Social Security Disability Benefits While Incarcerated and On Release

Can I Still Get Social Security Disability Benefits While I am Incarcerated?

Your SSDI benefit payments are suspended once you are convicted and incarcerated for more than 30 days.  Even though you cannot receive SSDI benefit payments due to incarceration, your spouse and children continue to receive their SSDI payments as long as they are eligible.

Your SSI benefit payments are initially suspended while you are incarcerated, but when your incarceration lasts 12 months or longer, your eligibility for SSI benefits then terminates.

How Do I get my Social Security Benefits Reinstated when I am Released from Incarceration?

You must contact Social Security to inform them that you have been released from incarceration, provide official release documents, and request that your disability benefits be reinstated. Once you have done this, your SSDI benefits can be reinstated the month following the month of your release, and SSI benefits can be reinstated in the month you are released.

If your SSI benefits were terminated, you can file a new application for SSI benefits a few months prior to your release. In fact, the institute where you are incarcerated may have a pre-release agreement with Social Security to help facilitate the application process. If not, you can contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to inform them of your scheduled incarceration release date and ask about applying for SSI. If you are approved for SSI benefits, payments cannot start until after your release from incarceration which must be confirmed by giving Social Security your official release documents.

Contact a Disability Lawyer for Help

If you need help with your disability claim, contact a lawyer at Cardea Law Group, LLC. We understand that you need Social Security disability payments as soon after your release as possible to help you so you move ahead with your life.  When we represent you, we provide you with information, guidance, and support at every step.  Call us at 334-440-6261.

 

 

 

How Do I Get My Medical and Other Records from Social Security?

This article discusses when you should make a request evidence in your Social Security claim file and how to access your records at Social Security.

When Should You Request Your Social Security Disability Records?

When you apply for Social Security disability, you can submit medical records you have obtained to Social Security so that they can add them to your claim file. You also provide information about your medical history to Social Security so they can obtain other records from your medical sources covering at least 12 months prior to a certain date, such as your protective filing date. See, POMS DI 22505.001.A.3. Social Security may also develop your disability claim by obtaining other evidence, such as information about your functional ability or work history. A Social Security adjudicator has the flexibility to use his or her own judgement to decide whether to develop outside of the 12 month period. See, POMS DI 22505.006.A.2.

While Social Security will help obtain medical and other evidence, it is in your best interest to ensure that all of your medical evidence makes it into your case record. You have the right to access your medical and other records in your claim file so that you can review the sufficiency and relevancy of the evidence. You can submit other evidence to Social Security to add to your file. Having a complete picture of your medical history and functioning is important because Social Security adjudicators evaluate only the evidence that is in the record. If you do not have all of your medical and other evidence submitted, it could adversely affect the decision in your case.

If your initial application for Social Security disability benefits has been denied, then it is critically important for you to review your file and determine if there is any additional evidence not currently in the record that could support your claim. For example, you can ask your treating doctor to provide diagnostic testing or other evidence not currently in the claim file and then personally submit this evidence to Social Security to add to your file. Make sure to keep a copy of any records you have submitted in case they do not reach your file and you need to resubmit them.

Again, it is very important for you to review your file at the time you request a hearing before an Administrative Law Judge (ALJ). Social Security will have an exhibit list of each item in the file. You will need to know what evidence the prior Social Security adjudicator based their determination. If the determination was made on insufficient evidence, for example, you will have a chance to add critically important information to the record that may likely result in a favorable decision on appeal.

In addition to getting access to your records when you apply for Social Security, you may also want to get your records once you are approved for disability benefits, especially if, for example, your case is selected for a continuing disability review.

How to Request Your Records in Your Social Security Disability File

Requesting access to your medical and other records from Social Security is relatively easy. You can now access your claim documents securely in the Message Center of your my Social Security account. To enable this option, contact the Social Security office where your disability case is pending and request access to the documents in your claim file.

Other options to request your records are to call Social Security’s toll-free number at 1-800-772-1213 (TTY 1-800-325-0778), or either call or write to your local office. You will need to provide Social Security with some personal information, such as your name, Social Security number, date of birth and the address to which you want the file mailed.

Once you have requested your records, they will be mailed to you on an encrypted CD. If you do not have access to a CD player, there may be a cost to get printed copies. To access the CD, your “password” is the first 4 letters of your first name (all lowercase), followed by a “#” and then the last 4 numbers of your Social Security Number. For example, John Smith, SSN 123-45-6789 would be, john#6789.

How Long Will It Take to Get My Records From Social Security?

The time it takes to get your records from Social Security depends on the method you chose in your request, Social Security processing time, and, if the records are being mailed, Postal Service delivery time. Usually, you can expect to receive the records within 2 to 4 weeks.

Contact a Disability Lawyer for Help

If you need help with your disability claim, contact a disability lawyer at Cardea Law Group, LLC for a free initial consultation. When we represent you, we will work with you to complete the application for disability and other necessary forms, as well as help you obtain the medical and non-medical evidence you need to prove your claim. We show our commitment by providing you with information, guidance, and support at every step.  Call us at 334-440-6261.

What is Non-Medical Evidence and How is it Considered in a Social Security Disability Claim?

Social Security considers “evidence” to be anything submitted to your claim file related to your disability claim, including medical and non-medical evidence. Having medical evidence is critical to proving your disability claim and, in fact, you must first have medical evidence from an acceptable medical source to establish you have a medically determinable impairment (MDI). After an MDI is established, Social Security considers all evidence to assess how a person’s impairments affects functioning and determine disability. Non-medical evidence is simply defined as any evidence that is not medical. Submitting non-medical evidence in your disability claim helps present a more complete picture of how your impairments and symptoms affect your daily functioning. In this article, we discuss several types of non-medical evidence and how it can help your disability claim. To read a blog article about medical evidence go here.

Non-Medical Evidence on Disability Checklists

Listed in the Social Security Adult Disability Checklist and Online Adult Disability Checklist is non-medical evidence, including general information about your age, your marital status, and your minor children. Also, listed is information about employment history going as far back as 15 years. Some evidence, such as the credits you have earned to be insured for SSDI, is necessary to prove you meet technical requirements. If you are applying for SSI, your income and resources will determine if you meet the strict requirements of this needs-based program. The Social Security field office is responsible for verifying technical eligibility requirements before they send the claim to the Disability Determination Services for adjudication.

Non-Medical Evidence You Provide

Statements you provide about your impairments and symptoms and how they affect your daily functioning are important non-medical evidence. You may complete a SSA-3373 Adult Function Report to describe your day-to-day functioning. You may also keep a journal or other personal record to describe your physical and mental impairments, related symptoms, and how they affect your ability to do ordinary daily activities. For example, you can record the frequency epileptic seizures that you have. Keeping a personal record helps you build a stronger disability case since it is a real-time description of what you have been experiencing. You can refer to it to help you remember accurately when it is time to testify at a hearing. In fact, this personal record may be submitted to your claim file as non-medical evidence.

Non-Medical Evidence from Third Parties

Third parties who may provide non-medical evidence in your claim include family members, friends, caregivers, neighbors, clergy, social workers, and even former supervisors and co-workers. The best evidence from third party sources comes from those who are close to you and can best describe your limitations due to your impairments. You may ask one or more of these non-medical sources to write a letter or testify on your behalf at your hearing about what they have witnessed regarding your impairments, symptoms and limitations in functioning. Social Security may ask at least one of these sources complete a SSA-3380 Third Party Function Report to obtain this non-medical evidence. Third-party evidence, particularly when it is consistent with the medical and other evidence, supports your claim of disability.

Evidence Relating to Symptoms

Social Security considers all of the evidence in the claim file when evaluating the intensity and persistence of symptoms after finding that the individual has an MDI that could reasonably be expected to produce those symptoms. See Social Security Ruling 16-3p Evaluation of Symptoms in Disability Claims. A person’s own statements about their symptoms is considered along with other non-medical and medical evidence using the following factors:

  1. Daily activities;
  2. Location, duration, frequency, and intensity of pain or other symptoms;
  3. Factors that precipitate and aggravate the symptoms;
  4. Type, dosage, effectiveness, and side-effects of medication(s) taken to alleviate pain or other symptoms;
  5. Treatment, other than medication, a person receives or has received for relief of pain or other symptoms;
  6. Any measures other than treatment a person uses or has used to relieve pain or other symptoms (e.g., lying flat on his or her back, standing for 15 to 20 minutes every hour, or sleeping on a board); and
  7. Any other factors concerning a person’s functional limitations and restrictions due to pain or other symptoms.

Non-medical statements from you and third parties can be very persuasive in describing the limiting effects of symptoms.

Contact a Disability Lawyer for Help

If you need help proving you are disabled, contact a disability lawyer at Cardea Law Group, LLC for a free initial consultation. When we represent you, we will work with you to complete the application for disability and other necessary forms, as well as help you obtain the medical and non-medical evidence you need to prove your claim. We show our commitment by providing you with information, guidance, and support at every step.  Call us at 334-440-6261.

 

What are the Rules about Evaluating Medical Evidence in a Social Security Disability Claim?

Social Security published “Revisions to Rules Regarding the Evaluation of Medical Evidence” in the Federal Register and they became effective on March 27, 2017. (Refer to 82 FR 5844.) For claims filed before March 27, 2017, Social Security continues to use some of the prior policies to evaluate medical evidence. This article discusses at a high level new rules Social Security uses to evaluate medical evidence in claims filed on or after March 27, 2017.

What Medical Evidence do I Need to Prove my Social Security Disability Claim?
To be approved for disability benefits, you must submit medical evidence to prove you have a medically determinable impairment(s), show your impairment(s) have lasted or are expected to last for at least twelve months or will result in death, and prove that your impairments cause limitations that prevent you from working at a substantial gainful activity level. Be aware that Social Security can deny your disability claim due to insufficient medical evidence.

Medical evidence is critical to proving you are disabled. Otherwise, Social Security can deny your disability claim due to insufficient medical evidence. Your medical records should contain enough information that Social Security can make a decision regarding the nature and severity of your impairment(s). Only providing your allegation of an impairment along with your doctor’s diagnosis is not sufficient to prove disability. The medical evidence must show how long you have had your impairment(s) and be detailed enough to show the severity and functional limitations of those impairment(s).

You should provide medical records from at least around the time when you first became disabled to the present. Medical records include all of your hospital, clinic, and doctor visits and medical treatments, such as surgical procedures. Medical records are also blood tests, imaging studies (such as x-ray, MRI, CT scan) or other diagnostic testing or procedures (such as an exercise stress test). Make sure to include medical evidence to support your complaints of pain or other symptoms that affect your ability to function. When you provide complete medical records of your impairment(s), it may eliminate the need for Social Security to take additional time to obtain more medical evidence in your case.

Does Social Security Help Get My Medical Records?
Social Security will give some assistance once you have provided them with the contact information of your medical sources and have signed form SSA-827, Authorization to Disclose Information to the Social Security Administration. Social Security will then request medical records on your behalf.

According to Social Security rules, they will make “every reasonable effort” to obtain a “complete medical history”. Every reasonable effort means Social Security will make an initial request for medical records and will make one follow-up request if they don’t receive the medical records. You may need to follow-up with your medical providers if Social Security has not received the medical evidence.

Social Security defines a “complete medical history” to mean medical records covering at least twelve months prior to a certain date, which is often the protective filing date but may be another important date, such as the date last insured for SSDI claims. However, it is in the discretion of Social Security whether to request medical evidence outside of the twelve-month period based on the facts of the case. Since you are likely to have other medical records that Social Security did not request, you will need to are request that medical evidence and submit it to Social Security yourself. Ultimately, it is your responsibility to submit evidence to Social Security that you are disabled.

When Does Social Security Order a Consultative Examination?
Social Security orders a consultative examination when the medical evidence is insufficient to decide the disability claim. Examples of when Social Security may decide a consultative examination is necessary is when there is no medical evidence or very little medical evidence in the file, or when the evidence does not establish the current severity and functional limitations of the impairment(s), or when a conflict or inconsistency in the case record cannot be resolved by recontacting you or another source of information.

Social Security contracts with licensed physicians and psychiatrists, as well as qualified psychologists to perform consultative examinations. Usually, Social Security will select the doctor who is scheduled to do your consultative examination, but you have the right to request that your regular doctor perform this exam if he is willing to do it.

Who is a Medical Source and Who is an Acceptable Medical Source?
A medical source is a healthcare worker working within the scope of practice permitted under law and includes a certified speech-language pathologist or school psychologist. An acceptable medical source is a certain type of medical practitioner identified in the regulations see https://www.ssa.gov/OP_Home/cfr20/404/404-1502.htm. Included as an acceptable medical source are licensed physicians, licensed psychologists, physician assistants (PAs), advanced registered nurse practitioners (ARNPs), and licensed audiologists and optometrists.

What Medical Evidence Establishes a Medically Determinable Impairment?
To establish a medically determinable impairment, Social Security rules require objective medical evidence of signs, laboratory findings, or both. The objective medical evidence must be from an acceptable medical source. Once the medically determinable impairment(s) is established, other medical evidence can be considered.

How Does Social Security Evaluate Medical Evidence?
With regard to disability claims filed on or after March 27, 2017, Social Security considers the persuasiveness of the quality of the evidence by taking into account the following factors when evaluating the medical evidence:
Supportability: The explanations by a medical source are supported by the objective medical evidence.
Consistency: A medical opinion or prior medical finding(s) is consistent with the other evidence.
Relationship with the claimant considers:
Length of the treatment relationship
Frequency of examinations
Purpose of the treatment relationship
Extent of the treatment relationship
Examining relationship
Specialization: The medical opinion of a specialist may be more persuasive about medical issues in his area of specialty.
Other factors: Factors that tend to support or contradict a medical opinion or prior medical finding.

Social Security will consider whether you impairment(s) meet or equal the criteria in set out in the Listing of Impairments, and if so, your disability case will be allowed. Otherwise, Social Security will continue to evaluate your claim to determine your residual functional capacity based on all relevant evidence and decide whether you have the ability to perform your past relevant work or any other work. If you cannot perform any work, your disability case will be allowed. However, if you can perform any work, Social Security will deny your claim for disability.

Contact a Disability Lawyer for Help
If you need help proving you are disabled, contact a disability lawyer at Cardea Law Group, LLC. When we represent you, we will work with you to complete the application for disability and other necessary forms, as well as help you obtain the medical and non-medical evidence you need to prove your claim. We show our commitment by providing you with information, guidance, and support at every step. Call us at 334-440-6261.

How Do I Apply For Social Security Disability And What Information Do I Need?

Once you have made the decision to apply for Social Security disability, you will want to complete the application as soon as possible to shorten your wait to receive benefits after you are approved for disability. If you are thinking about filing for disability in the near future (six months for SSDI and two months for SSI), you can let Social Security know that you plan to file and you will have a “protective filing date” that will become the application date.

SSDI pays benefits to disabled people who have worked long enough and recently enough to be insured by paying FICA taxes. For SSDI, you can receive retroactive pay as far back as 12 months from the date you apply for benefits if you are found disabled.  However, you have a five-month waiting period after the date you are approved for disability before you begin receiving SSDI benefits. There is also a 24-month waiting period for Medicare.

SSI pays benefits to disabled people who have limited income and resources. Once your disability is approved, SSI benefit payments become payable to you the month after the month your application is filed. You may be eligible for Medicaid benefits.

Create a my Social Security Account Before Starting the Disability Application

Create your my Social Security account first before you begin your disability application. If try to start the disability application first, Social Security will prompt you to create your account before you work on your disability application.To create your account, you answer a series of identity questions for verification. You must also have a:

  • Social Security number
  • Valid email address
  • S. mailing address

You must also be at least 18 years old to create an account. You can only create an account using your own personal information and for your own exclusive use. With your account, you will be able to review your earnings record to make sure it is accurate, and you will be able to check on the status of your disability claim after you complete your application.

Select Your Alleged Onset Date Before Applying For Disability

Give some consideration as to what date you became disabled or your alleged onset date. Your alleged onset date can affect how much SSDI backpay you get if you are approved. Often a person uses the date he or she became unable to work as the alleged onset date, but if you have had to work reduced hours or had to take extensive leave, you may decide on an earlier date.

Information You Need To Complete The Disability Application

The information you need to complete the disability application is detailed. Gather the documents necessary to help provide information about yourself, your immediate family, your medical condition, and your work. To get an idea of what information you will need, use the Checklist for Online Adult Disability Application  https://www.ssa.gov/hlp/radr/10/ovw001-checklist.pdf. You may also want to review information in the Adult Disability Disability Starter Kit provided by Social Security at https://www.ssa.gov/disability/disability_starter_kits_adult_eng.htm.

Begin by gathering your tax return, W2s, paystubs, marriage license, form DD 214 for military service, and other important documents to refer to as you work through the application. For background, here are a few of the questions you will be asked:

  • Your date and place of birth and Social Security number.
  • Your address, and telephone.
  • The name, Social Security number, and date of birth or age of your current spouse and any former spouse. You will be asked about the dates and places of marriage and dates of divorce or death (if appropriate).
  • Names and dates of birth of your minor children.

You will also be asked for your bank’s routing transit number and your bank account number that you will use for Direct Deposit if you are approved for disability benefits.

Educational information on the application includes the highest grade you completed in school and the name of the last school you attended. You will be asked whether you were in special education at school. You will also be asked if you have completed any vocational or trade school education.

To answer questions about your work, begin by making a list of your employers with the months and years you worked. You can refer to your earnings record found in your my Social Security account, as well as your tax information, pay stubs, or W2s. The application asks for your employment history covering the last 5 jobs you have had in the 15 years prior to the date you stopped working. You will be asked if your impairments are related to work and if you have received workers compensation. If you are self-employed, you will be asked for information pertaining to that work. You will also be asked if you or your spouse have worked outside of the United States.

Also, pull together any medical information you already have at home, such as treatment notes, diagnostic test results, emergency department summaries and hospital records. Use these documents to write a list of all of your diagnosed physical and mental conditions. You can also use these records and your pill bottles to make a list of all your prescribed medications and non-prescription medications you regularly take. Make another list of any laboratory or diagnostic testing you have had along with the place where the testing was performed and the dates.

You will also need to refer to this medical information for a list of the names, addresses and phone numbers of treating sources, hospitals and other medical sources where you have had or are continuing to have treatment. For each source, you will need to provide the month and year you began treatment and the month and year of the last time you were treated.

For your SSI application, you will be asked additional questions about you and your immediate family’s income and resources, as well as living arrangements since SSI is a needs-based program. Refer to this list for more information at https://www.ssa.gov/ssi/text-documents-ussi.htm.

Apply for Social Security Disability Online

You can apply online for SSDI or both SSDI and SSI disability benefits. You cannot apply for SSI only disability online. To start your application for disability, go to the Social Security website’s Apply for Benefits page. Read and agree to the Terms of Service and then click “Next”. Review the “Getting Ready” section to once again confirm you have the information you need to apply. Select “Start A New Application” and follow the prompts to enter the application information.

After you provide some basic background information about yourself and if there is anyone who is helping you fill out the application, you can get a “re-entry” number so that you will be able to save and exit and then later on use the re-entry number to re-access the application.

As you work through the application, you answer the questions on each page and select “next”, or you select any of the tabs at the top of the application page to move to another section. A green check mark means you have provided all the necessary information in that section. A yellow triangle means that you still need to provide more information in that section.

Once you complete the online process, a Social Security representative will contact you by mail or phone for additional information.

Actions to Take After Filing Online

Social Security will ask you to complete and sign form SSA-827 Authorization to Disclose Information to the Social Security Administration once you have submitted your application. The authorization allows Social Security to request medical records for your claim.

If someone else prepares the online application on your behalf, a Social Security representative will contact you by phone to:

  • Verify your intent to file.
  • Confirm the information provided.
  • Obtain any additional information needed for the application(s).
  • Give you the opportunity to provide a verbal signature and other relevant documents.

Other Ways to Apply for Social Security Disability

If you cannot submit your application online, you still can apply by contacting Social Security at 1-800-772-1213 (TTY 1-800-325-0778). In the past, you could go to the local Social Security office to submit your application in-person, but due to COVID, in-person visits have been significantly restricted.

Contact a Disability Lawyer for Help

If you need help applying for disability, contact a disability lawyer at Cardea Law Group, LLC. We have a free consultation. When we represent you, we will work with you to complete the application for disability and other necessary forms. In addition, we show our commitment by providing you with information, guidance, and support at every step.  Call us at 334-440-6261.

When Should I Apply for Social Security Disability?

Deciding when to apply for Social Security disability can be a very difficult decision to make for many people. First of all, be honest with yourself about your abilities and limitations. You are the one who knows what your body can handle both physically and mentally. You know whether it is feasible for you to work given your impairments. Secondly, there are some other issues you should be aware of before your make your decision about when to apply for disability. This article discusses several of those issues so that you can consider them as you make your decision.

When Am I Insured For SSDI And How do I Qualify for SSI?

You should be aware of your insured status for SSDI. Generally, you must have worked and earned at least 20 credits in the last 10 years to be insured for SSDI. Exceptions to insured status apply for those who are disabled and under age 31. In those situations, you can be insured for SSDI with fewer than 20 credits. You can check your work history on your My Social Security account.

It is possible that you were insured in the past for SSDI, but are not currently insured. You will need to know what your date last insured (DLI) was because you will have to prove that you became disabled prior to the DLI date. Do not delay in filing for disability in this situation since the longer you wait to file, the harder it is to prove your disability prior to your DLI.

If you are not currently insured for SSDI, you may be able to apply for SSI immediately if you have limited assets.  Insured status does not apply for SSI. Since SSI is a needs-based program, there are income and resource requirements that must be met to qualify.

Can Having A Protective Filing Date Help Me?

If are going to file for disability in the near future (six months for SSDI and two months for SSI), you can let Social Security know that you plan to file and you will have a “protective filing date” that will become the date you applied, even though you filed a few months later. The protective filing date can help you get more back benefits for SSDI if you are approved. For SSI, you can receive retroactive benefits back to the protective filing date, up to two months earlier than the date you filed your application, if you are approved.

What Is A Durational Requirement And Must I Meet It Before I Apply For Disability? 

There is a one-year durational requirement that you must meet in order to be qualified for disability under Social Security rules, but you do not have to meet it at the time you apply for Social Security disability benefits. You must be unable to work at a substantial gainful activity (SGA) level, which in 2020 is presumed to be $1260 a month. You also must have physical or mental impairment(s) that have lasted for at least 12 months, are expected to last 12 months, or can be expected to result in death. 

Therefore, it is reasonable to file a disability application when your earnings drop below the SGA level or the day after you realize that you are disabled and have to stop working. It is also be appropriate to file for disability when you have been diagnosed with impairment(s) that require months of extensive surgeries, therapy, or treatment. If your prognosis is that your impairment(s) will keep you from working for at least one-year, Social Security is not prevented from awarding disability benefits before the one-year duration. With impairment(s) that do not have a clear prognosis, such as a heart attack or stroke, Social Security may wait a few months to see if your condition improves.  During this waiting period, you should apply for disability so that you are in a better position to get the most benefits if your condition prevents your return to work.

Can I File For Disability Before I Submit My Medical Evidence To Social Security?

You are responsible for providing medical evidence showing you have a medically determinable severe impairment(s) that are disabling. While medical evidence is key to proving your disability claim, you do not have to wait until you have submitted your medical records before you apply for disability. You have time to obtain medical evidence after you file for disability. In fact, Social Security will help request and get medical evidence from medical sources who have evaluated, examined, or treated the person for his or her impairment(s). But you may want to have a conversation with your treating doctor to explain that you have decided to apply for disability and to ask for their support. Having a treating doctor’s support is important as you work to prove your claim.

If you do not have a treating medical source or your medical evidence is inadequate,  Social Security may ask you to go to a consultative examination with an independent doctor who will submit a report to Social Security. 

How Long Is The Social Security Appeals Process?

Once you apply for disability, you should be aware that you could be waiting a long time for Social Security to make a disability decision. 

For an initial determination, it may very well take more than the 90-120 days commonly estimated by Social Security. Since a majority of the initial disability claims are denied, you may be facing a long appeals process. It is usual for processing time to be about two years on average to get an Administrative Law Judge decision. So, it would make sense for you to apply as soon as you can to avoid unnecessary delay.

Should My Own Financial Situation And Resources Factor Into My Decision To Apply For Disability? 

You absolutely should consider your current financial situation and think about what resources you now have that may not be available after waiting for an extended period, such as the two years during the appeal process. Having a stable residence where Social Security can mail notices to you, as well as having resources, such as a phone and a computer, will help you stay in contact with Social Security throughout the process. Having transportation so that you can get to your doctor is important as well. Having health insurance and regular medical care makes it much easier to obtain the medical evidence you need for your disability claim.  Some people wait until their financial situation becomes unstable before filing for disability, making the process even more challenging. 

Contact a Disability Lawyer for Help

If you need help deciding when to apply for disability, contact one of our disability lawyers at for a free consultation. When we represent you, we show our commitment by providing you with information, guidance, and support at every step.  We can be reached at 334-440-6261. 

How Do I Handle a Social Security Overpayment?

Take Action to Avoid Being Overpaid

To  avoid being overpaid,  report all changes to your financial, marital, or living situation to Social Security. Also, inform Social Security if your disability has improved to the extent that you are attempting to work.

If you notice a change in the amount of your monthly checks and you did not receive an explanation from Social Security, call Social Security right away to make sure you are receiving the correct amount. 

What Happens When I receive a Notice of Overpayment?

If Social Security has found that you were overpaid, they will mail you a Notice of Overpayment.  The notice will have an explanation of why you have been overpaid, your repayment options, and your appeal and “waiver” rights.

First, check the notice information carefully. Are the dates and payment amounts correct or not? You have 60 days from the date on the notice to act by filing an appeal.  If you request a waiver within 30 days from the date of the notice, Social Security will not start to withhold any part of your benefits. Otherwise, if you do not take action,  Social Security will  take money out of your checks to repay the claimed overpayment amount. 

If you do not believe you have been overpaid or you disagree with the amount of overpayment, you can appeal. The appeal must explain why you believe you have not been overpaid or that the amount of overpayment is wrong.

If you agree that you were overpaid, you can still ask Social Security to waive the overpayment so that you don’t have to pay it back. Ask for a waiver if the overpayment was not your fault, and you cannot afford to pay the money back. Use form   SSA-632-BK to request a waiver. If Social Security denies waiver of the overpayment, you can appeal. 

If you agree that the overpayment was your fault or you can afford to pay it back, you can make a payment arrangement with Social Security to pay the money back a little at a time. That repayment arrangement would be based on how much of your income you need for your basic necessities. 

When you ask for either a waiver of the overpayment or request a payment arrangement, Social Security will require you to complete a financial statement.  You may need to provide some documents to support your financial statement.

Whenever you talk to a Social Security employee, write down their name, the date, and a summary of the conversation. 

How Does COVID-19 Impact My Overpayment?

Beginning on March 17, 2020, due to the COVID-19 emergency, Social Security stopped taking actions that could have resulted in a reduction, suspension, or termination of benefits or payments.  Since corrections to benefit payments were not made during this timeframe due to COVID-19, overpayments resulted.   

In an interim final rule, effective August 27, 2020, Social Security acknowledged that it would be against equity and good conscience to collect overpayments made between March 1 to September 30, 2020, and those who did incur an overpayment during this period are without fault. See https://www.govinfo.gov/content/pkg/FR-2020-08-27/pdf/2020-18834.pdf.  If you receive an overpayment notice during this time period, file a request for waiver since Social Security has already stated that a person who had incurred an overpayment during this timeframe is without fault.

Contact a Disability Lawyer for Help

If you get an overpayment notice from Social Security and need help, contact a disability lawyer.

When a disability lawyer at Cardea Disability, LLC represents you, we show our commitment by providing you with information, guidance, and support at every step.  For a free consultation, contact a disability lawyer at Cardea Disability, LLC at 334-440-6261 and visit our website at https://cardealawgroup.com.

Can My Use of Drugs or Alcohol Affect My Disability Claim?

Use of drugs and alcohol can affect your disability claim if it is a medically determinable impairment (MDI) that meets certain drug addiction and alcohol (DAA) criteria. By law, a person cannot be approved for Social Security disability benefits if DAA exists and is material.

First of all, Social Security must decide whether drug and alcohol use is DAA. To be DAA, the drug and/or alcohol use be an MDI of substance use disorder that rises to the level of maladaptive use as defined in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association.  One exception is nicotine use disorder is not DAA under Social Security policy.

Another very important criterion is whether DAA is material. Even if the individual’s drug addiction and/or alcoholism is DAA, a person can still win their claim for Social Security disability if DAA is not material.  If DAA is material, however, then a person would not qualify for disability benefits.

Social Security DAA policy is set out in Social Security ruling, SSR 13-2p Evaluating Cases Involving Drug Addiction and Alcoholism (DAA).

Is All Drug and/or Alcohol Use DAA?

Not all drug and alcohol use meet the criteria for DAA.  The important factor in deciding whether drug and/or alcohol use is DAA is whether an individual has a pattern of using drugs and/or alcohol in a dysfunctional way that causes disruption of work, family relationships, social activities, or results in physical damage to the individual.  Since addiction to, or use of, prescription medications taken as prescribed does not involve maladaptive substance use, this is not DAA.

Evidence of occasional or binge use of drugs or alcohol or a history of drug or alcohol use does not establish that the individual as an MDI of substance use disorder. Additional examples of evidence that, by itself, does not establish DAA are:

  • Self-reported drug or alcohol use.
  • Arrest for “driving under the influence” or “public intoxication”.
  • Third-party report of an individual’s drug and alcohol use.

How Does Social Security Determine Whether DAA is Material?

Once Social Security has evaluated a person’s impairments including DAA and found that the person’s condition is disabling, Social Security then conducts a second evaluation to determine whether DAA is material to disability. During the second evaluation, Social Security reviews the evidence again to determine whether the person would continue to be disabled if he or she stopped using drugs or alcohol.

Essentially, material means DAA substance use is contributing to, or worsening a person’s medical impairment(s).  DAA is not material to the determination that the claimant is under a disability if the person would still meet the definition of disability if he or she were not using drugs or alcohol. If an impairment is disabling without considering any limitations caused by drug or alcohol use, then the substance abuse is not material to the claim, since the other impairment is already disabling and any limitation caused by the substance abuse is irrelevant. Irreversible damage from alcohol or drug use, for example, is not material.  If DAA is not material, the claimant is disabled.  If DAA is material, there is evidence that the person’s impairment(s) can improve absent drugs and/or alcohol and the person is denied disability benefits.

When a person has a physical impairment(s), Social Security considers medical opinions from treating or non-treating sources about whether the physical impairment(s) would likely improve absent DAA.  For example, if a person who has drug addiction and a medically determinable physical impairment, such as a seizure disorder, Social Security will rely on medical opinions about whether the seizure disorder would medically improve if the person stopped using drugs.  If improvement is likely, then DAA is material and the disability claim would be denied.  However, if improvement is not likely, the case would be allowed.

Unlike cases involving physical impairment(s), Social Security cannot rely exclusively on medical expertise and the nature of a claimant’s mental disorder.  To support a finding that DAA is material, Social Security must have evidence in the record that establishes that a person with a co-occurring mental disorder(s) would not be disabled in the absence of DAA.  If the record is fully developed and there is no evidence that the person’s co-occurring mental disorder(s) would improve to the point of non-disability in the absence of DAA, then DAA is not material and Social Security would allow the disability claim.

For these reasons it is very important to have well documented medical records of medical impairment(s), both physical and mental.

What Must the Social Security Disability Decision Contain in a Claim Involving DAA?

When the issue is whether DAA is material, a Social Security adjudicator must make the following findings:

  • The person hasDAA;
  • The person’s impairment(s) are disabling considering all of his or her impairments, including DAA.
  • The person would still be disabled in the absence of DAA, or a finding that the person would not be disabled in the absence of DAA.

A Social Security adjudicator must provide sufficient information and document their reasons in the disability decision.

Contact a Disability Lawyer for Help

If you have a disability case that involves drug addiction and/or alcoholism, find a disability lawyer that is experienced to help you address these complicated issues. When a disability lawyer at Cardea Disability, LLC represents you, we show our commitment by providing you with information, guidance, and support at every step. We know what it takes to win your disability case. For a free consultation, contact a disability lawyer at Cardea Disability, LLC at 334-440-6261 and visit our website at https://cardealawgroup.com.

 

Why Hire a Disability Lawyer?

Every person has the right to be represented in his or her disability case before Social Security. It is your choice whether you file the disability application and pursue appeals on your own or whether you hire a disability lawyer to represent you. A disability lawyer provides advice and guides you through the administrative process. Disability lawyers know the Social Security rules and regulations, are able how to get evidence and make the arguments to prove disability. Having a disability lawyer may improve your chances of being approved for disability benefits.

What Can a Disability Lawyer Do for Me?

A disability lawyer you appoint can:

  • Answer your questions and address your concerns regarding your case;
  • Assist you with completing and filing the initial disability claim application;
  • Develop the best theory of disability and advocate your disability case;
  • Help you get medical records or other important information to support your claim;
  • Represent you in any interview, conference, or hearing you have with Social Security;
  • Write briefs to support your case;
  • Help you and any of your witnesses prepare for a hearing; and
  • Request appeals when necessary.

How Much Does Hiring a Disability Lawyer Cost?

The costs are fairly straightforward.  Most disability lawyers have a free consultation where they evaluate your case. Based on the information you get from the consultation, you will know the merits of your case going forward and can decide about hiring representation.

Many disability lawyers charge a contingency fee where they get paid only if you are found to be disabled and entitled to disability benefits. No payment is required if you are not approved. Contingency fees are regulated by law and approved by Social Security. The contingency fee amount is 25% of your disability back pay or no more than $6,000.  You pay the disability lawyer only if you win your case.  Disability lawyers are highly motivated to actively work to get your disability case approved by Social Security so that they will also get paid.

Another type of fee some disability lawyers charge is a fee for the number of hours worked on the disability case through a fee petition. The fee petition requests approval for hours of work. It is also regulated by law and must be approved by Social Security.

When Should I Contact a Disability Lawyer?

Even if you are just starting to consider filing a claim for disability, you should consult with a disability lawyer to answer any questions you may have and help you evaluate the strength of your case. It is a very good idea to hire a disability lawyer before you file your initial disability application with Social Security. The lawyer will help you identify and address the relevant legal issues right from the start of your case.

Throughout the adjudication process, the disability lawyer can give you advice and assist you with completing required forms and other paperwork as you work together to navigate your claim.

Should I Hire a Disability Lawyer if My Case is on Appeal?

If you filed your disability claim with Social Security on your own and you now have received notice that your claim has been denied, it is not too late for you to you appoint a disability attorney to represent you through the appeals process, such as reconsideration, an administrative law judge hearing, and Appeals Council review. The disability lawyer can help collect and submit key medical evidence, communicate with your doctor and any other medical professionals who have treated you, prepare you for any questions that the administrative law judge may ask at the hearing, and advocate for you with Social Security.

Contact a Disability Lawyer for Help

Choose a disability lawyer who is experienced and knows what is required to win your Social Security disability case. When a disability attorney at Cardea Disability, LLC represents you, we show our commitment by providing you with information, guidance, and support at every step. For a free consultation, contact a disability lawyer at Cardea Disability, LLC at 334-440-6261 and visit our website at https://cardealawgroup.com.

Does my child qualify for Supplemental Security Income (SSI)? Part 2

A child can get monthly SSI payments if he or she has impairment(s) that meets Social Security’s definition of “disabled” for children, and meets age and financial requirements. Impairment(s) must cause “marked and severe functional limitations” in order to be found disabling.  We began our discussion about child SSI in part 1 which is available at https://cardealawgroup.com/articles. Today, we unpack steps 2 and 3 of the three-step process and discuss some of the medical and other evidence needed as proof those steps.

SSA uses a three-step process for child SSI to decide disability.  The steps are: 

Step 1. Is the child working or engaging in substantial gainful work activity (SGA)? SGA (non-blind) is presumed at $1,260 a month in 2020. If a child is working at an SGA level, the child’s SSI claim will be denied. If a child is not working or earning SGA, SSA moves to step 2.

Step 2. Does the child have a medically determined impairment (MDI), or combination of impairments, that is “severe”? An MDI must be established by objective medical evidence from an “acceptable medical source”. A “severe” impairment is considered to be one that results in more than minimal limitations. If not, the child’s SSI claim will be denied. If the child has a severe impairment, SSA moves to step 3. 

Step 3. Does the child’s impairment(s) meet, or medically equal one of the listings in the Listing of Impairments, or does the child’s impairment(s) functionally equal the listing? Proof at this step requires significant medical and evidence and is critical as to whether the child’s impairment(s) are determined to be disabling. Child SSI can be allowed only at step 3.

Establishing an MDI that is “Severe” and Meets the Durational Requirement at Step 2

An MDI is established by objective medical evidence of signs, laboratory findings, or both.  Examples of signs are fever, swelling, and clubbing of the fingers.  Examples of laboratory findings are blood tests, electrophysiological studies, such as electrocardiograms, and medical imagining, such as x-rays, MRI and CT scans. The objective medical evidence must be from at least one acceptable medical source.  A diagnosis must be supported by signs, laboratory findings or both.  Acceptable medical sources include:

  • Licensed physician (medical or osteopathic doctor);
  • Licensed psychologist in independent practice; or licensed or certified school psychologist, or other licensed or certified individual who performs the same function as a school psychologist in a school setting, for impairments of intellectual disability, learning disabilities, and borderline intellectual functioning only; 
  • Licensed optometrist for impairments of visual disorders, or measurement of visual acuity and visual fields only, depending on the scope of practice in the State in which the optometrist practices;
  • Licensed podiatrist for impairments of the foot, or foot and ankle only, depending on whether the State in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and ankle;
  • Qualified speech-language pathologist for speech or language impairments only. For this source, qualified means that the speech-language pathologist must be licensed by the State professional licensing agency, or be fully certified by the State education agency in the State in which he or she practices, or hold a Certificate of Clinical Competence in Speech-Language Pathology from the American Speech-Language-Hearing Association;
  • Licensed audiologist for impairments of hearing loss, auditory processing disorders, and balance disorders within the licensed scope of practice only (with respect to claims filed on or after March 27, 2017);
  • Licensed Advanced Practice Registered Nurse, or other licensed advanced practice nurse with another title, for impairments within his or her licensed scope of practice (only with respect to claims filed on or after March 27, 2017); or
  • Licensed Physician Assistant for impairments within his or her licensed scope of practice (only with respect to claims filed on or after March 27, 2017).

An impairment is “severe” when it causes more than minimal functional limitations.  Severe impairment(s) must meet the durational retirement to last or be expected to last for at least 12 months or result in death. 

Other Important Evidence to use in a Child SSI claim once the MDI is established 

Once an MDI is established, information from others in addition to acceptable medical sources can be used to document the degree of limitations caused by impairment(s) and describe the child’s ability to function independently, appropriately, and effectively in an age-appropriate manner.  Additional information can be from a “medical source”, such as a healthcare worker, a speech-language pathologist, or a school psychologist licensed.  Also, information from “nonmedical sources” are important to proving your child’s case. Nonmedical sources include:

  • Educational personnel, such as school teachers, counselors, early intervention team members, developmental center workers, and daycare center workers;
  • Public and private social welfare agency personnel; and
  • Your child, your child’s family members, caregivers, friends, neighbors, employers, and clergy.

SSA will also consider school records, such as an Individualized Education Plan (IEP), and reports, such as progress reports or report cards, in evaluating the child’s limitations.  

Whether the Child’s Impairment(s) Meets or Medically Equals a Listing in the Listing of Impairments at Step 3

The listings sets out for each major body system the criteria resulting in “marked and severe functional limitations” that are disabling.  Part A of the listings is generally for adults, but can be used by children under certain circumstances. Part B of the listings is for children and gives appropriate consideration to the child’s growth and development, as well as the effects of the disease process in childhood. A listing is met when an impairment meets every criteria in the listing.

An impairment or combination of impairments is medically equivalent to a listing if the medical evidence is at least equal in severity and duration to listing criteria.  

Whether the Child’s Impairment(s) Functionally Equals the Listing at Step 3

If a child’s impairment(s) do not meet or medically equal any listing, SSA moves to the last part of step three to decide whether the child’s impairment(s) results in limitations that functionally equal the listings. There are six broad areas of functioning called domains that SSA looks at when determining whether or not a child’s impairment(s) is functionally equivalent to the listings. These six domains are intended to cover everything that your child can and cannot do. The child’s impairment(s) must cause “marked and severe functional limitations” in order to be found disabling.  The six domains of functioning in SSA regulations are:

  • Acquiring and using information
  • Attending and completing tasks
  • Interacting and relating to others
  • Moving about and manipulating items
  • Self-care
  • Health and physical well-being

While functional equivalence is a challenging and complex analysis, SSA allows more children in this part of the analysis than any other part. To functionally equal the listings, the child’s impairment(s) must result in “marked” limitations in two of six domains of functioning or an “extreme” limitation in one of six domains. “Marked” is defined as serious interference of the child’s ability to function. A “marked” limitation also means a limitation that is “more than moderate” but “less than extreme.” It is the equivalent of the functioning on standardized testing with valid scores that are at least two, but less than three, standard deviations below the mean. “Extreme” is very severe interference with the child’s ability to function.  SSA will find that a child has an “extreme” limitation when the child has a valid score that is three standard deviations or more below the mean on a comprehensive standardized test designed to measure ability or functioning in that domain, and your day-to-day functioning in domain-related activities is consistent with that score. However, no single piece of information taken in isolation can establish whether the child has a “marked” or an “extreme” limitation in a domain.

SSA will look at the information about how the child’s functioning is affected during all activities, including those the child engages in at home, at school, and in the community.  SSA may find that a limitation may be the result of interactive and cumulative effects of one or more impairments, SSA will consider evidence from medical sources describing the child’s limitations and restrictions. SSA also considers school records, including an IEP, and test scores, and other reports, such as attendance records and disciplinary reports.  In addition, SSA considers information from people who know the child well, such as parents and teachers, who can describe the child’s functioning at home, in childcare, at school, and in your community.  The Function Report – Child forms (SSA-3375 through SSA-3379) are used in child SSI cases to obtain functional information from the parent(s), and from other caregivers. On appeal, SSA uses Questionnire for Children Claiming SSI Benefits SSA-3381  to record information about nonmedical sources of evidence who can provide information about the child’s functioning. SSA will ask the child’s teacher to complete the Teacher Questionnaire Form 5665 and will ask for school records or other information using a Request for Administrative Information SSA-5666  In some instances, SSA may request that the child go to a consultative examination.

SSA considers how appropriately, effectively, and independently a child performs activities compared to how children their age who do not have impairments perform those activities.  SSA assesses functional limitations by considering:

  • How well a child can initiate and sustain activities;
  • How much extra help a child needs, and the effects of structured or supportive settings;
  • How a child functions in school;
  • The effects of medications or other treatment; and 
  • How the child’s impairment-related symptoms affect functioning. 

Therefore, you can strengthen your child’s SSI application by providing additional information and detail about your child’s functional limitations.

Each domain, with the exception of the sixth domain, Health and Physical Well-Being, contains age-appropriate criteria.  For the sixth domain, SSA may consider a child to have a “marked” limitation if the child is frequently ill because of his or her impairment(s) or has frequent exacerbations that result in significant, documented symptoms or signs. A child’s description of symptoms is an important part of proving a child SSI case. If the child is unable to describe his or her symptoms, SSA will accept a description of the symptoms from a person familiar with the child, such as a parent or guardian. Examples of symptoms include pain, fatigue, shortness of breath, weakness, nervousness, and side-effects from medication. The description of the child’s symptoms can include the precipitating and aggravating factors, intensity, persistence and the limiting effects caused by the symptoms.  SSA collects information about a child’s pain symptoms on for SSA-3371 Pain Report – Child.  For more information, see SSR 16-3p: Titles II and XVI: Evaluation of Symptoms in Disability Claims.

For purposes of the sixth domain, “frequent” means episodes of illness or exacerbations that occur on an average of 3 times a year, or once every 4 months, each lasting 2 weeks or more. SSA may also find a child to have a “marked” limitation if the child has episodes that occur more often than 3 times in a year or once every 4 months but do not last for 2 weeks, or occur less often than an average of 3 times a year or once every 4 months but last longer than 2 weeks, if the overall effect (based on the length of the episode(s) or its frequency) is equivalent in severity.

Social Security Rulings, published in March 2009, add greater guidance about determining functional equivalence for children. See:

SSR 09-1p: Title XVI: Determining Childhood Disability Under the Functional Equivalence Rule —The “Whole Child” Approach

SSR 09-2p: Title: Determining Childhood Disability — Documenting a Child’s Impairment-Related Limitations

SSR 09-3p: Title XVI: Determining Childhood Disability — The Functional Equivalence Domain of “Acquiring and Using Information”

SSR 09-4p: Title XVI: Determining Childhood Disability — The Functional Equivalence Domain of “Attending and Completing Tasks”

SSR 09-5p: Title XVI: Determining Childhood Disability — “Interacting and Relating with Others”

SSR 09-6p: Title XVI: Determining Childhood Disability — The Functional Equivalence Domain of “Moving About and Manipulating Objects”

SSR 09-7p: Title XVI: Determining Childhood Disability — The Functional Equivalence Domain of “Caring for Yourself”

SSR 09-8p: Title XVI: Determining Childhood Disability — The Functional Equivalence Domain of “Health and Physical Well-Being”

 

Tips on Using Medical and Other Evidence to Prove Impairment(s) Functionally Equals a Listing

  • Encourage your child to describe to you his or her impairment(s), symptoms, and limitations. Being able to express abilities and limitations will be helpful at a hearing before an Administrative Law Judge.  The child is expected to attend the hearing and will likely be asked questions about impairment(s) and the effect on his or her daily activities.
  • As a parent or caregiver, focus on when and where the child needs extra help (more help than a child of the same age without impairments would need).  Describe in writing the nature and extent of the help required and any accommodations to assist the child. Make sure to describe all additional help provided to the child to cope with his impairments such as additional supervision, help getting dressed or eating, help with grooming, additional help with doing homework or after-school activities. 
  • Ask for the help of other caregivers to describe in writing the child’s functional limitations they have seen. The term “caregiver,” as used by SSA, means a person who has a close, familial-type relationship with a child.  A child’s parent is usually a caregiver, but other individuals may also be caregivers. For example, grandparents, siblings, other relatives, or nonrelatives with whom the child lives or spends a lot of time. Some caregivers may present testimony if you have a hearing before an Administrative Law Judge.
  • Ask professionals who conducted the child’s testing to provide interpreted test results that are easily understood and compared to SSA requirements.
  • If the child requires a nurse, home health aide, or other professional assistance, make sure that SSA knows details about this additional help.
  • If the child needs an assistive device or assistive technology, get medical documentation of this need.
  • Seek support from the child’s teacher by having a meeting and discussing the child’s functioning at school. If the child’s teacher says the child is doing well, clarify whether the teacher is comparing the child to others with similar accommodations or children of the child’s age who do not have limitations. You may want to provide the teacher with Childhood Disability: Supplemental Security Income Program  A Guide for School Professionals for information.  Offer to provide any necessary information about your child’s functioning to assist the child’s teacher when answering the Teacher Questionnaire Form SSA-5665.
  • Obtain copies of school evaluations, testing, education plans, and other important documents to help create a complete profile of the child and the extent to which, his or her impairment(s) affects day-to-day functioning.    
  • If the child receives help from a tutor outside of school, make sure that you get that information to SSA so that they know the child requires additional help.

Contact a Social Security Disability Representative to Help with Your Child’s SSI Claim

Filing a child SSI claim is a complex process. You must provide proof that your child has a disability and meets all of the age and financial requirements.  A Social Security disability representative can help you complete an application for your child and obtain the necessary medical and other evidence to prove your child’s claim. If you need assistance with your child’s SSI claim, contact an experienced Social Security disability representative at Cardea Disability, LLC at 334-440-6261 or visit our website at Cardeadisabilityllc.com.