5 Tips When Seeking a Social Security Disability Benefit

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Struggling with getting Social Security Disability benefits?

Each year, thousands of people in Virginia apply or Social Security Disability benefits.  Unfortunately, 70 percent of initial claims are denied.

For Social Security Disability claimants in Virginia who appeal, it can take more than a year until a hearing before an Administrative Law Judge.  No one wants to wait a year or more before being approved for disability benefits.

There are ways you can improve your chances of getting approved for benefits

If you are applying for Social Security Disability benefits, it is important to understand the top 5 Tips When Seeking a Social Security Disability Benefit.  Understand if you are eligible and follow the tips below to maximize your chances of a successful Social Security Disability application.

1. Know what you have to prove to be approved

To meet Social Security’s definition of disability, you must have

1) a severe physical and/or mental impairment
2) that is expected to last at least 12 months or result in death, and
3) that meets or equals a medical listing or prevents you from earning wages above the substantial gainful limit.

Click here to determine the current gainful limit.

Social Security’s adult medical listing and their criteria.

If you suffer from an especially severe condition, such as certain cancers or rare diseases, Compassionate Allowance is one way to fast-track your claim to the front of the line. Social Security generally approves these cases quickly. Check the Social Security Administration’s Compassionate Allowances list.

If you don’t meet a listing or don’t have a compassionate allowance condition, you have to prove you are unable to sustain any regular work (8 hours a day, 40 hours a week) including simple, unskilled work. However, at age 50 Social Security begins to relax that criteria.

2. Determine which program(s) you may qualify for

If you have worked and paid FICA payroll taxes you probably have enough credits in the Social Security System to apply for Social Security Disability Insurance (SSDI).  With adequate wages you can earn up to 4 credits a year which count toward social security eligibility.  You need 20 credits, or 5 years of credits out of the last 10 years.  Your benefit amount depends on how much FICA tax you have paid.  You must satisfy a 5-month waiting period.

To determine if you have enough credits and your estimated benefit, set up a Social Security account.

If you have not worked, or earned enough credits, you can apply for Supplemental Security Income (SSI).  This benefit is a flat amount to be used for housing and food expenses.  There is a resource limit of $2000 for an individual or $3000 for a couple.  Once approved, SSI pays benefits from the date you applied.  SSI benefits may be reduced by one-third if you are not paying your fair share of household expenses.

Click here to determine the current benefit rate for SSI.

You may also go to Social Security’s Benefit Estimate Screening Tool to explore benefits available to you and your family.

3. Maintain healthcare

Your case is only as good as the ongoing and consistent record of your medical condition(s).  If you lose your health insurance, due to your disability, apply for Medicaid, which is now available to many low or no income Virginians who are uninsured.

Once approved for Medicaid, set up appointments with specialists that treat each of your conditions.  Follow your treatment plan.  Avoid canceling appointments and re-schedule if necessary.  Disability Determination Services will collect and review your records thoroughly to determine if your condition(s) meet Social Security’s criteria.  Large gaps in treatment can be harmful to your case.

4. Educate your doctors about your symptoms and limitations

Your medical records need to support the conditions you claim are disabling.  To educate your doctors and improve your records, create a list of your symptoms, their frequency and severity, and how they limit you.  Update your list from time to time and share it with your doctors at each appointment so they better understand and document how your impairments affect you. Symptoms are things like dizziness, weakness, pain, insomnia, anxiety, irritability, depression, difficulty with focus and/or memory.  Limitations can include difficulty bathing, cooking or cleaning your home; sitting, standing or walking for long periods; driving beyond a mile or two; getting along with others; or paying attention or recalling important things.  The more you detail each symptom limitation the better.

For example: headache pain occurs 1 day a week and lasts 6-10 hours requiring me to rest in a dark room. The pain is a 6-8 on the pain scale and medications provide limited relief. When working, I had to call in sick 4 days a month and I am unable to help at home when the symptoms occur.

5. Understand the process and hang in!

Obtaining a social security benefit can take time.  When you apply, it can take up to 120 days for a decision.  Most people are denied, especially those with weak documentation.  If you are denied you have the right to appeal within 60 days.  This appeal is called Request for Reconsideration and will require another 60-120 days for a decision.

If your Request for Reconsideration is also denied you can appeal, again, within 60 days.  This appeal is called Request for Hearing by an Administrative Law Judge.  This will involve a face-to-face hearing with a Social Security judge and can take a year or more to schedule.  With each appeal, you can submit more documentation to prove your case.  If you require a hearing, be sure to obtain legal help from someone with expertise in Social Security and even your specific condition.  To learn more about the application and appeal process see the disAbility Law Center of Virginia’s fact sheets called TIPS When Applying and TIPS When Appealing.