Disability And Injury FAQs

Injuries and illnesses that keep from work can cause considerable personal and financial strain. At these times, individuals and families rely on insurance policies to keep them secure. When those benefits are denied, it’s natural to have many concerns and questions. Browse our FAQs to find information and insight from our experienced disability and injury attorneys.

  • What is Disability Determination Services?
    Show Answer Hide Answer

    Most Social Security disability claims are initially processed through a network of local Social Security Administration (SSA) field offices and State agencies usually called Disability Determination Services (or DDSs).

    Subsequent appeals of unfavorable determinations may be decided in a DDS or by an Administrative Law Judge (ALJ) in SSA’s Office of Disability Adjudication and Review (ODAR).

    Social Security representatives in the field offices usually obtain applications for disability benefits in person, by telephone, by mail, or by filing online. The application and related forms ask for a description of the claimant’s impairment(s), treatment sources, and other information that relates to the alleged disability. (The “claimant” is the person who is requesting disability benefits.)

    The field office is responsible for verifying non-medical eligibility requirements, which may include age, employment, marital status, or Social Security coverage information. The field office then sends the case to a DDS for evaluation of disability.

    The DDSs, which are fully funded by the Federal Government, are State agencies responsible for developing medical evidence and making the initial determination on whether a claimant is disabled or blind under the law.

    The DDS usually tries to obtain evidence from the claimant’s own medical sources first. If that evidence is unavailable or insufficient to make a determination, the DDS will arrange for a consultative examination (CE) to obtain the additional information needed. The claimant’s treating source is the preferred source for the CE, but the DDS may obtain the CE from an independent source. After completing its development of the evidence, trained staff at the DDS makes the initial disability determination.

    Then, the DDS returns the case to the field office for appropriate action. If the DDS found that the claimant is disabled, SSA completes any outstanding non-disability development, computes the benefit amount, and begins paying benefits. If the claimant was found not to be disabled, the file is kept in the field office in case the claimant decides to appeal the determination.

  • Who is The Social Security Disability Examiner?
    Show Answer Hide Answer

    The Social Security Disability Examiner Evaluates Your Claim

    Social Security disability claims examiners make the initial determination (decision) on an applicant’s medical eligibility for Social Security disability Insurance (SSDI or SSD) and Supplemental Security Income (SSI) claims. In Florida, disability claims examiners work at the state agency called Disability Determination Services, or DDS. Although DDS is fully funded by the Federal Government, it is still a State agency responsible for developing medical evidence and issuing the initial determination as to whether the claimant is disabled under the law. Given the size of the State of Florida, our DDS office has several hundred disability examiners. The following provides a basic outline of what the DDS claims examiner does in evaluating a claim.

    Gathering Medical Evidence

    First, the disability examiner gathers all of your medical records and reviews any additional information from you, your representative, or your doctor. In other words, the DDS tries to obtain evidence from the claimant’s own medical sources first. In the alternative, the disability examiner may schedule you for a consultative examination (C.E.) under any of the following circumstances:

    • the records are unavailable,
    • your medical records are insufficient to adequately evaluate the claim, or
    • you have not seen any doctors (also called “medical treating sources”) within the recent past (typically the past three months).

    The claimant’s own treating source is the preferred source for the CE; however, the DDS may also obtain the CE from an independent source.

    The disability examiner should maintain contact with you to coordinate the proper gathering of medical evidence in your claim.

    Adding Vocational Information

    The disability examiner will then gather together your:

    • medical treatment records and notes;
    • residual functional capacity opinions from your treating medical providers;
    • consultative examination results;
    • your relevant past work history (jobs that you performed in the fifteen (15) years prior to the onset of your disability); and
    • your educational background.

    Making the Disability Determination

    After completing its initial development, the DDS makes the disability determination. The determination is made by a two-person adjudicative team consisting of a medical or psychological consultant and a disability examiner. If the adjudicative team finds that additional evidence is still needed, the consultant or examiner may recontact a medical source(s) and ask for additional/supplemental information.

    The DDS also makes a determination whether the claimant is a candidate for vocational rehabilitation (VR). If so, the DDS makes a referral to the State VR agency.

    In most cases, the disability examiner completes a medical decision write-up for the state disability physician to review. In writing the medical decision, the examiner will discuss whether your impairment meets the requirements of a disability Listing of Impairment, and if not, whether your residual functional capacity (RFC) is enough to allow you to work any other type of job. The medical consultant, or unit physician, is typically called upon to develop the RFC, but it does not always happen that way.

    The examiner is expected to consult the doctor on the nature and severity of the claimant’s medical impairments as well as what kind of additional medical evidence is required to decide the claim. The examiner is not permitted to make decisions on medical eligibility without consulting the doctor, except in quick disability determination cases (QDD). (QDD cases are those with very straightforward facts that warrant obvious outcomes. In QDD cases, a single decision maker (the examiner) can only approve a case (and cannot deny a case) without a unit physician review.

    After the DDS makes the disability determination, it returns the case to the field office for appropriate action depending on whether the claim is allowed or denied. If the DDS finds the claimant disabled, SSA will complete any outstanding non-disability development, compute the benefit amount, and begin paying benefits. If the claimant is found not disabled, the file is retained in the field office in case the claimant decides to appeal the determination.

    If the claimant files an appeal of an initial unfavorable determination, the appeal is usually handled much the same as the initial claim, except that the disability determination is made by a different adjudicative team in the DDS than the one that handled the original case.

  • How Long Does It Take to Receive an Approval or Denial Decision on a Disability Claim?
    Show Answer Hide Answer

    There is simply no way to determine or predict how long a case will take. Unlike other programs (such as the Department of Social Services, for example), the federal Social Security disability program unfortunately does not have deadlines to issue decisions on applications or appeals. Although there are no time limit deadlines to issue decisions, the following attempts to give some estimates of how long each stage of the disability process typically takes:

    The Initial Claim

    Social Security advises that it may take up to 180 days to issue a decision on a Social Security Disability Insurance (SSDI or SSD) or SSI claim. That being said, the average length of time it typically takes to receive a decision on your disability claim is from three to five months. It can vary depending on several factors, but primarily on:

    • The nature of your disability;
    • The number of medical providers you identified in your application;
    • How quickly we obtain medical evidence from your doctor or other medical source;
    • Whether it is necessary to send you for a medical examination in order to obtain evidence to support your claim; and
    • If your claim is randomly selected for quality assurance review of the decision.

    Reconsideration

    The first appeal after an initial denial is a Request for Reconsideration. A “Recon” Request typically takes between three weeks and three months to be decided.  The length of time at this stage is typically determined by the amount of new records that must be obtained, and whether a consultative examination has been ordered.

    The Hearing Before an Administrative Law Judge

    If the Request for Reconsideration is denied, the claimant must file a Request for Hearing Before an Administrative Law Judge (ALJ). There is “good news” and “bad news” about this stage of the process.  The good news is that this is the claimant’s best chance of winning (statistically).  The bad news is that it can take a horrendously long time to get to a hearing. In fact, it can take as long as two years for a hearing before and ALJ can take place and for benefits to be awarded.

    An appeal to an ALJ usually takes much longer because a hearing has to be scheduled and heard. In the Mobile, Alabama and Pensacola, Florida area, the wait averages 13 months. [Note: this does not run from the initial application; this is the wait from the time the Request for Hearing is filed after Reconsideration.]

    In many parts of the United States, the Social Security initial application and appeals process is taking longer and longer. Why is this happening? Part of the reason is a steep rise in disability claims, which may be due to the changing economy. The rise in claims may also be due to the fact that the population is aging.

    What Can You Do?

    At the Ortiz Law Firm, we understand that it can be difficult not knowing when you’ll receive an answer to your claim when you are out of work and short on income while you wait for your disability case to be decided.

    Fortunately, if you have a very severe medical condition with a clear diagnosis, you may be eligible for an expedited decision through one of Social Security’s expedited disability benefit programs:

    • The Quick Disability Determination program identifies straight-forward and easily-determined disability cases through a sophisticated software program;
    • The Compassionate Allowances program is available for many cancers and other severe illnesses that are easily diagnosed and documented with objective medical findings;
    • The Terminal Illness program (TERI) is available for those with terminal illnesses or who are in hospice;
    • The Presumptive Disability program (for SSI claimants only) gives applicants with certain conditions monthly SSI benefits even before their disability claim is approved or denied.
  • What Evidence Is Required by Social Security Disability?
    Show Answer Hide Answer

    What Evidence is Reviewed in a Social Security Disability Determination?

    Medical Evidence

    Under both the Title II Social Security Disability Insurance (SSDI or SSD) and Title XVI Supplemental Security Income (SSI) programs, medical evidence is the cornerstone for the determination of disability.

    Each person who files a disability claim is responsible for providing medical evidence showing he or she has an impairment(s) and the severity of the impairment(s). However, the Social Security Administration (SSA), with the claimant’s permission, will help the claimant get medical reports from his or her own medical sources. This medical evidence generally comes from sources that have treated or evaluated the claimant for his or her impairment(s).

    Acceptable Medical Sources

    Documentation of the existence of a claimant’s impairment must come from medical professionals defined by SSA regulations as “acceptable medical sources.” Once the existence of an impairment is established, all the medical and non-medical evidence is considered in assessing impairment severity.

    Acceptable medical sources are:

    • licensed physicians (medical or osteopathic doctors);
    • licensed or certified psychologists including school psychologists (and other licensed or certified individuals with other titles who perform the same function as school psychologists in a school setting) only for purposes of establishing mental retardation, learning disabilities, and borderline intellectual functioning ;
    • licensed optometrists only for purposes of establishing visual disorders (except in the U.S. Virgin Islands where licensed optometrists are acceptable medical sources only for the measurement of visual acuity and visual fields);
    • licensed podiatrists only for purposes of establishing impairments of the foot, or foot and the ankle, depending on whether the State in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and the ankle; and
    • qualified speech-language pathologists only for purposes of establishing speech or language impairments. For this source, “qualified” means that the speech-language pathologist must be licensed by the State education agency in the State in which he or she practices, or hold a Certificate of Clinical Competence from the American Speech-Language-Hearing Association.

    Medical Evidence from Treating Sources

    Currently, many disability claims are decided based on medical evidence from treating sources. SSA regulations place special emphasis on evidence from treating sources because they are likely to be the medical professionals most able to provide a detailed longitudinal picture of the claimant’s impairment(s) and may bring a unique perspective to the medical evidence that cannot be obtained from the medical findings alone or from reports of individual examinations or brief hospitalizations. Therefore, timely, accurate, and adequate medical reports from treating sources accelerate the processing of the claim because they can greatly reduce or eliminate the need for additional medical evidence to complete the claim.

    Medical Evidence From Health Facilities

    SSA also requests copies of medical evidence from hospitals, clinics, or other health facilities where a claimant has been treated. All medical reports received are considered during the disability determination process.

    Other Evidence

    Information from other sources may also help show the extent to which an individual’s impairment(s) affects his or her ability to function in a work setting; or in the case of a child, the ability to function compared to that of children the same age who do not have impairments. Other sources include public and private agencies, non‑medical sources such as schools, parents and caregivers, social workers and employers, and other practitioners such as naturopaths, chiropractors, and audiologists.

    Medical Reports

    Physicians, psychologists, and other health professionals are frequently asked by SSA to submit reports about an individual’s impairment(s). Therefore, it is important to know what evidence SSA needs. Medical reports should include:

    • medical history;
    • clinical findings (such as the results of physical or mental status examinations);
    • laboratory findings (such as blood pressure, x-rays);
    • diagnosis;
    • treatment prescribed with response and prognosis;
    • a statement about what the claimant can still do despite his or her impairment(s), based on the medical source’s findings on the above factors.
    • if the claimant is an adult age 18 or over, this statement should describe, but is not limited to, the claimant’s ability to perform work-related activities, such as sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking, and traveling.
    • in adult cases involving mental impairments or mental functional limitations, this statement should describe the claimant’s capacity to understand, to carry out and remember instructions, and to respond appropriately to supervision, coworkers, and work pressures in a work setting.

    if the claimant is a child under age 18, this statement should describe the child’s functional limitations compared to children his or her age who do not have impairments in acquiring and using information, attending and completing tasks, interacting and relating with others, moving about and manipulating objects, caring for yourself, and health and physical well-being.

    Consultative Examinations

    If the evidence provided by the claimant’s own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by recontacting the treating source for additional information or clarification, or by arranging for a consultative examination (CE). The treating source is the preferred source for a CE if he or she is qualified, equipped, and willing to perform the examination for the authorized fee. Even if only a supplemental test is required, the treating source is ordinarily the preferred source for this service. However, SSA’s rules provide for using an independent source (other than the treating source) for a CE or diagnostic study if:

    • the treating source prefers not to perform the examination;
    • the treating source does not have the equipment to provide the specific data needed;
    • there are conflicts or inconsistencies in the file that cannot be resolved by going back to the treating source;
    • the claimant prefers another source and has good reason for doing so; or
    • Social Security knows from prior experience that the treating source may not be a productive source.

    Consultative Examination Report Content

    A complete CE report will involve all the elements of a standard examination in the applicable medical specialty and should include the following elements:

    • the claimant’s major or chief complaint(s);
    • a detailed description, within the area of specialty of the examination, of the history of the major complaint(s);
    • a description, and disposition, of pertinent “positive” and “negative” detailed findings based on the history, examination, and laboratory tests related to the major complaint(s), and any other abnormalities or lack thereof reported or found during examination or laboratory testing;
    • results of laboratory and other tests (for example, X-rays) performed according to the requirements stated in the Listing of Impairments (see Part III of this guide);
    • the diagnosis and prognosis for the claimant’s impairment(s);
    • a statement about what the claimant can still do despite his or her impairment(s), unless the claim is based on statutory blindness.
      • if the claimant is an adult age 18 or over, this statement should describe the opinion of the consultant about the claimant’s ability, despite his or her impairment(s), to do work-related activities, such as sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking, and traveling;
      • in adult cases involving mental impairment(s) or mental functional limitations, this statement should also describe the opinion of the consultant about the claimant’s capacity to understand, to carry out and remember instructions, and to respond appropriately to supervision, coworkers, and work pressures in a work setting.
      • if the claimant is a child under age 18, this statement should describe the opinion of the consultant about the child’s functional limitations compared to children his or her age who do not have impairments in acquiring and using information, attending and completing tasks, interacting and relating with others, moving about and manipulating objects, caring for yourself, and heath and physical well-being.
    • the consultant ‘s consideration, and some explanation or comment on, the claimant’s major complaint(s) and any other abnormalities found during the history and examination or reported from the laboratory tests. The history, examination, evaluation of laboratory test results, and the conclusions will represent the information provided by the consultant who signs the report.

    Evidence Relating to Symptoms

    In developing evidence of the effects of symptoms, such as pain, shortness of breath, or fatigue, on a claimant’s ability to function, SSA investigates all avenues presented that relate to the complaints. These include information provided by treating and other sources regarding:

    • the claimant’s daily activities;
    • the location, duration, frequency, and intensity of the pain or other symptom;
    • precipitating and aggravating factors;
    • the type, dosage, effectiveness, and side effects of any medication;
    • treatments, other than medications, for the relief of pain or other symptoms;
    • any measures the claimant uses or has used to relieve pain or other symptoms; and
    • other factors concerning the claimant’s functional limitations due to pain or other symptoms.

    In assessing the claimant’s pain or other symptoms, the decision makers must give full consideration to all of the above-mentioned factors. It is important that medical sources address these factors in the reports they provide.

  • When Is a Person Considered Disabled For Social Security Disability?
    Show Answer Hide Answer

    “Disability” under Social Security is based on your inability to work due to an impairment, either physical or mental (psychological or psychiatric) in nature. Social Security considers you disabled under its rules for SSDI and SSI if:

    • You cannot do work that you did before;
    • Social Security decides that you cannot adjust to other work because of your medical condition(s); and
    • Your disability has lasted or is expected to last for at least one year or to result in death.

    Using Social Security’s language, you must be being unable to do substantial gainful activity (SGA for short, further discussed below). In addition, your impairment must have prevented you from doing SGA for at least 12 months, or will be expected to prevent you from doing SGA for at least 12 months. (This year-long requirement means that short-term conditions that last less than one year do not qualify as disabling conditions no matter how severe.)

    Substantial Gainful Activity

    To qualify as a disabled person under Social Security’s rules, a disability claimant must be unable to perform “substantial gainful activity” or SGA. Generally, SGA is defined as earning more than a set amount per month, currently $1,040 per month (in 2013). However, this set dollar amount does not apply to all situations. For example, where someone is self-employed and may not have much in earnings after expenses, there are other tests Social Security applies to determine if someone is doing SGA.

    Applicants cannot be working and earning above the SGA amounts when they apply for benefits and win benefits.  We understand that some applicants continue to work after applying for benefits, and plan to quit if they are approved for benefits. However, the claim will always be denied and never approved if the claimant continues to earn wages above the SGA level. In fact, anyone earning more than the SGA amount who applies for Social Security disability insurance or SSI benefits will be denied immediately, without even having their impairments or medical records evaluated.  This is what we call a “technical denial.”

    Disabled individuals may be working part-time when they apply for Social Security disability, as long as they do not earn more than the SGA amount (as long as this doesn’t lead Social Security to think you could work a full-time job).

    For more information on work activity and what Social Security considers substantial gainful activity, see our section on work, SGA and disability.

    Medical Evidence That Qualifies You for Disability

    As stated above, a disabling condition is a medically determinable physical or mental impairment that results in marked and severe functional limitations. Social Security requires sufficient medical information from you that will help it determine the existence, severity, and duration of your impairment(s). The medical condition(s) must be shown to exist by means of medically acceptable clinical and laboratory findings. Under the law, symptoms alone cannot be the basis for a finding of disability, although the effects of symptoms may be an important factor in Social Security’s decision whether a person is disabled. If the medical evidence alone shows that a person is clearly disabled or not disabled, Social Security decide the case on that information. Otherwise, Social Security go on to consider other factors, such as functional capacity in light of your impairment(s), age, education, and work background.

    Records from your medical providers should include a thorough medical history, and all pertinent clinical and laboratory findings (both positive and negative). Longitudinal clinical records and detailed historical notes discussing the course of your disorders, including treatment and response, are very useful for Social Security since it is interested in the impact of the illness over a period of time. In mental health cases, your providers should produce the results of any mental status examination, including any psychometric testing.

    Residual Functional Capacity Assessment

    You should also submit a statement of your doctor’s opinion about what work-related activities you can still do despite your impairment. This is referred to as your “Residual Functional Capacity” or RFC. Such an assessment should tell Social Security your doctor’s opinions about both physical and mental functions and, to the extent possible, the reasons to support the opinions, such as the clinical findings and/or observations of you. These opinions should reflect your abilities to perform work-related activities on a sustained basis, i.e., 8 hours/day and 5 days/week. Your doctor’s descriptions of any functional limitations noted throughout the time the doctor treated you are very important.

    Examples of work-related functions include:

    • Physical work-related functions: Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, and handling.
    • Mental work-related functions: The ability to understand, remember, and carry out simple instructions, the ability to use appropriate judgment, and the ability to respond appropriately to supervision, co-workers, and usual work situations, including changes in a routine work setting.

    Medical-Vocational Rules

    Social Security will uses the above-referenced RFC assessment to decide whether a disability applicant can work doing their past job (full-time). If it decides the claimant cannot perform his or her past work, Social Security is required to use a set of rules, called the medical-vocational grid, to determine if there are other jobs in the national and regional economy that the applicant can still do given his or her impairments (or be expected to learn to do). For example, a nurse who is limited in standing and walking might be expected to switch to doing data entry in a medical facility given his or her knowledge of medical terminology, if the other work is more tolerable physically. If an applicant is older (starting at age 50) and has a limited education (less than high school) and does not have transferable job skills, the medical-vocational grid framework may not expect the person to learn a new job, and will consider the person disabled.

    For additional information on what medical conditions are considered disabilities, please visit our section on disabling medical conditions and impairments.

  • Can You Qualify for Both SSDI and SSI Disability Benefits?
    Show Answer Hide Answer

    Some claimants only apply for Social Security Disability Insurance (SSD or SSDI for short) benefits. Others only apply for Supplemental Security Income (SSI) benefits.  However, in some instances claimants may qualify for both SSDI and SSI benefits. Applying for both types of benefits is called a “concurrent claim.”

    Concurrent Claim

    Under certain circumstances, a claimant may be eligible to collect SSI and SSDI at the same time (called “concurrent benefits”). This typically happens when a disability applicant is approved for SSDI but only receives a low monthly payment.

    [Note: A low SSDI payment can be caused by not working much in recent years or making low wages.]

    Qualifying for SSI

    In order to qualify for an SSI payment in addition to (or concurrently with) an SSDI payment, the claimant must have less than $710 per month of unearned income (this is the rate in 2013). Generally speaking, the SSI income limits can be fairly complicated. The income limit is higher in some states than others. And if you are working and making some earned income, an even different limit applies. The SSI program also has asset limits, which means that you can only have a limited amount of cash savings, valuable property and other assets to qualify for SSI. Similar to qualifying for food stamps, you must prove you are “poor enough” to qualify for SSI.

    In the end, if (1) your monthly income and overall assets are low enough to qualify for Supplemental Security Income, and (2) you have also worked long enough in one or more jobs and paid sufficient Social Security taxes into the Social Security Disability Insurance (SSDI) system to earn enough work credits, you may qualify to receive both types of benefits at once.

    However, you keep in mind that your SSDI payment is included as income in calculating whether you are eligible for SSI. In some cases, your SSDI payment will be so high you may not qualify for SSI benefits.

    Monthly Payment of Concurrent SSDI and SSI Benefits

    SSDI and SSI benefits do not “stack” on one another. In other words, you don’t add the entire amount you may qualify for under each program together. You cannot receive a higher monthly combined benefit than you would otherwise receive under the SSI program alone. Your SSI payment amount will be lowered by the amount of your SSDI payment to match the maximum SSI payment amount.

    For example, if your SSDI benefit is under $710 per month (the current maximum SSI monthly payment amount in 2013) and you qualify for SSI, you will receive an SSI payment for the difference between your SSDI benefit and $710. For example, if you are eligible to receive $500 in SSDI benefits and you are eligible to receive SSI, you would receive $500 in SSDI and $210 in SSI ($710 minus $500) each month for a total of $710.

    In short, if your SSDI benefits are less than $710 per month, you may receive both SSI and SSDI benefits at once.

    How You Apply for Concurrent Benefits

    Most claimants are not aware that there are two programs of disability with the Social Security Administration. So how can you be sure to apply for the right one or both? Whether you apply for SSI, SSDI (also called SSD), or both, your local Social Security district office will evaluate your income and assets and determine whether your claim is concurrent. The category of your disability claim (SSI, SSDI, or both) will not make a difference as to how the medical evaluation of the claim is processed. In other words, an SSI claim will be medically reviewed in exactly the same way as an SSDI claim. The same definition of disability and the same disability evaluation process is used for both programs of benefits.

    The Benefits of a Concurrent Claim

    The benefit to collecting SSI when you are collecting monthly SSDI benefit of less than $710 a month is that the SSI payment will raise your total benefits up to $710 per month.

    On the flipside, a benefit to being able to collect SSDI when you are also eligible for SSI is that you may be eligible to receive Medicare health insurance benefits as an SSDI recipient. [Note: There is a two year wait time before Medicare benefits kick in. You must wait two years from when your SSDI eligibility begins to qualify for Medicare benefits.]

    In contrast, SSI recipients are eligible to receive Medicaid benefits alone. Although Medicaid does provide payment for more services overall than Medicare, more doctors accept Medicare coverage, so it may be easier to find a Medicare provider.

  • What is a Baker Act in Pensacola Florida?
    Show Answer Hide Answer

    Florida’s Baker Act

    What is the Baker Act and What Does It Do?

    • The Baker Act is set forth in Florida Statutes, Chapter 394, Part I, and is also known as the Florida Mental Health Act.
    • The Baker Act provides legal procedures for mental health examination and treatment, including:

    o Voluntary admission
    o Involuntary examination
    o Involuntary inpatient placement (IIP)
    o Involuntary outpatient placement (IOP)

    • The Baker Act regulates:

    o Crisis stabilization units (CSUs)
    o Short‐term residential treatment facilities (SRTs)

    • The Baker Act protects the rights of all individuals examined or treated for mental illness in Florida.

    What Is Involuntary Examination and How Is It Conducted?

    • An involuntary exam is a psychiatric exam conducted without a person’s consent, often called “getting Baker Acted.”
    • Involuntary exams are initiated by:

    o Law enforcement officers (49%)
    o Mental health professionals and physicians (49%)
    o Circuit courts (2%)

    • Criteria for involuntary exam are that the individual:

    o Appears to have a mental illness;
    o Presents a danger to self or others; and
    o Refuses voluntary exam or is unable to understand need for exam

    • Involuntary exams are provided only by DCF‐designated Baker Act receiving facilities:

    o Hospitals
    o Crisis stabilization units (CSUs)

    • Services focus on stabilizing the immediate crisis.
    • Within 72 hours of arrival, facility must release the individual or file a petition for involuntary placement.
    • Average length of stay is 4.5 days.
    • Release must be approved by a psychiatrist or a clinical psychologist.

    Click here for: Florida Baker Act Information and Forms

    Florida Baker Act Public Receiving Facilities in North Florida, designated by the Florida Department of Children & Families, and licensed by the Florida Agency for Health Care Administration.

    [Note: Receiving Facilities designated with a (*) are public receiving facilities funded by DCF to provided examination and short-term treatment to persons without ability to pay for private care. Public receiving facilities (that are affiliated with a community mental health center) are required to ensure the centralized provision and coordination of acute care services for eligible individuals with an acute mental illness. The nearest receiving facility, whether public or private, must accept any person brought by law enforcement for involuntary examination.]

    DISTRICT 1 in Escambia, Okaloosa, Santa Rosa & Walton Counties:

    1. Baptist Hospital Emergency Room
      1000 West Moreno Street & Baptist Hospital Behavioral Medicine 1101 West Moreno Street Pensacola, Florida 32501
    2. *Bridgeway Center
      Crisis Stabilization Unit 205 Shell Avenue, S.E. Fort Walton Beach, Florida 32548
    3. Fort Walton Beach Medical Center
      1000 Mar-Walt Drive Fort Walton Beach, Florida 32547-6795
    4. *Lakeview Crisis Stabilization Unit
      1304 West Avery Street Pensacola, Florida 32501
    5. *West Florida Community Care Center
      5500 Stewart Street Milton, Florida 32570
    6. West Florida Regional Medical Center Emergency Room
      8383 North Davis Highway and The Pavilion, 2191 Johnson Avenue Pensacola, Florida 32514
  • Is There a Statute of Limitations for Social Security Disability Claims?
    Show Answer Hide Answer

    Is there a Statute of Limitations for Social Security Disability claims?

    This is a difficult question to answer, because there are multiple stages of the review process:

    Initial Application

    Social Security Disability Insurance (SSDI) Benefits: In order to qualify for SSDI benefits, you must prove your disability began while you were still insured for disability (or while you still had enough work credits to qualify for disability insurance benefits). You can apply for SSDI benefits after your insured status expires, but you must prove that your disability began while you still had insured status.

    In addition, although there is no time limit to actually file an SSDI claim, Social Security will not pay “back pay” or retroactive benefits for any period more than 12 months prior to the date of the SSDI application.

    Supplemental Security Income (SSI) Benefits: There is no time limit to file for SSI benefits either. So long as you have a severe disability that keeps you from working and you meet the other non-medical requirements, you may qualify for SSI.  However, you cannot receive SSI benefits for any month prior to the date of the SSI application.

    The Request for Reconsideration

    If your SSDI and/or SSI application is denied, you must request a reconsideration of the denial within 60 days after receiving the Notice of Determination on the initial claim.

    The Request for Hearing

    If your Request for Reconsideration is denied, you must request a hearing before an Administrative Law Judge within 60 days after receiving the Notice of Reconsideration on the appeal.

    The Request For Review of Hearing Decision with the Appeals Council

    If the Administrative Law Judge issues an Unfavorable Decision and denies your claim, you must file a request for review of the hearing decision with the Appeals Council within 60 days after receiving the Judge’s denial (or partially favorable determination).

    A Civil Lawsuit in Federal Court

    If you disagree with the Appeals Council’s decision, or if the Appeals Council decides not to review your case, you can file a civil suit in a federal district court. You must file a civil action in your area U.S. District Court within 60 days after you receive notice of the Council’s action in the case.

    If you want assistance from a Board Certified Social Security Disability Attorney in your appeal, call Mr. Ortiz at 850-898-9904 for a Free Case Evaluation.

  • Why Do Mental Disability Claims Get Denied?
    Show Answer Hide Answer

    When filing a claim for Social Security disability benefits, those involving mental health problems are often denied. This usually happens for one of a handful of good reasons. First, it is common for mental health specialists to make notes about office visits that are not very detailed. Social Security will want to know as much about the case as possible from a professional viewpoint, so request that your doctor send them a more detailed account of your visits and condition.

    Another common thing that can look bad for a disability applicant is if there is no medical record whatsoever for the treatment of the alleged condition. This most often happens with cases of depression, when a family doctor prescribes anti-depressant medication and the patient never sees a psychiatrist. This then provides no real back-up for the claim of severe depression.

    Other times, a patient will have been prescribed certain medications and records may show that those medications were never taken. Social Security will see this as a very negative action on the part of the patient, because without the proper treatment they are unable to determine how limited the patient’s abilities are. Sometimes, the patient simply cannot afford the cost of the medicine, in which case be sure to inform Social Security about it. They will either take this into account as a reasonable excuse for not taking the medicine or provide it for free.

    Then, there are cases where claims are denied because of a lack of a proper duration period of symptoms. A disability claims examiner or judge may determine that the applicant has not been disabled for the required twelve months or isn’t expected to be. Any claim made about a condition that is getting better or is expected to get better does not have a good chance at being approved for disability benefits.

    If you or a loved one has a long-term disability and would like to apply for Social Security, you should hire an experienced disability attorney like Nick Ortiz to assist you. If you have any other questions or concerns, call the office of Nick Ortiz at 850-898-9904.

  • Can I Sue The Insurance Company?
    Show Answer Hide Answer

    I have been asked many times by people who have been involved in car accidents whether or not they can sue the insurance company. After an accident, victims that have contracted severe or mild personal injury are faced with exhausting amounts of medical bills and expenses that the insurance company will try to avoid paying for as much as possible. Insurance claim representatives are well-trained to resist coverage of large claims, no matter how severe the injury is.

    If you and the insurance company can’t reach an agreement on a settlement amount, you can sue the company for what you think is a fair value. If the Court agrees that the insurance company was wrong in denying your claim, you can then receive full compensation for what is deserving. You should also be able to get additional damages for emotional distress, lost income and legal fees that have come about as a result of the extra trouble with the insurance company.

    Insurance companies want to make money and they will wrongfully deny some of the thousands of claims they receive every day to save money. If your insurance claim is denied or if you are offered a clearly insufficient amount, you should hire an experienced personal injury lawyer to help you get the compensation you need. Grounds that you can sue an insurance company for include failure to carry out proper investigations, undue delay in processing a claim, disregard for the rights of the policy holder and inadequate compensation for filed claim. Call experienced personal injury lawyer Nick Ortiz at 850-898-9904 for more information.