If You’re Disabled, is Social Security an Option for You?

The general belief regarding disability benefits is: if you’re disabled, you can receive benefits. If only the system was that easy and uncomplicated, but it isn’t. And, if it was, we wouldn’t be here writing about it today! We’ve mentioned before how difficult and complex the system may be. That being said, even those who would qualify for disability based solely on their impairments, may not actually qualify for benefits in the long run.

Last month, we discussed the five-step process that one must be vetted through in order to be determined eligible for disability benefits. We’re not about to say that the five-step process is the only criteria for qualifying for disability, because it isn’t. A recent post on our Facebook page got us thinking. If you feel as if you meet the steps to qualify for disability, are there other issues standing in your way to receiving benefits? The simplest answer is: Yes.

As you may know, there are two different types of disability one can collect—Social Security Disability (SSD) and Supplement Security Income (SSI) benefits. SSD pays monthly cash benefits to people who have paid enough FICA taxes to qualify, and are now unable to work for a year or more because of a disability. Conversely, SSI is a governmental program that pays monthly cash benefits to people who are age 65 or older, those who are blind or those who have a disability and who do not own much or have a lot of income.

If you've worked most of your life and have paid your FICA tax, generally you're going to be eligible for SSD. Specifically, you must have worked ten years in your lifetime and five years out of the last ten at the time you became disabled for SSD eligibility. Unfortunately, if you do not fit the above-noted criteria, there is a chance that you may not qualify for SSD. SSI is available to certain people, like disabled adults and children who have limited income or resources. To qualify for SSI benefits, you must meet certain eligibility requirements, which can be confusing and may vary state by state.

There is, however, a slight chance that—due to individual, family or household circumstance—one may not be eligible for either SSD or SSI. Often times an individual will find out that their household income places them outside of the criteria for SSI. At the same time, they suffer from a disability that does not allow them to return to work, but they cannot qualify for SSD as they have not worked at least five years out of the last ten in order to be eligible. It’s an unfortunate and frustrating situation to be in, and the Social Security Administration’s regulations are not able to be adjusted.

In the News.

We’ve touched on this before; Social Security Disability cases can take along time. Some cases will take longer than others, but with the most recent reports coming in, it appears as if all cases may start taking just a little bit longer. We want to keep you informed of these changes, no matter how big or small. If there is a change in the system that could possibly affect you and how long it takes to receive benefits, you deserve to know.

As of May 27, 2011, Social Security Administration Commissioner Michael Astrue began questioning the recent increase in pending appeals. At present time, more than 740,000 individuals are awaiting an appeal of their case. The current number of individuals awaiting appeal has grown 5% in the last year alone, which could very possibly increase the wait time. According to the Transaction Records Access Clearinghouse, a data research organization at Syracuse University, “history shows that if this growth is unchecked, as hearing dockets become more and more clogged, wait times will grow” (USA Today, June 23, 2011).

If there is an increase in wait, the extra time can, and will be, used to your benefit. Sometimes when cases progress quickly, there isn’t enough time to gather as much support as we would like. With any extra time, we will use it to your advantage, spending the extra days following up with doctors and medical centers to make sure we have all past medical records and current support we can get; in the end, it will help us to establish the strongest case we can on your behalf.

While the continued increase may seem daunting, as extended wait time is the opposite of what anyone is hoping for, there is a light at the end of the tunnel. Commissioner Astrue has indicated that there are measures in currently in place to speed up the decision making process. And, for those applying for benefits, the bottom line is quicker decisions—and hopefully a quicker route to much needed benefits.

The bottom line for us is to keep you informed; it helps us as we continue to do things Better and Nicer. If you are a client and have any questions or concerns about your case, or its status, feel free to contact us. We would be more than happy to let you know how it’s progressing with the Social Security Administration, and give you an update on the status of your case in our office.

Social Security Disability Fraud Resulted in Prison for a Former Missouri Police Chief

Less than a year ago, a former police chief was sentenced to federal prison…for Social Security Disability fraud. Vernis Farmer, a 52 year old police chief from Hayti Heights, Missouri, was sentenced to 21 months in prison on just one felony count of making a false statement to obtain Social Security Disability benefits and two felony counts of concealing information from the Social Security Administration.

An article from the Southeast Missourian dated September 1, 2010, discusses Mr. Farmer’s case in detail. They reported the following: “On March 13, 2007, Farmer reported to the Kennett Social Security Office that he was working 20 hours per week and earning only $800 per month, as the police chief for Hayti Heights, between November 2006 and February 2007. The amount of money he reported was important, because the Social Security Disability work rules allowed beneficiaries to earn up to $860 per month in the year 2006 and $900 per month in the year 2007, without having their benefits suspended. Bank records showed that Farmer was receiving $1,920 per month for full-time work as the police chief.

Since Farmer reported his earnings were below the maximum amount, the Social Security Administration continued to pay his disability benefits. In addition, to the nearly two-year term of imprisonment that was ordered, Farmer was ordered to repay $43,374.50. That figure represents the disability benefits Farmer fraudulently received in conjunction with the current criminal case. The District Court found that since 2001, Farmer fraudulently caused the Social Security Administration to make more than $66,000 in disability benefits that should not have been awarded.”

As uncommon as we would like this type of story to be, it isn’t. In fact, it’s one of the main reasons the Social Security Administration is so strict when it comes to deciding cases, and why the process can often take such a long time. There are a high number of applicants applying for Social Security Disability and Supplemental Security Income benefits, and the Social Security Administration must take their time determining which applicants are being truthful and which ones are not.

We don’t want our clients to end up in Mr. Farmer’s shoes. Rather, we emphasize the importance of being honest and upfront when filing a claim for Social Security Disability benefits, and encourage the same honesty when they appear before an Administrative Law Judge.

There's no test for back pain.

“I have been having severe back pain and it’s been effecting me working and even duties around the house. I’m trying to receive disability and keep getting turned down. I want to work but it’s hard when you have back problems”—Ms. R.

There’s so much we can say in response to Ms. R. After all, it is a story we hear much too often, and it doesn’t get easier to hear with time. Granted, everyone has experienced a bout with back pain once or twice in his or her life. But, to live with it on a constant, daily basis is a whole different story.

The biggest concern when it comes to back pain revolves around subjective pain. To clarify, back impairments are often objective; MRI scan and x-rays may easily indicate the culprit of pain. However, back pain is subjective. Regardless if tests and scans come back with or without evidence to indicate the cause of the pain, no one knows what you are going through, because there is no test for pain.

You might wonder what to do about your pain when it comes to applying for disability, especially knowing there is no specific test to measure your level of pain. Quite possibly, the most important thing you can do is to make sure you’re telling your doctor each time you visit. Most doctor’s offices record pain on a comparative pain scale, giving you a scale from one to ten (with ten being the worst pain ever) and asking you where you would place your own pain level along the scale. Additionally, it’s in your best interest to be as specific as you can with your pain. Is it sharp? Shooting? Burning? Whatever you’re feeling, it’s best to let your doctors know.

If you feel as though your pain has reached a level that has begun to interfere with not only your ability to maintain employment, but also your ability to maintain your activities of daily living, there are options for you. We won’t try to tell you we understand, because we know only you know the pain you are living with. But, we will try to help you in anyway we can; it’s just a part of the way we do things Better and Nicer at Binder & Binder®. 

More on Medicals, Medicals, and Medicals...

At Binder and Binder®, we often recommend that our clients consider having an Independent Medical Examination (I.M.E.). An I.M.E. is given by a Board certified physician, doing an examination in his field of expertise. This physician is also skilled at writing the kind of thorough report we need to win your case. An Independent Medical Examiner report is not designed to replace your treating doctor’s report. A well written treating doctor’s report will always outweigh any other report. But an I.M.E. report is often an extremely valuable supplement to your own doctor’s report. Alternatively, if we are working with medical records only, we often recommend an I.M.E. to provide an opinion in the absence of one from a treating doctor. It is often vital to winning your case, because it can provide the documentation or explanations that we need to prove your disability.

When we recommend that you have an Independent Medical Examination, it is not because your doctor’s report is not good, or that your doctor isn’t a good physician. It is because we want to win your case. Therefore we want the evidence to be overwhelmingly strong.

We’ve found that powerful “medicals” can turn a close case into one which is an almost certain “win.” When you consider the cost of a medical report, remember that it is a key element in winning benefits that may continue coming to you for many years. We will be seeking to prove not only past disability, but continuing disability. And of course, in addition to the money involved, Medicare or Medicaid come with your successful Social Security Disability or S.S.I. award. It is almost impossible to put a price tag on the value of such great medical insurance plans.

Almost every client asks at one time or another, “Are we going to win my case?” No one can predict the outcome of any case with absolute certainty. But we are very proud of the fact that we are “America’s Most Successful Social Security Disability Advocates®.” When we urge you to make an appointment for an Independent Medical Examination, it is very much in your best interest to do so quickly.

We are very well aware that the expense of an Independent Medical Examination can be a financial problem. But our more than 25 years of experience process that it is a very wise investment. Because the three most important factors in winning your disability case are: medicals, medicals, and medicals.

Medical, Medicals, and Medicals...

You’ve probably heard that the three most important factors in Real Estate are “location, location, and location.” In proving your Disability Case, the three most important factors are “medicals, medicals, and medicals.” And by far, the most important of your “medicals” is a report from your own treating doctor.

In a perfect world, your doctor (M.D., PhD. or D.O.) would be a Board Certified expert who is treating you within his or her specialty. For example, if you have heart problems your “Perfect Doctor” would be a Board Certified Cardiologist. This “Perfect Doctor” would write a thoughtful report listing the complete history of your condition, including all clinical findings and whatever laboratory results that support those clinical observations. The report would conclude with the diagnosis, the prognosis, an explanation of your limitations, and a clear statement of your degree of disability. Unfortunately, we have found that “Perfect Doctors” are just as scarce as “Perfect Advocates.”

Many of our clients do not have a Board certified private physician who will dictate the kind of Medical Report that we need to win your case. Some very good doctors are not Board certified, and some very good Board certified doctors write very poor reports. Furthermore, many of our clients have no insurance and go to clinics. That makes it even more difficult to get complete reports.

We know that this may seem overwhelming, and perhaps a bit daunting. But, if it wasn’t important, we wouldn’t be bringing this up. For those of you who have gone through the process of becoming our clients, you know the importance we place on medical support from your treating doctor. We will be seeking to prove not only past disability, but continuing disability. We want the evidence to be overwhelmingly strong. Anyone can apply for disability, but those with medical proof and doctor’s support of their disability will fare much better in the end.

High Jobless Rate Impacting the Social Security Disability Benefit Program

Perhaps it comes as no surprise that the state of the economy is, has been, and will continue to be, impacting the Social Security Disability benefit program (amongst other things). On the other hand, perhaps it does. Regardless, the numbers are quite staggering, and could undoubtedly have an affect on individuals applying for disability in the future.

A recent article in the Washington Post examined a 21 percent increase in disability application and discussed how the growth would not only add to administrative backlog, but may also impact the program’s fiscal stability. The 21 percent increase in application to the program occurred from 2008 to 2009, at the point in which the economy was facing serious trouble. That amount of growth was the sharpest in the 54-year history of the program, if that’s any indication as to how severe it was.

Many anticipated the number of individuals taking part in the program would be growing anyways, as we waited for the growing age of the baby-boom population to expand. However, policymakers suspect “the current surge has less to do with any worsening in the health of the workforce than with the poor health of the economy.”

The Social Security Administration (SSA) believes that their process for screening those with alleged disability allows them to screen out those who may be trying to obtain benefits without having a legitimate disability. However, when jobs begin to become few and far between, the SSA acknowledges that workers who might have otherwise struggled through their impairments will now try to secure disability benefits themselves.

But what affect will all of this have on you? The simplest answer is that the influx of all of the new applications is slowing the regular disability approval time. When the disability approval time can already extend beyond two years when factoring in appeals of unfavorable decisions, the increased wait time is something no one would look forward to. Despite having increased their staff, the SSA has continued to struggle to keep up with the workload.

Unfortunately, these issues are not predicted to end anytime in the near future. The overwhelming amount of new applicants is placing an unsustainable financial burden on the Disability Insurance Trust Fund. However, the SSA is taking measures in an attempt to make this less of a hardship on everyone. As we blogged yesterday, new work incentives and the Ticket to Work program have been created. The hope is that, with changed incentives to reward work, the drain on the fund will be lessened.