Thank you for reading this book! I’m a former claims representative and I strongly hope that this book helps you.
First, a few notes on what this book does and doesn’t do: it does not guarantee that you will win your claim. It also doesn’t disclose confidential information. It’s not meant to replace talking with someone who works for the Social Security Administration. If you call someone at your friendly local field office or one of the 800-number call centers, be sure to make your list of questions in advance. And if you can, read this book first. It’s always a very good thing to get a little more background. Much of the information in this book is available at thewww.SocialSecurity.gov Web site. That’s an enormous – and very educational – Web site. This book has boiled down the information that you need to have handy. One more thing, this book also does not give legal advice nor does it take the place of legal advice. This book does, however, cover a lot! You might be overwhelmed. Go slowly. I would rather give you too much than short-change you! If there are any items needing correction, be sure to go to the book’s companion Web site: www.WinYourBenefits.com ! I’ll get any changes or corrections that might be needed done quickly and listed there.
Hi. I’m Angela. I worked for the agency for eight years. Helping people with their claims and their questions became a passion and a privilege for me. I am the daughter of a 100% disabled Army veteran, a step-daughter of a WWII Navy veteran, the niece of a former Air Force “Flying Tiger,” and the daughter of an amazing, vital woman who had more creativity, beauty, and energy than Carters had “Little Pills!” I’m also a college graduate with two master’s degrees (Masters of Arts in Liberal Studies and Masters in Public Administration, both from the University of Southern Indiana). I’m a member of two unions – AFGE and SAG/AFTRA (probably not AFGE any longer, though, since leaving the agency). I’m divorced with no children – but have my silly pets: two oversized German-Shepherd mixes and three very entertaining cats. I also have three sisters (Linda, Mary and Charmi), a brother (Mike), nephews (Greg and Josh), and two great-nieces and two great-nephews.
Before my eight years working as a Social Security claims rep, my life’s main work had still been very public-oriented: I was a broadcaster. I worked at radio stations in Nashville, Tucson, Tulsa, Phoenix, New Orleans, Los Angeles and Evansville, Indiana (where I grew up). I was nominated Billboard Major Market Air Personality of the Year 1987 when I worked in Phoenix at KOOL-FM. It made my folks very proud. I lost, though (to Rick Dees).
The book you are reading is about a subject is very near and dear to my heart. It is my passion. I have seen it make a tremendous difference. As my fantastic boss in New Mexico said, “When people come to this office, we are often their last hope. Let’s solve their problem.”
I am now a non-attorney representative, what they call “EDPNA.” I represent people with their claims and appeals before Social Security. This is my calling. It is my hope to be able to really help now, and I think I can. I think I can help more now than I could before I left the agency. And I do love the agency. I miss it and the people I worked with.
Chapter 1 : The Claimant
Disability can result from almost any given situation. A disabling condition can happen suddenly or develop over time. You could experience a sudden, disabling accident. If you are a working adult, where it happened can be key. It may or may not have been on the job. Or perhaps your disabling condition developed slowly over a period of time—so slowly, and over such a long time span, that you did not even notice its impact on your ability to work until fairly recently.
What if you are the parent of a child who is disabled? Or whose development is being delayed by a disability? What if your child experiences the sudden onset of a disabling condition from an accident? Or, what if the child has had a disabling condition since birth?
In 1990, the laws covering disabled children were changed (“Zebley ” cases). Conditions that couldn’t “be seen” or otherwise weren’t plainly evident, started to get long-overdue attention, and children’s disabilities began to be determined on a “non-adult” scale (as in, not work-related). Before that time, children’s disabilities that tended to be physical and keenly evident (profound mental delay or cerebral palsy, for example) formed the bulk of cases. After 1990, conditions that weren’t so easy to see (but probably very visible to any parent) began getting their due. These conditions include attention deficit disorder (ADD), attention deficit/hyperactivity disorder (ADHD), and others.
Please Note: If your child receives a Social Security payment from a retired, disabled or deceased parent’s work record, this is an auxiliarybenefit to the child, not a payment because the child is disabled. Please remember to apply for SSI for that child upon his or her reaching eighteen (and ideally, the month right after turning eighteen).
(Side note: At that point, if the child has a parent who receives Social Security retirement or disability payments (or if the child has a deceased parent who was covered for Social Security), there is another application that needs to be taken –it is called CDBD/CDBR –disabled adult child (or “DAC”). More on that later.)
If the child already receives SSI, when the child turns eighteen there will be something called the “Age 18 continuing disability review” (covered later in this book). As a legal minor, the child’s disabling condition was based on factors that included a comparison made between how the child “functions” and the “functioning” of other children who are the same general age. However, upon turning eighteen, adultdisability criteria are used. The disabling condition decision is then based in part on adult vocational considerations.
As a working adult, you probably have Social Security disability coverage (“insured status”), if, generally speaking, you have earned a certain amount for at least five out of the last ten years (a good, but rough, estimate right now: around $4800 per year – but make certain by going to the agency’s Web site and search on “quarters of coverage”). Also, while you’re there, create your own “My SSA” account! It’s free, and you can see immediately what’s going on with your work and earnings record. Plus, you’ll get an idea of your early and full retirement benefits (and also if you delay retirement), and you’ll see what you might receive if you were to become disabled. Keep track of your username and password, by the way, and remember that you’ll need to change your password every three months or so. One more thing – it absolutely MUST be YOU creating your account:
- I understand that I may use this service only to access my personal information. Even with a person’s written consent, I understand that I cannot use this online service to access the records of a person:
- With whom I have a business relationship; or
- For whom I am an appointed representative.
- I understand that this computer program contains U.S. Government information.
- I consent to the monitoring and recording of my use of this program to ensure its appropriate use.
- I understand that it is a federal crime to:
- Give false or misleading statements to obtain information in Social Security records; or
- Deceive the Social Security Administration of an individual’s identity.
- I understand that unauthorized use of this service is a misrepresentation of my identity to the federal government and could subject me to criminal or civil penalties, or both.
- I understand that Social Security may stop me from using these services online if it finds or suspects misuse.
- I assume responsibility for the disclosure of my personal information if the computer or other device that I am using to access the MySocialSecurity application does not adequately safeguard my information. I also understand that Social Security is not responsible for the disclosure of my information due to my negligence or for the wrongful acts of others.
So, YIKES! Make sure it’s YOU clicking that mouse!!
Back to the story, now.
If you sustain an injury at work, generally speaking, you’re often able to get workers’ compensation . I f you weren’t injured at work, then maybe you have been enduring an ongoing, steadily (and slowly) deteriorating disabling condition (degenerative disc disease, for example). Or, it could be that you have experienced a “traumatic onset” of a condition that caused you to become disabled. Traumatic onsets are types of events that might involve a misstep, a vehicle, some kind of work-related/ industrial machinery, or some other kind of injury-causing circumstance. However it might have happened, the result could be a disabling condition that prevents work. So: if you find yourself in situations like these, you may find yourself considering filing an application for disability benefits.
If you are expected to heal in less than a year, you generally are not considered disabled. Keep in mind that any additional secondary effects from that injury that could take time to develop. It’s very important for your doctor to keep on top of that. You can help out by keeping a kind of “disability journal” of your experiences (physical problems, changes in activities, doctor/hospital visits, new issues, etc.). If you try to go back to work and it doesn’t work out, that might be designated as an “unsuccessful work attempt.” This might bolster your argument that your condition could last longer than 12-months.
Keep in mind that if you do receive workers’ compensation and file and win Social Security Disability benefits, if there are any past-due benefits (“back pay”), workers’ compensation payments may very well soak up a significant portion of the Social Security back pay (workers’ compensation is also a disability benefit and is subject to that process called “offset” that recoups some of the payments made to the worker).
What if you’ve never worked? That’s the cue for SSI to come into play. It is not based on your work history like Social Security disability requirements are (it is needs-based – more on that to come). You might not have worked, and now you have a disabling condition (or, perhaps you could not work because of your health issues). If you were a stay-at-home spouse and have/had a spouse who works, you probably (hopefully) have some kind of safety net with the health benefits your husband or wife receives from employment.
If you have never worked or haven’t worked lately, you might not be able to receive Social Security disability payments (you might not “covered” for Social Security disability – more on that shortly). If that is the case, you will probably be an “SSI-only” applicant.
First, you can apply. Absolutely, PERIOD, you have the right to apply! However, certain things may cause you to be “ineligible” for any benefit payable and it will prevent your application from moving forward to the disability examiners.
For example: if you are married to someone who works, if their income is fairly low, yes: your application could move forward (all other things remaining the same). Keep in mind though – you may not be eligible for SSI if your spouse’s earnings are too high and you have no minor children (belonging to you or your spouse) in the household. With high spousal earnings and no minor children in the house, you may be over the income limit.
Another thing that can knock you out of contention for your application moving forward is if you and your spouse are “over the resource limit” – for SSI, the couples’ resource limit is $3000 (this is covered elsewhere in the book). For single individuals, the resource limit is $2000. It is different with respect to children (again this is covered elsewhere in the book).
But – if you are over the income limit OR over the resource limit, your application is not eligible to move forward in the disability decision-making process (because there would be nothing to pay you).
As mentioned above, SSI is a “needs-based” benefit. SSI doesn’t depend on your work history – it depends on household (yours and/or your spouse’s) income, your living arrangements and things you and your spouse own (“resources”).
If your spouse’s earnings are lower and you are low-resource, and if you are over 65, blind or if you feel you are disabled, do file for SSI. Make that appointment or call or visit a field office – get your appointment set ASAP. Or, call or visit an attorney or non-attorney representative as soon as possible (the sooner the better, for SSI “filing month” reasons).
Also: if you have not seen a doctor recently, it’s likely that the disability examiners will send you a letter that tells you about an appointment you’ll be having with a healthcare provider (a “consultative exam”). Keep this appointment! If you can’t keep it, call the number on the letter as soon as you can to reschedule. And when the time for the appointment arrives, be sure to take copies of any and all documents with you that might help the healthcare provider understand more about your disabling condition!