APPLYING FOR DISABILITY IN HUNTSVILLE

When you apply for Social Security disability in Huntsville....

 Your application will be sent to a state agency in Birmingham known as the Disability Determination Service, or DDS.  A "disability specialist" will order and review copies of your medical records.  She will also evaluate your past work record. Depending on how complete your medical record is, you may or may not be sent for a consultative examination by a medical doctor or clinical psychologist.  Within about 4 months after filing your application, a decision will be made as to whether you meet the rules for Social Security disability.

In Alabama, about 76 percent of claimants are denied by the DDS.  They must appeal directly to an Administrative Law Judge (ALJ) for a hearing and request a new decision.

Should everyone whose application is denied appeal the decision?  YES.  In my experience, the DDS denies both good claims and bad ones in many cases.  Just because DDS says you are "not eligible for benefits according to our rules," does make it true.  They deny claimants frequently who should be getting benefits.  The purpose of the appeal is to allow a new set of eyes to review your case and reconsider all the evidence.  In almost 50 percent of the cases that go to a hearing level appeal, the new decision is favorable to the claimant.  So, by all means appeal your denial.

Is it expensive to appeal?  No, not at all.  An appeal should not cost you a cent unless you win.  If you win, the appeal may cost you a small percentage of your back pay (which you would have lost without the appeal).  This goes to pay your attorney's or representative's fee.  The fee is payable only after you win and after you get retroactive or back pay.

The Forsythe Firm represents hundreds of claimants each year before federal Administrative Law Judges in Alabama, Tennessee, Mississippi and other states.  We are happy to answer your questions or provide you with a free discussion of your claim--at no cost or obligation.  Our office is conveniently located directly in front of Bridge Street in Huntsville with plenty of free street level parking.  You may call us or make an appointment to visit.  (256) 799-0297. 

Visit our Website for More Information

WHATS IN YOUR MEDICAL FILE?

What's in your medical file may shock you.  And if you are coming up for a Social Security disability hearing, you should find out.  Doctor's files often contain more than medical information.  And just because it's in your medical file doesn't necessarily mean that it's true.

For example, I once had a client who was confronted about his two week vacation to Vail, Colorado.  Turns out, he had told his doctor and the doctor had included a note about the vacation in the medical record.

I have found citations in medical files about gambling, drinking, smoking, vacations, domestic abuse, drug use, marital problems, shoplifting or other criminal activities, and much, much more.  And not all of the information was accurate.  Most often, the claimants had no idea these things were in their files.

Social media seems to be another prime source for revealing, personal information.  Does Social Security look at your Facebook page?  I assume they do.  You should, too.



 

CONFUSING DISABILITY TERMS: WHAT DO THEY REALLY MEAN?

Some important terms stand out in Social Security disability regulations.  Here is what they mean.

Alleged Onset Date (AOD).  This is the date the claimant alleges to have first become disabled.  If it becomes the Established Onset Date (EOD), meaning that the Social Security Administration agrees that the claimant did indeed become disabled on that date, benefits may be paid back to that date.  So the AOD/EOD affects how many months of back pay or past due benefits the claimant is entitled to receive.

Waiting Period.  The waiting period for all Title 2 (regular disability) claims is 5 full calendar months.  This is really an elimination period.  5 months of benefits will be subtracted from the Established Onset Date.  For example, if you are found to have become disabled on March 15^th, your waiting period will include the months of April –August and your first benefit payment eligibility will be for the month of September.  This does not necessarily mean you would have to wait 5 months to get a benefit. It depends on when hour established onset date was. 

Duration Requirement.  Social Security regulations require a claimant to be disabled for at least 12 consecutive months in order to receive disability benefits.  And the 12 months must be from the same impairment(s).  For example, if a person is disabled for 5 months because of a heart attack, then becomes disabled again for 7 months because of back surgery, the two impairments cannot be combined to satisfy the 12 month duration requirement.  A claimant does not necessarily have to wait 12 months before filing an application for disability benefits, however.  If he/she expects to be disabled for a period of 12 consecutive months by the same condition or combination of conditions, the application can be filed immediately.  The requirement is that the claimant provides medical documentation that he/she can reasonably be expected to be disabled for at least 12 consecutive months.  Disability expected to last less than 12 consecutive months are not covered by Social Security.  Benefits may be awarded before the 12 month period expires.  The duration requirement is intended to eliminate benefits for impairments that are expected to last less than 12 months.

Date Last Insured (DLI).  This is the date the claimant’s Social Security disability insurance expires.  Yes, disability insurance does expire if you stop working and stop paying FICA taxes.  If your DLI is 12/31/17, for instance, you must file a disability claim before 12/31/17 or prove that you became disabled prior to 12/31/17.  Otherwise, you lose the right to file a new claim after 12/31/17.  If you are receiving disability benefits from Social Security, this date has nothing to do with when your payments will stop, when your case will be reviewed again, etc.  It simply means that there was a point in time beyond which you could not file a new disability claim.  That date is called The Date Last insured (DLI).  If you are receiving disability benefits, you obviously filed a claim prior to the DLI, so the date means nothing to you at this point.

SOCIAL SECURITY AS "INSURANCE"

Individuals qualify for Social Security disability coverage because they have worked and paid into the Social Security Disability Trust Fund (SSDTF).  They are required to have worked a minimum number of quarters to have coverage, often referred to as Title 2 coverage.  The contributions made by each worker, and matched by each employer, are referred to as FICA taxes.  FICA stands for Federal Insurance Contributions Act.  Contributions (taxes) are mandatory for most workers.  The current tax rate for Social Security is 6.2 percent, paid by the worker and another 6.2 percent is paid by the employer.  An additional Medicare tax of 1.45% of added.  Note:  The 12.4 percent Social Security tax funds both the Retirement Trust Fund and the Disability Trust Fund.

The minimum quarters of coverage required to be insured vary according to the age of the worker.  A very young worker may only need to have worked about 1 year to be insured under Social Security disability.  An older worker will need more work.

When a person stops working, contributions to FICA also stop.  However, Title 2 disability insurance coverage does not stop immediately.  For most individuals, they will lose Social Security disability coverage about 4 years after they stop working.  They may eventually regain coverage if they start working again.

Individuals who have not worked, or have stopped working and lost their Title 2 disability insurance coverage with Social Security, can only file Title 16 claims, often called "SSI" for Supplemental Security Income.  These claims do not require a work record or quarters of coverage. SSI claims are means tested.  There are income and resource limits for receiving SSI benefits.  Also, the monthly benefits available for SSI are usually less than for regular disability based on a work record.  For instance, the monthly maximum benefit in 2015 for Social Security Disability (Title 2) is $2,663.  The monthly maximum for SSI is only $733.

Can We Help You With a Disability Claim or Appeal? 

The medical qualifications for Title 2 and Title 16 (SSI) are exactly the same.  In short, both programs require the claimant to prove a disability based on the same medical standards (except for certain dependent's benefits based on a parent's disability).

FORSYTHE FIRM AT BRIDGE STREET

The Forsythe Firm, located directly across from Bridge Street in Huntsville, is dedicated to the practice of Social Security disability advocacy.  It's the only thing we do.

"We get paid only for success."

As a full service disability advocate firm, the Forsythe Firm can help clients--

• file the initial application for Social Security disability
• complete the attending questionnaires, interrogatories and supporting forms
• handle correspondence and phone calls to Social Security on your behalf
• gather medical evidence 
• appeal unfavorable decisions
• write supportive briefs to explain why you should be approved
• attend hearings before administrative law judges as your representative
• file further appeals with the Appeals Council if that is required
• advocate for your right to receive back pay or past due benefits
• help you collect all the money to which you are entitled

We get paid only for success:  If you do not win your case and collect retroactive pay or past due benefits, we will never charge you a fee for any service.  Our partners are direct pay eligible with the Social Security Administration.  This means that when you are approved for back pay, Social Security will withhold and pay our fee directly.

If you have a Social Security disability claim, we hope you will visit us in the beautiful Bridge Street area for a free case evaluation.  7097 Old Madison Pike NW, Suite 108, Huntsville, AL.  (256) 799-0297.

RESIDUAL FUNCTION CAPACITY

To decide a disability claim, Social Security must determine the claimant's residual function capacity (RFC).  This term defines the maximum level of exertion and function that an individual can perform when doing work related activitie--such as walking, lifting, standing or pushing/pulling.  RFC also includes postural activities such as sitting, kneeling, crouching, crawling, bending, etc.  The mental abilities of work must also be evaluated, including the ability to remember, concentrate, finish tasks, understand and carry out instructions or respond appropriately to supervisors and co-workers.

Strictly in terms of exertion, there are 5 levels of exertion:

Sedentary work - requires the ability to sit for up to 6 hours out of an 8 hour day, stand up to 2 hours of an 8 hour day and occasionally* lift and carry no more than about 10 pounds at a time or frequently* lift and carry 10 pounds.

Light work - requires an ability to stand for up to 6 hours per 8 hour day and occasionally lift and carry up to 20 pounds at one time or to frequently lift 10 pounds.

Medium work - will require an individual to stand at least 6 hours per day and to lift and carry no more than 50 pounds at one time or to lift 25 pounds or more frequently.

Heavy work - will require a person to lift and carry no more than 100 pounds at one time or to frequently lift 50 pounds or more, along with at least 6 hours of standing/walking per day.

Very heavy work - means that an individual must be able to lift and carry more than 100 pounds at one time or to lift 50 pounds or more frequently.

If a person is found to be capable of medium work, he is assumed that he can also do light and sedentary work, unless there are special circumstances, such as an inability to sit for prolonged periods, etc.

I think you can easily see how important it is for the Social Security decision maker to properly determine your residual function capacity (RFC).  Primarily, the RFC is developed from medical records but your testimony can also be considered.  I like to have a treating physician complete a residual function capacity form which states the claimant's particular limitations.  When this form is provided by a licensed treating doctor who has a history of providing medical treatment to the claimant and when the RFC is consistent with the entire medical record, decision makers will often use it to determine residual function capacity.  If the treating physician will not provide an RFC form, then the administrative law judge or other decision maker must come up with his own RFC--which can be problematic.
---------------------
* The term "occasionally" means very little to one-third of an 8-hour workday.
* "Frequently" means one-third to two-thirds of an 8 hour workday.
* "Constantly" means more than two-thirds of the time.

HOW DO WE EVALUATE YOUR DISABILITY CASE?

As Social Security disability advocates, the Forsythe Firm often has to evaluate a disability case to see what its merits and weaknesses are. The critical factors of any Social Security disability case are:

• the claimant's age
• residual functional capacity (the most you are able to do, functionally)
• education
• past work history
• duration of the impairment (how long it has lasted or is expected to last)

We will also need to determine whether you are now engaged in "substantial gainful activity (SGA)."  In 2015 if a person is working and earning at least $1,090 per month in gross wages, tips, salary or commissions, he is performing substantial gainful activity and is not eligible for Social Security disability benefits, no matter how severe his/her impairments may be, or what his or her age is.  In short, a person cannot work full-time and collect SSDI at the same time.

A small percentage of claimants may meet a Listing set forth in 20 CFR 404. Subpart P, Appendix I.  These individuals have very severe impairments which are very specifically defined in the Listing and should qualify for SSDI benefits if they are not working and if their impairment has lasted or is expected to last at least 12 months OR end in death.  Most claimants, however, will not meet a Listing level impairment.

Further, we will evaluate your claim to determine if a Medical-Vocational Guideline is met.  Generally speaking, these "grid rules" are easier to meet for individuals who are at least 50 years of age with limited education and unskilled work experience.  Others could also meet a grid rule.

If a claimant does not meet a Listing or a Medical-Vocational Guideline, we must determine whether he/she can perform any job which exists in the national or regional economy.  The bottom line here is often whether a claimant can perform unskilled sedentary work.  By "work," we mean work that is performed 8 hours a day, 5 days per week or an equivalent schedule, on a persistent basis.  

These are certainly not the only factors to be considered but they are major considerations in evaluating the odds of getting Social Security disability.  At the Forsythe Firm, all case evaluations are free and without obligation.  Keep in mind that opinions can vary from one representative to another.  Even if we may not agree to represent you it does not mean that another representative will not and it certainly does not mean that your case cannot be successful. 

www.ForsytheFirm.com