Calling the Social Security Administration (“SSA”) office is unlikely to help you understand whether or not you qualify for Social Security Disability. This is because when you call the SSA office you will be speaking with a service representative, who is not qualified to make a determination regarding a person’s disability. That is a decision that is assessed by disability examiners who work at DDS, Disability Determination Services, a state agency which is entirely separate from SSA.
DDS assesses many factors in determining a person’s ability to return to the workforce. First, the determination is made whether the claimant can return to their old job. If they can, their claim is denied. Next, DDS will consider whether the claimant has transferrable skills, and will consider factors such as the claimant’s level of education, past work experience, and age. After the age of 50, a person is generally not expected to learn a new trade or skill. Assessing these factors along with a claimant’s physical or mental disabilities or limitations is part of a complex process that service representatives at SSA cannot and should not attempt to inform potential claimants on. This is why you are better off seeking an attorney who is knowledgeable and experienced in navigating the process of proving one’s qualifications to obtain SSD benefits from the SSA.
The Social Security Administration requires that you have earned enough “work credits” in the past in order to be eligible to apply for Social Security Disability benefits.
What are work credits?
When you work and pay Social Security taxes, you earn up to a maximum of four “credits” for each such year.
The amount of earnings it takes to earn a credit has changed since 1978. In the year 2016, you must earn $1,260 in covered earnings to get one Social Security or Medicare work credit and $5,040 to get the maximum four credits for the year.
The number of work credits needed for disability benefits depends on your age when you become disabled. Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. However, younger workers may qualify with fewer credits.
This is why, when you call a Social Security Disability attorney about filing for disability, they will probably ask you the following question:
“Have you worked on the books for at least five of the ten years before you became disabled?
If you worked LESS, you may not even be eligible to apply for Social Security Disability Benefits (SSDB.)
In addition, the more you worked and earned over your lifetime, the higher your monthly benefit amount will be!
Most people have heard the old adage that ” everyone gets denied at first” when applying for Government Disability—more correctly called Social Security Disability (SSD.) This is not actually correct.
The actual nationwide denial rate is around 65% for the first application… meaning you have a 35% chance of winning the case by simply filing an application for benefits.
Obviously the odds are against you in the beginning.
The GOOD NEWS is that on appeal, the 65% goes the other way: 65% of cases that have been appealed then result in an award. (Nationwide average.) The bad news : Appeals take up to a year and a half to be heard!
(Interestingly, the fees that are payable to attorneys are based upon the retroactive number of months and the amount of retroactive payments that are recovered. The more retroactive money recovered, the closer the attorney can get to receiving the maximum fee which is usually $6000. This means many attorneys won’t even TAKE a case at the application stage because there won’t be enough retroactive money if they win right away!)
We have filed MANY applications for disabled clients that are accepted IMMEDIATELY without having to appeal and/or go in front of a SSD Judge!
Feel free to call us if you know someone who plans to file a Social Security Disability!
Winning. It’s the focus of professional athletes, and lawyers, too. Winning the case is paramount. So what goes into winning a Social Security Disability (SSD) case? After all, the Government can deny your case, and you could end up with nothing. My experience is that, especially when you get to the “hearing level” which means in front of a SSD Judge, there are several, sort of “hidden” (not obvious) factors that can enter into a Judge’s thinking that you as the claimant may not immediately think about. But a Judge will look at these things:
1. Is there a long , solid work history? Yes, believe it or not, judges look at how long the person has worked before they became disabled. If the work record is spotty—some years of work, some years of not much or no work—a Judge may feel the disabled worker is not a motivated individual, and hold it against them.
2. Is there regular treatment? If a disabled individual hasn’t seen their doctors on a regular basis or stopped going, causing large gaps in the medical records, that’s a bad thing. A judge may assume their medical conditions really aren’t as severe as they allege.
3. Is the claimant seeing the right kind of doctors? Treating with MD’s who specialize in the condition that they are suffering from- good. Only seeing physician’s assistants or family doctors—bad.
4. Is the claimant honest? Claimants who exaggerate their symptoms or try to “guild the lily” can be punished by receiving a denial. Credibility is key. The reason there is a Judge making a decision is because a Judge can look at and listen to the claimant and assess whether he/she is being truthful or not.
Judges almost always look at these “hidden” factors when deciding a SSDB case. Like the commercial says, “The More You Know……”
Do you know someone who has been injured or become seriously ill and has been unable to work? Which of these should they apply for?
Sick time pay —–Vacation pay——-Workers’ Comp——- Social Security Disability —–Short-term Disability—– Long -term Disability—— Unemployment
Imagine your Holidays with no income coming in. Seriously ill and injured people can face that plight every day.
Our law firm can help the injured and sick choose their best option and can fight to obtain for them a liveable income, when they are unable to fight for themselves. We love what we do, which is helping people support their families through tough times. Give us a call any time. Consultations are free. We only get a fee if we win your case.
Happy Holidays to all.
Dan Morrin, Esq.
I often get the question, what types of conditions would qualify me for Social Security Disability?
The answer is: there are hundreds of conditions, from common to unusual. Disabilities can be purely physical or psychological. They can result from accidents (including work-related accidents), or they can arise as an unexpected diagnosis or steadily worsening condition. Depending on their severity, disabilities can include:
- Back and neck injuries
- Knee and hip injuries
- Traumatic brain injuries
- Strokes, seizures and other neurological disorders
- Bipolar disorder
- Heart and Lung Conditions
Certain diagnoses are so terrible that they automatically qualify for benefits. You just have to prove you have the condition. These are called “compassionate allowance” cases.
Social Security Regulations cover EVERY different system of the body and almost every disease you can think of . Have leukemia? There’s a section covering that. Cardiac arrythmia? There’s a section covering that. Every condition has a “Listing” that basically says, if you meet these requirements, you are considered “disabled.” And all mental impairments are considered right along with the physical.
An example of one of the most commonly used “Listings” is the section that applies to spinal disorders. Generally, in order to “Meet or Equal” this Listing (so that you immediately qualify medically for benefits) you would have to show through medical reports, etc:
“nerve root compression;limitation of motion of the spine; motor loss, atrophy, sensory or reflex loss, positive straight leg raising………”
The trick part of Social Security Disability is that YOU CAN WIN EVEN IF YOU DON’T MEET THESE REQUIREMENTS.
These Listings for each condition just mean that BASED ON YOUR MEDICAL CONDITION ALONE, YOU WIN without taking into account other factors such as age, education, work experience.
Whether someone meets or equals a “Listing” is just “Step Three” of a Five Step Process that Social Security uses to determine if you are disabled.
Bottom line: almost any condition can render someone disabled under Social Security’s rules. But how severe that condition is, and how it affects the particular individual, is the key.
New York ODAR Offices
The Office of Disability Adjudication and Review (ODAR) conducts Social Security Disability (SSD) hearings and Supplemental Security Income (SSI) hearings in 10 different offices in New York. Currently, in New York, the average wait time for a SSI or SSD hearing is 12.2 months. The average case processing time in New York is 416 days.The New York average for winning a disibility hearing is 50%. Click on one of the cities below to see detailed information about the hearing office and the administrative law judges (ALJ) that work there. This information for ODAR offices located in New York was last updated on 5/5/2014.
All new york12.2 months416 days1.82.050%31%National Average:12.1 months394 days2.019%44%38%
Per Day Per ALJ
|Albany||9||12.0 months||420 days||2.0||15%||58%||27%|
|Bronx||7||10.0 months||416 days||1.9||19%||46%||35%|
|Brooklyn||12||16.0 months||505 days||1.6||23%||53%||24%|
|Buffalo||14||13.0 months||462 days||1.2||22%||44%||33%|
|Jericho||8||11.0 months||328 days||2.0||12%||63%||25%|
|New York||11||12.0 months||363 days||2.2||21%||45%||34%|
|Queens||9||11.0 months||418 days||1.2||20%||56%||24%|
|Rochester||4||13.0 months||484 days||2.0||21%||49%||30%|
|Syracuse||10||13.0 months||390 days||1.9||25%||42%||33%|
|White Plains||8||11.0 months||383 days||1.7||20%||40%||40%|
It’s a standard question: How long will it take for me to be approved for Social Security Disability Benefits? (SSDB)
As with so many other things, the answer is: it varies. In truth, it can take from one month to up to two years or more!
Let’s look at this a little closer. First of all, not every one’s disability case is the same. Some individuals will present medical impairments on their disability applications that will immediately stand out as obvious approvals (though this happens in only a small percentage of cases). Examples of clear cut cases include ALS, advanced cancer, severe kidney disease, blindness, AIDs, and double amputations.
Social Security has a list of “225 compassionate allowance” diagnoses. The Compassionate Allowances program expedites disability decisions for Americans with the most serious disabilities to ensure that they receive their benefit decisions within days instead of months or years.
But what about the most common disorders—back injuries, depression, heart attack, etc? How long does the average case take?
Nationally, it takes an average of 120 days for a Social Security disability applicant to receive an answer from the Social Security Administration on his or her initial application. 35% are awarded benefits at this level.
In 2013, here was how many days it took to process an appeal from an initial denial (remember, at that point you’ve already waited 4 months) and have a hearing in front of a Judge on an appeal (in NY, this is the second step in the process) in some local regions:
Brooklyn: 478 days
Manhattan: 320 days
Bronx: 359 days
Queens: 363 days
Long Island (Jericho) : 292 days
just to get a hearing!!!!
Source: NOSSCR Social Security Vol. 5, No. 5, May 2013
The waiting time for the Jericho (Long Island) Hearing Office, by the way, in 2013 was 8th fastest among 165 hearing offices in the country!
So to recap- if you file an application for benefits and you live in Long Island, it takes about 4 months to get a decision, and if you are denied, another 10 months to get a hearing. (And then a couple of months to get the actual decision from the Judge.)
And that’s comparatvely quick. In St. Louis, Mo., the worst hearing office in the country in terms of time to wait for a hearing, the wait to get a hearing in 2013 averaged 547 days!!!
And let’s not forget that since almost all SSDB applicants are not working, that’s an awfully long time to wait for income.
Many of my clients who are injured on the job in New York State are disabled and stay out of work longer than 12 months. In such an instance, can the injured worker ALSO receive Social Security Disability Benefits?
In many cases, the answer is YES.
If the Workers Compensation (WC) claimant (injured worker) is 24 years old and has a back injury, and stays out ow work longer than 12 months, I would say that person has a very low chance of winning a SSD claim. Probably too young. But let’s assume the injured worker is 55, speaks no English, has only had heavy jobs (requiring lots of lifting) their whole life and has that same back injury and time out of work (over 12 months.) Now, there’s a good SSD claim. I file both of these types of claims all the time for my clients………..if I win both, a client gets BOTH benefits at the same time!
The “catch” is that there is a monetary limit to how much a disabled worker can receive as a COMBINATION of SSD and WC. Here’s the rules:
1. SSD will only “offset” (lower its benefits) if the claimant also receives “public” benefits like WC, but not “private” benefits like a Long Term Disability policy that the client is covered by, or a private pension.
2. The applicable limit on receiving SSD and WC is the higher of either:
- 80% of the worker’s pre-injury income, called “average current earnings,” or
- the total amount of SSDI received by all of the members of the recipient’s family in the first month that worker’s compensation is received, called the “total family benefit.”
For most SSDI recipients, the 80% of earnings figure will be higher, and Social Security will use that figure in the offset calculation.
That’s why I practice in both areas of the law—–often, they go together like Batman and Robin, or peanut butter and jelly, or pork and beans, or…………..well, you get the picture!
Age Matters: Social Security Disability Favors Older (50+ years old) Workers
Does age matter when filing a Social Security Disability claim? Yes it does. Here are the four categories that the Social Security Administration (SSA) uses when evaluating age:
“Younger Individual”— Ages 18 to 49;
“Closely Approaching Advanced Age”— 50-54;
“Advanced Age”— 55-59
“Closely Approaching Retirement Age”- 60-65
The three factors most often used to evaluate a claimant’s case other than medical condition are AGE, education, and work experience. Let’s look at an example.
Two construction workers suffer similar, severe back injuries. They are both unable to lift anything heavy and in fact are limited by the injury only to the physical ability to do easy, sitting-down , “sedentary” work.
Comparing the age,education and work experience of the two construction workers who can only do “sedentary” work:
Worker A: 48 years old. Can speak and write English. No skills other than construction work. High School Graduate.
Decision by Social Security: NOT Disabled- (Regulation 201.18)
Worker B: 50 years old. Can speak and write English. No skills other than construction work. High School Graduate.
Decision by Social Security: Disabled- (Regulation 201.12)
SSA’s regulations would grant benefits to the 50 year old, but not to the almost identical 48 year old. Why?
The regulations state that “Individuals (50 and over) may be significantly limited in vocational adaptability….(if they have) no transferable skills…” (Regulation 201.00 g.)
Translation? SSA doesn’t expect 50 year old and older workers to learn a new trade or skill that would allow them to work a sedentary (physically easy) job. But it does expect those under 50 to do so. Hence, the bias in favor of 50 and over workers.
It is much easier to win if you are 50 or over, period.
So, when you contact a Social Security attorney such as myself, the first question they will ask you is: How old are you? Because age really does matter in the world of Social Security Disability Claims!