Disability Benefits: From Favorable Decisions to Denials

Navigating the world of disability benefits can be daunting, with applicants often facing hurdles like complex application processes, lengthy waiting periods, and potential denials. Whether you're awaiting a decision, dealing with a denial, or celebrating a favorable ruling, Morgan & Morgan’s disability benefits attorneys are here to help. 

What Are Disability Benefits?

Disability benefits are financial assistance programs designed to support individuals who are unable to work due to a disability. Administered by the Social Security Administration (SSA), these benefits fall into two main categories:

1. Social Security Disability Insurance (SSDI): For individuals with a sufficient work history who have paid into Social Security through payroll taxes.
2. Supplemental Security Income (SSI): For individuals with limited income and resources, regardless of work history.

Understanding the Disability Application Process

Initial Application for Disability

The process begins with submitting an application online, by phone, or in person at a local SSA office. The application includes:

• Personal information
• Medical evidence of your disability
• Work history details

Disability Determination

The SSA evaluates your claim using these criteria:

• Severity of Condition: Your condition must significantly limit your ability to perform basic work activities.
• Duration: The disability must last or be expected to last at least 12 months or result in death.
• Ability to Work: The SSA assesses whether you can perform your previous work or adjust to other types of work.

Favorable Decisions: What Happens When You’re Approved?

A favorable decision means the SSA has determined that you qualify for benefits. Here's what follows:

1. Notification of Approval

You will receive a written notice explaining the decision, including the amount of benefits and when payments will begin.

2. Payment Details

• SSDI Benefits: Calculated based on your average lifetime earnings before the disability.
• SSI Benefits: Determined by the federal benefit rate (FBR), which may be supplemented by your state.

3. Retroactive Payments

If your disability began before you applied, you may be eligible for back pay covering the time between your disability onset and approval date.

Common Reasons for Benefit Denials

Despite the need for assistance, approximately 65% of initial disability applications are denied. Common reasons include:

Insufficient Medical Evidence

The SSA requires comprehensive medical documentation to confirm the severity and duration of your disability.

Earning Too Much

Applicants earning above the substantial gainful activity (SGA) threshold may be denied. In 2024, this limit is $1,470 per month for non-blind individuals.

Failure to Follow Treatment Plans

If you do not comply with prescribed medical treatments, the SSA may assume your condition could improve and deny your claim.

Lack of Cooperation

Failing to provide requested information or attend medical exams can result in denial.

Short-Term Disabilities

Disabilities expected to last less than 12 months do not qualify for benefits.

What to Do If Your Disability Claim Is Denied

A denial is not the end of the road. The SSA provides a structured appeals process, and Morgan & Morgan can help you to appeal.

Reconsideration

Request a review of your claim by a different SSA representative. Submit additional evidence to strengthen your case.

Hearing by an Administrative Law Judge (ALJ)

If denied again, request a hearing. An ALJ reviews your case, and you can present evidence and testimony to support your claim.

Appeals Council Review

If the ALJ denies your claim, request a review by the Appeals Council. They may uphold the decision, remand your case for another hearing, or make a new ruling.

Federal Court Review

As a last resort, file a lawsuit in federal court to contest the SSA’s decision.

Common Mistakes to Avoid When Applying for Disability Benefits

There are many reasons an application can get back a denial or only a partial approval that’s inadequate for your needs. Some of the common mistakes that can lead to missing benefits that you deserve include:

• Submitting an Incomplete Application: Ensure all required forms and documents are filled out accurately and completely.
• Ignoring Deadlines: Missing deadlines for submitting applications or appeals can result in case dismissal.
• Overlooking Medical Evidence: Regularly update your medical records and ensure they align with SSA requirements.
• Underestimating the Importance of Legal Representation: Navigating the system without legal help can lead to avoidable denials or delays.

A Social Security lawyer from Morgan & Morgan can review your application and details to ensure that you file correctly and on time and that you can appeal an incorrect decision.

The Impact of a Favorable Decision

A favorable decision offers financial stability and access to resources, helping individuals manage their disability and improve their quality of life. However, the process doesn’t end there. Beneficiaries must:

• Report Changes: Notify the SSA of any changes in income, resources, or medical condition.
• Undergo Periodic Reviews: The SSA conducts continuing disability reviews (CDRs) to ensure ongoing eligibility.

Frequently Asked Questions 

What is the difference between SSDI and SSI?

Social Security Disability Insurance, or SSDI, involves benefits for individuals with a work history who have paid Social Security taxes.

Supplemental Security Income, or SSI, involves benefits for low-income individuals with limited resources, regardless of work history.

How long does it take to receive a decision on a disability claim?

Initial decisions typically take 3-5 months. Appeals may extend the process to over a year. With a free case evaluation, Morgan & Morgan can advise you on what your timeline may look like.

Why Would I Receive a Partially Favorable Decision?

There are many different factors that influence whether you will receive a partially approved or fully approved disability. Some of the most common reasons for partial approval are that the SSA believes you previously had a disability or that they disagree about your start date. This may be noted in your letter as a closed period of benefits. In this situation, the Social Security Administration issues you a one-time payment rather than ongoing monthly payments. 

For someone still suffering from the ongoing impacts of a disability, this can be problematic, as this one-time payment may not support you for the length of your current disability. 

This lack of understanding about your medical condition is very complicated to untangle, which is why hiring a Social Security lawyer working at Morgan & Morgan may be the best way for you to help navigate this legal process and improve your chances of getting a fully approved decision. 

What happens if my disability worsens during the application process?

If your disability worsens during the application process, it's important to update the Social Security Administration (SSA) as soon as possible. You can work with your attorney to make any updates or adjustments to your claim.

First, provide the SSA with new medical evidence documenting the progression of your condition. This can include:

• Recent doctor’s notes
• Test results
• Imaging studies (e.g., X-rays, MRIs)
• Hospital records

Your attorney can then notify the SSA about the worsening condition and how it further limits your ability to work. This information may help strengthen your case.

If the severity of your condition now meets or more clearly aligns with the SSA's listing of impairments, your claim may be reassessed with the new information.

In some cases, the SSA may allow you to amend your initial application to reflect your worsened condition. Discuss this option with a disability attorney or advocate. An experienced disability attorney can help ensure that your updated medical evidence is properly submitted and considered, increasing the likelihood of a favorable decision.

If your condition worsens, the additional evidence may:

• Strengthen Your Case: It can demonstrate the severity of your disability and its impact on your ability to work.
• Affect Back Pay: If the SSA determines that your disability onset date was earlier than initially stated, you may be eligible for additional retroactive benefits.

Staying proactive and providing updated medical information can make a significant difference in the outcome of your disability claim.

How Can Morgan & Morgan Help With Disability Claims?

Disability claims involve complex regulations and strict deadlines. Hiring an experienced disability attorney at Morgan & Morgan can significantly improve your chances of approval.

Your attorney can assess your case to determine the best strategy for applying or appealing. They will gather and organize the necessary medical and employment records to build a compelling case.

A Morgan & Morgan lawyer can then represent you during hearings, presenting evidence and questioning witnesses to strengthen your claim.

In short, your Morgan & Morgan legal team will fight for you to receive the maximum benefits, including back pay and any potential state supplements, that you need and deserve.