in death.
Again, as stated above, this definition can become more complex as you start considering your condition, but what is most important is to ask yourself:
- Can I still do the work I did before?
- Am I physically or mentally able I do another job instead?
- Is my disability likely to last for one year or more or result in my death?
If you can affirmatively answer "no" to the first two questions and "yes" to the third, then you are likely well on your way to at least having a credible claim.
Determine What Type of Benefits I Need:
If you have successfully passed the first hurdle, then understanding your own financial situation and your work history is very important at this stage. Here, you need to determine whether you are eligible for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) or both. Because this part of determining whether you are legally disabled and what benefits you may qualify for is terribly complicated, SSA provides step-by-step instructions on their website and a benefits calculator to make this easier.
Remember this, SSI is based on need.
Once again, there are many requirements in order to qualify, but you must be determined to be disabled and not make more than $721.00 per month for an individual and no more than $1,082.00 for couples. However, please understand there are exceptions here, such as SSA may only count some of your income towards your limit, and you also may be able to set aside some of your income if you are enrolled in the PASS (Plan to Achieve Self Support) program, or if you receive state supplements.
Basically, if you can remember or understand nothing more about SSI, understand that it is intended for those with very low income and those who have little or no liquid assets.
Social Security Disability Insurance (SSDI) is based on the amount of work credits you have earned.
There are different requirements for various age groups, but generally you need 40 credits, 20 of which were earned in the last 10 years before you stopped working. Again, this is very complicated to many people, but you earn credits by working. SSA determines that $1,200 equals one credit and a person is allowed a maximum of up to four credits per year.
Therefore, in determining the amount of income your household brings in each month and the amount of assets you have on hand and the amount of time you have worked, will determine whether you qualify for either SSI or SSDI benefits or both.
Criteria That is Used to Determine Whether You Are Disabled:
Finally, you need to understand how Social Security is going to determine whether your physical or mental condition keeps you from working.
If you don't take anything else from this article, it is important that you understand the importance of documenting your condition. Social Security states explicitly on its own website that medical evidence is the "cornerstone" of a disability determination. Every person who files for disability is responsible for providing medical evidence showing that he or she has an impairment and the severity of that impairment. While SSA does help claimants with collecting their medical records, ultimately it is up to the person filing for disability to see that SSA can make a determination with an adequate amount of medical evidence.
Therefore, as you go to the doctor, make it a point to tell your physician you are attempting to file a claim for disability. Ask your doctor to not just write shorthand about your condition, but to spell it out in his or her notes because those will be reviewed. SSA understands you have a physical or mental condition, but your doctor stating you are disabled is not sufficient. That is a legal determination that is made by SSA and not your doctor. He or she needs to explain that you cannot sit for long periods of time, walk more than 20 yards before sitting to rest, get along with others, follow directions, etc. This is what helps SSA determine whether or not you are disabled.
Social Security will also look at other evidence to determine if you are disabled. This "other evidence" helps to show the extent of the individual's condition and his or her ability to work in a business setting. Such evidence may be allowed to come from spouses, employers, friends, other family, etc.
If Social Security is not content with your medical records or has a difficult time obtaining them, then you may be asked to go through a Consultative Examination. This may be done by your own doctor or through one SSA designates. Here, there will be a report made about your condition and any results the physician feels is relevant for SSA to make a determination.
Lastly, you need to consider what evidence you have in regards to your condition which shows that you are unable to work. Social Security here will look at a number of factors such as:
- Your daily activities;
- The frequency of your symptoms and their intensity;
- Medication and its side-effects; and
- Any measures you have taken to relieve your condition.
Here, probably the most important thing is that you continue to see a doctor, even if it is only once every six months. Many people often find it difficult to keep up with their treatment because they are no longer working. They can no longer afford private care because they no longer have insurance. However, if you truly are disabled, it is imperative to stay under the care of a physician, even if it falls under indigent care.
Further, you must always be a good patient and do as your physician prescribes. Social Security will usually not consider your case if you can't even follow instructions from you own doctor in trying to better your condition. Remember, medical evidence is the cornerstone to making a determination as to whether you are disabled. A note from your physician stating that you are not following his recommendations will assuredly make it that much more difficult to be successful in your claim.
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