Category: Blog

New Timelines to submit new medical evidence or statements

Effective May 1, 2017, the Social Security Administration no longer allows individuals to submit evidence or statements less than 5 days before their hearing unless “good cause” exists. It should be noted, however, that the Administrative Law Judges are typically quite reasonable with this new standard and frequently will permit new evidence to be considered in spite of being less than 5 days if there is a reasonable excuse or explanation for failing to comply with this deadline.

Additionally, the Judges are often very willing to keep the record “open” if there is important major medical testing or procedures which are scheduled to be conducted shortly after the hearing. This permits the Judges to consider medical evidence that actually is generated after the hearing.  Understandably, the new medical procedures or tests do need to be conducted within a reasonably short time after the hearing as the Judges are reluctant to keep the record “open” for extensive periods of time.

A person’s disabling condition(s) must be the type that either has or will be expected to last for 1 year or more or end in death in order to qualify for social security disability benefits.

Many people focus on the medical severity of their condition when filing for social security disability benefits. While “severe” medical conditions is extremely important in the determination as to whether one is or is not “disabled” for social security disability eligibility, an individual must also keep in mind that the severe condition either has or is expected to last 12 or more months or end in death.  Consequently, “severe” medical conditions which clearly disable an individual but do not last (or likely to last) 12 or more months cannot qualify for this benefit due to the condition(s) not meeting the durational requirements under the Social Security Administration rules.

 

 

What is “insured status” for SSDI benefits?

In order to receive SSDI (social security disability insurance) benefits, you must be “insured” for these benefits. This means that you must have paid into the social security system through the Federal Income Contribution Act (FICA).  An individual must have worked a sufficient period of time to earn a requisite amount of quarters to be entitled to these benefits.  Every year a person can earn up to 4 quarters.  For 2017, 1 quarter of coverage is $1,300.00.  This means you must earn at least $5,200.00 for 2017 in order to obtain all 4 quarters for the year.

When am I eligible for Medicare coverage if I am disabled?

If you become disabled before retirement age and are awarded social security disability benefits, you will be entitled to Medicare benefits after a 24 month waiting period. Some disability recipients, however, do not even have to wait for 24 months to start Medicare.  The standard 24 month waiting period has been eliminated for SSDI recipients diagnosed with Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s Disease and for individuals diagnosed with end-stage renal disease or kidney failure.  These 2 exceptions are due to the poor prognosis of these diseases and the result of extensive lobbying efforts by support groups and advocates who work with individuals with these challenges.

Social Security Disability and Medicare – 3 common myths

Here are common myths about Medicare that all SSDI recipients need to be aware of:

Myth #1:         You must be 65 to receive Medicare benefits.

While this is true for many people, there are certain conditions that allow you to begin receiving Medicare coverage earlier, such as a disabling condition that qualifies someone for SSDI benefits. Social security disability recipients are eligible for Medicare benefits 24 months after their date of disability.

There are also certain conditions, such as ALS, that qualify people or Medicare the 1st month they become eligible for social security disability.

Myth #2:         Medicare covers all healthcare costs.

Many people mistakenly believe that Medicare covers all healthcare-related costs when, in fact, it does not. Long-term care (nursing home), most dental care and eye examinations related to prescribing glasses or contact lenses are not covered under Medicare.  Even for the services that Medicare does cover, there will still be a deductible or co-pay.  Medicare will cover 80% of the costs of most services.  There are supplemental Medicare plans available, such as Medicare Advantage and Medicare Part D that offer further coverage – but add an additional cost to you.

Myth #3:         Medicare costs the same for everyone.

When it comes to Medicare coverage, everyone does not pay the same amount. While there is a standard charge for Medicare Part B (medical insurance) coverage, there are surcharges that high-income individuals will have to pay.  Most SSDI recipients will not face these surcharges.

 

Social security disability programs provides modest but vital support

For most adult disability beneficiaries, SSDI and SSI benefits make up all or most of their income. SSDI benefits serve as the main or sole source of income for about 80% of beneficiaries.  About 1 in 3 SSDI or SSI beneficiaries have no other source of income.

SSDI and SSI benefits keep millions from deep poverty and homelessness. Without SSDI, an estimated one-half of beneficiaries would live in poverty, even with benefits.  About 1 in 5 SSDI beneficiaries live in poverty with the majority being low income.  About 43% of SSI beneficiaries live in poverty.

Online SSI claims now possible effective March 25, 2017 – for some people

Certain applicants may now apply online for SSI (supplemental security income) benefits if they meet all of the following criteria:

  • Age 18-64;
  • Resides in 1 of 50 states, the District of Columbia or the common wealth of the Northern Mariana Islands;
  • Alleges a disability but not blindness;
  • Never married; and
  • Claimant’s social security number does not exist in any SSI system (have not previously applied for SSI benefits)

 

Disability backlog tops 1 Million; thousands die on wait list

More than 1 million Americans await a hearing to see whether they qualify for disability benefits from Social Security with the average wait nearly 2 years – longer than some of them will live.

All have been denied at least once, as most applicants are initially rejected.

Last year, there were 7,400 people on wait lists who were dead according to a report by Social Security’s Inspector General. The Social Security Administration says it is working to reduce the backlog by hiring 500 new Administrative Law Judges (ALJs) and more than 600 support staff.  The Judges, who now hear about 1,600 appeals from people who were initially denied benefits.  Unfortunately, budget cuts over the past 5 years have frustrated efforts to reduce the disability backlog.  Last year, the agency’s budget was 12.6 billion, roughly the same as it was in 2011, even though an additional 6 million receive either retirement or disability benefits from Social Security.  Statistically, the best chance of success is at the hearing level before an Administrative Law Judge, however, the backlog makes it extremely difficult for individuals waiting for their hearing to be scheduled.

Review of your Case After Benefits are Being Paid

Often your case will be reviewed at a later date by the Social Security Administration to see if your disabling conditions(s) have improved to the extent that you are no longer disabled under the Social Security rules. Conditions that are expected to improve are often reviewed in 6-18 months. You will receive a letter advising you that the case is being reviewed and they will ask for additional medical information about your condition. It is important to continue to treat for problems that disable you if they remain severe so that proper documentation can be provided in the event of such a review.

What to Expect at an Administrative Law Judge Hearing

The Administrative Law Judge hearing is the last administrative stage in a SSDI or SSI appeal. It takes a year or more to reach the administrative hearing after making the request. It is intended to be an informal fact finding hearing to assist the judge in his or her decision on your case.

The people present at the hearing are the judge, your attorney, the claimant, and a hearing assistant. There may also be present a vocational expert or medical expert. The job of these experts are to give testimony concerning the evidence presented in the case.

The hearings typically last about an hour. The judge usually begins the questions and then affords your attorney the opportunity to ask questions as well. Sometimes the judge will have the attorney initiate the questioning. The questions asked will involve your past education and work history, your issues with the medical or psychological conditions that effect your ability to work and also what types of things you can and cannot do on a daily basis. Questions will also be asked by the judge to the vocational and/or the medical expert. Your attorney is also allowed to ask these experts questions as well.

Typically, the judge does not render his or her decision at the conclusion of the hearing. It is usually written and sent out to both the claimant and the attorney at a later date. Typically about a month or so but that can vary. A favorable decision will result in the initiation of benefits.

New Rules on “Acceptable Medical Evidence”

There have been recent changes to the Social Security rules which now expand the list of “acceptable medical sources” to include advanced practice registered nurses (APRNs), licensed audiologists, licensed optometrists and physician’s assistant. Additionally, the rules have changed so that no longer are treating physician’s opinions given controlling weight as compared to non-treating medical sources. This new rule affords the Administrative Law Judges more deference to weigh evidence as they see fit. Consequently, the opinions of a treating physician are no longer given controlling weight but rather are considered with all other medical information for purposes of the Judge’s decision. These rules take effect on all claims filed after March 27, 2017.