CONFUSING DISABILITY TERMS: WHAT DO THEY REALLY MEAN?

Some important terms stand out in Social Security disability regulations.  Here is what they mean.

Alleged Onset Date (AOD).  This is the date the claimant alleges to have first become disabled.  If it becomes the Established Onset Date (EOD), meaning that the Social Security Administration agrees that the claimant did indeed become disabled on that date, benefits may be paid back to that date.  So the AOD/EOD affects how many months of back pay or past due benefits the claimant is entitled to receive.

Waiting Period.  The waiting period for all Title 2 (regular disability) claims is 5 full calendar months.  This is really an elimination period.  5 months of benefits will be subtracted from the Established Onset Date.  For example, if you are found to have become disabled on March 15^th, your waiting period will include the months of April –August and your first benefit payment eligibility will be for the month of September.  This does not necessarily mean you would have to wait 5 months to get a benefit. It depends on when hour established onset date was. 

Duration Requirement.  Social Security regulations require a claimant to be disabled for at least 12 consecutive months in order to receive disability benefits.  And the 12 months must be from the same impairment(s).  For example, if a person is disabled for 5 months because of a heart attack, then becomes disabled again for 7 months because of back surgery, the two impairments cannot be combined to satisfy the 12 month duration requirement.  A claimant does not necessarily have to wait 12 months before filing an application for disability benefits, however.  If he/she expects to be disabled for a period of 12 consecutive months by the same condition or combination of conditions, the application can be filed immediately.  The requirement is that the claimant provides medical documentation that he/she can reasonably be expected to be disabled for at least 12 consecutive months.  Disability expected to last less than 12 consecutive months are not covered by Social Security.  Benefits may be awarded before the 12 month period expires.  The duration requirement is intended to eliminate benefits for impairments that are expected to last less than 12 months.

Date Last Insured (DLI).  This is the date the claimant’s Social Security disability insurance expires.  Yes, disability insurance does expire if you stop working and stop paying FICA taxes.  If your DLI is 12/31/17, for instance, you must file a disability claim before 12/31/17 or prove that you became disabled prior to 12/31/17.  Otherwise, you lose the right to file a new claim after 12/31/17.  If you are receiving disability benefits from Social Security, this date has nothing to do with when your payments will stop, when your case will be reviewed again, etc.  It simply means that there was a point in time beyond which you could not file a new disability claim.  That date is called The Date Last insured (DLI).  If you are receiving disability benefits, you obviously filed a claim prior to the DLI, so the date means nothing to you at this point.

2 WAYS TO APPLY FOR FEDERAL DISABILITY BENEFITS

#1 - Obtain Help From a Disability Advocate or Attorney who knows the system and the process.  The majority of claimants whose claims are approved are assisted by a Social Security disability advocate or attorney with experience in filing federal disability claims or handling appeals.  What does this representation cost?  The answer:  Nothing unless you win and receive back payments.  Representation is available on a "pay only if you win" or contingency basis.  There is no risk.  You never pay a fee unless you win your claim and receive a past due award settlement (back pay).

#2 - File your own claim and do your own paperwork and prep.  CAUTION:  Up to 75 percent of initial applications are denied and require an appeal.  Most of these claimants will end up getting professional help with the appeal.  You may want to consider getting professional help at the beginning.  In many cases, representation will cost you nothing -- even if you win.  Here is why:

There is a 5 months waiting period on all Title II disability claims.  You cannot be paid benefits during the first 5 months you are disabled.  If your claim is approved during this 5 month period, there would be no immediate benefit payable, thus no fee for your representative.  Fees are only paid out of back pay.  If there is no back pay, there is no fee.

However, if your representative is able to obtain back payments (perhaps dating back as long as 17 months prior to your application), or if a lengthy appeal is required, back pay may be awarded and a fee could be payable to your representative, which would be paid out of the back payments or past due benefits.

The Forsythe Firm will be happy to provide you with a free analysis of your claim and to answer any questions you may have about federal disability benefits---at no cost, no obligation. We will also explain how the contingency fee system works if we enter into an agreement to represent you.


THE FORSYTHE FIRM
Focused on Social Security Disability
7027 Old Madison Pike NW - Suite 108
"Across from Bridge Street"
Huntsville, AL 35806
PHONE (256) 799-0297         By appointment

DOCTOR'S ROLE IN YOUR SOCIAL SECURITY DISABILITY PROCESS

Doctor's always play a role in the Social Security disability process, although many of them are reluctant to "get involved."  Often, doctors will refuse to do more than provide medical records, which is often insufficient to get a fair disability determination.

 
Doctors' refusal to get involved may simply be a time saving decision on their part.  Or it may represent a misunderstanding in the appropriate role that doctors play in the disability decision making process.

Doctors are never allowed to determine whether a patient is disabled or not.  That decision is always reserved for the Commissioner of Social Security.

Doctors are asked to provide professional opinions about their observations and evaluations of their patients.  According to federal regulations (20 CFR 404.1527) a doctor who has a treating relationship with a patient is in the best position to accurately judge the nature and severity of the claimant's symptoms.

While a disability claimant may hire an examination from a consulting doctor, Social Security will give this doctor's opinion less weight than would be given to the doctor who regularly treats the claimant (20 CFR 404.1527(c)(2).

 

SOCIAL SECURITY OFFICE - LOCAL PHONE NUMBERS - FLORENCE, HUNTSVILLE, DECATUR

Here are those hard to find telephone numbers for North Alabama Social Security field offices.  Please note that all Social Security offices now use toll free numbers which DO ring into the local office shown below.  

FLORENCE, AL     (855) 884-3407

DECATUR, AL       (888) 289-9185 (Serves Athens, also)

HUNTSVILLE, AL   (866) 593-0665

HOURS OF OPERATION

Mondays, Tuesdays, Thursdays, Fridays  9 AM to 3 PM

Wednesdays:  9 AM to 12 Noon

Social Security offices close Saturday and Sunday and for all Federal holidays.

 

 Reaching a Social Security office on the telephone can be difficult.  Here are some tips that may help you out:

• All calls are now answered automatically by computer.  You will be given options.

• Option 1 asks you to dial 1 if you want information about health insurance, Obama Care, etc.  If you do not, press 2.

• The second option asks you to press 1 if you know the extension number you wish to reach.  You probably do not, so press 0 for the operator.

• You will have to listen to some recorded announcements and music while a Social Security employee finds time to grab the phone.  Just hold on and be patient.  If you want to try the national helpline number it is 800-772-1213.  Average wait time on this number is 15 minutes.

  If you need to speak to a disability advocate (someone dedicated to helping you win Social Security disability benefits) please call the Forsythe Firm in Huntsville at (256) 799-0297.  No fee unless you win.

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  This website is NOT sponsored by the Social Security Administration and the Forsythe Firm is not affiliated with the US Social Security Administration.

GETTING SOCIAL SECURITY BENEFITS AT AGE 50

If you are age 50 or over, you may qualify for Social Security benefits for any physical or mental condition which prevents you from full-time work.

Yes, younger individuals may also qualify.  However, Social Security uses Medical-Vocational Guidelines which relax the requirements somewhat for persons age 50 and over.

In addition to your age, other factors include your past work experience and education.  But being age 50 or more is the greatest single advantage a claimant has in being approved for Social Security benefits.

The Forsythe Firm will provide you with a free case evaluation and local consultation.  If we represent you, you will never pay a fee until you get benefits with back payments.  If you do not win benefits you will never pay us a fee for any service we perform.

Contact us at (256) 799-0297.  We're located across from Bridge Street.

AVOID THESE FATAL MISTAKES IN YOUR SOCIAL SECURITY DISABILITY CLAIM

Only about one-fourth of applications for Social Security disability benefits are approved without a hearing.  Below are some of the serious mistakes that claimants make.  If you are filing for Social Security disability, know these mistakes and avoid them for the best chance of winning benefits:

1.  Believing that the Social Security doctor will say that you are disabled.    This is technically impossible because doctors are not allowed to make the decision.  The doctor will only perform an examination.  The doctor Social Security sends you to will often spend no more than 15 -20 minutes with you and will perform a very limited examination.  He has no incentive to find you disabled, since he is paid by Social Security.  You certainly may get a more fair exam from your own doctor.

2.  Don't fail to ask your own doctor to complete a Medical Source Statement.  This is a form which explains what specific limitations you have in performing work related functions, such as sitting, standing, walking, lifting, bending, concentrating, etc.  This is in addition to routine medical records and does not require a special examination.

3.  Filing for disability while you are still working.  You cannot file for disability while you are working at "substantial gainful activity" or SGA.  In 2017, this amounts to work that pays you at least $1,170 per month.  Work that pays less than the SGA amount may not disqualify you.

4.  You have to prove that your disability will last at least 12 consecutive months (or that it has already lasted that long).  There is no short term disability with Social Security.  12 months is the minimum duration for a qualifying disability.

5. Failing to get medical treatment.  All disability awards must be based on "medically determinable impairments."  You will need your doctor to examine you, diagnose your problems and determine how severe your symptoms are.  Medical doctors, licensed physician's assistants and clinical psychologists are "accepted medical sources" with Social Security.  Chiropractors, licensed professional counselors and nurse practitioners are not.

6.  Failure to get psychological problems diagnosed and treated.  Social Security must consider psychiatric or emotional problems as well as physical problems - but they must be diagnosed by a psychiatrist or clinical psychologist, or at least by your family doctor.  Untreated psychological problems will go nowhere at Social Security.

7.  You must apply while you have Social Security coverage.  Not everyone has Social Security disability coverage.  You become covered by working and paying a special tax called FICA tax, which is required to be withheld on every worker and paid to the Social Security trust fund.You must earn enough quarters of work to be covered.  Also, when you stop working, you eventually lose your disability coverage with Social Security.  This usually happens after 4 years of no work.  If there are gaps in your work, your coverage may expire in less than 4 years.  The date you stop being covered is called your "date last insured" or DLI.  So, eligibility under Social Security is not permanent.

8.  You have to appeal unfavorable decisions within 60 days.  Being denied is not the exception, it's the rule.  Be prepared to file a request for hearing within 60 days after you receive a denial letter from Social Security.  This 60 day rule is very strict.  If you wait too long you cannot appeal the claim and must start all over.  Avoid this wasted time.

9.  Avoid trying to represent yourself (pro se representation).  Social Security law is a highly technical and specialized field.  The US disability program is governed by thousands of pages of rules and regulations.  If you don't meet the rules or follow the correct procedures you can be denied and this may cost you thousands--even hundreds of thousands of dollars over the years.  Consider getting a specialist to represent you and arrange a "contingency fee" situation where the representative gets paid only if you win. 

10.  Failure to prepare the vocational (work) aspects of your claim.  There are two important parts of a Social Security disability claim:  the medical aspect is the best known part.  However, there is an equally important vocational aspect to the claim.  Past work will be classified and a vocational expert will be asked to determine (a) whether you can perform any of your past relevant work and, (b) whether there are any other jobs in the US economy that you could still perform, in spite of your physical and/or mental limitations.  Failure to adequately prepare the vocational aspect of your claim will result in a denial, just like failure to prepare the medical part of the claim will get you denied.

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