Why Are Ssdi Benefits Denied
There are a number of reasons why so many SSDI claims are denied by the SSA.
As previously mentioned, the SSA will not approve your claim unless you are able to prove that you meet the legal definition of disabled. To prove this, you must submit medical documentation to the SSA. However, many people fail to submit enough medical evidence to prove that they are actually disabled, so the SSA has no choice but to deny their application.
There is no such thing as too much when it comes to providing medical documentation to the SSA. Its best to submit as much as possible to ensure the SSA has what it needs to approve your claim. Examples of medical documentation you will need to submit include:
- Official diagnoses
- Medical treatment history
- Prescription medication history
You should also ask your physician to prepare a statement that explains the severity of your condition and how it affects your ability to work.
You could also be denied as a result of your monthly income. The SSA will not approve you for SSDI benefits if you perform work that brings in more than the substantial gainful activity rate, which is $1,260 per month in 2020. If you are working and earning more than this rate every month, you will not qualify for benefits.
Your application could also be denied if you are unwilling to cooperate with the SSA. For instance, if the SSA asks you to provide additional documentation but you fail to do so in a timely manner, the SSA will have to deny your claim.
Pay Attention To Financial Qualifications
While the basic rule for Social Security disability is defined as a condition that has lasted or is expected to last for at least 12 months, that should not necessarily determine when you apply for benefits.
“If an individual is not working and earning income, then they’re allowed to apply now,” Geist said. “There’s not a set period of time where they have to wait to apply.”
However, there are certain financial restrictions that claimants will have to meet to be approved.
For starters, you must have paid so-called FICA taxes into the system. Generally, you have to contribute for at least 10 years in order to be eligible.
Additionally, your condition must meet Social Security’s definition of a disability. It must be so severe that you can no longer work. It must also be expected to last for at least a year or result in death.
In addition, your income must fall below certain a certain threshold known as substantial gainful activity. In 2021, that limit is $1,310 per month for non-blind individuals.
Those who have not paid FICA taxes may instead qualify for Supplemental Security Income, or SSI. However, those benefits are means tested and come with strict asset limits of $2,000 per individual, or $3,000 per married couple.
While some disabled workers may be tempted to take advantage of expanded pandemic unemployment insurance benefits that are still available in some states, that could hurt your chances of getting approved for disability benefits, Geist said.
How Long Does It Take To Get Ssdi Benefits After I Am Approved
Congratulations! Your social security disability benefits claim was approved. If you are like most of my Louisiana disability clients after your SSDI claim has been approved you want to know WHEN WILL I GET THE DISABILITY BENEFITS I HAVE BEEN AWARDED?
It will usually take a few months for your benefits to start AFTER YOU RECEIVE A FAVORABLE WRITTEN DECISION.
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Are You Able To Do The Work You Did Before Your Disability
The next step in the evaluation process is to decide if your disability prevents you from performing the job you previously did at a reasonable level.
The SSA has a system in place to help them evaluate your capacity to perform job-related tasks.
They will look at your relevant work history throughout the previous 15 years, which includes all the activities that youâve done for pay. So it excludes any hobbies or volunteer work.
Theyâll make their decision based on the following four factors.
Job descriptions – Your job descriptions from relevant work history will include the tasks youâve performed, as well as your average weekly workload. It will also include the skills you needed to perform the job, and a description of the environment you worked in.
Physical requirements of the jobs – This portion of the evaluation will determine the physical demands of the job. For example, if it was primarily a desk job, or if it involved manual labor like climbing, lifting, or extensive walking.
They will also look at any equipment you had to use on the job, and if your disability affects your ability to use it now.
Any difficulties that you faced – Your difficulties might include reduced hours due to your disability, or having to take frequent leaves because of your health. They might ask if you needed a lot of help from your coworkers due to your condition.
You Have Sufficient Work Credits
Social security disability is like an insurance program. Individuals pay into Social Security by working certain covered jobs, and their earnings are converted into work credits. In 2020, $1,410 in earnings is equivalent to one credit . You can earn a maximum of four credits per year.
Typically, you need 40 work credits to be eligible for social security disability benefits, 20 of which must have been earned in the 10-year period ending at the start of your disability. So, if you apply for disability in 2020 but became disabled in 2018, you must have earned 20 work credits in the period 2008 to 2018.
Younger disabled workers, however, may qualify with fewer work credits. The amount required depends on age and is as follows:
- Younger than 24: Six credits in the three-year period ending when your disability began
- 24 to 31 years old: You need work credits equal to half the time you worked between age 21 and the date you become disabled. For example, if you were disabled at age 29, you need four years of work history and 16 credits.
- 31 to 42 years old: You need a minimum of 20 work credits,
- Older than 42: The number of work credits needed is based on a sliding scale and adds two credits every two years to the 20 credit requirement. For example, a 50-year old applicant would need 28 credits.
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Enlist The Support Of Your Doctor And Medical Providers
Your doctor and healthcare providers are important allies in winning approval of your case. Ask your healthcare team to provide statements describing your limitations and how they affect your work and personal life for example, how long you are able to sit or stand, if you are capable of lifting objects and what weight, or if you need frequent rest breaks. This includes statements from homecare assistants regarding your daily routine and if you need help with daily personal care. If your doctor is unable or unwilling to assist you, find another medical provider who can assist you.
Document Your Physical Symptoms
Long haul Covid-19 may present a vague set of symptoms, not unlike other conditions such as fibromyalgia or chronic fatigue that have also been approved for Social Security disability benefits.
However, these types of conditions are more difficult to prove because they generally cannot be diagnosed with one medical test.
“Those aren’t going to be awarded as quickly, because you need to see those over a period of time,” Geist said. “You need a longitudinal history there, and those can be more difficult to document.”
The best way to establish a record of your symptoms is to share them with your doctor and to have them document what is going on.
For example, if you have migraines, how long do they last? What does your recovery process look like?
Keeping track of those details will help if your application has to be considered by a judge, Geist said.
Special Rules For People Who Are Blind Or Have Low Vision
We consider you to be legally blind under Social Security rules if your vision cannot be corrected to better than 20/200 in your better eye or if your visual field is 20 degrees or less, even with a corrective lens. Many people who meet the legal definition of blindness still have some sight and may be able to read large print and get around without a cane or a guide dog.
If you do not meet the legal definition of blindness, you may still qualify for disability benefits if your vision problems alone or combined with other health problems prevent you from working.
There are a number of special rules for people who are blind that recognize the severe impact of blindness on a person’s ability to work. For example, the monthly earnings limit for people who are blind is generally higher than the limit that applies to non-blind disabled workers.
In 2021, the monthly earnings limit is $2,190.
Qualifying For Retirement Benefits
Retirement benefits, like SSI and SSDI, are a type of monthly payment paid to eligible Americans by the SSA. Once you have amassed enough work credits, paid into Social Security through federal taxes, and reached age 62, you can begin collecting retirement benefits. The amount of your monthly benefit depends on how much you worked, how much money you made, and whether you decide to keep working past the age of 62.
If you wait until your full retirement age , your monthly benefit will increase. And, if you are able to and decide to keep working until you are 70 years old, you can maximize your monthly retirement benefits. Once you begin receiving retirement benefits, you will continue to receive them for the rest of your life.
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Inside The Social Security Disability Claim Review Approval Process
Getting your SSD benefits claim approved by the SSA is a lengthy process full of questions: What goes on behind the scenes during the Social Security disability claims approval process? How many people handle one application? How does the agency investigate a persons work history and confirm his or her medical condition? These are common questions many who are thinking about applying for SSD benefits ask themselves and their attorneys. Most people dont have an inside look at the claims approval process and may not realize a lot of work goes into examining each application.
The SSA has revised its disability approval process numerous times to make it more efficient and user-friendly to ensure all eligible applicants receive their needed payments. Understanding the internal process can help applicants gain a better picture of the SSD application timeline. Here are the basics of the process:
1. Application Handed Over to the State Disability Agency and a Disability Examiner
According to Tim Moore, a former disability examiner for the SSA, the first step in the long claims approval process is to send your Social Security disability benefits application to a state disability agency, which is also called Disability Determination Services .
2. Examiner Contacts Medical Personnel and Past Employers
3. Specialist May Ask You to Complete Daily Living Questionnaire
4. Examiner Makes Initial Claim Determination
5. Application Goes to the Office of Disability Adjudication and Review
Ideally You Should Have Already Been Out Of Work For Five Months Or More When You Apply For Ssdi
If you work up until the day you submit your disability benefits application, the SSA will almost certainly reject it. Thats because you must prove that you cannot work directly as a result of your disability to qualify for benefits. In some cases, you can show that it was difficult to work full-time because of your disability. But for the most part, spending the last five months unemployed because youre disabled seems to be the sweet spot. The SSA will also ask you:
- Whether your medical condition caused you to cease working at your previous job
- If you had to reduce hours before leaving work altogether
- Whether your employer had to provide special help in order for you to complete your routine job tasks
If you have an especially complicated claim, ask a Social Security attorney to review your application before submitting it. Lawyers often know disability secrets that apply to someone in your specific situation that you wouldnt find anywhere online.
IMPORTANT: Did you have an unexpected/abrupt accident or illness? If a sudden disability makes working obviously impossible on a short-term basis, you may be exempted from the five-month rule. The SSA will estimate how long your inability to work should last based on your medical diagnosis. If its one year or longer, you may still qualify for disability benefits.
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How To File A Disability Insurance Claim In California
1 Review Your Eligibility. You must be eligible to receive DI benefits. 2 File Your Claim. You have two options to file for DI benefits. 3 Physician/Practitioner Completes a Medical Certification. 4 The EDD Determines Eligibility.
The California State Disability Insurance program provides short-term Disability Insurance and Paid Family Leave wage replacement benefits to eligible workers who need time off work. You may be eligible for DI if you are unable to work due to non-work-related illness or injury, pregnancy, or childbirth.
Why Ssdi Requires Work Credits
As the acronym indicates, SSDI is an insurance program. You pay the premiums of this program through the Social Security deductions that your boss takes out of your paycheck and sends to the government on your behalf. That money helps to fund the monthly Social Security disability and retirement checks that people receive.
On the other hand, the source of funding for SSI benefits is general revenues, like income taxes and additional money that the government collects. Because SSI does not use payroll deductions for Social Security taxes as its source of funding, you do not have to pay into the system and accumulate work credits to be eligible for these benefits.
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Conditions Without A Listing
You may have a debilitating condition that isnt included in a Blue Book listing. If certain criteria are met, you can still be approved for disability benefits. The medical problem must have an impairment that is medically evident. A medically determinable impairment is a medical condition that is supported by tests, exams, and medical notes, so it is verified in your medical records. A residual functional capacity will be completed, and it must show that you are limited by the condition.
The RFC determines the most demanding activity you can perform with your medical issue and will allow the SSA to determine your exertional level, which could vary from sedentary work to very heavy work. Exertional levels are based on how much weight you can lift and carry while non-exertional limitations are also indicated, such as climbing, bending, environmental restrictions, anxiety and depression, and usage of the hands. When the RFC is reviewed, if it is determined you are unable to work, you can be approved for disability benefits.
You Cant Do Your Past Work Or Any Other Type Of Work
One determining factor for disability is your capacity to do work. If you cant go back to the job youve been doing before you got disabled, the SSA will assess if you can do other types of jobs. They will look at your age, skills, and educational attainment.
If they determined that you dont have the skills to do other jobs or are too old to learn a new skill, youll most likely get approved.
An Overview Of Work Credit Requirements For Ssdi
The Social Security Administration says that you generally need at least 40 work credits over your lifetime to qualify for Social Security benefits at retirement. However, the number of credits required to qualify for SSDI varies by age. You do not want to assume that you lack the right amount of work credits based on the facts of another persons situation. We can use the following scenario to explain the work credit system.
Suppose you worked with a 50-year-old man who became too ill to work because of Parkinsons disease, and he had only worked at a job that paid into Social Security for 5 years. You can earn up to 4 work credits a year. In this situation, your coworker would only have 20 work credits, and likely would not qualify for benefits.
If you worked at the same place of employment for 5 years and became disabled, you might assume that you do not have enough work credit but that assumption could be incorrect. For example, if youre 35 years old, you would only need 20 work credits to qualify for SSDI benefits. Again, your age and how long and how recently you worked a job that paid into Social Security will determine how many work credits you need to apply for SSDI.
Basic Eligibility For Benefits
The SSA must see that you meet basic eligibility requirements before further reviewing your application for benefits. This basic eligibility includes having:
- A formal diagnosis of a potentially disabling condition
- A diagnosed condition that will disable you for 12 months of longer
After the SSA confirms that you meet basic eligibility, they will then move on to review your medical condition in detail and verify that you meet all program requirements for SSDI and/or SSI.
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What Conditions Qualify For Disability Benefits
There are numerous mental, physical, adult, and childhood conditions that qualify for disability benefits, including but not limited to cancer, cardiovascular disease, high blood pressure, Crohns disease, diabetes, HIV/AIDS, arthritis, paralysis, anxiety, depression, and chronic pain. The SSA is less concerned with the nature of your condition than it is with its severity. In order for you to qualify, your condition must be so severe that:
- You cannot do substantial work due to your condition
- You condition has lasted, or is expected to last, for at least 12 months
The severity of your disability must be evaluated and confirmed by an SSA doctor, who may review your medical records and perform various examinations.