WHY MOST DISABILITY CLAIMS ARE DENIED

Decisions about disability applications are not made by Social Security directly.  They are farmed out to a state agency called the Disability Determination Service (DDS) in Birmingham, AL which will deny over 70 percent of claims.  Why?

1.  DDS gives each claim a perfunctory review, having never examined the claimant and never having spoken to them in most cases.

2.  DDS errors on the side of denial, not award.  If your claim is not air tight it will be denied for someone higher up the chain to sort it out later.  Usually, if your condition is not severe enough to meet a Listing level impairment, the claim will be denied.  Denials are common as dirt.  We jokingly call DDS the "Disability Denial Service."
3.  The DDS decision is the first, not final, decision on the claim.  In Alabama, denials can be referred up the chain to an administrative law judge (ALJ) for further review and new decision. This is the best chance to get your claim approved.

HERE ARE COMMON PITFALLS TO AVOID AFTER YOUR CLAIM IS DENIED:

• Waiting too long to file the appeal.  You only have 60 days.

• Failing to submit enough medical evidence to win the appeal, including new or additional evidence after the denial date.

• Failure to use the Social Security rules and regulations to your advantage.

• Not knowing what the hearing will be like and what the standard of proof is; going in with just the hope that "someone will believe me and everything will be alright."  It won't if you approach it on that basis.

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THE FORSYTHE FIRM
Social Security Disability Counselors
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806

PH (256) 799-0297

COMPASSIONATE ALLOWANCE FOR DISABILITY CLAIMS

Certain claimants with severe or catastrophic diseases may get Social Security disability benefits sooner if they meet the rules for a Compassionate Allowance.

A Compassionate Allowance means that a claimant may not have to wait up to 24 months for Social Security to award benefits.  These individuals may be approved simply by proving a doctor's diagnosis and basic medical records.  I've seen these awards made in less than one month.

For a complete list of the more than 200 diseases which qualify for a Compassionate Allowance, please use the following link:

List of Diseases Eligible for Compassionate Allowance


The Forsythe Firm is not affiliated with the Social Security Administration or the United States government.  We are a private professional firm representing claimants before the Social Security Administration.  "We help you get your benefits."

HOW YOU CAN HELP GET YOUR DISABILITY APPROVED

What can you, the claimant, do to help get your Social Security disability benefits approved?

1.  Respond immediately to any request for information--and fill out any forms sent you completely, accurately and fully.

2.  Send any medical records you have to Social Security as soon as you apply.

3.  Keep seeing our doctors regularly and follow their advice.  Continue to take your medications.

4.  If you have an orthopedic or musculoskeletal problem (back pain, joint pain, leg pain), try to get X-rays or an MRI to visualize the problem.  Get these reports to Social Security.

5.  Ask your doctor to complete a Residual Functional Capacity form for you.  This is also called a Medical Source Statement.  The form is available from disability lawyers or representatives.  You may also find one online; however, I don't think many of the generic forms found online are adequate.  My office has refined our form over the years to cover all the bases.  (We will send you a free copy on request).

6.  Attend any consultative examinations set up for you by Social Security.  In about one case out of 4, they will schedule an appointment with one of their contracted doctors.  Arrive 15 minutes early and take your medications with you.

7.  Call the state agency handling your application (Disability Determination Service) about every 2 weeks to be sure they have been able to get all your medical records from your treatment providers (doctors, hospitals, clinics).  If not, call the provider directly and ask them to send in their records.

8.  It will typically take 90 to 120 days for the Disability Determination Service in your state to give you a decision on whether you are approved or denied. (Up to 70% are denied). If you get a denial letter, you should file a written appeal within 60 days.  This deadline is very strict.  After 60 days, you lose the right to appeal.  Most claims are won in the appeal process, not in the application stage.

9.  Continue seeing your doctor and follow medical treatment during the long appear process, which can last 2 years or longer before you finally get a hearing.

10.  Consider whether you need an attorney or disability advocate to help you with your appeal and hearing.  The hearing is a legal process which applies complex Social Security laws, rules and regulations to your case to determine whether you qualify for a benefit under the law.  Your representative may only charge you a fee if your case is successful and you receive past due benefits.  You cannot be charged a retainer, an upfront deposit or fee, and you cannot be charged any fees or expenses if you do not receive back pay from Social Security.  Attorneys call this a "contingency fee" agreement:  pay us only if we are successful.  The fees are regulated by Social Security.  It is an accepted truth that claimants with experienced, qualified representatives are more likely to win and more likely to get their past due benefits (back pay).
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THE FORSYTHE FIRM
SOCIAL SECURITY DISABILITY COUNSELORS
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297

"ACROSS FROM BRIDGE STREET"               WEBSITE: SOCIAL SECURITY JUSTICE

NEW MEDICARE CARDS ON THE WAY - AND SO ARE SCAMS

JUNE 1, 2018 -  The Social Security Administration says it is about to begin mailing the newly designed Medicare cards to Alabama residents soon.  The new cards do not contain Social Security numbers and hopefully will make it more difficult for your number to be stolen by identify thieves.

Social Security will NOT call you and ask for any personal information, such as your name, address, Social Security number, bank information, etc.   Anyone who does this is probably running a scam.


If Social Security has your current address, you don't need to do anything to get your new Medicare card.  If you have recently moved, call your local Social Security office and report your new address.  But remember, Social Security will NOT call you and ask for any information.  Beware of anyone calling and pretending to be from Social Security.

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The Forsythe Firm is not affiliated with the Social Security Administration or the US government.

FAQ (FREQUENTLY ASKED QUESTIONS) ABOUT DISABILITY BENEFITS

THE FORSYTHE FIRM                                   
7027 Old Madison Pike
Huntsville, AL 35806
(256) 799-0297                        


Q.  How old must you be to apply for Social Security disability?

A.  Anyone under full retirement age can apply for SSDI benefits.  At full retirement age (66 for most people) you already qualify for Social Security retirement benefits and being disabled will not increase your benefits.

Q.  What medical conditions qualify for SSDI benefits?

A.  Any medical condition which is severe enough to make you unable to work can qualify for benefits.

Q.  Do I have to be off work 12 months before I apply for disability?

A.  No, you may apply as soon as you become unable to work.  The so-called Duration Rule says that Social Security only pays for disability that has lasted or is expected to last for 12 consecutive months.  It does not pay for short-term disability.  However, do not wait 12 months to apply unless you are reasonably certain that your condition will improve within 12 months and allow you to return to work.

Q.  What is the 5-month waiting period all about?

A.  Stated simply, Social Security will not pay for the first 5 full months of disability.  Example:  You become disabled March 9th.  You would lose April - August to the waiting period.  Your first month eligible for a payment would be September. (SSI has different rules).

Q.  Is it true that most disability applications are denied on the first try?

A.  Yes, unfortunately about 70 percent are denied.  However, many of these will be approved during the appeal process.  If denied, you must appeal within 60 days or lose your right to appeal.

Q.  Is an appeal the same thing as filing a new application?

A.  No, not the same thing at all.  An appeal keeps your old or original claim alive and sends it up the chain of command for a higher level of review.  It will also preserve potential back pay which might be lost by filing a new application.  In most cases, it is best to file an appeal--not a new application.  An attorney or disability advocate can give you better advice based on your personal circumstances.

Q.  How much will my disability check be, if I am approved?

A.  Checks vary by individual, based on your age, how long you have worked and your past wages on which you paid FICA (Social Security) taxes.  In 2018, the average disabled worker gets about $1170 per month.  The maximum benefit is $2788 per month.

Q.  I have some money saved and my spouse has a good job.  Will this income and savings prevent me from getting Social Security disability?

A.  No.  Social Security disability under Title II is not means tested.  This means that there are no financial or household income restrictions.  The amount of savings you have is not considered, neither is a spouse's income or other household income.  (SSI is a separate program altogether with different rules).

Q.  What are basic requirements to qualify for SSDI (Title 2) benefits?

A.  Here is an over-simplified list of requirements:

• You are not now working at a full-time job.
• You have enough past work credits to be covered.
• You have a severe, medically determinable impairment that prevents you from working.
• This impairment has lasted or is expected to last for at least 12 consecutive months OR to end in death; and
• You have medical evidence to prove your impairment and its severity.

Q.  Why is it easier to get disability benefits if you are age 50 or over?

A.  Because of the Medical-Vocational Guidelines, also called Grid Rules.  These rules combine several factors that make it easier for persons age 50 and over to be approved.  Essentially, Social Security recognizes that the older an individual is, the more difficult it will be for them to adjust to different work or more difficult work.  But remember, young individuals CAN be approved.

Q.  Does it take a long time to get a decision on a disability claim?

A.  It takes 90 to 120 days to get the initial decision.  If the first decision is a denial and the claim goes to appeal, it will take from one to two additional years to get a hearing.  Some disabled veterans and some non-veterans with dire need may get a faster decision.  But generally the process is not fast.

Q.  Will I get Medicare health insurance when my disability claim is approved?

A.  Under Title 2 claims, you will become eligible for Medicare 29 months after the established date of your disability (or at age 65 if that is sooner).  This is 29 months from the date you first became disabled, NOT the date Social Security finally gave you a decision.  Of course, if your 65th birthday occurs earlier, you will qualify for Medicare based on your age.

Q.  What's my first step?

A.  You can file a disability application online at www.socialsecurity.gov or by going to any Social Security office.  You may want to speak to a disability attorney or non-attorney advocate about the process and your chances before applying.  My office will provide a free consultation and case evaluation.  If we agree to represent you, we will file your applications for you and handle the claim, including any appeals.  You pay a fee only if you win and recover back pay.

THE FORSYTHE FIRM
Social Security Disability Counselors
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806

PH (256) 799-0297

GET DISABILITY REPRESENTATION

FEES ARE REGULATEDC TO PROTECT CLAIMANTS

About 90 percent of claimants trying for Social Security disability benefits are represented by attorneys or non-attorney advocates who charge a fee for their representation.

Social Security has structured the fee for these representatives to protect the claimant, not the representative.  This assures the claimant that he/she can get top notch legal representation and not worry about high legal fees.

Some examples of how Social Security protects the claimant:

1.  No fee unless you win your case.

2.  No fee unless you also receive back pay.

3.  In most cases, up-front fees are not allowed.

4.  The fee is limited to 25 percent of your back pay and there is a dollar-amount cap on top of that.

5.  Social Security must approve the attorney's fee in writing before a fee may be charged.

This arrangement assures the claimant that may be charged will be the result of a successful claim or appeal, that the amount of the fee will be reasonable and fair (and agreed to upfront by both the claimant and representative).

WHAT IS AN SSI BENEFIT? WHO CAN GET IT?

SSI stands for "Supplemental Security Income" and it's a type of welfare for the elderly or disabled.

SSI differs from Social Security disability (SSDI) in several ways:

1)  SSI has severe restrictions on household income and financial resources.  If someone in your household earns a little too much or has too much in savings, you can't qualify.  (There are no income restrictions for Social Security disability).

2)  SSI does not require any work credits or work history to get a benefit.

3)  To receive SSI, you must have either reached retirement age OR be medically disabled.  You must also meet the income and resource restrictions.

4)  The maximum monthly benefit for SSI is currently $755.  The maximum benefit for Social Security disability is over 3 times that amount.

How are the medical disability requirements for SSI different from those of Social Security disability (SSDI)?  Actually, the medical requirements are exactly the same.  If you are medically disabled for SSI, you will be medically disabled for SSDI as well.  Only the financial requirements are different.

Other than household income, what other financial facts are considered for SSI?  The answer, your living or housing arrangement will be considered.  Usually, if someone is providing you with a place to live at no cost, this will reduce your SSI monthly benefit by up to one-third.

How does a person apply for Supplemental Security Income?  If you want to check on your eligibility for SSI or file an application, call your local Social Security office.  SSI is processed by the Social Security Administration, although it is not the same program as Social Security disability.