Disability and Injury FAQs
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Do I Have To Pay Income Tax on Social Security Disability Benefits?
The answer is, “It depends.” You must pay federal income taxes on your Social Security disability benefits if either of the two following situations applies to you.
- You file an individual federal tax return and your total income is greater than $25,000. Or,
- You file a joint return and the income of you and your spouse is greater than $32,000.
You should also refer to the Internal Revenue Service (IRS) Notice 703 on the back of your Social Security Benefit Statement, Form 1099, to determine if any of your benefits are taxable. A copy of Notice 703 may be found by clicking this link: Notice 703.
Further note that the above only references federal income tax. Social Security does not have the authority to withhold state or local taxes from your disability benefits. However, many states and local authorities do not tax Social Security benefits. You should consult with your tax advisor and your state or local taxing authority for additional information.
Disability for Diabetes (Type I or II) | Diabetic Neuropathy
Diabetes occurs when the body does not produce enough insulin to process glucose, which results in excessive amounts of glucose in the blood and urine, excessive thirst, and weight loss. In some cases, there is a progressive destruction of small blood vessels which leads to such complications as diabetic neuropathy, infections and gangrene of the limbs, or blindness.
Diabetes can often be controlled with medication and a proper diet. However, as a person ages, sometimes diabetes cannot be controlled. This is a problem as uncontrolled diabetes can cause damage to internal organs and other problems.
Symptoms and Complications of Adult Diabetes
Symptoms of both Type I Diabetes and Type II Diabetes include:
- frequent urination,
- unusual thirst and hunger, and
- extreme fatigue.
Individuals with type 2 diabetes also can experience numbness and tingling in the hands and feet, frequent infections, and cuts that are slow to heal.
Complications from diabetes may include:
- retinopathy (eye and vision problems)
- nephropathy (kidney disease)
- neuropathy (nerve damage) in feet or hands that disrupts your ability to stand, walk, or use your hands
- hypertension (high blood pressure)
- heart disease
- gastroparesis (a type of nerve damage that interferes with digestion)
- peripheral arterial disease (reduced blood flow to your limbs)
- cellulitis (skin infections), and
Qualifying for Disability Benefits with Diabetes
If you have uncontrolled diabetes and you have been unable to work for at least 12 months, or you expect that you will not be able to work for at least 12 months, then you may be eligible for Social Security disability (aka SSDI or SSD) benefits or Supplemental Security Income (SSI) benefits. To qualify for disability benefits, you must be able to demonstrate that the damage caused by your diabetes severely limits what you can do.
One of the biggest reasons disability claims are denied is because the patient is “non-compliant” with the doctor’s orders. If your diabetes is uncontrolled because you failed to follow your doctor’s prescribed treatment, your claim for disability will likely be denied. For more information, see our article on failing to comply with treatment orders.
Meeting a Disability Listing for Diabetic Complications
The Social Security Administration (SSA) has a Listing of Impairments (the “Blue Book”) that tells you how severe an illness must be to qualify for disability benefits. Diabetes is no longer included as a separate Listing, so a diabetes diagnosis will not automatically qualify you for disability benefits. However, if you have complications arising from your diabetes that fall under a Listing, you may be approved for benefits.
If your complications meet the requirements of a Listing of Impairments, you will automatically be approved for disability benefits before Social Security goes any further in the five step sequential evaluation process.
The following are some listings that may apply to patients with complications from diabetes (both hyperglycemia and hypoglycemia):
- Diabetic retinopathy (Listing 2.00). If you have blurred vision, poor visual acuity (between 20/100 and 20/200 in your better eye), or poor peripheral vision from surgery to correct your central vision, you may qualify for disability benefits under this listing. More about disability for vision loss.
- Diabetic nephropathy (Listing 6.06). If your kidneys are no longer filtering properly and you require daily dialysis or there is evidence of too much protein or creatine in your plasma, you may qualify for Social Security disability benefits. More about disability for kidney disease.
- Diabetic peripheral neuropathies (Listing 11.14). Many patients with diabetes have some form of neuropathy or nerve damage in their hands, feet, arms, or legs. To qualify for benefits under this Listing, you must demonstrate that your neuropathy causes a significant impairment of your ability to walk, stand, or use your hands in a skilled way. More on disability for peripheral neuropathy.
- Cardiovascular problems. Diabetes can lead to coronary artery disease (listing 4.04), chronic heart failure (listing 4.02), peripheral vascular disease (listing 4.12), and an irregular heartbeat (listing 4.05). More about disability for heart problems.
- Poorly healing skin and bacterial infections (Listing 8.04). If you have ulcerating skin lesions that last for three months or longer despite treatment and such lesions make it difficult for you to walk or use your hands, you may qualify for disability benefits under the listing for chronic skin infections.
- Amputation of an extremity (Listing 1.05). If you’ve had a foot amputated due to nerve damage and poor circulation caused by diabetes, you may qualify for benefits if you have other limitations as well. More about disability for amputation.
- Diabetic ketoacidosis (DKA), DKA is an acute, potentially life-threatening complication of Diabetes Mellitis (DM) and usually requires hospital treatment to correct the acute complications of dehydration, electrolyte imbalance and insulin deficiency. If you have serious complications resulting from your treatment, SSA will evaluate your condition under the affected body system. For example, the SSA evaluates cardiac arrhythmias under the Cardiovascular System (Listing 4.00), intestinal necrosis under the Digestive System (Listing 5.00) and cerebral edema and seizures under Neurological (Listing 11.00). Recurrent episodes of DKA may result from mood or eating disorders, which SSA evaluates under Mental Disorders (Listing 12.00).
[Note: Because Social Security’s disability listings require that the above complications be severe to qualify for disability, Social Security finds that most people who apply for disability due to diabetes do not meet a listing.]
Should I Request Reconsideration Using a Lawyer If My Disability Claim is Denied?
Requesting Reconsideration Using a Lawyer if a Disability Claim is Denied
If you have filed for Social Security Disability Insurance (SSDI or SSD) or Supplemental Security Income (SSI) benefits, and your application for disability has been denied, you have the right to file an appeal of the denial. The first stage of appeal in Florida is the Request for Reconsideration. You can either file a reconsideration appeal on your own or find an attorney to represnt you and file the appeal.
You Are Likely to be Denied Again After Your Request for Reconsideration
If your initial application is denied, then it is very likely that your reconsideration appeal will be denied as well. A lawyer may be able to help you turn things aground if you left out important information in your application; however, there is no guarantee.
If your reconsideration request is denied, you will have to file a second appeal ton continue with your claim. The second appeal is decided by an administrative law judge (ALJ) at a disability hearing. Before your hearing you should have legal counsel.
Numerous studies have shown that ALJs are significantly more likely to approve disability benefits to those who are represented than to those who represent themselves. Statistically, less than 40% of unrepresented individuals who apply for SSI or SSDI and have their case heard before a administrative law judge (ALJ) will end up winning disability benefits. About 70% of individuals who are represented by an attorney will end up winning disability benefits.
Be Aware of the Deadline
Anyone can file their own appeal online or at their local Social Security District office. However, many of those who choose to file reconsideration appeals on their own have a tendency to procrastinate, sometimes to the point of missing the appeal deadline. Always remember that Social Security only allows 60 days from the date of denial (plus 5 additional “grace” days to allow for mailing time) for an appeal to be filed at the Social Security office.
A surprising number of disability claimants who fully intended to file an appeal miss this deadline. Most of these make the mistake of thinking that the deadline only means that their request for reconsideration has to be postmarked within 60 days from when they received their notice of denial. But tt actually has to be in the Social Security office, not just postmarked, within 65 days of the date stamped on the denial letter. This is one reason why it is a good idea to get a lawyer before you file an appeal. A good disability lawyer will file all appeal paperwork for you on time.
If You Want Help, Seek it Early On In the Process
If you do decide to hire a disability attorney for your reconsideration appeal (or for a disability hearing), do not put this task off until it is too late for the lawyer to be of any real help to you. In order to act on your behalf in proceedings before the Social Security Administration, your lawyer must have certain forms signed, such as an Appointment of Representative, an attorney fee agreement, and permission to get your medical records (Form SSA-827, which is a medical records release form). If you wait too long to hire an attorney, you may not allow enough time to complete the forms, and you may end up having to request an appeal on your own so that you do not miss the 60-day deadline.
Time Limits For An Appeal
Generally, you have 60 days after you receive the notice of our decision to ask for any type of appeal.
- In counting the 60 days, the Appeals Council presumes that you received the Administrative Law Judge’s unfavorable Notice of Decision five days after Social Security mailed it unless you can show that you received it later.
- If you do not appeal on time, the Appeals Council may dismiss your appeal. This means that you may not be eligible for the next step in the appeal process and that you may also lose your right to any further review.
- You must have a good reason if you wait more than 60 days to request an appeal. If you file an appeal after the deadline, you must explain the reason you are late and request that Social Security extend the time limit. The people in the Social Security office can explain further and help you file a written request to extend the time limit. The Appeals Council will consider your request and decide whether to extend the time limit.
What Are The Steps In The Social Security Disability Application and Appeal Process?
The first step in the disability process is to actually apply for Social Security disability benefits. You can file an application for Social Security disability (SSDI) benefits by phone, by mail, online or in person at your local Social Security Administration District Office. Your lawyer can help you file your application.
A claim for Supplemental Security Income (SSI), on the other hand, must be done in person at the local Social Security office or by phone appointment with an SSA Representative.
Your disability claim will then be processed by a representative from your local Social Security field office, and by and your state agencies. The Social Security representative will verify your age, marital status, employment and whether you have enough work credits to qualify for SSDI benefits by having paid Social Security taxes into the system. Your file is then sent to Disability Determination Services (DDS) to determine whether your medical condition is disabling. The DDS is responsible for gathering the required medical records from your doctors. DDS may also make arrangements for you to be seen by consultative examining doctors (that are paid by the Social Security Administration) to determine the severity of your impairments.
Once DDS determines they it has enough medical evidence, it will issue the first decision as to whether you are disabled under the Social Security disability regulations. If you meet the medical requirements for disability the DDS will return your file to the local Social Security field office to calculate the amount of your disability benefits, and you will then begin receiving those benefits. If the DDS finds you are not disabled, then the file is still sent back to the Social Security field office where they will wait to see if you appeal the decision.
To appeal the decision in the state of Florida you must go through the process of reconsideration. You must file a Request For Reconsideration, which is basically a repeat of the initial claim process. [Note: In other states, such as Alabama, if you appeal your initial denial you will skip the Reconsideration stage and go straight to the hearing stage before an Administrative Law Judge.]
If you are denied on reconsideration, then you proceed to the hearing stage. Your case is now in another office called the Office of Disability Adjudication and Review, or ODAR for short. The ODAR that covers Pensacola, Florida is in Mobile, Alabama. The average wait time for a hearing is extremely long, with national averages ranging from 12-18 months (and sometimes longer). As of March 2013, the Mobile ODAR had a wait time of 13 months. And that is not calculated from the initial application. That wait begins at the time the Request for Hearing is filed. If you win at the hearing stage (and your case is not reviewed by the Appeals Council), it will be sent to the local field office for payment.
If the Administrative Law Judge issues a “Notice of Decision – Unfavorable” and you lose at the hearing stage, you can appeal the decision to the Appeals Council.
The Appeals Council will do one of three things: deny your appeal, remand the case for another hearing, or find you disabled. If you continue to lose at the Appeals Council your only recourse is to file a civil action (lawsuit) in United States Federal Court.
Abbreviations in Social Security Disability Claims
This list indentifies many of the common abbreviations used in Social Security Disability claims.
A AACT Abbreviated Account query – Title II AAJ Administrative Appeals Judge – AC adjudicator AC Appeals Council ACE Average Current Earnings – factor used in WC offset calculation ADL Activities of Daily Living AI Aged Individual – Title XVI ALJ Administrative Law Judge AME Agreed Medical Examiner – WC term AME Average Monthly Earnings – benefit calculation factor AOD Alleged Onset of Disability or Alleged Onset Date AR Acquiescence Ruling AUSA Assistant U.S. Attorney • B BHA Bureau of Hearings and Appeals – former name of ODAR BO Branch Office – sub-office of a DO BWO Blind Work Expenses • C CAB Civil Actions Branch of AC CALJ Chief ALJ CDB Childhood Disability Benefits – Title II CE Consultive Examination or Examiner / Consultative Examination CFR Code of Federal Regulations CIB Child’s Insurance Benefits – Title II COBRA Comprehensive Omnibus Budget Reconciliation Act COLA Cost of Living Adjustment • D DAA Drug Addiction and/or Alcoholism / “Drugs and Alcohol” DAC Disabled Adult Child – Title II DED Disability Evaluation Division – the state agency DEQY Detailed Earnings Query – Title II DDS Disability Determination Service – the state agency DHHS Department of Health and Human Services – former SSA parent agency DI Disabled Individual – Title XVI DIB Disability Insurance Benefits – Title II DISM Same as DSM, the preferred acronym DISM Disability Insurance State Manual DIWC Disabled Individual, Worker or Child – Title II claim type DJ District Judge DLI Date Last Insured – Title II disability insured status DLM Date Last Met – same as DLI DO District Office – local SSA field office DOB Date Of Birth DOE Date Of Entitlement – Title II DOT Dictionary of Occupational Titles DSM Diagnostic & Statistical Manual of Mental Disorders • E EAJA Equal Access to Justice Act EOD Established Onset of Disability EPE Extended Period of Eligibility – Title II ER Earnings Record • F FBM First Benefit Month FBR Federal Benefit Rate – Title XVI FIB Father’s Insurance Benefits – Title II FMAX Family Maximum – Title II benefit limit FO Field Office – a DO or a BO FOIA Freedom of Information Act • G GLPSC Great Lakes Program Service Center – PC4 • H HA Hearing Assistant HALLEX Hearings, Appeals and Litigation Law [Lex] – OHA policy manual HCFA Health Care Finance Administration HE Hearing Examiner – former title of ALJ HIA Health Insurance, Part A – Medicare HIB Health Insurance, Part B – Medicare HOCALJ Hearing Office Chief ALJ HOA Hearing Office Administrator HOM Hearing Office Manager HOSA Hearing Office Systems Administrator HPI Hearing Process ?Improvement? • I IAP Interim Assistance Program – Title XVI IAR Interim Assistance Reimbursement – Title XVI ICD International Classification of Diseases ID Initial Determination IEP Initial Enrollment Period – SMIB IFA Individualized Functional Assessment – former SSI child dib. standard IME Independent Medical Examiner – WC term IRWE Impairment-Related Work Expense ISM In-Kind Support & Maintenance – Title XVI • L LMER Last Met Earnings Requirement – same as DLI LPC Legal Processing Clerk LSDP Lump-Sum Death Payment • M MA Medical Advisor – former title of an ME MAMPSC Mid-America Program Service Center – PC6 MATPSC Mid-Atlantic Program Service Center – PC2 MBR Master Beneficiary Record – Title II ME Medical Expert – designated physician at OHA level MER Medical Evidence of Record [also MEOR] MIB Mother’s Insurance Benefits – Title II MRFC Mental RFC MSS Medical Source Statement • N NEPSC NorthEastern Program Service Center – PC1 NH Number Holder – “Wage Earner” – Title II • O OASDI Old-Age, Survivor & Disability Insurance – Title II OCRO Office of Central Records Operations – Baltimore, MD – PC9 ODAR Office of Disability, Adjudication and Review (formerly OHA) ODIO Office of Disability & International Operations – Baltimore, MD – PC8 ODO Office of Disability Operations OGC Office of General Counsel OHA Office of Hearings and Appeals – former name of ODAR OIG Office of the Inspector General OOH Occupational Outlook Handbook OPIR Office of Program Integrity Review • P PA Privacy Act PASS Plan to Achieve Self Support – Title XVI PCI Payment Cycling Indicator – staggered benefit payment dates PE Post Entitlement – Title II PE Post Eligibility – Title XVI PEBES Personal Earnings and Benefit Estimate Statement – Title II PIA Primary Insurance Amount – base benefit rate PMV Presumed Maximum Value – Title XVI income term POMS Program Operations Manual System – SSA claims manual PPD Permanent Partial Disability – WC term PPS Program Policy Statement – SSR precursor PRUCOL Permanent Residence Under Color Of Law PRW Past Relevant Work PSC Program Service Center • Q QA Quality Assurance QC Quarter of Coverage – Title II QMB Qualified Medicare Beneficiary QME Qualified Medical Examiner – WC term • R RC Regional Commissioner of SSA RCALJ Regional Chief ALJ RFC Residual Functional Capacity RFH Request For Hearing RFR Request for Reconsideration RIB Retirement Insurance Benefits – Title II RMO Regional Management Officer RO Regional Office – OHA management unit RPO Regional Program Officer RRB Railroad Retirement Board • S SDI State Disability Insurance SDM Single Decision Maker SEPSC SouthEastern Program Service Center – PC3 SEQY Summary Earnings Query – Title II SGA Substantial Gainful Activity SHA Supervisory Hearing Assistant SIB Spouse’s Insurance Benefits – Title II SLMB Special Low-income Medicare Beneficiary SMIB Supplemental Medical Insurance Benefits – same as HIB SSRT Simple, Routine, Repetitive Task SSA Social Security Administration SSA Supervisory Staff Attorney SSDC Social Security (Title II) and SSI (Title XVI) concurrent claim SSDI Social Security Disability Insurance – Title II SSI Supplemental Security Income – Title XVI SSID SSI Disability SSID SSI Display – computer query SSIRD SSI Record Display – computer query SSLP Social Security Law and Practice – West Group SSP State Supplementary Payments – optional state SSI add-on SSPG Social Security Practice Guide – Matthew Bender SSRS Social Security Reporting Service – West Group SSR Social Security Ruling • T Title 2 Social Security Disability Insurance Title II Social Security Disability Insurance Title 16 Supplemental Security Income Title XVI Supplemental Security Income TTD Temporary Total Disability – WC term TWP Trial Work Period – Title II • U UI Unearned Income – Title XVI UI Unemployment Insurance UP Under-Payment USC United States Code USCA United States Code Annotated UWA Unsuccessful Work Attempt • V VE Vocational Expert VR Vocational Rehabilitation VTR Value of the one-Third Reduction – Title XVI • W WC Worker’s Compensation WE Wage Earner – Title II WIB Widow’s Insurance Benefits / Widower’s Insurance Benefits- Title II WNPSC WesterN Program Service Center – PC5
How Do I Report Fraud?
Unfortunately, fraud is a reality in any entitlement program, including Social Security disability.
How to Report Fraud in Social Security Disability and SSI Claims
The Social Security Administration’s Office of the Inspector General (“OIG”) is responsible for investigating fraud in Social Security programs. Among its many responsibilities, the OIG detects and prevents fraud, waste and abuse in Social Security disability insurance and Supplemental Security Income (“SSI”) claims.
You, as a responsible US citizen, can use this online form to report allegations of fraud, waste, and abuse in SSA disability programs. The OIG has the jurisdiction and authority to investigate allegations of work and the concealment of assets. The OIG also investigates misuse and misappropriation of assets by representative payees.
How Do I Appeal The Denial Of Social Security Benefits?
There are many ways you can appeal:
- First, you can contact Social Security by calling 1-800-772-1213 and tell the representative that you want to file an appeal. They will send you the proper appeal paperwork. However, it is still up to you to file the appeal paperwork with Social Security within the sixty day time limit.
- Second, you can file an appeal online at: https://secure.ssa.gov/apps6z/iAppeals/ap001.jsp. Click on the button that says, “Start a New Appeal” and you are on your way.
- Third, you can go down to your local Social Security office and file the appeal in person.
- Fourth, you can call an attorney like me to assist you, and guide you through the appeal process. I would be happy to answer any questions you have about the appeal process. Call us at (850) 308-7833, or fill out the contact form.
How to Speed Up Social Security Disability Claims
I would now like to name some specific things that everyone who has an SSD or SSI claim should do to make their Social Security decision happen as fast as possible. First, make sure you answer every question on your application and double-check for accuracy. When Social Security reviews it, they will have to reconnect with you for any additional information needed, further delaying the next steps of the process. Be sure to respond as quickly as possible if Social Security does tell you they need more information, even if it’s something you’ve already told them.
Another good time-saver is to make sure that you have submitted to Social Security all of your medical records that are relevant to the case. Stay in contact with your lawyer, if you have one, to be certain that all the medical evidence for your case has been retrieved by either your lawyer or the Social Security office. It is good to check in with your lawyer every couple of months no matter what.
Social Security applicants with the best chance of winning are those that provide opinion evidence from their doctors that describe what illness is causing the disability and how it is preventing the ability to work. You can get this by simply having your doctor write up a report or fill out a residual functional capacity form (RFC).
After applying for disability benefits, call Social Security or your lawyer within a month or two to double-check that nothing was omitted from your application, and then do your best to get the missing information for them, which could make a good impression before the first hearing. If you are at the hearing stage of your claim process, it could very well take a year or two to get an SSDI or SSI hearing. After requesting the hearing, call the hearing office or your disability lawyer to see what you may need to add to your Social Security file to better your evidence and improve your chances at a hearing.
If you are at this level, that probably means you have lost your chance at hearing once or twice. If you don’t already have a disability lawyer by this point, I strongly encourage you to consider hiring one. Improvements will be better made to your Social Security file if you have a professional’s viewpoint.
One way to get a favorable decision made on your claim without waiting for a hearing date is to request an on the record decision (OTR). This can be best used if it is sent by an experienced disability lawyer, especially one who has had success with OTRs before. This would give you a good chance of winning without having to have a hearing. A request for an on the record decision is most effective when it is written in a legal letter brief format which shows good reason for your disability that is supported by medical evidence. You can request an OTR without a lawyer, but writing a strong brief can be difficult for someone with no legal experience.
An OTR may get ignored if a lawyer is known to submit OTRs frequently or if a brief looks unprofessional. Due to the great number of such requests received at the Social Security hearing office and the much smaller number of lawyers and judges there to review them, there is a good chance yours could be passed by. If you have a disability lawyer who does not feel your case is ready for an OTR, you should respect that decision and ask what else can be done to help strengthen your claim.
An OTR is a request for a completely positive decision made without hearing or testimony. Therefore, many cases are not appropriate for such action. You can have a strong case that has good chances of winning at a hearing, but some testimony is often needed to receive a favorable decision. You can still request an on the record decision without losing your case or damaging your chances of getting a hearing, but not many cases are approved at this early level without a hearing.
Being Noncomplaint | Failure to Follow Doctor’s Orders
Failure to follow a doctor’s orders or prescribed mode of treatment is an easy way for your claim to be denied. When you fail to follow treatment recommended by an attending physician, then you are considered to be a “noncomplaint” patient. Your noncompliance will be noted in the medical records.
Some examples of failing to follow orders are as follows:
- continuing to smoke while claiming disability for a heart condition or breathing problem, such as COPD;
- missing multiple appointments with the doctor;
- failing to follow prescribed medical treatment;
- failing to attend physical therapy when recommended;
- failing to take medications as prescribed to you by the doctor;
- failing to go through additional counseling sessions when recommended by a psychiatrist or psychologist;
- failing to change your diet or lose weight when a doctor recommends such to control diabetes; and
- failing to cease taking illegal drugs or alcohol when recommended by the doctor.
These are just some examples of treatment that may be recommended by a doctor that gets ignored.
Your best chance of maximizing your chance of winning your disability claim is to be in a position to testify that you still continue to suffer from a severe impairment despite doing everything you doctor has asked of you.