How to Qualify for Disability

Social Security uses a strict 5-step process to determine if you qualify for disability. That's true regardless of whether you apply for SSDI or SSI benefits.

If you're questioning how to qualify for disability, you are unlikely to receive benefits if you don't match the criteria listed in the below steps. So let's get to it.

Step 1 - Are you working?

The Social Security Administration looks at whether or not you have Substantial Gainful Activity (SGA). In 2022, SGA reflects earnings of $1,350.00 per month. For blind applicants, it requires earnings of $2,260.00 per month.

In general, the rule applies that if you earn $1,350.00 per month, you do not qualify as disabled. As a result, the SSA’s review of your application stops at this point.

If you are working and earning less than $1,350.00, or $2,260.00 if you are blind, your case will move forward to Step 2 of the analysis; however, your chance of receiving benefits is far less likely.

Step 2 – Is your condition severe?

To be found disabled, you must have a medically determinable physical or mental impairment or a combination of severe impairments. Severity gets determined by how the condition(s) interferes with your ability to perform basic work activities.

The duration of the severe condition MUST: last for 12-months; be expected to last for 12-months; or result in death. You must meet both the severity and duration requirements to move on to the next step.

Step 3 – Does your condition meet the severity of a Listing?

Social Security maintains medical criteria in a listing to determine the severity of an applicant's condition. Listings for physical and mental health conditions include specific, detailed, and stringent criteria. Meeting those criteria involves analyzing the available medical records, relying little on an applicant's subjective complaints or anecdotal history.

If you meet or equal the severity of a Listing and your condition meets the duration requirement defined in Step 2, the SSA qualifies you as disabled.

Should you fail to qualify, the medical reviewer handling your case will develop an x capacity or residual functional capacity (RFC). The RFC defines how they feel your condition limits your ability to perform work activities. Your case will then move onto Step 4, where the SSA uses the RFC to determine your ability to perform work.

Step 4 – Can you perform your past relevant work?

Past relevant work (PRW) includes your work in the last 15 years. In addition, that work meets (SGA) standards, and its duration was long enough for you to have learned how to do the job. However, the SSA determines you as unqualified if you have the residual functional capacity to physically and mentally perform your past relevant work.

If you cannot perform past relevant work or have questions regarding your ability to perform it, the case moves to the final step of the analysis.

Step 5 - Can you make an adjustment to perform work other than your past relevant work?

During this final step, the reviewer determines if you can perform other work. Some things they consider are your:

  • age
  • education
  • vocational history
  • residual functional capacity

The older you are, the less educated, the longer you have performed the same type of work, and the more physically demanding your past relevant work was, are all factors considered in this step.

If you are between the ages of 18-49, and have a high school diploma, the chances of getting disability benefits during the initial application process are unlikely.

The burden of proof that Social Security needs to meet to show you can adjust to and perform other work is minimal. If you are between 50-54, your chances improve slightly but not significantly. It may be beneficial to go over the differences between SSDI and SSI and how they pertain to your situation.

Unsure if You Qualify for Disability

If you're unsure how to qualify for disability, talk to a disability lawyer in our Bucks County law office. Contact Linay Haubert R.N., Esq. at 215-345-8888.

Can You Get SSI for a Fibromyalgia Diagnosis?

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.

Navigating the Social Security Disability Benefits Application Process in 2021

Obtaining medical records from applicants’ medical providers is a crucial part of processing applications for disability. COVID-19 has affected the staffing of physicians’ offices resulting in long delays in obtaining those records. Social Security also sends many applicants for medical evaluations when there is not sufficient evidence in the records to make a decision on a case. For months the vendors that provide physicians to perform these evaluations were closed. While most have reopened with restrictions, appointments have accumulated resulting in continued delays.

If you are applying for disability benefits, requesting reconsideration of a denial of benefits or are waiting for a hearing before an Administrative Law Judge in 2021, below are answers to the most frequently asked questions we have received.

I was diagnosed with COVID-19 and was hospitalized. Am I eligible for social security disability benefits?

The short answer is no.
In order to qualify for disability benefits, one of the requirements is that you must have a condition that resulted in you being unable to work for 12 months or a condition that is expected to keep you from working for at least 12 months.

As we gather more information about COVID-19, it appears that there may be individuals who experience long term or permanent damage to their lungs, heart, kidneys, and nervous system which could result in an inability to work for the required one-year or more. If you fall into this category, they you may be eligible for benefits.

What information should I have available for the SSDI application?

Applicants should have information such as the names, addresses and phone number of your treatment providers readily available. SSA.gov also provides a more detailed list of the information you should have prior to starting your application.

Do I need an SSDI lawyer to file my application?

There is no requirement for you to be represented by an SSDI attorney to apply for Social Security Disability Benefits (SSDI or SSI).

So, what are the benefits of having an SSDI lawyer on my side?

It may be beneficial to have an attorney assist your through the application process. Experienced disability attorneys will be able to answer your questions as you go through the process. They can provide assistance with obtaining, reviewing and interpreting your medical records, completing forms that are required after the initial application is filed, and be there to assist you through the next steps of the process if your application is denied.

How long will it take for Social Security to process my application and make a decision on my case?

While there was no definitive timeframe for processing an application prior to COVID-19, the average wait time from start to finish was around 3 to 5 months. Currently, during the pandemic, it is taking closer to 4 to 7 months depending on the availability of medical records.

If Social Security requires you to attend a medical evaluation it may further prolong a decision on your case. Obtaining copies of your medical records and providing them to Social Security with the application and returning all forms/documentation requested by Social Security in a timely manner, may shorten your wait time.

I was diagnosed with cancer. Is there anyway to get my SSDI application processed more quickly?

Social Security has a Compassionate Allowance Program which identifies claims where the applicant’s disease or condition clearly meets Social Security’s statutory standards for disability. There is a list of diseases and conditions that include certain types of cancers, adult brain diseases and rare disorders that affect children that will trigger Social Security to expedite a case. The complete list of Compassionate Allowance diagnoses can be found on SSA.gov.

When should I apply for social security disability benefits?

The answer to that questions may vary depending on who you ask.
Due to the lengthy process, many disability advocates suggest applying for benefits as soon as you are unable to work. In my practice, I consider each case individually before making a recommendation as to when you should apply for disability. Several factors play into my decision-making process including:

  • the length and frequency of medical treatment
  • whether or not the medical records document the applicant’s limitations
  • how long someone has been out of work
  • what kind of work they performed, their age, etc.

A little time preparing an SSDI case can shorten the time processing a claim and increase the chance of a favorable outcome.

What is the maximum amount you can receive per month in 2021 for SSDI benefits?

The maximum amount you can receive per month in 2021 is $3148.00. Also, SSDI benefits are considered taxable income.

What is the maximum amount you can receive per month in 2021 for SSI benefits?

SSI monthly benefit payments start the 1st full month after the date you became disabled. The maximum amount an individual can receive in 2021 is $794.00 per month. The maximum amount a couple can receive is $1,191.00 per month. SSI beneficiaries are eligible for Medicaid when payments begin. SSI payments are not taxable income.

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.

If you are in need of an SSDI attorney at any crucial step of the social security disability process, please contact Linay Haubert R.N., Esq of the Doylestown office of High Swartz law firm at 215-345-8888.

Denied Social Security Disability Benefits? Here are your options.

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.

11 High Swartz Attorneys named to PA Super Lawyers and Rising Stars lists

High Swartz is pleased to announce that 11 of its attorneys have been named among Pennsylvania’s 2019 Super Lawyers and Rising Stars. Among the highlights are two inclusions on the 50 Top Female Lawyers in Pennsylvania list going to Melissa M. Boyd and Mary Cushing Doherty of the High Swartz Domestic Relations practice.

2019 High Swartz Super Lawyers Melissa Boyd David Brooman Mary Cushing Doherty Mark Fischer Gilbert High, Thomas Panzer Thomas Rees Joel Rosen
2019 High Swartz attorneys added to the Super Lawyers List

What is Super Lawyers?

The Super Lawyers list recognizes no more than 5 percent of attorneys in each state. The Super Lawyers Rising Stars list recognizes no more than 2.5 percent of attorneys in each state. To be eligible for inclusion in Rising Stars, a candidate must be either 40 years old or younger, or in practice for 10 years or less. High Swartz 2019 Super Lawyers and Rising Stars are listed below in alphabetical order.

Melissa M. Boyd: Has been nominated to her 5th consecutive Super lawyer list preceded by 6 Rising Star distinctions. On top of her streak, Missy has been nominated to 3 Super Lawyers Top Lists in Pennsylvania. Those accolades are 100 Top Lawyers in Pennsylvania, 100 Top Lawyers in Philadelphia and 50 Top Female Attorneys in Pennsylvania. Missy is a partner and family law attorney with High Swartz and advocates in various areas including divorce, prenuptial and postnuptial agreements, child custody and child support, equitable distribution, alimony, adoptions, protection from abuse and juvenile law.

David J. Brooman: 2019 marks the return to the Super Lawyers list for David. This is his 10th selection. As a land development and litigation attorney, David J. Brooman has more than three decades experience in zoning and land use development, as well as environmental law.

Mary Cushing Doherty: This will be Mary’s 16th consecutive selection to the Super Lawyers list. Along with her distinction, she’ll join the 50 Top Female Lawyers in Pennsylvania list. With a distinguished record of professional and community service, Mary Cushing Doherty has more than 35 years of legal experience as a family law lawyer. She concentrates her practice on all aspects of marital dissolution and family law issues including divorce, child support, custody, spousal support and alimony, premarital agreement asset protection, complex property division, and is the chair of High Swartz’s Family Law practice.

Mark R. Fischer: Mark has been nominated to his second consecutive Super Lawyer designation. He focuses his practice primarily on representing businesses in breach of contract, payment collection, construction defect, and consumer protection disputes throughout Pennsylvania and New Jersey.

Gilbert P. High, Jr.: This will be Gil’s 14 section in a row. Gil’s impressive career is devoted primarily to the practice of municipal and Real Estate and Land Use Law. He regularly speaks on issues pertaining to municipal liability, particularly regarding the maintenance of the Urban Forest, a subject on which he has lectured nationally.

Thomas E. Panzer: This is Tom’s first and much-deserved selection to the Super Lawyers’ list. Thomas E. Panzer, a workers’ compensation attorney, joined High Swartz in 2016 as a result of a merger with McNamara, Bolla & Panzer, Attorneys at Law, a firm for which he served as Managing Partner. Mr. Panzer is active in his community and is currently the Bucks County, Pennsylvania Treasurer.

Thomas D. Rees: Elected to his 14th Super Lawyers list, Tom heads the firm’s Litigation and Employment Practice. He focuses his practice primarily on employment law and private education law. In the education area, Tom represents a number of independent schools in the Philadelphia area, handling employment, student discipline, contract, and governance matters.

Joel D. Rosen: As High Swartz’s Managing partner, Joel has been a Super Lawyer since 2017. With more than 30 years of legal experience as a corporate law attorney, Joel Rosen’s areas of practice include franchise law, business and commercial law, employment law, trademark/copyright law and commercial leasing.

list of 2019 high swartz super lawyers rising stars
2019 Rising Stars attorneys from High Swartz

Kevin Cornish: Recently elected as a partner at High Swartz, Kevin receives his 8th Super Lawyers Rising Star selection. Kevin focuses his practice on commercial, civil, and contract & multi-state litigation support. His clients include individuals as well as local, regional, and national businesses up and down the east coast.

Elizabeth Early: has been nominated to her third consecutive Rising Star selection. Her areas of specialization include divorce, custody, support, equitable distribution, pre and post-nuptial agreements, parenting coordination and abuse matters. Liz also serves as court-appointed counsel and guardian for minor children.

Brittany M. Yurchyk: High Swartz congratulates Brittany’s first nomination to the Super Lawyers’ list as a Rising Star. Specializing in alternative dispute resolution, Brittany concentrates her family law practice on equitable distribution, child custody, child and spousal support, abuse and domestic relations.

How were the High Swartz Super Lawyers selected to the list?

Super Lawyers nominates the best attorneys using a unique selection process. Peer evaluations and nominations are combined with independent research. Nominees are evaluated on 12 indicators from professional achievement through peer nominations. Nominations are made on an annual, state-by-state basis. The Super Lawyers objective is to create a credible, comprehensive and diverse listing of outstanding attorneys on a national level that can be used as a resource for attorneys and consumers searching for legal counsel. As an aid to those selecting a lawyer, Super Lawyers only selects outstanding local lawyers who are able to be retained by the public.

Social Security Disability: Meeting the Financial and Medical Eligibility Requirements

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.

You May Be Entitled to Multiple Disability Benefits! The Eligibility Requirements and the Interactions Between the Benefits Programs

If you are disabled, you may be entitled to disability benefits through multiple benefit programs. Before applying for disability benefits from multiple programs, it is important to know how benefit programs interact and how each applying for one benefit may affect your eligibility for another for other benefits.  Knowing what is available to you and when you should apply for these benefits is crucial. Seeking the advice of an attorney experienced in navigating multiple benefits programs will help you through the complicated process and help you get the best financial result.

Social Security Disability, Workers’ Compensation, Long Term Disability and  Veterans’ Administration benefits are the most routinely sought by disabled individuals.  We have highlighted some of the most important interactions to be aware of when applying for these benefits.

Workers’ Compensation Benefits and Social Security Disability

If you are receiving workers’ compensation benefits, you may also be entitled to Social Security Disability benefits (SSDI). The two programs are completely separate and the guidelines used by each to determine disability are very different. Workers’ compensation programs vary by state, but in general, you are considered disabled if you are no longer capable of performing the job you were doing when you were injured. The Social Security Administration’s definition of being disabled is broader and the requirements more rigorous. To qualify for SSDI you must be found totally disabled from performing any of the past work you have done and unable to perform work in any field in which you could be reasonably retrained to work.

For example: A certified nurses’ assistant (CNA) injures her low back while lifting a patient and now cannot perform the heavy physical requirements of her pre-injury position; she would likely be considered disabled by workers’ compensation standards. Under the requirements for SSDI, it may be determined that while the CNA cannot work as a CNA, she has the residual functional capacity to do less physical work such as being a receptionist, a companion or housekeeper, and so she would not be considered disabled.

If you are receiving workers’ compensation benefits and then are awarded SSDI, the total amount of the combined benefits you receive cannot exceed 80 percent of your average current monthly earnings before you became disabled. Your workers’ compensation benefits act as your “primary” benefit and then SSDI will supplement your income up to the 80 percent maximum, but no more than your full SSDI benefit rate.

For example: Your average monthly earnings before you became disabled as determined by Social Security was $4,000 per month. You are presently receiving $2,400 per month in workers’ compensation benefits. Your maximum SSDI benefit rate per month is $1,800. Because the combined total of the potential benefits ($4,200) exceeds 80 percent of your average monthly earnings ($3,200), your SSDI benefits would be reduced to $800 per month. If your workers’ compensation benefits are reduced, you would report the change to Social Security and your SSDI benefits can be increased.

There are advantages and disadvantages regarding when you apply for SSDI while receiving workers’ compensation benefits. The timing of your applications may affect your future medical benefits and a potential lump sum settlement of your workers’ compensation claim. If you plan on receiving both benefits, it would be well advised to seek the advice of an attorney that has experience with both workers’ compensation and SSDI claims.

Long Term Disability and Social Security Disability

If you are receiving private long term disability benefits you may also be entitled to SSDI. The definition of disability and the medical evidence required to meet the disability requirements differ among private insurance carriers and will be very different from requirements of the Social Security Administration.

The amount of SSDI monthly benefits you are entitled to receive if found disabled are not affected by your private long term disability payments. On the other hand, with private insurance, your long term disability benefits are defined contractually and the insurer may be entitled to an offset for any SSDI benefits you receive. In fact, many insurers require you to apply for SSDI benefits for just this reason, and failure to apply for SSDI could result in termination of your long term disability coverage.

The long term disability insurers often offer to assist you with your SSDI claim as it benefits them financially. If you are receiving $3,000 per month in long term disability and are awarded $2,000 in SSDI per month, the long term disability plan will begin paying you only $1,000 per month. If you receive back due benefits from SSDI, the long term disability insurer will seek reimbursement for the same $2,000 per month offset retroactively from any back SSDI benefits you receive.

Long term disability does not provide medical benefits coverage so it is important to apply for SSDI benefits to become Medicare eligible. In order to be entitled to Medicare, you must be disabled for two years. The SSDI process can be lengthy and onerous but is extremely important to undertake if you need affordable medical coverage under Medicare.

You should consult with an attorney experienced in Social Security Disability to advise you through the SSDI application process. Keep in mind, although your disability insurer may offer assistance with obtaining SSDI, you may actually never meet a representative until the day of a hearing. It may be beneficial to seek counsel from an attorney that is located in your local area so that you can meet with them from the onset of your claim.

Veterans Administration benefits and Social Security Disability

If you are receiving Veterans Administration (VA) benefits you may also be entitled to SSDI. The definition of disability and the medical evidence required to meet the disability requirements for VA disability differs from those of the Social Security Administration.

The SSDI monthly benefits you are entitled to receive if found disabled are not affected by your VA disability benefits. You are entitled to receive both concurrently without any reduction or offset between the two agencies.

Up until March 27, 2017, Social Security considered whether an individual was receiving VA disability benefits and gave it great weight in the review process of determining an applicant’s disability. For applications filed on or after March 27, 2017, VA disability decisions are considered “ inherently neither valuable nor persuasive to us”. The intent of Social Security was to make it clear that it is never appropriate to “credit as true” any medical opinion. Revisions to Rules Regarding the Evaluation of Medical Evidence in the Federal Register (82 FR 5844). While Social Security will consider VA  medical records in their determinations, the VA disability determination by itself will not guarantee an award of SSDI benefits.

If you have questions regarding your entitlement to Social Security Disability, assistance in applying for benefits or filing an appeal of a denial of benefits, please contact Linay L. Haubert at 215-345-8888 or lhaubert@highswartz.com.  As a registered nurse, I also have the medical knowledge and experience to navigate your 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.

Private Short and Long Term Disability Benefits: Use Them If You Have Them

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.