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.
How To Win Your Social Security Disability ClaimShow Answer Hide Answer
This page will help show you how to win a Social Security Disability Insurance (SSDI). It will also give you tips to win SSI, or Supplemental Security Income. The information contained on this page and throughout this site is extensive. However, if you are committed to maximizing your chance of winning your SSDI and/or SSI claim, keep reading this site.
Watch the videos. Search for questions that have been answered before. I have helped over one thousand people win disability and hope this information helps you too. If you would like me to represent you too, fill out the form below or call 850-898-9904 for a free case evaluation.
This page provides simple, straight-forward information on winning Social Security Disability (SSDI) or Supplemental Security Income (SSI) benefits. It summarizes the most important things you can do to win your SSDI or SSI claim.
This page does not provide legal advice. It is not a substitute for hiring an attorney to represent you in your claim. Nor is it a substitute for doing further research into the Social Security disability process. I will attempt, however, to provide you some insider tips while pursuing disability. Again, I will not discuss the law or get into specific procedures here. Instead, I will give five tips on things you can do to help your own disability case.
Guide to Winning Social Security Disability
1. The FIRST TIP to help give yourself the absolute best chance of winning is to make sure you submit ALL relevant medical records to Social Security, or give them to your attorney to give to Social Security.
Relevant medical records include those that relate to your illness or injury from one year prior to the date you became disabled up to the present day. This includes:
- your doctor’s treatment notes;
- the test results for all tests performed such as MRIs, X-Rays, blood work, EKGs, EEGs, EMGs, etc.
- emergency room treatment records; and
- records from any hospitalizations.
Residual Functional Capacity Forms / Physical Capacity Evaluation Forms
Residual Functional Capacity (RFC) forms, also called Ability to do Work Related Activity forms or Physical Capacity Evaluation (PCE) forms, can be the difference between winning and losing your SSDI or SSI claim. If your doctor supports your claim for disability, try to get him or her to give you a detailed written report of your condition(s) and how they limit you. This can be extremely persuasive evidence in helping you win your claim for Social Security disability benefits.
You can obtain an RFC or Ability to do Work Related Activity Form from Social Security or your attorney. The SSA’s Ability to do Work Related Activity Form (Physical) is a “one-size-fits-all” form. It is used for any type of physical disability. Because different physical disabilities can impair you in different ways, my firm has customized RFCs for certain conditions. For example, we have a Back RFC, a Fibromyalgia RFC, a Heart RFC, a Cancer RFC, a Crohn’s RFC, a COPD RFC, a Seizure RFC, etc. Contact us about your disability and I will send you the appropriate RFC for your condition.
Physical RFCs should be filled out by any doctor treating you for your physical conditions, and Mental RFCs should be filled out by a mental health provider such as a your psychologist or psychiatrist.
2. The SECOND TIP to help boost your chance of winning is to keep a journal of your activities of daily living. Sit down and write down how your condition limits you on a daily basis. Keep this journal handy at all times so that if you experience any mental or physical problems that limit your chores and other activities during the day you can make a note of it.
Begin this journal now, even before you apply for Social Security Disability Insurance or SSI benefits. If you have already applied by the time you are reading this, then start keeping the diary now.
Now that you have this journal, what information do you put in it? You should start with a description of how your disability keeps you from performing work you have done in the past. List the duties you performed in your past jobs, and note why your conditions keeps you from performing those duties. You should note other issues you are experiencing, such as how your disability disturbs your sleeping patterns, the amount of pain you have when performing chores and other tasks (or even at rest), and how you need to take breaks even when doing simple tasks.
Think about other activities like shopping and social activities like going to church, and how they are now limited. Perhaps you are unable to do certain things at all any more, such as hobbies like fishing and gardening. Note how your disability affects your ability to perform even simple, routine, repetitive tasks (SRRTs) such as driving a vehicle, grocery shopping, visiting family, taking care of family, sitting, standing, walking, remembering and attending appointments, cooking, dealing with stressful situations, dealing with other people, and more.
Think about things you used to be able to do and can no longer do due to your disabling conditions and make a note of those as well. Perhaps there are other things you can still do, but only do them for limited periods of time due to pain or fatigue. For example, you may have difficulty with your grip strength using your hands, a more limited ability to push and pull, and a more limited ability to lift and carry weight with your arms and hands.
You may have memory and concentration problems, difficulty sitting very long, chronic pain, etc. You should also note any side effects you experience from your medication. Not side effects like cotton mouth, but side-effects that would affect your ability to work like extreme fatigue or tiredness, dizziness, and being foggy-headed.
Please remember, these are just examples. Do not use them as examples in your journal unless you are actually experiencing these issues. Your journal is specific and unique to you. Thus, you should note your own personal issues, concerns, problems, limitations, and pain.Many claims will be decided on whether you can do a sedentary (sit-down) job or not, especially if you are under 50 years old. Thus, you should think about and write down why you could not even do a sit-down job. Keep in mind sedentary jobs are sit-down jobs where you do not have to lift greater than 10 pounds on a regular basis. Sedentary Jobs are explained more in the GRID Rules section of this site.
After you have written and maintained this journal, give it to your attorney for review.
3. The THIRD TIP to help increase your chance of winning your SSDI and/or SSI claim is to continue to obtain medical treatment from your doctors and always take your medications as prescribed. When making a disability determination, Social Security will often make the wrongful assumption your condition must not be that bad if you are not getting medical treatment and/or you are not taking your prescribed medication like you are supposed to.
Moreover, if you do not continue treatment with a doctor, or if you have long gaps of time between doctor visits (more than 90 days between visits), then you may not have enough evidence in the form of medical records to support your claim.
On a similar note, if you stop taking your medication, or you do not take it exactly as prescribed by your doctor, then Social Security may deny your claim because you are being “non-compliant” with your doctor’s orders. The SSA’s rules and regulations state Social Security must consider why an individual is not following a prescribed medical treatment or medication regime in issuing its decision.
For example, your excuse may be lack of money or health insurance to get medical care. However, my experience has shown that lack of treatment or failure to take your medication can tremendously hurt your chances of winning Social Security Disability Insurance or SSI benefits.
The reasons why many people do not take their medication vary. Oftentimes it is simply a question of money or financial ability. It seems like simple logic – if you cannot work because of your disability, then you cannot afford to continue to get treatments or medications. However, regular medical care for your medical disabilities is important for your health as well for your claim.
You must try your best to get treatment. There are numerous programs that can help you get the medical care you require. These groups include medicaid and charity care, if you qualify. When you do go to the doctor’s office, you may make mention of the fact you are pursuing Social Security benefits. Be sure not to go overboard. When I review medical records in a Social Security disability claim, it is frustrating to read in the doctor’s treatment notes that the patient is obsessed about getting disability.
Finally, when you do see your doctor make sure that you tell your doctor all of your medical problems (from head to toe) and how they are affecting your daily activities.
4. The FOURTH TIP to help improve your chances of winning your SSDI and/or SSI claim is to be sure Social Security has as many of your medical records as possible before you go for a Consultative Exam (CE). Chances are Social Security will schedule you one or two Consultative Exams (CE).
Before you go to the CE, make sure Social Security has as many of your records as possible before the actual examination. If you just started seeing a doctor, just recently received some of your records, or you just recently sent your records in to Social Security, take a copy of the records with you to the exam to make sure the SSA has them and give them to the examining doctor.
5. The FIFTH TIP is for the consultative exam. Tell the CE doctor all of your medical conditions, even if he or she does not ask you about them. If it is a CE for physical problems, the doctor will perform a physical exam. Keep in mind he or she is observing you the whole time you are there – from the time you are in the waiting room until you leave in your car.
If it is a CE for a mental condition, the psychologist or psychiatrist will ask you a series of questions and he or she will be observing everything about you, including how you answer the questions, your mood, and your demeanor.
The doctor will note your appearance such as how you are dressed, whether you are showered, if your hair is done, whether your nails are trimmed and painted, etc. When answering these questions keep in mind the doctor has seen hundreds (if not thousands) of claimants trying to get disability benefits.
Do not try and fool the doctor by purposely giving ridiculous answers or intentionally missing the question. If you do, chances are the doctor will note in his or her report that your answers were contrived. Not only is this dishonest but this could destroy your disability claim.
Other advice. Another piece of advice on how to win Social Security Disability Insurance (SSDI) or SSI is to remember your non-exertional limitations become even more important if (1) you do not meet a listing, and (2) you are under 50 years old or you are 50 years old or older but had past relevant work that is considered sedentary. In this situation you will have to show that your conditions are so severe that you cannot even do a sedentary jobs.
Some important examples of limitations that may prove this are: inability to sit for long periods of time, mental limitations (such as difficulty with memory, concentration, getting along with others, dealing with stressful situations, etc.), limitations in reaching, pushing and pulling, and limitations in your posture (such as twisting, bending, stooping, etc.). But just telling the doctor you have these limitations is not enough. The limitations must be supported by the medical evidence. This is where the RFC from your treating doctors becomes so important.
That brings us back to the Residual Functional Capacity Forms (RFC forms), also called Ability to Do Work Related Activity Forms or Physical Capacity Evaluations (PCEs). It is important to remember medical evidence, especially RFCs/PCEs, is the key to winning an SSDI or SSI claim.
It is the claimant’s responsibility as the one trying to get disability to show he or she has an impairment and to prove the severity of the impairment. The Social Security Administration will request medical records from any doctors, hospitals and clinics you identify. However, do not leave everything to them.
If the SSA requests medical records from your doctor’s office and the doctor’s office does not respond to the request, Social Security does not send follow-up requests. Social Security will simply issue a decision without those records.
It is up to you to make sure Social Security has all of your records. Your medical records and other evidence should come from “acceptable medical sources.” Acceptable medical sources include: licensed physicians (medical or osteopathic doctors), licensed or certified psychologists, licensed optometrists, licensed podiatrists, and qualified speech language pathologists.
Additional evidence from a provider who is not considered an acceptable medical source (such as a Chiropractor) will be considered but such evidence is given considerably less weight in the decision. Let’s say, for example, you are applying for disability with a back problem. If you are seeing a chiropractor for such problem, you should make sure you are also seeing a medical doctor (preferably a specialist such as an orthopedist).
Medical record evidence from both the medical doctor and chiropractor will be considered. However, the orthopedist’s records will be given considerable more weight than the chiropractor’s records. Remember, Social Security will also want all of your records from any hospitals, clinics, urgent care facilities, and other health facilities where you have been.
The most important medical evidence in your case will come from your treating sources. If you want to win your disability benefits, it is up to you to make sure Social Security has all the evidence from your treating providers. Social Security is supposed to place special emphasis on evidence from treating sources.
A well-written letter or narrative report detailing your condition, treatment and resulting impairments – along with your treating sources treatment notes and an RFC from him or her – will go a long way to improving your chances of winning your Social Security Disability or SSI claim.
If you want to win your disability benefits, continue to read this site and Social Security’s website to become as knowledgeable as possible about winning Social Security Disability benefits.
Medically Determinable ImpairmentShow Answer Hide Answer
The statuory definition of disability specifies that you must have a “medically determinable physical or mental impairment”.
A medically determinable physical or mental impairment is an impairment that results from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques. A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and/or laboratory findings-not only by the individual’s statement of symptoms.
By definition, those impairments which cannot be proven by an objective medical test (such as an X-Ray or MRI) are more difficult to prove. For example, the diagnosis of fibromyalgia relies significantly on the patient’s subjective complaints. There is not an X-Ray which will prove the existence of fibromyalgia. That is why these types of soft tissue disorders are more difficult to prove than say a “broken back”, which can be proven with an MRI. Moreover, the above definition means that mental disorders are difficult to prove. Not impossible to prove. Just more difficult because you cannot exactly prove a disorder like bipolar disorder with an X-Ray.
In short, some disorders are more difficult to prove than others. This is why the claimant’s credibility and medical records are so important.
Acceptable Medical SourceShow Answer Hide Answer
In evaluating a Social Security Disability benefit claim, Social Security will review your medical records acceptable medical sources.
An acceptable medical source is a person or institution that can provide evidence to support the existence of your disability. Such evidence must be in accordance with the Social Security’s guidelines, as set forth in SSA’s publication Disability Evaluation Under Social Security, which is also known as the “Blue Book.” The Blue Book contains information on all of the medical conditions that the Social Security Administration considers as potentially disabling and for which you may receive Social Security Disability benefits. In connection with establishing the existence, duration, and severity of a disabling condition, each listing includes medical evidence that must be submitted to the SSA by an acceptable medical source.
Under Social Security’s guidelines, “Acceptable medical sources” include:
- Licensed physicians (medical or osteopathic doctors);
- Licensed or certified psychologists. Included are school psychologists, or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, for purposes of establishing mental retardation, learning disabilities, and borderline intellectual functioning only;
- Licensed optometrists, for purposes of establishing visual disorders only (except, in the U.S. Virgin Islands, licensed optometrists, for the measurement of visual acuity and visual fields only). (See paragraph (f) of this section for the evidence needed for statutory blindness);
- Licensed podiatrists, for purposes of establishing impairments of the foot, or foot and ankle only, depending on whether the State in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and ankle; and
- Qualified speech-language pathologists, for purposes of establishing speech or language impairments only. For this source, “qualified” means that the speech-language pathologist must be licensed by the State professional licensing agency, or be fully certified 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.
The Social Security Administration’s “Program Operations Manual System” (POMS), section DI 22505.003, further illustrates the appropriate list of acceptable medical sources. In addition to evidence from the acceptable medical sources listed in DI 22505.003B.1., Social Security may also use evidence from other sources to show the severity of an individual’s impairment(s) and how it affects his or her ability to work or, for a child, the child’s functioning. Other sources include, but are not limited to:
- Medical sources not listed in DI 22505.003B.1. (for example, nurse practitioners, physician assistants, naturopaths, chiropractors, audiologists, and therapists);
- Educational personnel (for example, school teachers, counselors, early intervention team members, developmental center workers, and daycare center workers);
- Public and private social welfare agency personnel; and
- Other nonmedical sources (for example, spouses, parents and other caregivers, siblings, other relatives, friends, neighbors, and clergy).
What To Do After a Bicycle AccidentShow Answer Hide Answer
We are often asked what to do immediately after a bicycle accident. Here what to do after a bicycle crash:
- Safety First! Get to a safe location. Make sure that you are out of the way of moving traffic and that you are readily visible to oncoming traffic.
- If you are injured, call an ambulance to take you to the hospital.
- Call 911 to report the crash to law enforcement. If you are injured and taken from the scene for medical treatment, the investigating officer may meet you at the hospital. You may otherwise later regret not reporting the crash. Insist that a police report is made.
- Note the investigating officer’s name, precinct and report number.
- Request a copy of the Accident “Short Form” from the officer.
- Gather as much information at the scene of the accident as you can. If you physically cannot do so due to your injuries, then have someone do it for you.
- Take photographs of your bicycle, the vehicles involved in the accident and the surrounding area (roadways, traffic, etc).
- Take photos of your injuries.
- Preserve all property damage (your bicycle, helmet, damaged electronics, etc). Do not throw away or discard them because they are damaged. They may be necessary for evidence later.
- Have your local bike shop manager assess and document the damage and provide an estimate for repair or replacement.
- Write down the name of the at-fault Driver, Vehicle Owner, License Plate Number, Make, Model and Color of the vehicle.
- Request and note the vehicle’s insurance information and the insurance policy number.
- If the driver is not the owner of the vehicle, request the driver’s car insurance information as well.
- If the accident involves a street or road defect, take a photo of it. Road conditions can change quickly or be repaired without notice.
- Get the names and contact information for all witnesses, including their phone numbers, emails and mailing addresses.
- Report the accident to your own car insurance company.
- Request a copy of the “Long Form” police report. You may be able to buy it from https://www.buycrash.com.
- Do not admit fault or give a “sworn statement” or “examination under oath” to anyone before speaking to an attorney.
- If you are cited and you pay the ticket or otherwise do not contest the citation, you may look guilty as the at-fault party in the accident.
- Anything you say to an insurance adjuster or in traffic court could be later repeated and used against you in court.
- Do not write about your accident on social networks such as Facebook, Tumblr, Twitter, etc.
When you feel you are ready to talk to an attorney, call us for a free case evaluation to discuss your legal rights and options.
The Ortiz Law Firm can be reached at 850-898-9904.
Can a Doctor’s Letter Win a Disability Case or Get You Approved For Benefits?Show Answer Hide Answer
A letter from your personal doctor or physician that states you are disabled and unable to work will not guarantee that your long term disability (LTD) claim will be approved. However, depending on the form and substance of the letter, such a letter can greatly improve your chances of being approved.
In most LTD cases, generic letters from physicians will have little impact on the insurance company’s disability decision. This is due to the fact that doctors submit letters that are so short and lacking in detail in most cases that the letter’s value to a disability examiner is practically non-existent. For example, if all the doctor does is summarize your medical diagnoses and conclude that you are disabled and unable to work, then that letter will not assist the claims handler in understanding why you are unable to work. Unfortunately, this type of letter is the most common one we see from disinterested physicians.
So what makes a good letter? We know that a detailed statement from a doctor who is knowledgeable about a claimant’s medical problems can make all the difference as to whether or not a disability claimant is approved for disability benefits. A good statement goes beyond reciting the patient’s medical diagnoses and gives an opinion as to the patient’s resulting functional limitations.
This type of statement is called a “medical source statement” or “residual functional capacity” evaluation. These medical source statements help in the evaluation process because most insurance company claims adjusters are not medical professionals. They rely on the medical professionals to identify the claimant’s level of impairment; therefore, adjusters give weight to detailed opinions of medical professionals, particularly those who are directly involved in the claimant’s medical treatment. The claims examiner should accept a treating doctor’s medical source statement as true and accurate unless they have good reason to reject it (such as where the doctor has no credibility or is not a specialist familiar with the claimant’s particular illness or injury).
To help a long term disability case, the doctor’s medical source statement should be:
- objective, and
- specifically assess the claimant’s physical capacity or mental capacity and the physical or mental limitations that result from the claimant’s medical condition and problems.
The statement should explain why the patient has certain limitations (for example, the patient cannot stoop because of a herniated disc in the back), and also be support by the medical evidence on record in the claim (for example, include an X-ray or MRI showing degenerative discs).
There is a form that accomplishes these goals, known as an RFC form. (RFC stands for residual functional capacity.) To learn more about RFC forms and to download one you can give to your doctor, see our downloadable RFC page.
What is the difference between Social Security Disability and SSI?Show Answer Hide Answer
The Social Security Administration (SSA) manages two programs that provide benefits based on disability or blindness, the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program.
Social Security Disability Insurance Program (SSDI) (Title II) (Title 2)
SSDI provides benefits to disabled or blind individuals who are “insured” by workers’ contributions to the Social Security trust fund. These contributions are based on your earnings (or those of your spouse or parents). In order to qualify for SSDI benefits, you must have earned enough credits by paying your Social Security taxes as required by the Federal Insurance Contributions Act (FICA). Title II of the Social Security Act authorizes SSDI benefits.
Supplemental Security Income (SSI) (Title XVI) (Title 16)
The SSI program makes cash assistance payments to aged, blind, and disabled individuals (including children) who have limited income and resources. There is no work history requirement. The Federal Government funds SSI from general tax revenues. Many states pay a supplemental benefit to individuals in addition to their Federal benefits. Some of these states have made arrangements with Social Security to combine their supplemental payment with Social Security’s Federal SSI payment into one monthly check to you. Other states manage their own programs and make their payments separately. Title XVI of the Social Security Act authorizes SSI benefits.
Social Security Disability Insurance Supplemental Security Income Eligibility A disabled individual must have paid Social Security taxes and earned enough work credits to become insured for benefits. A disabled or blind adult or child must meet all of the following categories:
1. Have limited income;
2. Have limited resources;
3. Be a U.S. citizen or national (or in one of certain categories of aliens); and
4. Live in the United States or Northern Mariana Islands.
Payment The monthly disability benefit amount is based on the Social Security earnings record of the insured worker. The monthly payment is based on need and varies up to the maximum federal benefit rate. Some states add money to federal SSI payments. Medical Coverage The worker will get Medicare coverage automatically after receiving disability benefits for two years. In most states, beneficiaries are automatically eligible for Medicaid. More Detailed Explanation of the Benefit Social Security Disability Supplemental Security Income What is the difference between individual disability policies and group disability policies?Show Answer Hide Answer
The major difference between individual and group policies is that individual policies are underwritten with respect to the individual purchasing insurance coverage, while group policies are not individually underwritten. Instead, group policies are issued by disability insurance companies based on certain underwriting assumptions related to the general health of a group of people. Individual policies are typically bought and paid for by the insured, separate and apart from an employer. Group coverage, on the other hand, is usually offered by an employer or union, and the premiums are paid (in whole or in part) by the employer. There may be circumstances where an employer will purchase and pay the premiums for an individual policy on behalf of an employee. Conversely, an individual may personally obtain group LTD coverage unrelated to his or her employment by joining a group which has group coverage available for its members.
My employer offers me LTD coverage as a fringe benefit cheaper than I can buy it on my own. Is the group coverage the same as if I bought my own individual disability policy?Show Answer Hide Answer
No. They are not the same. It is almost always better to have an individual policy over a group policy. First of all, the monthly benefits are tax-free if you pay the insurance premiums yourself. If the premiums are paid by a business employer, you may have to pay tax on the benefits. Moreover, if the insurance company does not pay a claim, your legal rights are very different with an individual policy than with a group policy. In short, your legal rights are much more favorable with an individual policy than with a group policy. For these reasons, you should purchase an individual policy over a group policy.
I already have a good health insurance policy. Do I need really need disability insurance?Show Answer Hide Answer
Your health insurance pays for your medical bills, but what about your other monthly expenses in the event that you are unable to work due to a disability? Disability insurance is meant to be a wage replacement in such cases where you cannot work due to a disability. An individual disability policy will typically pay you sixty percent (60%) to seventy percent (70%) of your monthly earnings leading up to the onset of your disability. You can purchase coverage that will cover you so long as you cannot perform the substantial duties of your own individual job, and you can buy coverage that will cover you for two (2) years, five (5) years, or until retirement age (typically age 65).
So the answer is Yes, you should buy as much coverage as you can.
When is an insurance company considered to have committed a “bad faith” denial of a disability claim?Show Answer Hide Answer
According to Black’s Law Dictionary, the definition of bad faith is: “The opposite of ‘good faith,’ generally implying or involving actual or constructive fraud, or a design to mislead or deceive another, or a neglect or refusal to fulfill some duty or some contractual obligation, not prompted by an honest mistake as to one’s rights or duties, but by some interested or sinister motive.” In contract law, there is the concept of “the covenant of good faith and fair dealing,” which means the insurance company has certain duties in carrying out its obligations according to the insurance policy contract. The following are examples of an insurance company’s bad faith after a policyholder files a claim for disability:
- the insurer fails to conduct a reasonable and full investigation into the claim;
- the insurance company acts unreasonably in evaluating the claim;
- the insurer unfairly delays the processing of your claim;
- the insurance company wrongfully denies the claim;
- the insurance company unreasonably delays payment of benefits or pays less than the full value of benefits owed under the policy.
If your long-term disability claim is governed by ERISA, then you cannot sue for bad faith or punitive damages. This is because ERISA is a federal law that pre-empts state law claims such as bad faith and punitive damages. You can only sue for the benefits due.
An Experienced Disability Attorney Can Help You Navigate an ERISA-Governed Appeal
In ERISA disability litigation, the terminology used is a little different than “bad faith.” Federal courts will review the insurance company’s decision to determine whether the denial was “arbitrary and capricious.”
Without legal guidance from an attorney, claimants may unknowingly hurt their ability to prove the insurance company’s bad faith. For example, the claimant may allow the insurance company multiple opportunities to deny the claim by filing multiple appeals when multiple appeals were not required before making the carrier accountable in a lawsuit. As stated above, whether to appeal is a decision that you should make only after consulting with an experienced disability attorney.