What does Medically Determinable Physical or Mental Impairment Mean?

A medically determinable physical or mental impairment is a medical condition that can be shown to exist by medically acceptable clinical and laboratory diagnostic techniques. (20 CFR §404.1508). Social Security Regulations specifically state, “a physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings, not only by your statement of symptoms.”

Even if you have a number of symptoms that are preventing you from working, if you have not received a diagnosis, you cannot be found disabled. (See 20 CFR §404.1529). This is why medical treatment is so important to Social Security disability claims. If your symptoms, such as pain, fatigue, weakness, or nervousness, are not explained with medical signs or laboratory findings that show a medically determinable impairment, Social Security cannot determine that your symptoms affect your ability to do basic work activities. (See 20 CFR §404.1529).

Obtain a Medically Supported Diagnosis Before Applying for Disability Benefits.

If you are experiencing symptoms that prevent you from working, you must receive treatment to determine the cause of your limitations. Once you receive a diagnosis, your symptoms must be supported by signs and laboratory findings. “Signs are anatomical, physiological, or psychological abnormalities which can be observed, apart from your statements.” (20 CFR §404.1528). Laboratory findings are “anatomical, physiological, or psychological phenomena which can be shown by the use of medically acceptable laboratory diagnostic techniques.” (20 CFR §404.1528).

In the simplest form, you must receive treatment, your doctor must confirm that the symptoms you express are occurring, and test results should support the diagnosis. If you have not been diagnosed, or your diagnosis is not supported by signs and laboratory findings, you cannot be found disabled.

I suggest to my clients that they have open conversations with their doctors about their medical condition. If you are unable to obtain a diagnosis from your primary doctor, ask for a referral to a specialist. If you are diagnosed with a condition, but have not underwent any medical testing, ask if a test could confirm your diagnosis. Make sure that your doctors are asking you about your condition on each visit, and that you report any symptoms that you are experiencing.

Persistence is so important when you are suffering from serious symptoms affecting your ability to work. Make sure that your doctor understands what you are experiencing, and that her or she is helping you obtain an explanation and treatment for your symptoms. If your condition cannot be explained by a physical condition, also ask your doctor to explore possible psychological causes.

This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.

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Recently James publishing launched JamesDisabilityLaw.com. I was excited to see the launch of the site, as I am a subscriber of five Social Security Disability practice guides published by James Publishing. The practice guides help me stay informed of developments in Social Security Disability Law, and educate myself on unique issues that I do not see on a daily basis. These practice guides are a great resource that have helped improve the representation I provide to my clients.

I was disappointed to see that JamesDisabilityLaw.com is not as helpful for claimants. Although some topics on the website are useful for individuals applying for disability, advice provided regarding representation is not. I have previously written several articles on this site about the advantages of having an attorney, how an attorney can help you with your initial application, and how you can improve your application before applying. Since I previously discussed these topics in detail, I will not rehash the entire articles, but I will simply state that you should never be discouraged from obtaining an attorney as early as possible in the disability process.

My problem with JamesDisabilityLaw.com is that the site suggests that you should not obtain an attorney to help until you are denied at the reconsideration level. You are also discouraged from obtaining an attorney when initially applying for benefits. The site indicates that most observers agree that this timing works, but no authority is cited for this proposition.

In the “Common Social Security Disability Questions” section of JamesDisabilityLaw.com, it is again indicated that the best time to obtain an attorney is before an Administrative Law Judge Hearing. What is surprising about this statement, is question 6 indicates that two of the biggest mistakes you can make in the disability process are: 1) failing to appeal; and, 2) failing to obtain appropriate medical care.

Why I disagree with advice from JamesDisabilityLaw.com

The reason that it is important to have representation while pursuing disability benefits, is that an attorney will advise you on how to strengthen your claim. The three biggest mistakes that I find people make in initial applications are: 1) failing to properly document treatment received; 2) failing to list all medical impairments; and, 3) failing to properly answer questions in disability questionnaires. All of these errors remain in your file throughout the disability process. Although you can file amendments to your application in the future, I have seen many individuals denied benefits because they improperly answered questions when they were unrepresented.

I would never suggest that every individual that is applying for disability benefits requires an attorney when pursuing disability benefits; however, there are advantages for everyone pursuing disability benefits to have representation. Although attorneys will charge a fee for the representation that they provide, you should be advised to weigh the advantages of the assistance with the cost for the services. This should be an individual decision based on your specific circumstances.

General disability websites do not provide state specific advice

When reviewing General Information about Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) payments, it is important to note that there are differences in the disability process based on the state you live in. Although the disability standard is the same, I have also written several articles discussing the difficulty of being approved at the Administrative Law Judge level in Delaware. (See High Delaware ALJ Denial Rates, Impact of High Denial Rates in Delaware, and Fiscal Year 2010 Denial Rates Remain High in Delaware). Mistakes made at the initial and reconsideration stages can cause you to continue to be denied benefits in the future, or to lose eligibility for considerable past-due benefits.

Because of the high denial rate at the Administrative Law Judge level in Delaware, it is important that you take every step to be approved for benefits at the earliest possible time. Steps taken to strengthen your claim before you get to the Administrative Law Judge level will also strengthen your claim if you eventually require an ALJ Hearing.

Initial consultations for Social Security Disability are usually free

The great thing about the Social Security disability process is that attorneys cannot charge any fee without authorization from the Social Security Administration. Since authorization is needed in order to charge a fee, most Social Security disability attorneys see you for a free initial consultation before agreeing to take your claim. This free initial consultation helps you make an informed choice of whether representation would help based on your specific circumstances. Although many individuals are successful in obtaining benefits without the help of an attorney, with the growing backlog of disability claims and the high ALJ denial rate in Delaware, it is important that you make an informed decision before proceeding with an application without legal assistance.

I have forwarded my complaints to JamesDisabilityLaw.com, and I hope that my feedback will help improve the website. There are several areas on JamesDisabilityLaw.com that help educate you on the disability process, but I am just concerned that by discouraging individuals from obtaining legal assistance, they may cause more people to be denied benefits.

UPDATE: I received a response from Jim Pawell, President of James Publishing, shortly after emailing my complaints. I am happy to report that Mr. Pawell graciously accepted my criticism, and is very open to including opposing viewpoints of representation on his site. I am hopeful that areas that caused me concern will be revised in coming days. I also encourage others to forward suggestions to Mr. Pawell. I truly believe that the goal of James Publishing is to provide a site that is complimentary to the excellent practice guides that they publish. I will continue to explore this site myself and provide feedback that can assist individuals pursuing benefits.

This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.

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When you apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) payments from the Social Security Administration, it is important to realize that different standards are used to determine your disability based on your age. As an adult, it is hardest to qualify for benefits if you are between the ages of 18-49. The closer you are to full retirement age, the easier it is to qualify for benefits.

Below is a brief overview of what you must establish in order to prove that you meet the medical requirements of disability. These are just general guidelines, so it is always important that you speak to an attorney about your eligibility even if it appears that you will not qualify based on the information below.

Disability Benefits for Individuals Ages 18-49

• Generally to be found disabled:*
  
  • You must have a solid work history (have worked in 5 of the last 10 years before becoming disabled and earned sufficient lifetime work credits); and
    
  • You must have less than $1000/month (in 2010) of earned income; and
    
  • You must have a medical condition (or a combination of medical conditions) that prevents you from performing any of the work you have done in the last 15 years; and
    
  • You must be unable to perform any full-time work (regardless of pay or experience).
    

Disability Benefits for Individuals Ages 50-54

• Generally to be found disabled:*
  
  • You must have a solid work history (generally have worked in 5 of the last 10 years before becoming disabled and at least 7-8 years during your lifetime); and
    
  • You must have less than $1000/month (in 2010) of earned income; and
    
  • You must have a medical condition (or a combination of medical conditions) that prevents you from performing any of the work you have done in the last 15 years; and
    
  • You must be limited to lifting no more than 10 pounds of weight; and
    
  • You must be unable to stand for more than 15 minutes every hour in an 8 hour workday; and
    
  • There must be no sit-down jobs that exist in the economy that use skills that you have acquired from jobs performed in the last 15 years that you still have the ability to perform today.
    

Disability Benefits for Individuals Age 55-64

• Generally to be found disabled:^*
  
  • You must have a solid work history (generally have worked in 5 of the last 10 years before becoming disabled and at least 8.5-10 years during your lifetime); and
    
  • You must have less than $1000/month (in 2010) of earned income; and
    
  • You must have a medical condition (or a combination of medical conditions) that prevents you from performing any of the work you have done in the last 15 years; and
    
  • You must be limited to lifting no more than 20 pounds of weight; and
    
  • There must be no jobs that exist in the economy that use skills that you have acquired from jobs performed in the last 15 years that you still have the ability to perform today.
    

Documentation Required to Proof Disability

• You must have a documented medical impairment; and
  
• You must be receiving ongoing care for your medical condition; and
  
• You must comply with your doctor’s orders (take medication, attend scheduled appointments); and
  
• Your doctor should support your application for disability.
  

Advantages of Being Found Disabled as Opposed to Early Social Security Retirement

• Your Social Security Retirement benefits are not reduced (if you begin retirement early your benefits are reduced for the rest or your life); and
  
• You are eligible to begin Medicare coverage after 24 months of Social Security disability payments; and
  
• You protect your earnings record so that your retirement rate does not decrease.
  

When to Consider Social Security Disability

• You are injured in any way that prevents you from performing work;
  
• You are diagnosed with a medical condition that prevents you from performing work or is terminal;
  
• You retire from work early because you are unable to continue to perform your work
  

What Happens if You do Not have Sufficient Work Credits to Qualify?

• If you have limited income and resources, you may qualify for Supplemental Security Income Payments (SSI);
  
• SSI has the same medical requirements as SSDI, but you also have to establish financial need for eligibility;
  
• Social Security also considers income of spouse when determining eligibility.
  

This is just general information to help individuals that are considering applying for Social Security disability benefits. Please contact our office, the Social Security Administration, or another attorney if your situation matches the criteria discussed above.

^* The rules are slightly different for individuals that are illiterate or unable to communicate in English.

This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.

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Luckily, SSA has many services available online. The services are mostly easy to use, but caution is still necessary. Although many activities can be completed online, it is often still necessary to submit paper documents to complete the process.

The following are the most relevant online services for individuals that are pursuing disability benefits from SSA:

• Research Disability Requirements
• Request SSA Benefit Statement
• Check Status of Social Security Disability Claims
• File an Appeal of your Social Security Disability/Supplemental Security Income Denial
• File an Application for Social Security Disability Insurance Benefits

Although SSA has done an excellent job of providing online resources for individuals pursuing disability benefits, it is always recommended to consult an experienced legal respresentative before relying on the information found. SSA does not tailor information on its website to you specifically, and it is possible that information you find may not be accurate based on your unique circumstances.

Researching Requirements of Disability Programs

The SSA Website provides a wealth of details about SSA disability programs. One of the most useful tools is the Benefit Eligibility Screening Tool (BEST). BEST uses details that you provide to help determine which SSA programs, if any, you qualify for. Although this tool normally correctly identifies the programs that individuals may be eligible for, do not assume that the answers are always accurate. If BEST indicates that you do not qualify for benefits, I would still be available to help determine if the information that was provided is accurate.

My favorite part of SSA’s online services, is information that it provides to help you understand SSDI and SSI. An overview of the disability program requirements, application process, and the determination process are provided. There is also a section for Frequently Asked Questions about SSDI and SSI. Most information is general, but it still is a great educational resource. I provide much of the same details found on SSA’s website during an initial consultation appointment, but potential clients often find it helpful to have knowledge of the disability programs before we meet.

Request Social Security Benefit Statement

SSA normally sends a benefit statement to all adults with reported income several months prior to their birthday each year. The Social Security Benefit Statement provides information that is useful in determining eligibility for SSA disability programs. The benefit statement provides estimates of your eligibility amount for various Social Security Programs including disability, and helps an advocate determine whether you have sufficient work credits to qualify for SSDI.

If you have not received a Social Security Benefit Statement recently, SSA allows you to request a benefit statement from its website. It typically takes between 2 to 4 weeks to receive a statement after it is requested. I recommend that all potential clients request a Social Security Benefit Statement prior to applying for benefits. The statement provides the single best way of answering the question, “how much will I receive if I am approved for disability benefits?” If you do not have earnings information available when you meet with me, I am normally unable to answer that question. The Social Security Benefit Statement solves that problem.

There is no hazard of requesting your benefit statement without assistance from a legal representative, and I highly recommend that anyone considering applying for disability benefits request one.

Checking the Status of Your Disability Application

When you apply for SSDI or SSI you are provided with an application confirmation number. This number is provided whether you apply for benefits online or in person at your local SSA office. If you apply in-person, your application number is on your application receipt. When you apply online, the confirmation number is provided when submitting your application.

With an application confirmation number, you are able to check the status of your application through SSA’s website. Typically, the only information provided is that your application is pending. You are not provided with specifics of the process or alerted to problems with the processing of your application.

Although the information provided is not currently very useful, I expect that this will improve in the future. Currently, I warn my clients not to rely on any of the information that is found on the online status page. I have found that several times after an appeal is submitted, SSA’s website has not yet updated the status of the claim. If you are concerned about the information provided when you check on your status, I can work with SSA to obtain accurate information.

File an Appeal Online

SSA allows you to file an appeal of an initial denial or reconsideration denial of SSDI or SSI online. However, there are multiple steps that are necessary to actually complete the appeal. Although an experienced attorney is able process an appeal online without difficulty, an inexperienced individual can easily miss a required step when attempting to file an online appeal. If you fail to accurately complete your appeal, it is possible that you could lose substantial benefits or even eligibility.

I personally use the online appeal process for all my clients. It saves time for SSA because a claims representative does not need to enter all of the information by hand. It saves time for my office because we receive receipts confirming the submission of the appeal and I know the information was entered accurately.

The process is simple if you know what you are doing, but small mistakes can lead to the loss of substantial benefits. Before using the online appeal process, I would highly recommend obtaining the help of a legal representative. If you are unable to obtain help from an attorney, it is in your best interest to appeal in-person at your local SSA office.

Filing an Application for Social Security Disability Insurance Benefits (SSDI)

SSA encourages all individuals applying for SSDI to apply online. By applying online, you save valuable time for claims representatives. Instead of a claims representative having to take 30 to 60 minutes to meet with you to complete application, they simply review the information transmitted from the Internet and make sure that you have completed all steps necessary to apply for benefits. Since SSA resources are limited, online filings assist representatives with handling more claims.

SSA indicates that it takes an average of 30 minutes to complete an online application for SSDI. Although it is not very time consuming to complete, the answers that you provide will have a long-lasting impact on your eligibility for benefits. For individuals that are not well versed in the disability process, several mistakes can be made. Entering the wrong date can cost you several months or years of disability eligibility. Incorrectly providing information can also be considered fraud with criminal implications.

I agree that the online application is great productivity tool for SSA, but I am concerned that individuals can potentially harm themselves by completing an application without the help of an experienced legal representative.

The value of applying in person is that an SSA claims representative is also required to screen your claim for eligibility for other programs. When you apply online, you can currently only file an application for SSDI. Additional steps are necessary in order to complete an SSI application. Failure to apply for SSI can result in loss of potential financial and medical benefits.

I normally use the online application process to complete applications in my office. This allows my staff to review the information being submitted and confirm its accuracy. It is important to note that after you complete an online application on SSA’s website, several additional documents still need to be submitted before your application is actually complete. If you fail to submit all documents, your application may never be processed and you could lose potential benefits and even eligibility. If you need help filing an application for disability benefits, contact my office so I can determine if I can assist you.

Be Careful Using Social Security Online Resources without Help

Although I applaud SSA for embracing technology and using it to be more productive, many risk are involved with the online tools that have been made available. I recommend that individuals strongly consider scheduling a consultation with my office before pursuing Social Security disability benefits or appealing disability denials using the online tools.

The value of the free initial consultation is that there is no obligation when consulting my office for help. SSA Online services are helpful for individuals to educate themselves and obtain general information, but the services introduce inherent risks that were not present when you were required to interact with an SSA claims representative.

This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.

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When reviewing disability, the Social Security Administration requires medical proof of your disability. This means that the Social Security Administration will look for objective results that support your limitations. It is important that your treatment records contain details reflecting your symptoms, your response to treatment, results of diagnostic testing, and a plan of treatment.

The Medical Society of Delaware (“MSD”) is a society of physicians with the core purpose to “guide, serve and support Delaware physicians, promoting the practice and professional medicine to enhance the health of our communities”. In May 2006, MSD developed treatment guidelines for chronic pain. Although MSD abandoned the development of new guidelines in February 2009, the previously developed guidelines remain available for review.

According to MSD, the guidelines were created to assist primary care physicians in treatment of patients with chronic pain in recognition that chronic pain causes physical and emotional suffering of patients. It is specifically recommended by MSD that consultation with specialists be incorporated into the patient’s treatment plan. Physicians are directed to consider not only the pain diagnosis, but also emotional and functional impact pain has on their patients.

The following areas are notable in the guidelines:

• The diagnosis of a painful condition should include an extensive differential diagnosis that rules out treatable and reversible etiologies while rationally managing symptoms of severe pain.
• An initial assessment of chronic pain should include a detailed history (including vocational issues related to pain), full physical exam, consideration of diagnostic studies, differential diagnosis, and a plan of care. The plan of care should be developed with consideration of patient’s history, examination, and goals.
• When implementing a treatment plan, physicians are instructed to ask about pain regularly, accept patient reports of pain, intervene early, and provide information that helps empower patients to make appropriate decisions.
• Timetables should be developed and the rationale of treatment should be discussed with patients. Documenting the treatment by measuring the progress of pain is essential.
• Objective examination results that reveal abnormalities should raise red flags that lead to specialist referral.
• After diagnostic assessment of pain, conventional treatment (including physical therapy, exercise, chiropractic evaluation and short acting pain medications) should be followed by specialist referral if no improvement in symptoms after more than 6 weeks of treatment.
• Family physicians should determine if psychiatric symptoms exist and consider referral for psychiatric or psychological assessment.
• After an initial treatment plan is created, physicians should monitor and record changes in medical history, perform a focused exam to correlate subjective complaints, observe functional limitations, order and review diagnostic testing, and revise the treatment plan based on the patient’s response to treatment.

The guidelines suggested by MSD explain why specialist care is important when you suffer from long-term chronic pain. If your family physician has not referred you for specialist care, it is important that you discuss and question that decision. If your pain fails to respond to the treatment that you are receiving, suggest additional care to better evaluate your symptoms and discuss the guidelines with your physician.

I am not suggesting that a family physician should not be involved in chronic pain treatment, only that your physician should realize when additional care is needed. The plan for pain management care should be reviewed with your family physician, and your family physician should manage and coordinate your care with other physicians. The purpose of these guidelines is to help you obtain relief of your pain. If your physician follows these guidelines, your condition will be better documented, you will receive heightened care for your condition, and it will ultimately be more likely that you will qualify for Social Security disability benefits if your condition fails to improve.

This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.

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Even if your doctor believes that you are currently unable to work because of your diagnosis, the most important question is how long the diagnosis will prevent you from returning to work. Early stages of breast cancer are normally treated with a lumpectomy followed by possible radiation, mastectomy, and/or chemotherapy. I have had several clients that have completed all of their treatment for breast cancer and experienced a complete remission within 6 to 10 months of their initial diagnosis. Since the Social Security Regulations require that an impairment be severe enough to prevent you from performing work for a full 12 months, these individuals are denied benefits unless side effects of treatment (or other medical conditions) otherwise limit their ability to perform work.

While the immediate concern with breast cancer will be the treatment of the cancer itself, it is important to pay attention to other symptoms that occur. Due to the traumatic nature of the disease, it is common to experience depression because of a breast cancer diagnosis. It is important to discuss any emotional symptoms that you experience with your doctor, and if necessary to even seek psychotherapy. If you fail to seek treatment for these symptoms, it is unlikely that the Social Security Administration will consider any limitations that are directly related to depression.

If you are required to undergo chemotherapy or radiation, it is also important that all side effects of your treatment be discussed with your oncologist and/or radiologist. It is normally determined that during chemotherapy and radiation an individual would have a difficult time performing full-time work, but it is still important that difficulties are recorded by your treating physician. Some individuals with mild symptoms are actually able to continue performing work activities while undergoing treatment. Since not every individual has the same side effects, your doctor must be aware of any problems you are experiencing.

If your cancer is detected early and your oncologist is optimistic that remission will occur after only a brief period of time, consult with an attorney to determine the likelihood of success if a disability application is pursued. Depending on your unique circumstances, an attorney can advise whether it is in your best interest to file a disability application immediately or if you should wait until after you have underwent your initial treatment. An attorney will also remind you of the importance of receiving treatment for other symptoms and not just those that you relate to your cancer diagnosis. This could be very important for establishing that the durational requirement of the Social Security disability program is met.

Luckily the majority of my clients with breast cancer have experienced complete remission within 6-18 months of diagnosis. Most of these individuals ultimately qualified for a closed period of disability benefits because their symptoms prevented them from performing full-time work for at least 12 months, but several were found to be ineligible for benefits because with treatment they were able to begin work again less than 12 months after their initial diagnosis. Only a small portion were eligible for ongoing benefits, and normally this was because the treatment was unsuccessful or because the cancer treatment caused severely limiting side effects.

The important thing to remember when you are diagnosed with breast cancer is that with early detection, the disease is much more treatable and remission is more likely. To have the best chance of being approved for Social Security disability benefits, it is important that you understand the process and the rules of the Social Security disability program. Consulting with an attorney early in the process will help protect your rights and assist you in better documenting your eligibility for the Social Security disability programs.

This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.

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Sample Social Security Disability Denial Letter

My clients are often concerned that they were denied benefits because their doctors indicated to Social Security that they could work. The notice specifically states, “the following reports and records were used to decide your claim”. It is often assumed that if a doctor is listed in the notice, that a medical report was provided regarding the individual’s disability status. This assumption is normally wrong. In my experience, 99% of the time only medical records were provided to the Social Security Administration after the Disability Determination Service requested information. The notice is simply providing a list of any doctors that provided medical information to the Disability Determination Service.

What Information did my Doctor Provide to Social Security?

Often your physician does not even realize that he or she has sent information to the Social Security Administration. This is because your doctor’s staff normally responded to the medical request on your doctor’s behalf. In Delaware, the Disability Determination Service is only authorized to provide a flat fee of $15 for any medical evidence requested from your doctor. Most doctors are not willing to provide a detailed medical opinion regarding your disability and to make copies of all of your medical records for $15. Consequently, they simply provide a copy of your medical records.

The reason that it is important to understand that Social Security simply relied on medical records, is because otherwise you may assume your doctor believes that you can work and that you are not disabled. I have had multiple clients that have told me that they did not appeal a decision because they believed that their doctor indicated to Social Security that they could work. They never discussed the decision with the doctor, and sometimes even switched to a new doctor because they blamed the denial on their doctor’s report.

But if Social Security Denied me, doesn’t that mean that my Medical Records don�t Support Disability?

If you are pursuing disability benefits, it is important that you discuss your disability application with your doctor. Tell your doctor that you plan to apply for benefits, and ask for him or her to provide you with a letter in support of your disability application. If your physician provides detailed information indicating the limitations that you experience because of your medical condition, it is more likely that the Social Security Administration will actually know your doctor’s medical opinion.

It is not sufficient for your doctor to indicate that he or she believes that you are disabled; he or she also needs to provide an explanation to support that conclusion. Ask your doctor to provide a detailed description of your medical diagnosis, any test results that support your diagnosis, your symptoms and limitations, and how your medical condition would interfere with your ability to complete a normal workday or workweek. The Social Security Administration normally rejects a simple conclusion that you are unable to perform work. Social Security needs to know why your doctor believes that you cannot perform work. Without this detailed information, the Disability Determination Service must try to determine what your doctor thinks based on his or her records alone.

After you receive a denial from the Social Security Administration, I recommend again discussing your disability with your doctor. Ask your doctor to read your decision and determine if your doctor agrees with the decision. If your doctor disagrees with the determination, ask your doctor to provide another letter explaining why he or she disagrees with the conclusion. Ask your doctor if additional treatment is available or if you should be referred to a specialist. Make sure your doctor understands the importance of you receiving disability benefits.

Work with an Attorney to Review and Appeal your Denial.

It is important to remember that the notices sent by the Social Security Administration are form letters. You will not receive a detailed explanation of why your records do not support your disability, instead you will receive only a short summary indicating that your condition will not last long enough in order for you to qualify for Social Security Disability, that you can still perform some type of work, or that you do not meet other non-medical requirements of the disability program. Because this information can be misleading, it is important that you simply do not abandon your claim and accept the conclusion of the Social Security Administration without understanding the decision.

The majority of attorneys that handle Social Security disability claims will see you on a free consultation basis, and usually are willing to review your decision and try to make a determination if additional information can be provided to the Social Security Administration that will establish that you meet the disability eligibility requirements. Take advantage of this free consultation before deciding to abandon your claim, and find out how an attorney can help improve your claim.

This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.

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Why Change Anything, I Am Happy with My Health Insurance?

Most individuals I speak to regarding these issues are not worried about the healthcare debate because they are happy with the current coverage that they have. These individuals often ignore how easy it would be to lose this coverage. For the majority of Americans, healthcare coverage is linked to your job. If you lose your job, you also lose your medical coverage. Although this is not an issue for a healthy individual that is able to obtain a new job (and new coverage), if you have lost your job because of your medical condition, you may quickly find yourself without medical insurance coverage. Even if you are eligible for COBRA coverage, when the choice is paying your mortgage and buying groceries or paying for health insurance, most individuals choose the necessities. No one ever expects to be in a position that they will not have health insurance available to them.

Medical Coverage does not Begin Immediately with Social Security Disability

What is shocking to most people is that if they are found disabled by the Social Security Administration, they do not immediately qualify for healthcare coverage. Under the best-case scenario, an individual that is ultimately found disabled is not entitled to Medicare coverage until 29 months after they last worked. (This is assuming that the individual was found disabled on the first of the month that they stopped working, and that the Social Security Administration determined that the medical condition was severe enough that they were entitled to disability from the day that they stopped working.)

If you are found entitled to Supplemental Security Income payments, you are entitled to Medicaid coverage immediately. However in order to qualify for SSI, you must be able to establish that you have very little assets, and little or no income on a monthly basis. Your spouse’s income is considered when determining your eligibility for SSI. The majority of the time if you qualify for SSI, it is likely that you already had Medicaid coverage, because the Medicaid criteria are similar to SSI.

During the waiting period for Medicare, no assistance is provided for medical treatment. If you do not have health insurance, you are expected to pay for your treatment out-of-pocket. Due to the amount of your Social Security Disability Insurance, you normally do not qualify for any income-based assistance from your State. Although the government has determined that your condition is severe enough to prevent you from performing work, no help is provided to obtain the treatment you need. Once Medicare beings, these benefits are just extended to the disabled individual and are not available to a spouse or dependents.

The Importance of COBRA

The thing that surprises me about many of the uninsured people that I meet is that they had an opportunity to purchase COBRA. The individuals refused COBRA because of the cost of the coverage. These individuals were unaware of the wait time for Medicare coverage and did not realize that they would not qualify for Medicaid because of their household income. Their immediate concern was paying their existing bills. They rarely considered the impact that one hospitalization could have on them financially. Many of these individuals are later forced into bankruptcy because of the cost of required medical care.

Even though COBRA initially sounds like a expensive alternative, you must consider how much your treatment will cost without insurance coverage. I have several clients that have medications that would cost more than the monthly COBRA premium. They quickly find after they refuse COBRA coverage, that the cost of one hospitalization would have paid for 12 months of COBRA. These individuals also discover that when they are unable to pay for medical treatment, it becomes less likely that they can establish their eligibility for Social Security Disability. Since they are unable to work and they do not have medical coverage, their financial situation only becomes worse.

Alternatives for individuals without Healthcare Coverage

It is possible for individuals without healthcare coverage to purchase personal policies. However these policies are often expensive, and rates raise with age. Insurers are allowed to consider your pre-existing health conditions, and in certain situations even exclude coverage based on pre-existing conditions. Affordable personal healthcare policies for older individuals normally require high deductibles. A yearly deductible of $5000 or more may be enough to prevent an individual from obtaining treatment even though they have healthcare insurance.

Medicaid is available to individuals with financial need, but if you have any source of income or your spouse is employed, it unlikely that you will qualify for this program. If you do not qualify for Medicaid, Delaware Residents may qualify for the Community Healthcare Access Program (“CHAP”). CHAP is a network of physicians and healthcare centers in Delaware that agree to provide discounts for medical services. There are still financial eligibility guidelines, but CHAP extends medical coverage to an additional group of individuals that normally would not qualify for help.

If you do not qualify for Medicaid or CHAP, healthcare is also available through a sliding-scale healthcare center. These facilities determine your eligibility for their services based on financial criteria, and limit the number of patients that they can see. Households with higher incomes will still be required to pay out-of-pocket co-pays for healthcare treatment, but will receive a substantial discount off the normal cost.

Although all of these options are better than no treatment, you will still not receive the same level of care that you would with a traditional health insurance plan. It will be harder to obtain specialist treatment for your condition, and some tests and medications that are needed will be excluded. Since treatment will be limited, establishing disability will be harder.

Pay Attention to Healthcare Debate

The purpose of this post is not to advocate any specific plan for reform, but instead to raise awareness of unforeseen healthcare concerns. Most of the uninsured people that I meet never expected to find themselves uninsured. They are normally hard-workers that simply did not realize that if their job ended due to disability, they would also lose medical benefits. These are individuals that always had healthcare coverage, and now when the need it the most, no affordable option is available.

Because continuing treatment is important to the Social Security Disability determination, many of these people will be denied benefits that they deserve because they cannot obtain the medical treatment that they need. These people need to share their stories with elected officials, family, friends and the public. It is only through increased awareness of these problems that there will ever be support for meaningful reform.

Relevant Links:

• Delaware Low-Cost Healthcare
• Delaware Division of Medicaid & Medical Assistance Programs
• Community Healthcare Access Program (CHAP)
• Delaware Uninsured Resources
• Delaware Insurance Commissioner’s Health Insurance Guide

This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.

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Most people do not realize that there is a clause in their LTD policy that indicates that if you are approved for SSDI, your LTD benefits will be reduced. Your LTD benefits are normally reduced by almost the entire amount of your SSDI (there is a normally a clause in your LTD policy that states that you will receive a minimum monthly amount of $50-$100, even if your SSDI is greater than your LTD benefit). This is why you are required to apply for SSDI if you are approved for LTD benefits. If you are approved for SSDI, your LTD company will issue an overpayment and require you to repay any amount that you receive in SSDI for the same month that your received LTD benefits.

Most individuals that are approved for LTD benefits sign a form acknowledging that they are being paid at their full LTD rate, but informing them they will be responsible for repaying a SSDI offset if they are eventually approved for SSDI. Once you are approved for SSDI, the LTD company will request a copy of your SSDI Notice of Award, and will compute how much you should have received on a monthly basis in LTD payments if you had received your SSDI payments when they were actually due. You must repay the difference between what you should have been paid by the LTD company and what you were actually paid.

It is important to remember that you do not have to use the legal representative offered by your LTD company. You can hire your own attorney to help you with your SSDI application. I normally recommend that individuals contact their LTD carrier prior to hiring their own attorney. It is important that you receive a written statement from your LTD carrier indicating that if you are approved for SSDI, you will receive a credit for the attorney fee before the LTD overpayment is assessed. If you receive a credit for the SSDI attorney fee, you end up having the assistance of a private attorney for free.

Reasons why you should consider obtaining your own attorney.

• The attorney will work directly for you. They will not represent the interest of your LTD company in any direct way. They will not share information with your LTD company without your authorization.
• You get to choose someone that you are comfortable with. Most of the legal representatives used by LTD carriers are national companies. You normally work with a non-attorney during the SSDI process, and you cannot visit a local office of the person representing you. If you choose your legal representative, you can make sure that you are actually working with an attorney.
• If your LTD benefits are terminated, you may also lose the legal representative that your LTD company hired. The legal representative provided by the LTD company may have a primary responsibility to your LTD company and not to you. If you are no longer eligible for LTD benefits, your LTD company may not have an interest in continuing to pay for your legal representation for your SSDI application.
• National legal representatives do not have local knowledge. The companies used by LTD carriers may not be familiar with the nuances of the local Social Security offices and the Administrative Law Judges in your area. Since they do not represent a large number of individuals in your area, they do not approach your claim with the same unique knowledge that a local attorney has.
• You support your local community. A local attorney normally lives in the same community as you. The local attorney pays local taxes, and uses the money that they earn to help other local businesses prosper. By obtaining a local attorney, you help your own community, and you help the local attorney stay in business so that they can also be available to assist friends and family members with similar issues.

Why it is important to pursue SSDI while obtaining LTD benefits.

Although you are required to apply for SSDI based on your LTD policy that is not the only reason that you should pursue SSDI. There are several other advantages for you if you are approved for SSDI.

• You may be eligible for SSDI longer. Most LTD policies define you disabled for up to 24 months if you are unable to perform the duties of your past work, or if you are unable to work because of a mental illness. After 24 months, you are normally only entitled to continue to receive LTD payments if you have a physical condition that prevents you from performing any full-time work. If you are under the age of 50, you will only be approved for SSDI if you are able to establish that you are unable to perform all full-time work. However, you are entitled to continue to receive SSDI with no time limit even if you are found disabled and remain unable to work solely because of mental illness.
• Medicare Coverage. If you are approved for Social Security Disability, you also become eligible for Medicare after you receive SSDI for 24 months. The only way that you can receive Medicare before the age of 65, is if you are found disabled by the Social Security Administration and receive SSDI.
• SSDI is not reviewed as often. Once you are approved for SSDI, normally the Social Security Administration only reviews your SSDI eligibility every 3-5 years (sometimes longer). Depending on your condition, it is common for LTD companies to review your eligibility as frequently as every few months. I have represented many individuals that have lost their eligibility for LTD benefits while a SSDI claim was still being decided. Since the Social Security Administration reviews claims so infrequently, it is likely that you will remain eligible for SSDI longer than LTD.
• To remain eligible for SSDI coverage. SSDI has a recent work requirement in order to qualify for benefits. You have to have worked in 5 out of the last 10 years prior to becoming disabled in order to qualify for SSDI. If you wait to apply for SSDI for an extended period after you stop working, not only are you potentially losing past-due benefits from SSDI ( you can only receive past-due SSDI payments for a maximum of 12 months prior to your application date), but you also risk losing your SSDI insured status. That means that you may not ever be able to submit a new application for SSDI if you are denied on the first claim you file.
• You protect your Social Security earnings record. If you fail to apply for SSDI and you are unable to work for several years, each of those years will show up with no earnings in your Social Security Statement. This can cause your retirement benefits to be reduced. However if you are approved for SSDI, any year that you are disabled, a “disability freeze” is placed on your Social Security record. In other words, the Social Security Administration will remove any years that you disabled from your earnings statement, and your Social Security Retirement benefit amount will not continue to be reduced for every year that you are not working.

Keep your SSDI attorney advised of any changes in your LTD Benefits

If you are pursuing both LTD and SSDI, it is important to notify your attorney if you are also applying for LTD and if you approved for LTD. It is important to remember that even if you are awarded SSDI, the majority of money that you are awarded in past-due benefits will have to be paid back your LTD company. Your should provide copies of any forms that your doctors complete for your LTD company, to your SSDI attorney. A knowledgeable SSDI Attorney can help advise you of any other issues that you may encounter as you pursue both SSDI and LTD payments, and can provide you with instructions on what to do if you are approved for SSDI and you also received LTD payments.

This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.

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From my experience in Social Security Disability, I have learned that the Unions that represented employees at each of these plants had done a great job of protecting workers. Despite serious medical limitations, many employees were able to maintain their employment thanks to accommodations that were made for them. With the disappearance of the large manufacturing sector in Northern Delaware, is unlikely that many of these individuals will be able to obtain competitive work despite the skills they have acquired over their lifetime and their long work history. Even if many of these workers find alternative employment, without the protection of the Union, it will be more difficult for those with medical limitations to maintain work.

It is important that individuals age 50 and over consider Social Security Disability Insurance Benefits if they have become displaced because of a plant closing. If you are over the age of 50, the Social Security Administration Disability Regulations require that greater attention be paid to the work that you performed in the past. It is much more likely that an individual over the age of 50 will be approved for Social Security Disability Insurance if they have performed skilled physically demanding work in the past. The main consideration will be on whether you can perform the same type of work you did in the past. (If you are under 50 you are only disabled if you are unable to perform all full-time work).

Normally, individuals that have performed work on an automobile assembly line or at a refinery have a much better chance of being approved for disability benefits than individuals that have performed less physically demanding work. If you are experiencing difficulty finding work since you have become unexpectedly unemployed, it is important that you consider an application for disability benefits if you have a medical condition or conditions that limit your ability to perform work in any way.

My office is available for free consultations for individuals that have been displaced from manufacturing work and have been unable to obtain alternate employment because of physical or mental disabilities. It will be important that you are able to describe your physical and mental limitations, and that you can describe in simple terms how your condition limits your ability to sit, stand or lift. It is also important that you have regular medical treatment for your medical condition or conditions.

Social Security disability insurance is an entitlement program that you pay into when you are working and have taxes withheld from your paycheck. Unfortunately, many people that lose manufacturing jobs and are over the age of 50 do not recognize that they may qualify for these benefits. If you are considering collecting early retirement or you are unable to continue to work and are over the age of 50, I would strongly advise that you also determine if you qualify for Social Security Disability Insurance.

Related Posts:

• Social Security Disability Insurance as an Alternative to Early Retirement
• Information Needed at Initial Consultation Appointment for Social Security Disability/SSI
• The Initial Consultation Appointment for Social Security Disability/SSI Representation
• 10 Things to Know Before Applying for Social Security Disability

This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.

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2. Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) Eligibility Criteria by Age When you apply for Social Security Disability Insurance (SSDI)...
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