Disability steps
Posted: Tue Nov 11, 2014 2:20 am
Here is the info I was given by a Disability Attorney. Simply insane that as sick and in pain as we are that all of this is required. How does anyone survive financially who is single during the appeals battle?
Chime in if you had to go thru all if this.
If you are earning above what SSA calls "substantial gainful activity" level (currently $1,070 per month before tax) you would be automatically denied at Step 1 because you are working. You cannot work above SGA level and be disabled at the same time under the regulations.
If you are earning above SGA level ($1,070 per month in earned wages, salary) you would be automatically denied at Step 1.
By the way, here are the "steps" that are taken to decide if you meet SSA's rules for disability:
Step 1: Are you now working at SGA level? If Yes, you are denied. If No, go to step 2.
Step 2: Do you have a medically determinable impairment that has lasted or is expected to last at least 12 months OR end in death? Obviously, yes to lasting at least 12 months, so go to step 3.
Step 3: (A): Do you meet a Listing? I cannot answer this now based on limited information - but most claimants do not meet a listing because the severity of symptoms required to meet a listing are so extreme that few claimants can meet them. YOU CAN BE DISABLED WITHOUT MEETING A LISTING, AT STEP 5. (B) What is your residual functional capacity? In short, what is the most you are able to do in terms of work related activity? This will be determined by your medical records and your statements (testimony).
Step 4: Are you able to perform ANY of your past relevant work? Past relevant work is work you have performed at SGA level during the past 15 years; generally, this applies to full-time or almost full-time work that you performed long enough to become proficient in the work. So past work history is important. If Yes, you are denied. If No, continue to step 5.
Step 5. If you cannot perform any past relevant work (PRW), can you perform any other work that exists in significant numbers in the national, regional or local economy, based on your residual functional capacity, age, education, and work skills? If Yes, you are not disabled. If No, you should be approved.
Finally, there are guidelines called "Medical-Vocational Rules" or commonly called "Grid Rules" that direct a disability determination at Step 5. To determine whether you "grid" DISABLED under these guidelines, I need answers to the questions above about your education, current and past jobs.
I can tell you that age 57 is favorable because a person can "grid" as disabled much easier at "advanced age" (55 and over). A person with less education, advanced age, and no transferable work skills, who is also limited (RFC) to either light or sedentary work is likely to grid as disabled. However, you cannot be working or, as I said, you will be denied at Step 1.
As to time frames: In Alabama (I assume that's where you are) - it takes 90 to 120 days to get an initial decision. 72 percent of all initial decisions are denials. (Of course, that doesn't matter if you are approved; and at age 57 you would have a higher than average chance of approval, I think). If you are denied and have to appeal, it normally takes 11 to 12 months to get a hearing before an administrative law judge (after you are denied). After the hearing, it takes an additional 1 to 3 months to get a decision. After you get a favorable decision, payment of any back pay awarded takes up to 60 more days. So, I tell clients that you are potentially looking at a good 18 months start to finish if you have to go through the entire process.
Finally, it is possible to get "back pay" for the months you waited to be approved (after filing the application). From the "established onset date" of disability (the date Social Security finds you to have first become disabled), there is a 5-month "waiting period" in which no benefits are payable. For instance, if you are found to have become disabled on October 10, 2014, your waiting period would be November - March 2015 and your first actual payment would be for April 2015. (They eliminate the first 5 months of payments).
As for Medicare insurance, you have to wait 24 months from the date you first became eligible for payment of disability benefits.
Chime in if you had to go thru all if this.
If you are earning above what SSA calls "substantial gainful activity" level (currently $1,070 per month before tax) you would be automatically denied at Step 1 because you are working. You cannot work above SGA level and be disabled at the same time under the regulations.
If you are earning above SGA level ($1,070 per month in earned wages, salary) you would be automatically denied at Step 1.
By the way, here are the "steps" that are taken to decide if you meet SSA's rules for disability:
Step 1: Are you now working at SGA level? If Yes, you are denied. If No, go to step 2.
Step 2: Do you have a medically determinable impairment that has lasted or is expected to last at least 12 months OR end in death? Obviously, yes to lasting at least 12 months, so go to step 3.
Step 3: (A): Do you meet a Listing? I cannot answer this now based on limited information - but most claimants do not meet a listing because the severity of symptoms required to meet a listing are so extreme that few claimants can meet them. YOU CAN BE DISABLED WITHOUT MEETING A LISTING, AT STEP 5. (B) What is your residual functional capacity? In short, what is the most you are able to do in terms of work related activity? This will be determined by your medical records and your statements (testimony).
Step 4: Are you able to perform ANY of your past relevant work? Past relevant work is work you have performed at SGA level during the past 15 years; generally, this applies to full-time or almost full-time work that you performed long enough to become proficient in the work. So past work history is important. If Yes, you are denied. If No, continue to step 5.
Step 5. If you cannot perform any past relevant work (PRW), can you perform any other work that exists in significant numbers in the national, regional or local economy, based on your residual functional capacity, age, education, and work skills? If Yes, you are not disabled. If No, you should be approved.
Finally, there are guidelines called "Medical-Vocational Rules" or commonly called "Grid Rules" that direct a disability determination at Step 5. To determine whether you "grid" DISABLED under these guidelines, I need answers to the questions above about your education, current and past jobs.
I can tell you that age 57 is favorable because a person can "grid" as disabled much easier at "advanced age" (55 and over). A person with less education, advanced age, and no transferable work skills, who is also limited (RFC) to either light or sedentary work is likely to grid as disabled. However, you cannot be working or, as I said, you will be denied at Step 1.
As to time frames: In Alabama (I assume that's where you are) - it takes 90 to 120 days to get an initial decision. 72 percent of all initial decisions are denials. (Of course, that doesn't matter if you are approved; and at age 57 you would have a higher than average chance of approval, I think). If you are denied and have to appeal, it normally takes 11 to 12 months to get a hearing before an administrative law judge (after you are denied). After the hearing, it takes an additional 1 to 3 months to get a decision. After you get a favorable decision, payment of any back pay awarded takes up to 60 more days. So, I tell clients that you are potentially looking at a good 18 months start to finish if you have to go through the entire process.
Finally, it is possible to get "back pay" for the months you waited to be approved (after filing the application). From the "established onset date" of disability (the date Social Security finds you to have first become disabled), there is a 5-month "waiting period" in which no benefits are payable. For instance, if you are found to have become disabled on October 10, 2014, your waiting period would be November - March 2015 and your first actual payment would be for April 2015. (They eliminate the first 5 months of payments).
As for Medicare insurance, you have to wait 24 months from the date you first became eligible for payment of disability benefits.