“He ain’t disabled…”

The popular misconception.

The popular misconception.

Perhaps one of the most frequent complaints a disability advocate will hear starts out with, “I know somebody collecting disability…” Then there is some description of the person which paints them as the picture of health. The complaint ends with something like, “he ain’t disabled… And if he is, then I should be found disabled too.” While we have touched on how our hypothetical complainer can prove his or her disabilities and begin receiving benefits, we have not talked about people that are already receiving benefits. Specifically, what benefit recipients must do continue receiving benefits.

For the most part, life on disability is the same as life without it. However, there are some requirements that disability beneficiaries must keep to as long as they are collecting benefits.

First off, an applicant for disability must remain disabled. This seems like common sense. However, some disabilities go away: cancer can go into remission, back surgeries are successful more often than not, a psychiatrist can finally find the right medication to control symptoms, etc. If a claimant experiences a significant improvement in medical symptoms he or she must report this improvement. The cynical reader would say this is how so much of the tremendous disability fraud is allowed to happen as the typical claimant is sure to not report these changes.

The Social Security Administration, though, is not content to take claimants’ words for it. Another major requirement for claimants is that they comply with Continuing Disability Reviews (CDR). CDRs take two primary forms and which form it takes is currently chosen by a computer. According to the Deputy Commissioner of SSA, the agency uses statistical modeling to determine which cases are most likely to need a continuing review. While the deputy commissioner did not specify how this modeling works, it is a reasonable assumption that the more a determination of disability depends upon subjective evidence at the outset, the more likely it is to receive a more intensive review.

CDRs can be done in paper or in a doctor’s office. Many disability claimants will have been required to visit a doctor as part of developing their claim. The examination they receive after they have been approved is essentially the same examination. The most major difference is that the doctor might assume at the outset that the claimant’s conditions were, in fact, disabling when the claimant was awarded benefits and is now looking to see if they still are. The rest of the CDR may involve an interview with the claimant, running earnings reports, and querying bank databases to ensure compliance with earning and asset rules.

A paper CDR is what is assigned to cases that are less likely to see an improvement in symptoms or that were awarded based on very solid objective evidence. In these reviews, the Administration sends claimants function reports, disability questionnaires, and work activity reports, among others, to record statements from the claimants about how they live their lives and what treatment they are getting. Any suspected medical improvement or unreported work will trigger the more intensive CDR.

Beyond the CDRs, claimants are responsible for notifying the agency of any material changes in their lives. This could be a simple change of address or, in some circumstances, things that seem less relevant such as the marriage or death of a dependent. Generally, these requirements are much more stringent for claimants receiving SSI than they are for those only receiving SSDI as these individuals can only exceed the original qualifying criteria under certain circumstances.

For instance, an SSI claimant that is single with no children is required to have $2,000 or less in the bank at all times. If the claimant does not report to SSA even a single time when their bank account may be over the allowable limit (a lump sum child support payment for instance) they can be deemed overpaid and required to repay all of the benefits that they have received after the overpayment occurred. So, in order to maintain benefits, a claimant will need to educate themselves as to the requirements applicable to his or her situation.

While these requirements may not seem to be particularly taxing, the ramifications for an individual who is relying upon these benefits to make ends meet are enormous. So, while it may appear that that neighbor, friend, or relative is not disabled, SSA has reviewed their case and will continue to do so to ensure that they are, in fact, disabled.

If you have questions about maintaining your benefits or applying for disability contact us today!

The SSI/SSDI Appeals Process

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One thing that any new applicants for disability benefits will hear about shortly after submitting their application is the disability appeals process. It can sound like a daunting and difficult process filled with claimant participation, occasionally making the claimant feel responsible for keeping the process moving. However, most times, while the claimant will be asked to fill out some paperwork, go to an interview, or a doctor’s visit, the process for claimants can be relatively seamless. This post (and the parts that come after it) will take readers through some brief descriptions of the steps in the appeals process and what the roles of the claimant and representative are at each stop.

The Application

The application is actually the first step in the appeals process. Most people think of the application as only beginning their claims for benefits. However, even the best compiled application can fall into the 60-65% of applications that are denied. Well thought out applications and supporting documents will lay the foundation for any subsequent appeals that may be necessary.

At this stage of the process a claimant should gather everything that they can to provide to SSA either directly or through their representative. This information is going to include doctors’ names, addresses, and dates of treatment; former employers and dates employed, education history, bank account information, and more. It is a lot of information to provide, but the more of it you have on hand, the more complete your application will be; the more complete your application is, likely means the quicker the response from SSA will be and with a greater chance of success.

For the application, the representative will have the responsibility of compiling the information from the claimant in a way that makes sense to SSA. This is going to mean several things. First is literally organizing the information. When completing an application for a claimant a representative will be required to enter this information in a certain order for an online application and then mailing, faxing, or both the packet of information collecting from the claimant to the Administration. The representative will have to find out which office it goes to, to whom the case has been assigned, and whether to request that SSA take certain actions such as requesting a consultative exam.

They will also be responsible for pointing SSA to the locations of the claimant’s medical records so the agency can procure everything relevant to the claim. Many representatives will do more to develop the record such as collecting medical source statements, collecting letters from collateral witnesses, and drafting briefs. The representative may also work closely with an SSA case worker on more detailed cases or SSI cases which are dependent upon the confirmation of detailed information and subjective valuations (i.e. blue book value vs. true car vs. eBay auction value) of assets such as homes and cars.

In a nut shell, it benefits the claimant to present as much information as possible when submitting a disability application. So, the representative’s role is generally to assist them in collecting it and communicating it to SSA in a manner that is easily digested by the agency.

Stay tuned for the next part of our discussion of the roles of the representative and the claimant during the appeals process! If you have questions about this before our series is done please do not hesitate to contact us!

Can I Earn Money While On Disability?

This is one of the most common questions disability advocates hear from individuals applying for or receiving Supplemental Security Income and Social Security Disability Insurance. The short answer is yes. However, there some limitations to be considered. Let’s begin with the rules for SSI since this is a little more complicated.

For SSI, some income is excluded from consideration by the Administration and is therefore not “countable income.” This is usually the first $65 to $85 (depending upon certain circumstances) of earned income and then half of the amount over the $65 to $85. Here is Nolo.com’s example of how that works:

For example, if you make $1,465 per month, the SSA will subtract $65 (to get $1,400) and then half of the amount over $65 (to get $700). That $700 is your countable income from work, and it will be subtracted from your monthly SSI payment (which is $733 without a state supplement). You would still get an SSI payment of $33.

Nolo concludes by stating that, “In a nutshell, you can make about $1,550 a month before your SSI benefit is reduced to zero.” One thing to consider about that, though, is that SSA can infer that you are actually capable of working full time if your SSI benefit is so substantially offset most or every month. This is, in part, because the substantial gainful activity earnings limit of $1,130 per month still applies to non-blind individuals collecting SSI. In other words, while you can possibly earn that much while receiving benefits, doing so could cause your benefits to be terminated.

There are other types of income that are excluded from consideration as well as work incentive programs that can help you keep your benefits while you work and earn money. There are also some types of income that SSA will consider along with earned income when deciding whether to offset your SSI benefit such as settlement payments, child support, investment dividends, and more. The SSA has a guide to earning money from work while collecting benefits that anyone considering working while collecting SSI should read.

For SSDI, things are a bit simpler. A person may not earn over the substantial gainful activity (SGA) limit in order to continue to qualify for SSDI payments. Many, if not most, types of unearned income are not considered in analyzing whether a person is earning SGA. Generally, SGA is based on earned income. So, you must not work and earn in excess of the $1,130 monthly limit in order to continue to qualify for benefit payments.

If your earnings do happen to exceed SGA, then there are a few exceptions to the SGA rule that can apply. For instance, if you earn in excess of SGA for one to three months but then stop working you will likely be considered to have completed an unsuccessful work attempt and the income you earned will not be counted against you. For work attempts up to six months, the same rules apply, however, you will have to show SSA that you had difficulty meeting the requirements of the job and ultimately stopped working due to your conditions. There is also the trial work period rule that will allow you to work and earn over SGA for nine months out of a rolling sixty month period. There are other types of work, sheltered workshops for instance, where the earned income may not be counted against you for the purposes of computing SGA.

SSA has these exceptions to the earnings rule to encourage people living with a disability to attempt to adjust to any manageable types of work without losing the benefits that they otherwise may need to live. However, as with most things in the disability process, for the exceptions to the rules to apply, you must be willing to work with SSA by reporting your work activity and providing records of accommodations, subsidies, or anything else your employer may be doing to help you get back to work.

Please contact us today if you have any more questions about earning money while on disability or if you are considering filing a disability application.