Results tagged “Social Security Disability Insurance” from Indiana Long Term Disability Lawyer Blog

Eligibility for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)

June 17, 2014

When applying for Social Security disability benefits, claimants should be aware of the two types of disability programs available. The Social Security Administration (SSA) offers Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
For both programs, the SSA reviews whether the claimant meets the applicable definition of disabled. The SSA defines "disabled" as follows:

An individual shall be considered to be disabled for purposes of this title if he is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months.

On the SSA's website, the SSA further describes its standard of disability and how it decides whether the claimant is disabled. If adequate proof of disability is not provided, a claim for either SSDI or SSI benefits will be denied. If a claim for SSDI or SSI benefits is denied, the claimant has a maximum of 65 days to timely appeal.

Social Security Disability Insurance (Title II)

SSDI benefits act as a federal insurance program to workers. Taxes are deducted out of workers' payroll checks. The tax deductions serve as a premium to qualify for SSDI. If a worker has earned 20 Social Security credits in 10 years, then they will have enough work credits to be eligible or SSDI benefits. The SSA's website provides more details on how work credits are earned.

To be eligible for SSDI benefits, the claimant must also be under 65 years old. For SSDI claimants, there are no requirements that the claimant have a limited amount of resources. However, as of June 2014, the SSDI claimant cannot be earning $1070 per month in wages. Of course, to be eligible for SSDI benefits, claimants must meet all other work earnings requirements and proof of disability requirements.

Continue reading "Eligibility for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)" »

Disabilities Caused by Mental Health

October 15, 2013

Some may associate disability with physical impairments like the inability to walk or stand. However, disabilities are not limited to physical ailments and many people suffer from disabling mental health conditions. Proving that a mental health condition is disabling can be challenging because disorders like major depression and bipolar disorder may take time to conclusively diagnose.

In order to prove that a mental health condition is disabling, a person's medical treatment must document the severity of symptoms over an extended duration. This requires that the claimant regularly treat with a psychiatrist and/or licensed psychologist. Although a therapist or counselor may treat someone for mental health problems, the Social Security Administration and long term disability insurers give more weight to the opinions of licensed psychologists and psychiatrists rather than therapists or counselors. Generally, the Social Security Administration affords more weight to the opinions of accepted medical sources, like a treating psychiatrist or psychologist, while long term disability insurance companies more freely pick-and-choose which medical opinions they rely upon to make a determination.

Severe mental health problems can also be evidenced by visits to the hospital and inpatient treatment. Some mental health listings under the Social Security Administration require episodes of decompensation. Medical records of a hospitalization can serve as strong evidence of an episode of decompensation. Moreover, the opinions from third parties, like a family member or friend, may help show episodes of decompensation. Any person who has been able to observe the claimant's personality or behavioral health over time can provide relevant evidence revealing the severity of the claimant's mental health condition.

Continue reading "Disabilities Caused by Mental Health" »

The Importance of Vocational Evidence in Disability Claims

July 29, 2013

In both private disability insurance claims and Social Security disability claims, vocational evidence is usually considered when determining whether an individual is disabled or not. Vocational evidence is information about an individual's occupation or the occupations they may be able to perform when considering their functional capacity, training, education, and work experience. This kind of evidence can consist of job descriptions from the employer, self-reported job duties, information from the Dictionary of Occupational Titles or other similar resources, and the opinions of vocational experts (also known as vocational rehabilitation consultants).

Long Term Disability Insurance

When someone becomes disabled and their employer provides long term disability insurance, then that person often applies for disability benefits under the requirement that they are unable to perform the duties of their "own occupation." Under this type of definition of disability, the individual must show to the insurance company that because of their medical condition(s), they cannot return to their previous job.

During this stage of the disability claims review, the insurance company may consider the individual's job duties and may gather information from the employer, the claimant, publications like the Dictionary of Occupational Titles, or a vocational expert. It is most common for the insurance company to at least gather the employer's job description as part of their claims analysis.

Most private disability insurance policies limit the time for which a person can receive disability benefits under the "own occupation" definition and after a predefined amount of time (often 24 months), the definition of disability requires that the individual prove that because of their medical condition(s), they cannot perform the duties of "any occupation". At this stage of the disability review, vocational evidence becomes even more important because the claimant has to prove that there are no occupations he or she can perform. The insurance company may use the opinions of vocational experts and resources like the Dictionary of Occupational Titles or ONET (Occupational Information Network) to find other occupations that the claimant may perform.

Continue reading "The Importance of Vocational Evidence in Disability Claims" »

Appealing the Denial of Your Social Security Disability Claim

June 17, 2013

After claimants go through the long process of completing paperwork to apply for Social Security disability benefits, it is common for them to receive the unfortunate news that their claim has been denied. The Social Security Administration (SSA)'s initial review is conducted by a state agency, the Disability Determination Bureau (DDB). The DDB is responsible for processing the claim, ordering consultative examinations if necessary, obtaining medical records, and determining whether the claimant meets the standards of Social Security disability benefits.

Request for Reconsideration

About 75% of claims for Social Security Disability Insurance and Supplemental Security Insurance are denied. A claimant has a maximum of 65 days from the date of the denial letter to appeal the decision. It is of the utmost importance to file a timely appeal. Otherwise, a denied claimant may be forced to file a new claim unless they can prove that there was an exceptional circumstance to explain why their appeal was not timely filed. When the claimant is appealing the DDB's initial denial, this is called a "request for reconsideration." A claimant has the right to legal representation and a qualified attorney can help a claimant file a request for reconsideration.

Continue reading "Appealing the Denial of Your Social Security Disability Claim" »

Multiple Sclerosis Disability Claims

May 14, 2013

Multiple Sclerosis is an autoimmune disease that affects the brain and spinal cord. The symptoms and severity of Multiple Sclerosis (MS) can vary among those afflicted with the disease, but it is not uncommon for the condition to prevent a person from working. Symptoms can include fatigue, loss of balance, muscle spasms, numbness, weakness, tremors, problems with coordination, difficulty walking, vision problems, bowel/bladder difficulties, inability to concentrate, memory problems, and speech impairments.

When MS prevents a person from working and they file a disability claim with their insurance company or the Social Security Administration, there are a few things that can help prove that MS is disabling. The first step is to make sure that the patient has been diagnosed properly. That includes undergoing exams like MRIs of the brain and spine, nerve function studies, and lumbar punctures. These objective test results are essential to ruling out other conditions and determining whether a patient has MS. Moreover, these test results can also indicate the severity level of a patient's MS.

Continue reading "Multiple Sclerosis Disability Claims" »

Fibromyalgia Disability Claims

March 13, 2013

Fibromyalgia is a condition that may prevent someone from working. In these situations, the person may be able to apply for short term disability benefits, long term disability benefits, or Social Security disability benefits. When it comes to filing a claim for disability benefits, it can be challenging for claimants to prove that their fibromyalgia is disabling. These challenges appear in claims to both insurance companies and the Social Security Administration ("SSA").

Those who suffer from fibromyalgia experience chronic, widespread pain and fatigue, but the objective test results may not show this. Unlike conditions such as Multiple Sclerosis or degenerative disc disease, fibromyalgia does not appear in MRIs or x-rays. Because fibromyalgia is a disorder which does not appear in medical imaging or blood tests, it can be a difficult condition to diagnose. If a fibromyalgia patient is applying for disability benefits, they should follow these steps to document proof of their disability:

Continue reading "Fibromyalgia Disability Claims" »

Seventh Circuit Decision: Administrative Law Judge Must Properly Consider Treating Physician's Opinion

February 18, 2013

The Seventh Circuit issued its decision in Roddy v. Astrue on January 18, 2013. 2013 WL 197924 (7th Cir. 2013). In Roddy, the claimant appealed the Administrative Law Judge's denial of her Social Security Disability Insurance ("SSDI") claim. After the district court upheld the ALJ's decision, Ms. Roddy appealed to the Seventh Circuit. The Seventh Circuit held that the ALJ did not adequately explain why the treating physician's views should be set aside and that the ALJ wrongly based his credibility finding on 1) the claimant's failure to seek professional treatment for her back after 2006 and 2) her ability to perform household tasks.

Ms. Roddy suffers from severe lower back pain and was forced to stop working as a shift manager at Taco Bell. When she became unable to work, she applied for SSDI benefits, but her claim was denied both initially and at the ALJ hearing level. After her claim was denied by the ALJ, the Appeals Council declined review and the Southern District of Indiana affirmed the ALJ's denial. The Seventh Circuit, however, found numerous errors in the ALJ's decision and remanded her case back to the Social Security Administration.

Continue reading "Seventh Circuit Decision: Administrative Law Judge Must Properly Consider Treating Physician's Opinion" »

Overpayment in Long Term Disability Insurance Cases

December 19, 2012

Unfortunately, there is a common surprise for claimants who have been approved for long term disability ("LTD") benefits through an employee group benefit plan. LTD benefits are usually subject to a list of offsets that will reduce the amount that a claimant receives in disability insurance benefits.

One of the most frequent offsets is when a claimant is approved for Social Security Disability Insurance ("SSDI") benefits. When a claimant receives both LTD insurance benefits and SSDI benefits, the claimant's LTD benefits will be reduced by the amount that they receive from the Social Security Administration.

For example: assume a claimant has been approved for LTD benefits and receives $2000 per month. If that claimant has also been approved for SSDI benefits at $1500 per month, then the claimant's LTD benefits will be reduced to $500 per month. The net effect is that the claimant still receives $2000 per month - the amount they were owed under the long term disability policy - however, the monthly long term disability benefit is now much lower.

The most significant result of this offset occurs when a claimant has been approved long term disability benefits soon after they stop working, but then has to wait for a hearing with the Social Security Administration to determine whether or not they will receive SSDI benefits. In some cases, a claimant can wait two years or longer for a hearing with the Social Security Administration. If a claimant is approved for SSDI benefits at the hearing level, they will likely owe the long term disability insurer for "overpayment" due to the offset provision in their long term disability policy.

Continue reading "Overpayment in Long Term Disability Insurance Cases " »