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.
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  • What is the Virtual Screening Unit?

    The Virtual Screening Unit is a stage in some cases between Reconsideration and the Hearing. An Senior Attorney will review the claim and determine whether a decision can be made “on the record” without the need to have the hearing. The good news is that you cannot be denied at this level. If you are approved, you win. If the VSU attorney determines that an on-the-record determination cannot be made, then you continue on to the hearing.

    Here is Social Security’s Commissioner’s statement about the VSU in 2010:

    “We are building upon the success of our senior attorney adjudicators this fiscal year by deploying a Virtual Screening Unit (VSU) of 100 senior attorney adjudicators to assist our most heavily backlogged hearing offices. These senior attorney adjudicators who are from hearing offices throughout the country screen electronic cases and write favorable decisions that result from the screening. The VSU started screening cases in November 2009 and went into full production in January 2010. So far, the VSU has screened 19,547 cases and issued 5,757 favorable decisions, while referring 239 cases to ALJs for favorable decisions. The VSU’s work has resulted in fewer remands to the already burdened DDSs. The VSU has assisted 43 hearing offices.”

     

  • Are You Disabled?

    Are you Disabled?

    You may be asking yourself, “Am I disabled?” Or, “How does Social Security determine if you are disabled?”

    This page will provide you with some information to learn about how Social Security determines if you are disabled for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

    Social Security’s definition of disability in SSDI or SSI is the same. It is the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

    Social Security Follows a Five (5) Step Sequential Evaluation Process in reviewing disability claims. Click the link in the previous sentence for more details about the 5 step process. Then watch the video below for a more general overview of the application and appeal process.

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  • Can They Garnish My Social Security SSDI Disability Check?

    The Social Security Act prohibits alienation or assignment of benefits, such as execution, levy, attachment or garnishment. See 42 U.S.C. § 407(a). However, there are two narrow exceptions to the anti-assignment provision. First, Title II benefits are subject to withholding in accordance with State laws enacted pursuant to subsections (a)(1) and (b) of 42 U.S.C. § 666 (2000), and to any other “legal process” for the enforcement of alimony or child support obligations. See id. § 659(a). Subsections (a)(1) and (b) of 42 U.S.C. § 666 do not mention any procedure for collecting alimony or child support other than income withholding subject to the percentage limitations of the CCPA, codified at 15 U.S.C. § 1673. “Legal process” is defined as “any writ, order, summons or similar process in the nature of garnishment” issued by a court or administrative agency. See 42 U.S.C. § 659(i)(5)(A)(i) (emphasis added). The regulations at 5 C.F.R. § 581 et seq., and POMS also do not authorize any form of Title II benefits assignment other than income withholding in the nature of garnishment for the limited purposes stated.

    Second, 26 U.S.C. §§ 6331 and 6334(c) permit the Internal Revenue Service to levy upon Social Security benefits only for collection of Federal income taxes.

  • How Do I Check Status of My Social Security Disability Claim?

    If you applied for benefits online then you can check the status of your Social Security disability application online.

    The online application status will advise you:

    • when your application was received;
    • whether additional evidence or other documents have been requested;
    • the address of the local Social Security office that is processing your application for benefits; and
    • whether a decision has been issued.

    If you receive an error, it may be because:

    • You entered an incorrect Social Security number or confirmation number;
    • You did not complete the application; or
    • Social Security made a final decision on your application more than four months ago.

    If you do not have online access, or are otherwise unable to check the status of your application online, you may also check the status of your claim by:

    • Calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) between 7 a.m. to 7 p.m., Monday through Friday. Or
    • Contacting your local Social Security office. Pensacola’s contact information is available at this link.

  • Reasons to Apply for Social Security Disability

    Why should you apply for Social Security Disability Insurance (often called SSD or SSDI for short) and/or Supplemental Security Income (SSI) disability benefits from the Social Security Administration (SSA)?

    First, if you found disabled then you are entitled to monthly cash benefits. However, in addition to cash benefits, also qualify for medical health insurance benefits. SSI recipients qualify for Medicaid right away, and SSDI recipients qualify for Medicare after two years of receiving benefits.

    As for when you should file a disability claim, here are two lists that may help

    Reasons to Apply for Social Security Disability

    If all of the following apply to you, you should are eligible for disability benefits and should file an application:

    • You have a mental or physical condition that is severe.
    • Your disabling medical condition has lasted at least one year, or is expected to last for at least one year or longer.
    • Your condition is severe enough that it prevents you from performing full time work, or keeps you from earning more than $1,040 per month (or $1,740 if you’re blind). Social Security considers this the Substantial Gainful Activity (SGA) level.

    If you believe your medical condition is severe, will last 12 months or longer, and will prevent you from earning SGA, you should contact your nearest Social Security field office to start a disability claim. Do not hesitate to do this because the application process on a disability claim can be extremely lengthy.

    Reasons NOT to Apply for Social Security Disability

    You should not apply for disability if any of the following apply to you:

    • Your condition is not severe.
    • Your condition is expected to be temporary, or last less than one year. An example would be a broken leg that is expected to heal within 12 months.
    • You are consistently able to earn over $1,040 per month (even though you think you are eligible for benefits because you cannot work full-time or earn as much as you used to make).
    • You have not worked long enough or paid enough Social Security taxes to be eligible for SSDI, and your family income or assets are too high to qualify for SSI.

     

  • Should I Hire a Disability Attorney to File a Claim for Disability or Go It Alone?

    lawyerStatistically, the majority (over 70%) of all Social Security Disability and SSI claims are denied at the initial application level. Approximately 88% continue to be denied at the Reconsideration level, which is the first level of appeal. Click here for a visual chart of Social Security’s allowance and denial rates for 2012 at each stage of the application process.

    An attorney can help prepare you case at each of these levels to help improve your chance of winning at each of these levels.  An attorney can help you gather the medical record evidence that will be critical in establishing the severity of your condition. An attorney can also help you obtain opinions from your treating medical providers that will be important in establishing your resulting impairments.

    However, even with an attorney, most Social Security Disability Insurance (SSDI/SSD) and Supplemental Security Income (SSI) claims must continue on to a hearing before an Administrative Law Judge (ALJ) in order to be approved for disability benefits. It is at ALJ hearing level that having an experienced disability attorney can really help win a claim. While no disability attorney can guarantee that a claimant will be awarded Social Security Disability or SSI benefits, an experienced Social Security lawyer can guarantee that a case will be properly “developed” prior to your hearing date.

    Developing a Disability Case

    The simple fact of the matter is this: even after scouring the internet and reading up on disability claims, the vast majority of SSDI and SSI claimants will have no idea how to thoroughly and properly prepare a disability claim for a hearing. By comparison, an experienced attorney should have a high level of familiarity with Social Security’s policies, procedures, rules and regulations. Here at the Ortiz Law Firm, Mr. Ortiz has several years of invaluable SSDI and SSI claims experience to lend to his clients’ disability cases.  He knows what a judge will be looking for with respect to a particular medical condition, and will know what questions to ask your doctor(s).

    Because disability attorneys are paid on contingency (only if you win), they work hard to ensure that an SSDI or SSI claim will have the best chance of winning. These responsibilities include tracking down important medical records and test results, obtaining detailed opinion statements from a claimant’s treating physicians and other medical providers, and applying a thorough understanding of SSA regulations and prior rulings to the entire disability adjudication process.

    The Odds of Winning Without Legal Help

    Can a claimant who is not represented by an attorney still win an SSD or SSI disability claim on their own at an ALJ hearing? Yes. However, the odds of winning a disability claim before an ALJ are markedly decreased when a claimant does not hire an attorney. (Here’s a breakdown of statistics on win rates of those who hired an attorney versus those claimants who went at it alone.)

    You must weigh the risk of going unrepresented to a hearing when your future income and health insurance (Medicare or Medicaid) is literally at stake against the percentage of your backpay that you’ll have to pay an attorney if you win (25%, limited to $6,000 for Social Security cases). Click here to learn more about how disability lawyers are paid.

    Although an attorney is never required in an administrative disability claim (an appeal to federal court is the exception), going to a hearing before a judge without the assistance of an experienced disability attorney can result in a lost opportunity to win disability benefits.

    Lawyers Can Also Help You Win More Backpay

    Even where unrepresented claimants are successful and win their claims on their own, they may not obtain the most favorable “onset date” of disability. This affects how much backpay they will receive from Social Security. The established date of onset of the disability, as decided by the claims representative handling the claim, determines how much a claimant will receive in backpay.  Therefore, proving the earliest possible onset is of extreme importance in an SSDI or SSI claim. (Learn more about onset date and backpay.)

  • How to Determine Your Social Security Earnings History

    You do not need to know your exact earnings history to file for disability. However, if you really want to know your reported earnings history you can request a copy of your Social Security earnings history from the Social Security Administration (SSA).  Up until just recently you could do so by filing a Form SSA-7004 (Request for Social Security Statement). In light of the current budget situation, however, SSA has suspended the Request a Social Security Statement service.

    The new way of obtaining your “green form” statement is to sign up and get your Social Security Statement online. You can use a my Social Security online account to get your Social Security Statement, to review:

    • Estimates of your retirement, disability, and survivors benefits;
    • Your earnings record; and
    • The estimated Social Security and Medicare taxes you’ve paid.

  • How Can I Get SSI Disability?

    Qualify For SSI

    Social security claimThere is another article on this website that is fairly similar to this one titled, “How You Qualify For Social Security Disability Benefits.” So you may be wondering why we’ve written this separate article on Supplemental Security Income (SSI). The short answer is that while Social Security Disability Insurance (SSDI) benefits and SSI disability benefits are both disability programs with the Social Security administration, they have different requirements to qualify for benefits under each program.

    First, let’s look at the difference between SSDI and SSI.

    Social Security Disability (SSD or SSDI) vs. Supplemental Security Income (SSI)

    Social Security Disability (SSD or SSDI) is a disability insurance benefit program administered by the Social Security Administration (SSA) that falls under Title II of the Social Security Act.  SSD is available to any individual who has enough coverage credits. To have “insured status” – that is, to have sufficient coverage to be eligible to receive Social Security disability insurance benefits – a claimant must have paid enough Social Security taxes earned enough “work credits.” Credits are earned by working and paying FICA taxes. You must have worked long enough and earned enough credits to be eligible for disability benefits. SSD benefits are paid out of the Social Security trust fund.

    Supplemental Security Income (SSI) is another disability benefit program that is also administered by SSA. [Interesting side-note: Individual states formerly ran their own low-income disability programs as part of their general welfare programs until President Nixon worked to federalize these programs into the U.S. SSI program in 1972.] SSI falls under Title 16 of the Social Security Act and is funded by the general treasury, not the Social Security trust fund.

    There is no work requirement for SSI benefits. SSI is available to disabled claimants who have never worked and to those who have not earned enough work credits to qualify for Social Security disability insurance. However, eligibility for SSI is still subject to income and asset limits.

    SSI is also available to individuals who worked in the past and were once eligible to receive Social Security disability but are not eligible any longer because they have not worked in a long time (and, thus, their coverage has lapsed). It is also available to children who are disabled and whose families have low income and assets.

    SSI is $710 per month in 2013, but may be reduced if someone is helping the claimant financially. As stated above, SSI also has income and asset requirements. For more information on SSI, look here.

    Note: It is possible to receive both SSDI and SSI benefits, but only if you meet all of the requirements for both programs and are found disabled by the Social Security Administration.

    Learn more about the basics of SSI.

    How Do You Get SSI?

    To apply for SSI disability benefits, you should visit your local Social Security field office. The application will be taken by a Social Security claims representative. Claims representatives work at local Social Security field offices. In addition to performing other duties such as processing retirement claims, claims reps take SSI disability applications. After an SSI disability application is completed, it sent off to another agency that specializes in doing nothing but processing medical determinations on SSI, SSDI and Medicaid claims. In most states, including Florida, this agency is known as Disability Determination Services, or DDS for short.

    When an SSI disability application arrives at DDS the file is immediately assigned to an individual who will process the medical portion of the claim. This individual is known as a disability determination specialist, or disability examiner. After being assigned an SSI claim, the claim examiner will send out medical releases to the claimant’s treatment sources (hospitals, clinics, doctors, counselors, etc.), requesting the claimant’s medical records. Because many medical providers (especially large hospitals and practice groups) are slow when it comes to copying and mailing records, sometimes the time to process medical records requests can take several months.

    Once the records finally do arrive they will be evaluated by the DDS disability examiner. The examiner may then consult with a physician and/or psychologist who act as a medical consultants.

    Can You Collect SSD and SSI at the Same Time?

    When an claimant files for disability, the Social Security office will review the claim to determine whether the claim will be for Social Security disability insurance benefits, SSI disability benefits, or both. Filing for both SSD and SSI at the same time is known as a concurrent disability claim. A concurrent claim may be appropriate for those individuals who have sufficient quarters of coverage for SSD benefits, but whose monthly benefit amount might be particularly low.

    What Determines Whether You Will Receive SSI?

    Whether your disability claim  will be approved really comes down to what evidence is contained in your medical records. That’s why it is so important continue treating with a medical doctor on a consistent and regular basis. Then you will have the medical evidence to support a favorable determination in your claim. Keep in mind that older, more dated records are not enough to win a disability claim. The examiner also needs to have access to more recent records (those that are no older than 60 days) in order to determine whether you are currently disabled. For example, it would not be enough to have a 5-year old MRI evidencing a herniated disc. You would also need to show more recent records, such as recent treatment notes from a pain management doctor, to evidence the fact that your disability is current.

    It is always nice to have opinion evidence from a doctor who supports your claim. Your treating physician’s notes may have a large impact on whether you receive SSI.  In a perfect world, your medical records should indicate what your physical and mental limitations are.  What you are capable of doing (or limited in doing) is referred to as your residual functional capacity.

    Lean more about the medical records required for disability benefits.

    Your Residual Functional Capacity

    How does your residual functional capacity (RFC) play into whether you will receive SSI disability? Your residual functional capacity will be first be evaluated to determine whether you are capable of going returning to any of the jobs you did in the past. If it is determined that you cannot return to your past work, your claim will be evaluated to determine whether you are able to perform “other work” of some kind, given your age, education, and skill set. Most SSI claimants who are denied SSI benefits are turned down on the basis of being able to do some other work; in other words, the DDS decides that although the claimant is not able to do his or her prior job, he or she is capable of doing some form of work other than that performed in the past.

    Learn more about the RFC disability process.

    Do You Need a Lawyer for an SSI Case?

    The SSI disability process is indeed a fairly difficult one to navigate, except in the most clear-cut cases. Most SSI applications are denied at the initial stage. So, to win most SSI claims, you must be willing to appeal the initial decision and go to a hearing. Even if you have just applied for SSI, a lawyer may make a difference in the claim. Studies have shown that claimants represented by attorneys win more often than claimants who represent themselves.

    If your SSI case has been denied by the SSA, you should consider hiring a lawyer to represent you at the hearing. The lawyer will help organize your medical records and get the opinion evidence you need to prove that your medical impairments are disabling.

  • How to Apply For Social Security Disability

    One of the top reasons applicants are denied Social Security disability benefits is because the claimant failed to complete his or her application!

    How Does That Even Happen?

    People frequently ask me, “How can a person fail to complete the application?” If I had to venture a guess, I would say that some claimants fail to complete the application because of all the work that is required to file a claim.

    Perhaps it would be easier to explain this by detailing what information is required to file a disability claim with the Social Security Administration.

    How to Apply for Social Security Disability

    There are three ways that you can apply for disability benefits: on the internet (online), in person, or on the telephone.

    When you file a claim either in your local field office or by telephone, a Social Security representative will interview you and complete the application for disability benefits and the Adult Disability Report.

    Even if you choose an application interview in person or on the telephone, you can greatly reduce your interview time as much as 50% by starting the process online. You can complete both the application for benefits and the Adult Disability Report online by going to SocialSecurity.gov.

    You still need to keep your scheduled appointment with your local field office so a Social Security representative can review your information.

    How to Apply Online

    You can apply for disability via the internet by visiting SocialSecurity.gov.

    There are four (4) steps to apply online

    1. Review the Adult Disability Checklist.
    2. Fill out the Disability Benefit Application.
    3. Fill out the Adult Disability Report.
    4. Fill out the Authorization to Disclose Information Form and mail or take it to your Social Security Office.

    How to Apply On the Phone

    The first thing you should do is call Social Security’s toll-free number, 1-800-772-1213, to set up an appointment for someone to take your claim over the telephone. If you are deaf or hard of hearing, you may call Social Security’s toll-free TTY number, 1-800-325-0778.

    The disability claims interview typically lasts from one to three hours, depending on how well prepared you are for the interview. If you schedule an appointment, Social Security will send you a Disability Starter Kit to help you prepare for your disability claims interview. The Disability Starter Kit also is available online at Socialsecurity.gov. For your information and convenience I will list much of the information you will need to gather below.

    How to Apply In Person

    Again, you should call Social Security’s toll-free number, 1-800-772-1213, to make an appointment to file a disability claim at your local Social Security office. In the greater Pensacola area, you may call the Pensacola office directly at 1-877-505-4550.

    What Completes The Application?

    To apply for disability benefits, you must complete (1) a Social Security Benefit Application, (2) an Adult Disability Report, and (3) an Authorization to Disclose Medical Records.

    The Authorization is a one-page medical release that gives Social Security permission to request your medical records from your doctors. The Social Security Benefit Application is your claim for benefits. It does not take very long to make a claim. The real time-consuming part of a disability application is the Adult Disability Report, which collects detailed information about your personal history, work history, medical history and current disability.

    If you cannot complete the Adult Disability Report online, you can still complete Social Security’s (1) Medical and Job Worksheet (“Worksheet”) and (2) Checklist – Adult Disability Interview (“Checklist”), and have them ready for your appointment. I made a shortcut web address for the Worksheet and Checklist, which you can access at SSA.gov.

    Use the following Checklist to prepare for your application, whether it be online, in-person, or on the telephone:

    • Medical records already in your possession. (You do not need to go out and gather all of your medical records. You only need to gather what you already have. Social Security will help you obtain the rest of your medical records.).
    • Workers’ compensation information, including the settlement agreement, payout ledger (distribution), date of injury, claim number, and proof of other disability awarded payment amounts.
    • Names and dates of birth of your minor children (under 19 years old) and your spouse.
    • Dates of marriages and divorces.
    • Checking or savings account number,including the bank’s 9-digit routing number, if you want Direct Deposit for your benefit checks.
    • Name, address, and phone number of a person Social Security can contact if it is unable to get in touch with you.
    • If a medical release Form SSA-827 (Authorization to Disclose Information to the Social Security Administration) was mailed to you by Social Security, complete (sign and date with witness signature) and return it as directed.
    • As stated above, if you are unable to file for benefits online, complete the “Medical and Job Worksheet – Adult” and take it to your interview.

    Take the Checklist items and information to your appointment or have them with you if your appointment is by telephone.

    You should keep your appointment even if you do not have all of the information. Social Security will help you obtain any missing information.

    You should also complete the Medical and Job Worksheet to prepare for your in-person or telephone appointment, or when filing online. This Worksheet is not an application for Social Security disability benefits. It is meant to help you fill out the application for benefits.

    The Worksheet requires you to list the following information:

    1. Medical Conditions: You should list all of the physical or mental conditions (including emotional or learning problems) that limit your ability to work. If you have cancer or any other condition that is measured in stages, you should include the stage and type.
    2. If you are not working, list the date you stopped working.
    3. Your height without shoes in feet and inches.
    4. Weight without shoes in pounds.
    5. Medical Sources: You should list any doctors, hospitals, clinics, therapists, or emergency rooms you have visited because of your conditions. For each medical provider, you should list the name of the provider, address, phone number (with area code), the date you were first seen (or admission date), and the date you were last seen (or discharge date).
    6. Medicines: You should list any medicines you take, why you take them (for which medical condition), and the prescribing doctor’s name.
    7. Medical Tests: List any medical tests you have had, or are going to have in the future. For each test, you should also provide the type of test, the name of the doctor who ordered the test, and the date(s) of the test.
    8. Job History: List the jobs (up to the most recent 5) that you had in the 15 years before you stopped working. For each job, you should list the job title, type of business, dates worked, number of days worked per week, hours worked per day, and rate of pay.

    Armed with the above documents and information, you are well-prepared to file your claim form for disability. It is strongly recommended that you have someone such as an attorney experienced in handling disability claims go through your application with you.

    Mr. Ortiz is a Board Certified Social Security Disability Advocate Attorney and offers free case evaluations. Call today at 850-308-7833 for your free consultation.

  • Proof of Number Holder Name Change

    You checked the status of your Social Security disability application. It says, “We requested that you send the following documents to the office that is processing your application:
    Proof of Number Holder Name Change.” What in the world does that mean?

    For women, it may mean that Social Security wants to verify your previous names, such as maiden name, prior married names, etc.

    For men, it is much less common to have name changes. So why would a man receive such a message. Well, it may mean that your records show a misspelled name, nickname or alias.

    Just be sure to respond to Social Security with any requested information to be sure your application moves forward.