Disability Overview: What You Need to Know - Aaron Delgado & Associates

Disability Overview: What You Need to Know

by Maria Indelicato
03/10/21 (Updated: 03/12/21)

Are you thinking about applying for disability? You’ve discovered you just can’t keep a job or aren’t able to work anymore because of your illness? Here is what you want to know before you start your journey.

What Are the Types of Disability?

There are two types of claims you can file: Title II (SSDI) and/or Title XVI (SSI) claims.

Title II claims are not needs based. Your work history will determine whether you qualify for Title II benefits. You must qualify for disability per Social Security. Title XVI claims (SSI) are need based. You must qualify for disability per Social Security (or over 65years of age) AND must meet the income criteria which is determined on the cost of living in your area. You essentially need to have very little assets and little or no real countable income.

The Social Security Administration defines being disabled as: Being unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

What Do You Need to File for Disability?

Still want to file? Ok. Before you file for disability you need to gather a lot of information. Make sure you have the following:

  • Date and place of birth
  • Name of your current spouse or any former spouse and their date of births
  • The beginning (and end) date of your marriage for each spouse and where you were married
  • If you have any children that are disabled prior to the age of 22 – their names and date of birth
  • Any military service record you have
  • Your employer details including the name, start/end dates, total earnings for the current year and the last two years – grab those W2s
  • Any self employment details (name of business and total net income) for the current year and the last two years – grab those 1099s
  • Your direct deposit information (yes, you need to have a bank account and the routing number available)
  • An alternate contact who knows about your information
  • A list of you medical conditions
  • Information about doctors, healthcare professional, hospitals and clinics
  • Information about your other medical records - any jail/prison medical records, any vocational rehabilitation records, any workers compensation records, etc.
  • The date you medical condition began affecting you ability to work
  • The 5 types of jobs you’ve had in the last 15 years
  • The type of duties you did on the longest job you had
  • The highest grade in school you completed and if you were in any special education classes
  • Name of any special job, trade school, or vocational training and date you completed that

Now, you have the information you need and you can fill out the Social Security Disability claim online. (We have the initial link below.) The process is relatively simple if you collected all of that information.

The Disability Claim Process

You filed the claim. You will have to wait anywhere between three and six months to hear if you were approved or denied. During this time, your claim is going to two places: a field office and a state agency. The field office will determine the non-medical issue (if your work history qualifies you for SSI or SSDI or both) and the state agency reviews and determines if your medical issues meet any of the 14 chapters of “listings” or the definition of disabled.

The claim is judged through five steps at every level.

  1. Substantial gainful activity (non-medical) – SSI, SSDI, both, or neither work/financial qualifiers
  2. Severe impairment
  3. Meet or equals a listing of impairment alone or in combination
  4. Perform past relevant work with new residual functional capacity (RFC)
    a. Work history for last 15 years
  5. Will new RFC preclude other types of work

If you were approved and are hoping your benefits start right now, that may not be the case. If your onset date isn’t two years ago, you’re going to still be waiting for the ability to have Medicare. Your onset date must be 24 months before your Medicare benefits kick in.

If you were denied, you only have 60 days to file an appeal.

This appellate level is called “reconsideration.” Sometimes it's because your documentation wasn’t what the state agency wanted to see. The state agency normally wants at least 12 months of medical evidence, unless you’re terminally ill. (This would be a compassionate allowance.) They are considering if your documented medical impairments are of such a severity that you can no longer do your current/previous works, but also considering your age, education, and prior work cannot work do any substantial work in the national market.

If you are at the reconsideration level and are within the 60 day timeframe, we can help you. We can help make sure that you have the documents and are represented appropriately. Our goal is to try to get you a quick disability determination at this point. Once a reconsideration is filed, your information will go to the state agency again where a different medical consultant and examiner does another independent review.

If you’re denied again, your next step here is to appeal. Again, you only have 60 days to file an appeal. The appeal at this level will bring you to a hearing with an Administrative Law Judge (ALJ). We highly recommend you have an attorney by the time you’re at the hearing level. You DO NOT want to go to a hearing with an ALJ alone. You want someone who knows the 14 chapters of disability listings by your side to help the ALJ and you navigate through it.

An ALJ can call witnesses. They can call experts – medical or vocational and they can send you to a medical consultant prior to the hearing. Your attorney can help you cross examine the expert. At the hearing, the ALJ will have likely read through the file but to what extent if unknown. An attorney can help the ALJ see the important parts for your individual case.

At the hearing level, it can take many months between your appeal and your hearing date with the ALJ. There are only 1500 ALJs at 150 hearing offices in the entire country. Claims get backed up. On top of it most ALJs do not make a decision in the hearing; most make a decision after the hearing in the form of a letter.

If you were again denied you can appeal, but again you only have 60 days to appeal. Once you do that an appellate counsel made up of ALJs and appeals officers review the decision by the judge and makes a recommendation. If you’re denied again, your last and final course of action is to appeal into the U.S. District Court, which is a federal court.

Our firm helps clients from reconsideration through the hearing levels. If you want us to help you and you’re in the greater Daytona Beach area, please call us for a free consultation.

File your initial application here: https://secure.ssa.gov/iClaim/dib

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