WHAT WILL A TIMELY APPEAL DO FOR YOU IF YOU'VE BEEN DENIED?

Let's face it.  7 out of 10 applications for disability will be denied for one reason or another.  Very few people get approved with an application.

You must appeal the denial within 60 days.  What does the appeal do for you?

First, the appeal keeps your claim alive.  It protects your back pay, your disability onset date and other benefits under the original claim.  If the appeal is eventually decided in your favor, benefits can go back to the original onset date of your disability.  This can pay you tens of thousands of dollars in past due benefits or back pay.

Second, a timely appeal puts you on track to appear at a hearing before a US Administrative Law Judge (ALJ).  It will take a long time to get there, however, the appeal is the same thing as a Request for a Hearing.

Third, the appeal gives you time to gather new or additional evidence.  You should keep seeing your doctor(s) and submitting the new records to your file.  

Finally, the appeal allows you to appear in person before a judge who will give you a new decision without being bound by the negative decision already made on your claim.  The judge will review all the facts in your case, including new evidence, including your testimony, including your attoney's arguments.  You are entitled to be represented at these hearings and you should be.  It won't guarantee a victory but it will increase your chances of winning.

I come in contact with claimants who have been denied three, four or even five times.  They keep filing new claims and getting denied over and over again.  This is the worst way to approach an SSDI claim.  A new application goes to the same people who denied it previously.  The same people make the same decision again.  Another denial.  Spinning your wheels, getting nowhere.

The 3 must do rules for a denied claim are:

1.  Appeal
2.  Appeal
3.  Appeal

 

OVER PAYMENTS MUST BE RETURNED TO SOCIAL SECURITY

A lot of people get into trouble with Social Security by taking benefits they are not entitled to.  This can go on for several years before Social Security catches on.  Then, the government demands that you pay the money back.  Probably, the money has been spent.  You just don't have it to pay back.  This is a serious problem.

How do people get themselves into this fix?  By taking money that they are not entitled to.

It usually happens this way.  An individual gets approved for disability and receives an SSDI check each month.  After a couple of years, he feels better and decides he can go back to work.  He does so but doesn't notify Social Security that he is working.  So, Social Security keeps sending the monthly disability checks, which the beneficiary is no longer entitled to.  But the checks keep getting cashed, creating a huge over-payment.  

This may go on for up to two or three years.  It appears that everything is fine because nobody has screamed about it.  

However, Social Security has multiple ways of knowing when people get checks they are not entitled to.  Eventually, they will find out.  They always do.  Then, they will demand their money back.

Of course, the money has already been spent.  That doesn't matter.  Social Security wants their money back, no excuses.

I get five or six calls a month from individuals in this situation.  "I've spent the money, I don't have it any more, and now they want it back.  Can you get me out of this?"

The short answer is, "No, I can't."  If you take money you are not entitled to, you will have to pay it back.

I do realize that earning a paycheck and getting a disability check too is tempting.  But it is also illegal.  

Here is my recommendation to anyone receiving a benefit from Social Security:

Realize your reporting responsibilities.  If you go back to work, either full-time or part-time, immediately notify Social Security in writing.  Telephone calls are nearly impossible to prove and never make a good record.   If Social Security doesn't respond, don't just assume that cashing their checks is OK.  Keep contacting them until you get the right information.  Ultimately, cashing checks that you're not entitled to cash only gets you into trouble.  There is never an acceptable excuse and there are no loopholes.  When in doubt, don't cash the check!

Fighting fraud is Job 1 at Social Security these days.  If outright dishonesty or misrepresentation is involved, you may be subject to arrest and criminal prosecution--in addition to paying back the money you took. It isn't worth it to put yourself in that position.  If you go back to work, report it.  If they send you a check anyway, return it.  

There are a very limited number of situations where a person might be entitled to keep getting a check after returning to work. An example would be a person participating in the Ticket to Work program.  But this is a formal program where a person works with the permission of Social Security and there are rules and limits.   

TOP 10 MISTAKES ON A DISABILITY CLAIM

TOP 10 SOCIAL SECURITY DISABILITY MISTAKES

Social Security has its own rule book.  To get benefits, you have to know their rules and play by them.  Other rules just don't work.  Here are my Top Ten Mistakes that can cause you problems with SSDI:

1.  Trying to file when you haven't worked enough. You must have worked enough to accumulate the minimum Quarters of Coverage.  Without the required work history, your claim will automatically be denied.  And this type of denial can't be successfully appealed.  Check this with the Social Security office before you begin an SSDI claim.  The question you need to ask:  "Do I have enough work credits to support a new Title 2 claim?"

2. Filing a claim while you are still working.  If you work enough to earn substantial wages, you will be given a denial at the first step in the process.  In 2018, wages of at least $1,180 per month will get you denied.  You must stop working or reduce wages to below the maximum before filing.

3.  Alleging an onset date in the past but Social Security finds that you were still working on that date.  For example, you allege disability began on 4/14/17 but you were still at working at substantial gainful activity (SGA) on that date.  You should amend your alleged onset date to a later date after you stopped earning SGA wages.

4.  You have a serious condition but it isn't expected to last at least 12 consecutive months. Short term disabilities that won't last for at least 1 year are not covered unless they are expected to end in death.

5.  Failure to get your own doctor's support. Your doctor knows you better than anyone.  He or she can give you a form called a "medical source statement" that can help you get approved.  You have to seek out this from your doctor; Social Security won't do it.

6.  Depending on Social Security's doctor to help you will always let you down.  They have consulting doctors that often do examinations for persons who file claims but lack medical evidence from their own doctors.  These exams seldom help get a favorable decision and most often doom the case to a denial.

7.  Failing to get medical treatment is a big mistake.  Social Security bases its decision on what is in your medical file.  It is crucial to have consistent treatment from your doctor(s).  Claiming to have a disabling impairment without medical evidence for it is a waste of time.  For many conditions, treatment by a medical specialist is a really good idea.  By the way, nurse practitioners are not considered acceptable medical sources by Social Security.  They want a doctor (MD or DO).  Records from a nurse practitioner won't take you very far with Social Security.

8.  Waiting too long to file a claim can hurt you.  Every worker's Social Security disability coverage comes with a "Date Last Insured," which is the time limit for filing a new claim.  When you stop working, for any reason, your Date Last Insured begins to creep up on you.  Don't wait too long to file an SSDI claim or you may find yourself uninsured at Social Security.

9.  Failure to file an appeal in a timely manner.  Up to 70 percent of SSDI claims will be denied at the first stage.  It's just expected.  You have 60 days to file an appeal.  After 60o days passes and you do not appeal, the claim is dismissed and can't be reinstated in most cases.  Don't let the 60 days pass.  (Appeals are where most cases are won).

10.  Failure to get legal representation.  Social Security is one of those places where you may represent yourself.  However, this is a really bad idea.  There are complex books of regulations that govern Social Security disability.  You need someone who knows the system and understands how to get cases approved.  You only pay your representative if you win and if you collect past due benefits.  Social Security will deduct the amount of the fee you have agreed on and pay the representative directly.  There are reasonable maximum fees set by Social Security and you will never pay more than these amounts by law.  You never have to pay anything up front.
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THE FORSYTHE FIRM
Social Security Disability Representatives
7027 Old Madison Pike NW, Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297

SOCIAL SECURITY JUSTICE: OUR WEBSITE

HOW MUCH WILL MY SSDI CHECK BE?

Social Security disability benefits are unique to the individual.  The amount of your monthly benefit depends on your age, how long you have worked and how much you have earned.

The maximum SSDI benefit can be over $2,700 per month.  That would be for an individual with many years of high earnings.

The average SSDI check in 2018 is around $1,170 per month.

SSDI benefits are not "means tested."  Benefits are not reduced because you have other income, property, savings, etc.  

Supplemental Security Income (SSI) is a totally different program and its maximum benefit is $750 per month.  That amount can be reduced based on household income, living arrangements and other factors because SSI is for low income individuals or families.

Social Security no longer mails estimates of benefits, as they once did.  However, you can call your local Social Security office and ask about your estimated monthly benefit in case of disability.

Keep in mind that SSDI beneficiaries also get Medicare insurance, which is a valuable benefit.  (SSI recipients get Medicaid).