Sometimes, an individual can be quickly approved for disability benefits by use of the "grid rules." What are grid rules and how are they helpful?
The so-called rules are officially the "medical-vocational guidelines" published in 20 CFR 404, Subpart P, Appendix 2.
The grids look at several factors in addition to your medical impairment to see if a finding of disability is directed by the published guidelines.
The information is laid out in a table with 5 columns in a grid (hence the name, GRID RULES).
These rules can only be used for physical impairments. If you have psychological impairments or non-exertional impairments, the rules don't apply.
Also, these rules only apply to claimants who are at least 50 years old. (Young individuals can get benefits, but not by using grids).
The following 5 things are considered by the grids:
- your age
- your education level
- the skill level of the work you did in the past 15 years
- whether you have learned any skills that can be used in a different job, and
- your residual functional capacity (RFC) – what you can do despite your impairments.
Here's an illustration of how we would apply the grid rules:
In column 1, John's residual functional capacity is limited to sedentary work. In column 2, he is 55 years old, hence a person of "advanced age." In column 3, John has a 9th grade education, considered a limited education. In column 4, past work experience has been in an unskilled job, so there are no transferable skills. Based on all of these factors, column 5 directs a decision of disability, based on Grid Rule 201.01.
CAUTION: At the application level, decision makers tend to deny most applications. Therefore, I suspect that John's claim would be denied at the first level of review. He will probably still get a letter stating something like this: "You are not eligible for disability benefits. This is because you are not disabled according to our rules."
Why would they deny this claim? Because the decision maker will not concede the fact that John is limited to sedentary work. They will say he can perform light or medium work. Since they set his Residual Functional Capacity too high, he won't meet a grid rule and a denial results. About one-half of the applications that I see denied encounter this error.
John will need to appeal this denial within 60 days. The appeal, if filed in time, will take his claim before an administrative law judge (ALJ) who will reevaluate his medical evidence and, hopefully, recognize his RFC as limited to sedentary work. When this happens, John will meet the grid rule (201.01) and be awarded his benefits.
The chore for John's attorney will be to prove that his client is limited to sedentary exertion level, using medical evidence from John's doctors. The attorney will quickly analyze the denial and see right away what the problem is. He or she will also know immediately must happen to get the denial overturned at the hearing.
So, John's attorney will go into the hearing focused on the main problem. The goal will be to use evidence to demonstrate that Grid Rule 201.01 will determine that John is disabled under Social Security's own rules and that he should be paid.
This is so much different than what would happen if the claimant just went to the hearing unrepresented and hoped for the best. Being unaware of Grid Rule 201.01, John would probably tell the judge the truth about his impairments--but fail to direct the case to its proper focal point--Rule 201.01, where his age, education, lack of skilled work and proper residual functional capacity would direct approval of benefits.
REPRESENTED BY COMPETENT COUNSEL: John could be found disabled on his alleged onset date of 2/18/15.* He will receive $37,604 in past due benefits and will get a check for $1,687 per month for as long as he is disabled. He will also get Medicare insurance to pay for medical treatment. He will pay his attorney-advocate a $6,000 fee, taking home $31,604 in past due benefits and all of his monthly award.
UNREPRESENTED: John may be denied again. If so, he will receive $0 back pay and $0 per month in benefits. He would get no Medicare insurance. Did he just save a $6,000 attorney's fee? Well, that's not the way I would look at it!
You don't have to understand Social Security's complicated rules. Just be sure you hire someone who does!
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THE FORSYTHE FIRM
Social Security Disability Representation
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297
FORSYTHE FIRM: SOCIAL SECURITY JUSTICE
*All names used in this post are fictional so that no claimant's identity is compromised. Numbers are reasonable representations of benefits that might apply, not actual numbers. Having a representative does not guarantee that you will win your case because, obviously, some represented claimants also are denied. But having adequate representation gives you a better chance for approval, especially at appeal. This post is used for general information and not for legal advice on any particular situation. Consult an attorney or Social Security representative about your case.
Social Security disability rules change at age 50, making it somewhat easier to get benefits.
Starting at age 50, it is possible to get a Medical-Vocational Allowance. Social Security uses published "grid rules" that consider age, education, past work experience and residual functional capacity to determine if you qualify for disability benefits.
This means that a 50 year-old individual might be approved, while a younger individual with the same education, past work record and medical condition would be denied.
Starting at 50, claimants fall into a new age category known as "closely approaching advanced age." The rules are more lax than they are for "younger individuals" (below 50).
Starting at age 55, claimants change age categories again, this time landing in the "advanced age" category. And, you guessed it, the rules get even easier at 55.
Social Security recognizes that individuals lose their ability to adapt to new types of work as they age. Even if a 30 year-old claimant cannot perform past work, he may not be disabled because there is other (easier) work that he could do. However, a 55 year-old individual would not be expected to make the change to different types of work and could be found disabled.
Disability approval is certainly not automatic at age 50 or 55. But your odds do improve quite a bit after age 50.
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Charles W. Forsythe
The Forsythe Firm
7027 Old Madison Pike, Suite 108
"Across from Bridge Street"
Huntsville, AL 35806
PHONE (256) 799-0297
10,000 people died last year waiting for a Social Security decision about their disability claim.
There are now 1.1 million people waiting for a hearing. There are about 1,600 administrative law judges available to hold hearings.
That means that the average wait time for a hearing is almost 2 years, sometimes longer. And that's in addition to the 4 months it took to get a denial on the application.
So, when people talk about waiting up to 3 years to have their disability case decided, they are not kidding.
The wait time is atrocious. But we have to remember that you only get one hearing--one chance to make your case. If that fails, there is no good option. Sure, you can make further appeals but they have an even smaller chance of success than any other part of the process. The hearing is your best chance!
After waiting 2 years or more for a chance to be heard, an awful lot is riding on that 45-minute hearing. Hopefully, your attorney-advocate has prepared your case well. He knows the medical evidence inside and out. He has prepared you to give your testimony effectively. He has prepared for testimony offered by Social Security's vocational witness, who will use jobs from the Dictionary of Occupational Titles (DOT) to advise the judge about work you may still be able to do. Your advocate knows that the D.O.T. was written during the Great Depression (1930s) and has not been updated since 1991. It's outdated, archaic and in many cases irrelevant to today's job market; however, Social Security thinks of it as the absolute truth about jobs in the United States. So, you have to be prepared for this monster.
This hearing can change your life. It can save your life. Nobody can guarantee that you will prevail. But you owe to yourself to make a fight of it and to present your case as well as you possibly can. That takes more than passion or emotion. It takes fact and skill and hard work.
You won't see the hours that I have spent on your case. You won't see me locked in my study late at night pouring over your medical records, or researching case law about vocational testimony before the office opens for the day. In fact, what I do may look easy to you. You might get the impression that I stroll into your hearing with my briefcase and just hope for the best. But that's not really what I do. I dedicate myself to giving you the best chance I can give you to have a life-changing experience at your hearing.
Do I sometimes get disappointed? Yes, of course. But I must say that there are more victories than defeats. I love it when I can call a client who's been waiting for 2 or 3 years and say, "Hey, we just got a fully favorable decision; a check will be on the way."
That isn't greed: that's medicine to relieve pain, utilities that won't be shut off, and a chance to hang on to the house. It's groceries and a chance to see the doctor again. Maybe it's not being afraid to answer the phone again because the bill collectors can be kept at bay. Whatever else it is, it's a mighty good feeling.
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Charles W. Forsythe
7027 Old Madison Pike, Suite 108
Huntsville, AL 325806
PHONE (256) 799-0297
When Social Security denies your disability claim, you will get a 4 or 5 page denial letter. Most of the letter is "broiler plate" language--just form language that they use in all their letters.
But hidden away in the denial letter is the real reason they denied your claim. This is usually found on the very last page of the letter, near the bottom of the page--often the last paragraph or next to the last paragraph.
Sometimes it will say: "We have made diligent attempts to obtain enough information to make a decision on your claim. However, we have not been able to get enough evidence to make a decision...," etc.
This means one of two things: Either you don't have sufficient medical treatment OR Social Security wasn't able to find your records, possibly because you didn't give them your doctor's correct name, address or contact information.
There are 2 ways to correct this:
1. You can file a new application and furnish all the correct medical information. Social Security will order your records again and this time hopefully find them. Obviously, if you don't have medical records, this would be a waste of time. Social Security will pay for the records they order.
2. You may file an appeal and ask for a hearing, which will take place 18 to 24 months in the future. Someone will have to order the correct medical records and pay for them and Social Security will not pay. If you represent yourself, you will need to pay for your records out-of-pocket. If you have an attorney-advocate representing you, he or she will usually pay for the records and then bill you when the case settles favorably.
It is obviously to your advantage to provide full and accurate medical information in your original application. It saves time, money and gives you an opportunity to start getting benefits months or years sooner. Nothing guarantees a denial more than failure to give Social Security correct contact information on all your doctors, clinics, hospitals, emergency rooms, counselors, psychologists--or other treating providers.
Disabled persons are often in a poor financial fix: unable to work and depending on Social Security disability to survive. But just how much can you get from Social Security?
In 2018, the average Social Security disability benefit is $1,197 per month. The maximum benefit for a non-blind individual is $2,788 per month. Now, that's quite a range.
Your actual benefit is based on a formula that considers your age, how long you have worked and your earnings (how much you have paid in Social Security taxes). That's why each person's benefit is different.
You may be able to collect back pay (retroactive benefits) if
1) You were disabled for a while before filing your application, in which case you may claim benefits for up to 12 months before your filing date;
2) You have to wait a long time to get a decision on your claim, such as waiting for an appeal hearing. Benefits may accumulate while you are waiting on Social Security.
The main point I like to make in these blog posts is this: It is common for Social Security to deny disability claims. They deny over 75% of claims. When that happens, you must file an appeal with the 60 day deadline. The appeal is your best chance to get paid. Do not file a new claim and spin your wheels--file a proper appeal. Consider getting a lawyer-advocate at that point, too.
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Charles W. Forsythe
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297
E-Mail us: forsythefirm@gmail.com
SOCIAL SECURITY JUSTICE: THE FORSYTHE FIRM
