Practice Area: Social Security Disability

An experienced disability lawyer representing you early in the SSD application process will help build a strong case for your entitlement to benefits from the onset and help answer all your questions as you navigate the process.

How Long Does It Take to Get Social Security Disability Benefits in 2023?

The timeline for processing an SSD application ranges between three to six months, depending on the availability of medical records and the applicants’ timely completion of necessary forms.

If you have been denied disability, you’ll need to file an appeal through a Request for Reconsideration and a Request for a Hearing before an administrative law judge. That process can take an additional six to 18 months. It may take less time if you agree to a hearing by telephone. However, it’s questionable whether you will get the best result by selecting that option.

When Should I Apply for Social Security Disability Benefits?

The answer to that question varies depending on whom you ask. Due to the lengthy process, many disability advocates suggest applying for benefits as soon as possible. In my practice, however, I consider each case individually before recommending when you should apply. Several factors play into my decision-making process, including how long you have been out of work due to your condition(s)

• The conditions are keeping you from being able to work.
• Your age and the type of work you have performed.
• The length and frequency of your medical treatment and the type of providers where you receive treatment.

The answers to these questions determine the right time to apply for benefits. For example, Social Security guidelines consider how long you have been out of work and how long you will be out of work if your condition is terminal. So, preparing a case and filing an application at the appropriate time can increase your chance of a favorable outcome.

If I’m working part-time, can I apply for disability benefits and get approved?

If you are 18 or over, the first step to Social Security’s evaluation of your SSDI application is to determine your work activity. For example, if you engage in substantial gainful activity (SGA), you are not considered disabled under Social Security’s guidelines. Engaging in SGA means you are working and earning wages of $1,470.00 or more before taxes. As a result, even if you have a severe health problem but continue to work at SGA, you will not be able to collect Social Security Disability benefits.

You may be eligible if you work part-time and earn less than SGA. However, having consistent, part-time work may result in Social Security denying your SSDI application unless you have documentation from a medical doctor addressing why you cannot work full-time.

How Much Will I Receive Monthly if I Am Awarded SSDI Benefits?

The amount you will receive per month varies depending on what you have paid into the program through your wages over the years. If you set up an SSA.gov account, you can see the monthly amount you would be entitled to if found disabled. A person’s maximum benefit per month in 2023 is $3,627.00.

How Much Will I Receive Monthly if Awarded Supplemental Security Income (SSI)?

SSI is a disability program available to individuals who have not worked or paid into the Social Security Program. To be considered for this program, you must have less than $2,000.00 in assets.

The maximum monthly amount you can receive for an individual in 2023 is $914.00. The maximum for couples is $1,371.00. However, the monthly amount you receive may be reduced if you receive assistance from family or friends, including free room and board.

If My SSDI Application is Approved, When Do the Payments Begin?

After filing an SSDI application and being awarded benefits, those benefits begin five months after your disability date. For example, if SSA determines you became disabled as of January 1, 2023, your benefits will start on June 1, 2023.

SSI payments begin the first full month after your disability date. So, if SSA determines you became disabled as of January 1, 2023, your benefits will start on February 1, 2023.

Both programs provide for payment of back-due benefits depending on the date you filed your application. SSDI will pay back-due benefits up to 12 months before the filing date. SSI will pay back due benefits to the first month after the date of filing.

Are SSDI and SSI Benefits Taxable?

SSDI benefits are considered taxable. Generally, the IRS will tax SSDI income over a certain threshold. The threshold is $25,000 in these instances:

• Single
• Head of household
• Married and filing separately (not living with a spouse)
• Qualifying widower

If you are filing married and jointly, the threshold is $32,000.00. The threshold is zero if you are married and filing separately but lived with your spouse during the tax year.

SSI benefits are not taxable.

Do I Need a Disability Lawyer to File an SSDI Application?

No, there is no requirement for you to be represented by an attorney in the SSDI application process.

However, an attorney’s assistance may be helpful even at the initial application stage. An experienced disability attorney will be able to answer your questions as you go through the process. In addition, they can assist in completing the application and the required forms after applying.

We can assist you with obtaining, reviewing, and interpreting your medical records. We can also determine whether the documents are sufficient to support a favorable decision on your claim for disability.

 

Have you been diagnosed with Fibromyalgia and unable to work owing to the severity of your condition? If so, you may be wondering if you can get SSI for Fibromyalgia.

Before applying for SSD benefits, you should be aware of how the Social Security Administration views Fibromyalgia. The SSA requires rigorous evidence that you will need to provide to be considered disabled under the administration's guidelines. It may be helpful to have an SSDI attorney available to support your claim.

Can I get Social Security Disability Benefits for Fibromyalgia?

First, let's start with a breakdown of Fibromyalgia, its symptoms, and how covid can impact its severity.

According to the Social Security Administration (SSA), Fibromyalgia (FM) is a complex medical condition characterized by widespread pain in the joints, muscles, tendons, or nearby soft tissues that persists for at least three months. In addition to chronic pain, Fibromyalgia presents other conditions like difficulty sleeping, memory, and cognitive problems otherwise known as "fibro fog," chronic fatigue, depression, recurring migraine headaches, irritable bowel problems, muscle fatigue causing twitching and spasms, and temperature sensitivity.

For those who have Fibromyalgia, COVID-19 may have a significant impact on their health. The effects of COVID-19 on our everyday life have increased stress, depression, reduced physical activity, and weight gain for many people. While these changes are not unwanted for anyone's health, they are particularly concerning for those with Fibromyalgia as they can result in painful and debilitating flare-ups of their condition.

What do I need to know before I apply for SSI benefits?

• Establish diagnosis and treatment. First, you must establish the diagnosis and treatment for Fibromyalgia by a medical or osteopathic doctor. The Social Security Administration (SSA) will review the doctor's treatment notes, findings on physical examination, and the diagnostic studies. Then, the SSA will evaluate whether the doctor's records are consistent with a diagnosis of Fibromyalgia and whether your reported symptoms over time have been severe enough under the Social Security Administration's requirements to find you disabled.
• A Rheumatologist is vital. Social Security Administration evaluates Fibromyalgia through the criteria established by the American College of Rheumatology. If you have been diagnosed with Fibromyalgia by a physician and not a rheumatologist, documentation may be insufficient to meet the requirements the SSA uses to evaluate claims.
• Evidence. There are three critical pieces of evidence that the Social Security Administration will look for in your medical records to establish the diagnosis of Fibromyalgia. An SSDI attorney can help support you during the process.

1. Your Records. Records must establish that you have had widespread pain that has persisted for at least three months. Widespread pain involves pain on both sides of the body and in both upper and lower halves of the body.
2. Tender points. There are 18 tender points identified on the body and addressed in evaluating Fibromyalgia. Of the 18 tender points, you must have pain in at least 11 of them. If your doctor is not documenting delicate point testing, meeting this criterion will be difficult.
3. Ruling out other diagnoses. There must be documented evidence ruling out other disorders likely to cause the same symptoms.

Symptoms. Considering the severity of Fibromyalgia, the Social Security Administration looks for evidence of having repeated manifestations of six or more fibromyalgia symptoms or co-occurring conditions such as fatigue, cognitive or memory problems ("fibro fog"), waking unrefreshed, depression, anxiety, and irritable bowel syndrome.

Is it challenging to get SSD benefits if you have Fibromyalgia?

Obtaining Social Security benefits based on a fibromyalgia diagnosis can be extremely difficult for several reasons. First and foremost, diagnosis typically occurs between the ages of 35 to 45. At that age, the Social Security Administration considers you to be a younger individual and presumes that you are not disabled based upon their regulatory guidelines. Fibromyalgia diagnosis relies on a combination of subjective symptoms which cannot quickly be established and are not always well documented. The SSA relies heavily on medical records when making disability determinations. If the medical records do not substantiate your complaints, the SSA will most likely disapprove the claim.

Should I Work with an SSDI Attorney?

While you are not required to utilize the services of an SSDI attorney during the benefits application process, it is crucial to put your best case forward from the very beginning. If Fibromyalgia is your primary disabling condition, you should consider consulting with an experienced SSDI attorney near you before entering your claim. If you are denied benefits at the initial stage, it then takes a significant time to get a hearing date before an Administrative Law Judge (ALJ), with some offices reporting a wait of 18-months.

Talk to the attorneys at our law offices in Doylestown for advice. They'll make sure you the best advantage of winning your claim.

Being denied disability benefits is frustrating, especially during the pandemic. Where to start? How long will it take? You have 3 options moving forward.

If you are denied social security disability benefits, it’s important to understand it might not be your fault. At this point it may be beneficial to enlist the help of a social security disability lawyer to help you navigate your next step. As stated, you have 3 options moving forward. They are:

1. Appeal the disability determination
2. Reapply for benefits
3. Do nothing

Preserving your rights to benefits.

If you choose to reapply for SSDI benefits or let the determination stand, it’s important to understand that you will not be entitled to seek disability benefits for any period of time prior to the date of the disability determination. The only way to preserve your right to receive disability benefits for the period of time before the initial date of denial is to file an appeal.

The importance of preserving your right to the benefits before the denial is two-fold:

1. you may lose retroactive disability payments. For example, you stopped working on January 1, 2019, due to your disability. You waited until you had been out of work for 12-months and then applied for benefits on January 1, 2020, and you were denied on June 1, 2020. If you had been awarded benefits you would have been entitled to monthly benefit payments starting on June 1, 2019. If you do not appeal the denial, you can never obtain that year of retroactive benefits.
2. if you do not appeal the denial, you will lose the year of time that passed that would have counted toward your entitlement to Medicare benefits.

How does the appeals process work?

After you receive your initial denial, you have 60 days to file a Request for Reconsideration. The Reconsideration involves having another medical examiner with Social Security review your file. During the reconsideration phase, if you have additional medical records to submit, they will be accepted.

Social Security may also obtain additional records on your behalf if you’ve undergone additional treatment since the last time records were received by Social Security.

What are your chances of getting approved?

Unless you’ve undergone significant treatment, like a surgery, a hospitalization, significant changes in your medication or treatment regimen, etc. you will likely be denied for second time at the Reconsideration level.

Do I need an SSDI Attorney to file a request for Reconsideration?

You do not need an attorney to file a Request for Reconsideration, however due to the likelihood of a second denial, you may want to consider engaging an attorney at this point. The next step if you are denied is to request a hearing before an Administrative Law Judge. It is advisable to have an attorney present when you request the hearing. It is not required, however if you come to a hearing without an attorney, the Judge will likely suggest you obtain an attorney prior to proceeding.

How long will it take to get a hearing?

Prior to the pandemic, a request for a hearing was taking approximately 12 to 16 months to get a date. Since in-person hearings andhave not been held since March of 2020, that time frame may lengthen.

I am scheduled for a telephone hearing on my SSDI appeal. How does that process work?

In order to move forward with hearings before Administrative Law Judges during the pandemic, hearing offices have been scheduling telephone hearings. On the day of the hearing, the court reporter assigned to the case will call you, your attorney, the judge and possibly a vocational expert and join you in a conference call. Each party must be in a separate location therefore your attorney will not be with you other than by phone during the hearing. There will be no video, so the judge will not see you when making determinations about your credibility and you will not see the judge.

I really don’t want a telephone or video conference hearing. Do I have options?

Under the law, you are entitled to a face-to-face hearing and you may object to participating in a telephone or video hearing.

What are the pros and cons of an in-person hearing?

There are pros to an in-person hearing especially if you have a visible physical manifestation of your disabling condition. For example, if you have rheumatoid arthritis with severe joint swelling in your hands that has not been sufficiently documented by your treatment providers, having the judge see the swelling and how it limits the use of your hands and causes you pain is more compelling than you verbally describing it over the phone. Other examples of visual evidence of the severity of a condition may include tremors, gait abnormalities, dramatic weight loss or gain, etc.

The con of not accepting the telephone hearing is that it will prolong getting a hearing and decision on your claim. An SSDI attorney would discuss the pros and cons in your specific case and assist you in making the best decision about how your hearing should be held.

Navigating a claim through the SSDI process can be daunting especially if you are dealing with physical or psychological impairments and a loss of income. There are attorneys and non-attorney advocates that can assist you in presenting the best initial case possible to Social Security through your application and support you if you are denied benefits and want to appeal the determination.

The questions addressed here are only a very small portion of those that will likely arise during this process. Obtaining an experienced and compassionate attorney that also has a strong medical background will be able to answer these questions for you and provide the assistance you need moving through the process.

Being diagnosed with a potentially disabling medical condition and not being able perform the work you used to do is not a guarantee that you will be entitled to Social Security Disability benefits. There are stringent rules and requirements, both financial and medical, which must be met in order to be approved for Social Security benefits.  Applying for benefits without both knowing these rules and seeking the assistance of a professional experienced in Social Security Disability could lead to an initial denial of your claim and then a lengthy appeals process.

Social Security evaluates claims in a five step sequential process.  First, when you submit an application for disability benefits, the field office will determine whether you are financially eligible for benefits.  If you are engaged in “substantial gainful activity” or “SGA” your claim will be denied.  SGA is “work that involves doing significant and productive physical or mental duties and is done for pay or profit”.  In 2018, if you earn $1,180 per month (non-blind applicants) or $1,970 per month (blind applicants),  you will be considered gainfully employed and not eligible for benefits.  The fact that your monthly earnings are zero or less than SGA does not establish disability, but will move you to the next step of the evaluation.

During Step 2 Social Security will evaluate your claim under the  “duration test”. In order to be disabled, your medical disability must have lasted for one year, or be expected to last for at least one year, or must be expected to result in death. If the medical evidence does not establish one of these requirements, your claim will be denied at Step 2.

Step 3 is designed to allow for the most severely disabled applicants to be approved.  Social Security has a Listing of Impairments for physical and mental conditions.  Each Listing contains codified clinical criteria that must be met in order for Social Security to find you disabled at this step.  The Listings provide very specific standards that must be met for diagnostic studies, objective findings on evaluation, and subjective symptoms documented within the medical evidence.  The Listings are extremely difficult to meet.  If you have not treated with medical providers that have performed all of the necessary diagnostic testing and documented all of the pertinent abnormal findings on examination, you will not meet a Listing and will not be approved at this step.

If you did not meet a Listing, your case will move on to Step 4, which examines whether or not you can perform the basic skills and requirements of your past jobs.  Social Security will look at what types of work you have performed over the last 15 years and determine from the medical evidence if you could now meet the physical and/or mental requirements of those jobs.  If Social Security determines that you can perform any of these past jobs, your claim will be denied at this step.  If Social Security determines that your physical and/or mental capacities have decreased to the extent you can no longer perform your prior jobs, your claim can move forward to Step 5.

Step 5 evaluates whether you are capable of performing other work in the national economy other than what you have done in the past. The evaluation takes into consideration what Social Security has determined are your residual functional capacities, which include ability to sit, stand, walk, lift, carry, use of hands/feet, reaching, bending, etc. and the length of time these activities can be performed in an eight-hour work day.

At this step, Social Security also examines your prior work to determine if you have transferrable skills which would allow you to do similar work in a less physically or mentally taxing position. Social Security also looks at whether you could be trained to perform work different than your past work that would be within your residual functional capacity. Your age, level of education and vocational history are part of this analysis. The disability examiners use the “medical-vocational guidelines” which is often referred to as “the grid”. It is extremely difficult to be found disabled under the “grid” if you are a high school graduate under the age of 50 and can perform light duty work.  In most instances, an applicant that falls under this category will be considered capable of performing entry level work or capable of being retrained to perform different work. Many factors that you think should be considered in reaching the determination of whether or not you can perform work are not given much weight at this step in the evaluation. For example, driving restrictions, lack of access to public transportation, lack of availability of work in your general area do not factor into Step 5.

Although we strongly recommend getting professional advice during the application stage of the process, most people do not seek counsel until their application has been denied by Social Security. If it is your intention to appeal the Social Security’s unfavorable determination, you should obtain counsel as soon as possible.  At the present time, you may not be able to have a hearing before an Administrative Law Judge (ALJ) until 18 to 24 months after denial of your disability application. If you come to a hearing without legal representation, the ALJ will usually advise you that you have a right to an attorney and that in general it is recommended that you have one present with you at the hearing. The ALJ will often allow you to reschedule your hearing to allow you to seek an attorney.

An attorney experienced in Social Security Disability will be able to help you develop a strong medical and legal argument as to why you meet the requirements of the Social Security Administration to get your benefits. They will be able to examine your full evidentiary file to determine where your application and medical evidence fell short and assist you in putting your best case before an ALJ and/or through a request for reconsideration of your claim. In general, attorneys practicing Social Security Disability are not paid hourly. Attorneys are paid on a contingency fee basis and only if they are able to get you past due benefits. Most attorneys will perform an initial evaluation of your case in person or through a telephone conference.

If you have questions regarding your entitlement to Social Security Disability benefits or need assistance in applying for benefits or filing an appeal, please contact me at 215-345-8888 or lhaubert@highswartz.com. As a registered nurse, I also have the medical knowledge and experience to navigate you claim through the rigorous medical requirements of the disability application and appeal process. Our attorneys see clients in both our Bucks County and Montgomery offices and have the knowledge and experience in all facets of disability issues.

The information above is general: we recommend that you consult an attorney regarding your specific circumstances.  The content of this information is not meant to be considered as legal advice or a substitute for legal representation.

A person who is disabled may be able to avail themselves of private short or long term disability benefits.   Not everyone has access to short or long term disability benefits.  Unlike Social Security benefits, short and long term disability benefits are based on a private contract of insurance.  Usually, short and long term disability benefits are obtained either as a group benefit of employment or are individually purchased from an insurer on the open market in a manner similar to obtaining a life insurance policy.   Policies obtained through an employer are often paid for by the employer, while private policies are paid for by the individual.  If you do not have this coverage through your job or a private insurance policy, then short or long term disability benefits may not be available to you.

Disability benefits are designed to provide some wage replacement during the time period a person is disabled due to illness, injury, or a combination of these factors.  Generally, any type of disability is covered, regardless of cause.  Unlike Workers’ Compensation benefits, a short or long term disability claimant does not generally have to prove that her or his disability stems from a work-related cause.

Short and long term disability benefits can be provided separately or in conjunction with one another.  The usual practice is that disability that lasts less than six months is considered to be short term, while disability lasting longer than six months is long term.  Often, these coverages are provided together, so that disability that lasts longer than the short-term period becomes a claim for long term disability after the short term period expires.

As these coverages are governed by contracts, it is highly recommended that a potential claimant for short or long term disability insurance obtain a copy of that contract, or at least a copy of the Summary Plan Description, from their employer or insurer.  Each policy can be different, and these policies often have short filing deadlines or brief appeal periods which must be timely complied with or valuable rights can be lost.   Know what you are dealing with and take steps to protect your rights by getting a copy of that insurance contract.

Most policies that combine short and long term disability benefits pay a percentage of your wages lost to disability based on the number of weeks the claimant is out of work.  Usually, short term disability benefits begin as a high percentage of your income, sometimes as high as 90%.  As time goes on, and generally by the time long term disability benefits commence, the percentage of pre-disability income provided can drop, sometimes to 50% of pre-disability earnings.  How your pre-disability income is calculated and the percentage of it you would receive is governed by the specific policy of insurance.

The definition of disability can vary from contract to contract.   Some insurance policies require the claimant to be disabled just from their pre-injury employment, and others may require that the claimant be disabled from any employment.   Again, the insurance contract controls.

It must be kept in mind that short and long term disability benefits only cover lost wages.  Private disability benefits generally do not cover medical expenses, whether related to the disabling condition or not.   If the policy is provided through your employer, the employer may choose to keep you covered by their medical plan, or you may be able to continue your medical coverage via COBRA.  Medical coverage for you and your family can be a significant issue.

Many times, obtaining and keeping short and long term disability coverage is as simple as filling out the required forms and providing medical information from your doctors that support the claim that you are unable to work.  However, sometimes insurers may unjustly deny or prematurely terminate benefits.  Insurers have been known to improperly delay investigation of a claim, delay deciding a claim or payments that are due, or pay only part of the benefit owed.  There may be inappropriate multiple requests for medical information, or it may become difficult to get a response from your claim representative.

If you are facing or having difficulty with a claim for short or long term disability benefits, please contact a High Swartz attorney.  Our Bucks County and Montgomery County disability attorneys have knowledge and experience in all facets of disability issues. Let us help you get the Social Security disability benefits you have earned.

The information above is general: we recommend that you consult an attorney regarding your specific circumstances.  The content of this information is not meant to be considered as legal advice or a substitute for legal representation.