Navigating the Disability Process

There may have come a time when you or someone you know can no longer work. Maybe there has been an accident, an illness or protracted injury/healing process. The process to start disability benefits can either be as short as a few months to years. There are many variables that can help or hurt your case. What is listed here are tips to consider before and during the application process. When in doubt, you should always consult a disability attorney.

So what can you expect from this material? Below are the topics and forms we will go over here:

• Terms You Need to Know

• The Difference Between SSI & SSDI

• What to Do Before You File

• Medical Records

• Vocational Rehabilitation

• The Disability Process

• SSDI Application (SSA-16-BK)

• SSI Application (SSA-8000-BK)

• Adult Function Report (SSA-3368-BK)

• Work History Report (SSA-3369-BK)

• Winning, Back Pay & Review Cycles

• CDR Forms (Long & Short)

It is always best to write out the answers to the application questions on a piece of paper before filling out the application. You should also have a hard copy of everything you send into the SSA. Put the dates mailed on your copy. If SSA does not have your copy in their computer by three weeks, go to the local office and turn it in there. Get a printed receipt showing they have received your documents. If you require help filling out the forms, ask trusted friend or family member to help you. SSA allows all applicants to have help with the forms from any trusted person of the applicant’s choice. This ideally should be someone who knows your disability and its limitations.

Here are some of the words/terms that come up in conversation when talking about the disability process. You should take time to really understand what each of these things mean to your case.

ALJ: Administrative Law Judge. Basically the judge at your hearing.

CDR: Continuing Disability Review. Everyone has a review schedule. Read more about it in the CDR Forms section.

COLA: Cost of Living Adjustment. How much of an increase, if any, that people get on their check.

DLI: Date Last Insured. The last date you are eligible to receive Social Security disability insurance (SSDI). In order to receive SSDI you need to have worked the past 5 out of 10 years.

DOD: Date of Disability. The month/year that you did not receive SGA due to disability. This is often defined in different ways but if you are working enough to make the SGA, then how disabled are you? SSA will ask that question.

RFC: Residual Functional Capacity. A determination of disability.

SGA: Substantial Gainful Activity. For the year 2021, this is a monthly GROSS (before taxes) amount of $1310 for non-blind people.

SSDI: Social Security Disability Insurance. The benefit program for people who have worked long enough (and recent enough). The amount a person receives and is based on their work history.

SSI: Supplemental Security Income. This is based on a person’s disability and the household income/asset information. The monthly maximum Federal amounts for 2021 are $794 for an eligible individual, $1,191 for an eligible individual with an eligible spouse, and $397 for an essential person.

VE: Vocational Expert. The person at your hearing whose job is to say what potential jobs you can work.

One of the main differences between SSI and SSDI is the RECENT work history of the person applying for benefits. Work benefits expire after 5 years in a 10 year period. It does not matter if you worked from age 15 to 45 but only applied at 55 years old. You need to take note of your DLI. Once this has passed, you can only apply for SSI.

Another difference between the two programs is the amount given to people. SSI is needs based as well as based on disability. It takes into consideration the HOUSEHOLD income and asset level. Households are not just family but also any other living arrangement under the same roof as you. If your household is over the income and asset levels, it does not matter how disabled you are because SSI takes that information into account.

So now let’s talk about filing for disability. As an applicant, you will get a number of different forms. We will discuss the most common ones. These are not the only forms out there but most everyone will have to fill these out to get benefits.

There are things you need to do and know before you even contact SSA to start the process. From each and every doctor/specialist/etc that you have seen in the past 2 years, get a copy of your medical records. This may seem boring and slow but the information in these records will be judged by your examiner, judge, etc.

Now there are some very specific pieces of information that you are looking for in these documents, On a separate piece of paper, write down the doctor’s name, clinic name, date of service (day you saw the doctor) and information.

The first thing you are looking for is your list of diagnosis’. You need the actual diagnosis and the month/year you were first diagnosed officially. Under each diagnosis, write the treatment plan the doctor has prescribed for you. Be specific.

You will need the month/year that the doctor noted in your records as your date of disability. Look carefully for this information. This is where “Patient X can no longer return to work due to…” is in the record. Some doctors and clinics do not participate in the disability process. You need to have a clear discussion with each of your providers about this issue. The date of onset of disability can become a bone of contention during the process and can cause a denial if not notated clearly. Any month you were working and making SGA is likely NOT a month SSA will consider you disabled enough. Many people work while ill/injured but don’t understand that it is not beneficial to their case. SSA does not care that you were suffering. They just see that you somehow made SGA for that month.

Have you exhausted all treatments? Not following treatment recommendations can cause a denial unless there is a really good reason to no do something.

If you have a lack of good medical records, you may need to get a RFC form filled out, usually by your specialist. Some doctors/clinics charge for this form. It is a GOOD thing to get as soon as possible.

Another option to explore is an evaluation done by your local vocational rehabilitation office. This office connects disabled people to job and schooling options. Why is this good? You will get a Vocational Expert at your hearing. It is best to find out what a VE can say before you file. Also if the office is unable to place you, it becomes part of your official record and can be turned into the SSA as part of your case.

One of the most overlooked problems in applying for benefits is how are you going to afford to live, eat, pay bills, go to doctors and pay for medicine. Most cases can take 1-2 years or more. Most attorneys do not want you to work or collect unemployment during this period. If you stop treatment then you are very likely going to get denied for your claim. Look into low income clinics. Check the cost of medications before you lose your insurance. Downsize your living arrangements. Get SNAP benefits. Do everything you can BEFORE you lose your income. You need to make a list of bills and decrease expenses. Having a realistic financial outlook is for the best.

So what is the disability process? So you have the initial application for benefits (either SSI or SSDI). This process usually lasts at the very least 3 months. If you get approved, you will receive an award letter and backpay. If denied, your claim goes to the next step. You will have 60 days to request a reconsideration of your claim. Some states do not have this level. If you are denied again or this is not available, you will go to the next step-a hearing before an administrative law judge. Many people are approved at this stage. You definitely should have an attorney after your first denial and before you get a hearing. This is where a Vocational Expert can testify against you. All they need to do is name up to three jobs (available anywhere in the US, not just where you live) and that is counted against you. A decision from the ALJ can take months to write up and review. Your attorney can see updates sooner than you in most cases.

Before you get an initial determination of disability, SSA is going to send you a ton of forms. If you have work credits, you will get the SSDI Application Form (SSA-16-BK). This is the start of the application process. Most of the form is simple and self-explanatory. We need to address two parts.

Question #9 states: When do you believe your conditions became severe enough to keep you from working. This is NOT a question of when you were diagnosed with your condition. Disability, as defined by the SSA, is a 12 month period where you are unable to make SGA. The month/year that your medical team has decided and notated in your records as you being unable to return to work is the answer. Many people and sometimes their attorneys look to claiming a large back pay for a period of time when the person applying has been working. Disability is where you are unable to work. You may have been sick or injured and still worked but if you were making SGA, that can be counted as not disabled by the SSA.

The Remarks section on page 5 is the other area. If you have been fired because of your disability then state it clearly here. Include the boss’ name and position if possible. If you have gone for a voc rehab services and were denied, state it here. Be very specific.

The initial SSI Application (SSA-8000-BK) addresses the non-medical portion. I cannot stress enough that you need to be completely honest and include everything and everyone that is in your household. Not just married or family. Understand that you may be asked for bank statements, a lease, utility bills, etc. If you have not drawn up a notarized statement detailing your future financial responsibilities, do so now. That may include how much rent you are expected to pay, how the utilities are split, are you expected to pay for your phone, cable, groceries, household, etc. Note any money being lent to you by people to cover expenses during your application process. Detail a repayment schedule. After your application has been sent in to SSA, you are obligated to report ANY change in the household. SSA is very strict on this information. Get someone to look over and verify all information on this document before sending it through the mail. Make a copy to keep and refer to it at least monthly to make sure all of the details in it are current.

Now once you have your benefits, anyone can work part-time or establish an ABLE account if they are on SSI. First, let’s address working a part-time job. Be aware that any work experience can trigger a review at any time unless you sign up with Ticket To Work through the SSA.

Ticket To Work (TTW) is a program designed to allow beneficiaries to test their ability to work without getting reviewed by Social Security. You can sign up with this program through any Vocational Rehabilitation office. You may also call 1-866-YOURTICKET for information.

You can work without the TTW. Every payday or at least monthly, you are required to submit paystubs to the SSA office.

The first thing to remember is that your Trial Work Period (TWP) lasts nine months. During this time, there is no income cap so long as you report your paystubs and remain disabled as SSA defines it. You can use these months during any five year period. After that, you are done with it. SSA defined a TWP as any month you make over $910 gross. This includes any self-employed person working 80 hours in a month.

Once TWP ends, you enter the Extended Period of Eligibility (EPE). This is the 36 month period after your TWP where you can earn up to $1260 (in 2020) without harm to your check.

Reinstatement of benefits can happen in the five years after your EPE to get your check back if the SSA has ended it due to your work.

The rules for earning income are different if you get SSI benefits. Per the SSA website, “We do not count the first $65 of earned income plus one–half of the amount over $65. Therefore, we reduce your SSI benefit only $1 for every $2 you earn over $65 “

SSI recipients can have an ABLE account. ABLE accounts are used to pay for disability expenses and do not interfere with your benefits.

If you are on SSDI and need help paying for medications and the cost of Medicare, then the Medicare Savings Program (MSP) can help. Before you start the application process, you will need to get a current award letter, three months bank statements and information on any assets. This includes life insurance, stocks, etc. You will take this to your states Food stamp or health and human services office. They can sign you up on the programs that will work best for you. You are required to renew this application every year.

Hopefully the information here has helped answer some of your basic questions. Remember to keep copies of everything you send to the SSA. Best of luck!