Whether you are applying for disability through a private insurer or the Social Security Administration, you need to be prepared. The Social Security Administration and most private insurance companies rely primarily on your physician’s records to determine whether you have a qualifying disability. The burden to produce these records falls solely on you.
How Do I Know If I Qualify?
The Social Security Administration defines a disability as a medically determined physical or mental condition which could result in death and that prevents you from engaging in a substantially gainful activity for a continuous period that will last no less than 12 months. Substantially gainful activity is a term the Social Security Administration uses to define your capacity to work. For 2021, substantially gainful activity is having monthly earnings greater than $1300 or $2190 if you are blind.
Medically determined physical and mental conditions are those that result in an anatomical, physiological, or psychological abnormality shown by medically acceptable diagnostic techniques. Diagnostic tests include cat scans, MRIs, X-Rays, colonoscopies, sonograms, and other tests used to discover illnesses.
While documenting your symptoms daily is important for demonstrating your performance level, a statement of symptoms is not enough to support a disability claim.
Private insurance companies will follow guidelines similar to the Social Security Administration to make a determination. However, if you are submitting a claim through a private insurance company, you need to read the policy carefully. Certain restrictions may preclude your claim. A pre-existing illness can bar your claim for a certain amount of time, known as an exclusion period. Exclusion periods can last anywhere from 90 days to 2 years. Certain insurance companies will not cover nervous and mental conditions, intentional acts that inflict a disability, suicide attempts, alcohol and substance abuse, and war.
If one restriction applies and you have other documented conditions, one of those conditions may make you eligible to receive benefits. It is important to include all your medically determined physical and mental conditions when you file a claim. It shows the full scope of your overall wellness and gives a clearer picture of your inability to financially support yourself.
When Do I Apply?
As soon as you receive a diagnosis and as a result of that diagnosis one of the following are true. 1. You start having difficulty completing full days of work on a regular basis or 2. are on short term disability and expect that your condition will not improve when your short-term disability coverage ends. Do not wait. I cannot emphasize the need to act enough. The review period can be lengthy. It can last for 3 to 5 months. If you are initially denied coverage and must appeal your claim, the process will take longer.
If your injury was initially caused because of an accident, you might want to find an attorney who can give you advice. There are many disability advocates in the U.S., however FreeCaseEvaluations.com is one place you can find one. The website is a marketplace of the some of the best legal leads for attorneys or best legal leads for lawyers, who specialize in your situations and can help you get the benefits you deserve, before starting the social security disability process. Hopefully, setting you up for a better future.
Visit Your Doctors
It sounds obvious. Once your claims process begins, the purpose of the doctor visit is twofold: 1. To obtain medical treatment. 2. To gather the records, documents, and diagnostic test reports you need to support your diagnosis and the ways it limits your daily activities. Once you start the claim process, you need to focus not only on medical treatment but obtaining detailed medical records. Make your doctor aware that you are applying for disability and need detailed records. Specifically request records of all diagnostic tests. Make sure that the report is well written and includes as many supporting notes to describe your condition. A report of symptoms alone will not help you, you need specific record of the findings in diagnostic tests that qualify your disability.
Some qualifying disabilities include but are not limited to endocrine disorders, heart disease, inflammatory bowel disease, hearing, speech and vision loss, lupus, cancer, anxiety, bipolar, schizophrenia.
Be Realistic
The claim application, whether it is the Social Security Administration application or an application through a private insurance company will ask many questions about your ability to perform specific tasks. These tasks will relate to activities you do every day: standing, walking, sitting, preparing meals, concentration, and many other tasks you may need to do in a work environment.
It can be quite humbling to admit that you have difficulty with basic tasks. Now is not the time to act proudly, it is the time to be honest. Think of the worst day you have with your condition; can you complete these tasks? Also think of the amount of time you need to rest in between performing these tasks. Remember when you work a full-time job, you may not always get a break. Questions to think about include-
• How well you function under stress?
• When you are in pain or don’t feel well, can you concentrate?
• How many days you will need sick leave?
• What special accommodations you need?
Take all these factors into consideration when answering the questions before you.
What to Expect
Once you file a claim, the Social Security Administration or your insurance company will request records from the physicians and medical professionals that have been treating you. They will review all of these records and may request additional documentation from your treating physicians, order additional diagnostic testing, and schedule an appointment for you with one of their physicians.
In addition to medical records, the Social Security Administration will review your prior work history. They will look at things like the type of work you did, your education, and special training you have. In reviewing your prior work history, the Social Security Administration not only considers your ability to continue your former job, but your ability to adapt. For example, an individual engaged in a job that required lifting heavy boxes, who has a high school diploma, and no special training will not easily adapt to another job. However, an individual with college education and a degree in business may be able to find other work.
Stay Calm
Requests for additional documents, tests, and meeting with physicians (other than your own) are all routine parts of the process. You can minimize these requests by obtaining as many records as possible from your treating physician and gathering information that relates to your work history.
During this time, you will have to answer questions about your health history that can be upsetting when you are already not feeling well. Do not let this deter you from submitting a claim. There are ways to manage the stress of the claim process which can last for many months It is wise to have a support system to help you through this time and an attorney to guide you through the process.
Remember, until you have a determination, nothing has happened. So, respond to the requests and wait.
What Happens When My Claim is Denied
You will receive a letter in the mail. You will have a period of time to request a reconsideration. Generally, the time to reconsider is listed in the letter. For Social Security, it is 60 days. Review the letter carefully paying close attention to the specific grounds for denial. Gather documents and supporting medical records to respond to each denial listed in the letter.
For Social Security, this process can be done online. Private insurers will have specific rules to follow for reconsideration.
It is important to follow each step closely and adhere to all the deadlines. You do not want to be denied due to a preventable reason like omitting information or missing a deadline.
Once you submit these documents, an independent person who has not previously been involved with your case, will review the determination.
In the event that you receive a second denial letter, you will be given an opportunity for a second level of appeal. For Social Security, this Appeal is with an administrative law judge. This might be the best time to check out www.freecaseevaluations.com/ssdi4 for a questionnaire on social security disability referrals for lawyers, so you can get paired with a disability advocate. Going in front of an administrative law judge is not easy, and can be very nerve wracking; why not go in with the confidence of a qualified, specialized attorney that can fight for you?
What Happens When My Claim Is Approved
You will receive a letter stating that you are eligible for benefits based on your disability. This letter will provide the onset date of your disability. This is the date that Social Security finds the disability began. Social Security will begin paying benefits 6 months after the onset date. If this date is prior to the date you submitted a claim, you will receive pay for the months prior to your claim submission but before Social Security received your application.
How Do I Calculate My Benefit Amount
The monthly payment you will receive from Social Security Disability is determined using your earnings prior to the onset of your disability as a starting point. The formula is rather complex — it is based on your “covered earnings.” Covered earnings are the amount of Social Security taxes you paid out of your prior earnings. The Social Security Administration has a benefits calculator on their website.
Your benefits are not based on the severity of your disability or the amount of financial resources you have. However, your Social Security Disability Benefits will be reduced if you receive benefits through private insurance, workers compensation or some other source. For 2020, monthly payments for Social Security Disability ranged from $800 to $1800 with the average payment about $1,200.
Benefits received through private insurance are based on their company specific rules. Review your policy to determine the amount of monthly benefit you are eligible for.
Working While Disabled
Social Security does encourage you to work if you are able to do so without jeopardizing your medical well-being. The Social Security Administration provides programs to help you work while you are disabled. The main program called the “Ticket to Work Program” provides services like retraining, career planning and coaching, job placement, and accommodations. More details about this program are available on the Social Security Administration website.
You may continue to work and receive benefits as long as you are not engaged in substantial gainful activity. For 2020, this amount is around $910 per month. Once you start earning this amount, you are eligible for what is known as a trial work period. During this trial period, you can continue to receive your benefits for a period of time. In 2020, this time period is 9 months. For more information about the trial work period, visit the Social Security website.
Many private insurance policies will preclude you from working during the time you are disabled. Your ability to work and still receive benefits through a private insurer depends on the terms of your specific disability insurance policy.
Health Insurance
While you are receiving Social Security Disability benefits, you are eligible for health insurance under Medicare. However, coverage under Medicare will not begin until 24 months after you first become eligible for disability. During this waiting period, you may be able to get health insurance from a previous employer.
Plan for the Future
Having a chronic illness is expensive and the pay you will receive on disability is minimal. Private insurers usually pay more than Social Security Disability Insurance pays. It is important to protect your assets and you may have to find additional assistance to help meet your expenses. You may want to consider consulting with an attorney to create a special needs trust and discuss options for an insurance plan.
Talk to a Lawyer
When considering applying for social security disability benefits you may want to consider talking to a lawyer, to help fight for your benefits. In fact, more than 60 percent of applicants are denied on the initial application and the appeal process can take even longer, so it’s best to get it right the first time. Consultations are usually free, and more information is always better. At least then, you can be fully confident in your decisions, and know you looked at all your options.
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