The attorneys at Morgan & Morgan understand the impact a denied Social Security disability claim can have on an individual and their family, especially when these benefits are the applicant’s main source of income. More often than not, applications for Social Security disability are initially denied; however, an initial denial does not necessarily mean that the applicant is not entitled to benefits.
Unfortunately, applicants who have been rejected may choose to abandon their claims instead of proceeding with an appeal — a process that is undoubtedly intimidating to claimants even in a more typical personal injury case — where they could potentially recover the benefits they are rightfully owed. At Morgan & Morgan, our Social Security attorneys have extensive experience representing individuals in the application and appeals processes, among other practice areas, and have the resources needed to recover the benefits our clients deserve.
Denied Social Security Disability benefits? Don’t lose hope! Download our SSD benefits and claim guide to learn everything you need to know about the application and appeals process.
How to Apply for Social Security Disability Benefits in Florida
Injured workers, such as those that are eligible for workers’ compensation, should apply for Social Security Disability benefits as soon they become disabled. You can apply for SSD benefits by scheduling an appointment with a Social Security Administration (SSA) representative or by applying online. The claims representative assigned to your case will answer any questions you may have about the application process.
He or she will also handle the paperwork needed to send your claim to Disability Determination Services (DDS), which will make an initial determination as to whether you are considered disabled under the SSA’s requirements. The claims representative will also determine the disability programs for which you may be eligible, as well as determine benefits you are eligible to receive based on your work history.
We highly encourage applicants to speak with a Social Security disability attorney before beginning the application process. An attorney will be able to explain the process for filing for benefits and gather the documents needed to submit a claim.
How Can a Social Security Disability Attorney Help Me File a Claim?
Nearly 60 percent of all first-time applicants are initially denied disability benefits, and close to 90 percent of applicants seek the help of a representative at some point in the process. The process of applying and appealing denied claims is often complicated, and the chances of success are far greater with the help of an experienced Social Security disability attorney.
Retaining a lawyer can increase your chances of approval and help avoid denials based on technicalities or other common errors. Our experienced attorneys can help gather information vital to your claim’s success and ensure you complete the steps necessary for obtaining benefits.
If you hire a Social Security Disability attorney to help with your claim, he or she will guide you through the following process:
Preparation: Preparing your claim, which will include gathering documents and other required information is an essential part of the claims process. An attorney can help gather the documentation needed to substantiate your claim, such as personal information (including information on your children or spouse); military information, if applicable; IRS forms; bank account information; addresses and phone numbers; detailed medical records and referrals; medication history; a list of prior employment history; and information on other disability claims, if applicable.
You will be required to submit extensive documentation to the SSA, and determining which information is required for your claim can be a difficult process. An attorney can help ensure your claim satisfies the SSA’s requirements, which can help expedite the application process. He or she can also assist in gathering documents that you are unable to access on your own.
Communication: An attorney can keep track of the status of your claim, alert you to any requests for new information, and speak with Social Security Administration (SSA) representatives on your behalf to answer questions that may arise regarding your application. At Morgan & Morgan, we understand that many applicants work and care for their families and may not have the time needed to deal with the SSA as it reviews their claim.
Finalizing a Claim: If your disability claim is approved, your attorney will review the SSA’s calculations to determine if any vital information was missed or if any errors were made. He or she will also address any questions you may have concerning your new benefits.
Appeal: If your application for benefits was not approved, you may be able to file an appeal with an attorney.
Appealing a Denied Social Security Claim
If your application for SSD has been denied, or you believe you were not compensated properly, you may appeal the decision by filing a written request within 60 days of receiving the decision letter. Your claims will then go through four levels of appeal, including:
Reconsideration: If your initial application for benefits has been denied, your attorney will file a request for reconsideration. During this stage, a claims examiner who was not involved in the initial review process will reconsider your application. They will take into consideration any new evidence that you or your attorney have uncovered to supplement your claim. Your attorney can respond on your behalf to any questions posed by the claims examiner during this stage.
Hearing: If your claim is repeatedly denied, or if you do not agree with the results, the next step is to request a hearing by an administrative law judge. During this stage, your attorney may prepare you for questions that could be asked at your hearing; request the judge to subpoena witnesses vital to proving the legitimacy of your claim; argue your case before the judge; question witnesses and experts; present new evidence or information you believe was not reviewed properly; and, if you have already been awarded benefits, ask the judge to review and reassess the calculations.
Appeals Council: If the judge’s determination does not suit your needs, and you are dissatisfied, you could ask to be reviewed by the Social Security Appeals Council. However, know that the Council is not required to grant you another hearing. If you are granted a secondary determination, your case may be resolved or presented to the administrative judge. If the latter occurs, your attorney will essentially have to repeat the steps taken in the initial hearing.
Federal Court: If your claim is denied for review in front of an ALJ, or if you disagree with the Appeal Council’s decision, you can file a lawsuit in federal district court.
Types of Social Security Disability Benefits
Disability Insurance Benefits (SSD or SSDI): This is most popular benefit provided by the SSA. Disability insurance benefits cover millions of people who were recently employed but are now disabled. Eligible applicants include those who have worked a total of at least five of the 10 years before developing their disabilities. Dependents, including children and spouses, may also be able to collect if a parent qualifies for SSDI. Disability benefit amounts are based on the applicant’s work history and earnings.
Disabled Adult Child Benefits (DAC): Disabled children between the ages of 18 and 22 may be eligible for benefits if their parents receive Social Security retirement benefits or SSD, or are deceased.
Disabled Widow or Widower (DWB): These benefits are provided to widows or widowers over the age of 50 who develop disabilities within seven years of their spouses’ deaths. The widow or widower is required to have been married to the deceased for a minimum of 10 years.
Am I Eligible for Social Security Disability Benefits?
The SSA has created a five-step process to determine whether an application for SSD is approved. The criteria include the following:
Step One: Is the applicant working? The SSA will not consider a person for disability if they make more than a specified amount each month. If they make less than the designated amount, the SSA will take a more in-depth look at the applicant’s medical condition.
Step Two: Is the applicant’s medical condition severe? For the SSA to rule the applicant “disabled,” the medical condition must prevent the applicant from performing basic functions of work for at least one year. If this is the case, the SSA will look at step three.
Step Three: Is the applicant’s medical condition on the SSA’s list of disabling conditions? If the applicant’s medical condition is not on the list of illnesses that automatically qualify for disability, the SSA will check to see if the condition is as severe as those on the list. If the condition does not fit the list, the SSA will look at step four. Some of the SSA’s disabling conditions include:
- Mental disorders, such as bipolar disorder, autism, depression, panic attacks, anxiety, schizophrenia and post-traumatic stress disorder (PTSD)
- Musculoskeletal system problems, such as back and spine conditions, arthritis, amputations, fractures, carpal tunnel syndrome, scoliosis and fibromyalgia
- Skin disorders, such as psoriasis, burns and ichthyosis
- Respiratory illnesses, such as asthma, emphysema, primary pulmonary hypertension (PPH), cystic fibrosis and lung transplants
- Immune system disorders, such as multiple sclerosis (MS), HIV/AIDS, lupus and rheumatoid arthritis
- Digestive tract problems, such as Crohn’s Disease, liver disease, hepatitis and inflammatory bowel disease (IBD)
- Impairments that affect multiple body systems, such as lyme disease and metabolic disorders
- Senses and speech issues, such as vision, hearing and speech loss
- Endocrine disorders, such as diabetes, thyroid problems, neuropathy and obesity
- Cardiovascular conditions, such as heart failure and coronary artery disease
- Neurological disorders, such as cerebral palsy, stroke, traumatic brain injury (TBI), Parkinson’s disease and epilepsy
- Genitourinary impairments, such as chronic renal (kidney) disease and chronic hemodialysis
- Hematological disorders, such as sickle cell disease, hemophilia and myelofibrosis
- Malignant neoplastic diseases, such as leukemia, lymphoma and most kinds of cancer
Step Four: Can the applicant perform the work they did before? The agency will review the applicant’s claim and decide, based on the applicant’s injury, whether they are capable of performing the work they did before the injury. If they cannot, the SSA will move to step five.
Step Five: Is the applicant capable of performing any other work? The SSA will review the applicant’s age, medical condition, education, past work experience, and skills to determine if they can perform gainful employment in a different capacity. If the applicant is not physically capable of performing other work, the SSA will rule the applicant “disabled.”
Work Eligibility Tests: In addition to the aforementioned requirements related to disability, applicants must meet two tests the duration of work test and the recent work test, to qualify for benefits.
Social Security Disability Work Credit Requirements
The SSA determines whether workers have worked long enough to receive benefits by calculating the amounts they should receive and converting their earnings into work credits. A worker can earn four credits for a year of work, depending on his or her yearly income (one-quarter of coverage, or QC) changes every year. In 2017, a worker will earn one work credit for every $1,300 of wages or self-employment income. However, when the worker earns more than $5,200, they are capped for the year as he or she received four credits. The formula for this number is complicated, but it is recalibrated annually and never decreases.
Social Security Death Benefits
Social Security is meant to be a form of protection for working parents and their families. If a parent dies, their children may be entitled to receive benefits to compensate for the financial loss.
Unmarried children may collect benefits after a parent’s death if they are:
- Younger than 18
- Between the ages of 18 and 19, but are enrolled as full-time students at secondary schools
- Ages 18 and older, but have serious disabilities that manifested before they were 22
Benefits for Disabled Children
Supplemental Security Income (SSI) may be able to help families with children who have severe disabilities if they have minimal income and limited resources. These benefits may be paid regardless of a parent’s ability to work, and will continue as long as a child is disabled and unable to provide for himself or herself financially.
Children may be eligible for SSI Disability insurance if:
- They have physical or mental conditions that are so severe that they result in serious functional limitations
- They have these conditions for at least 12 months
- The conditions will likely be the cause of the their deaths
- They are not gainfully employed and doing work the SSI administration considers “substantial work”
Why Are People Denied Social Security Disability?
The following are the main reasons SSD applicants are initially denied:
Past Convictions: Generally, prior convictions will have no bearing on the ability to collect SSD benefits. However, convicts will not be eligible for benefits if the disability manifested during the commission of a felony; the disability arose or worsened while in a correctional facility; they intentionally orphaned or widowed themselves to receive benefits; or parole or probation is violated.
Disability Stems From Drug or Alcohol Dependence: If the applicant has a drug or alcohol addiction that was a material contributing factor to the disability, they will not be eligible for benefits.
Refusal to Cooperate: The SSA requires applicants to submit their treating doctors’ medical records. Failure to comply may result in the denial of SSD. For applicants who do not have a treating doctor, the SSA will request an examination with one of their doctors. Applicants who miss their appointments or refuse the consultative examinations may be denied.
Fraud: The SSA may terminate an applicant’s benefits if they obtained SSD by lying on their application and may be prosecuted for fraud.
Short-Term Disability: To be eligible for SSD benefits, the SSA must determine that the injury or impairment, such as those sustained in a car accident, will last for at least a year or will be fatal. Blind applicants are the only exception.
Long-Term Disability Benefits
Some individuals have long-term disability (LTD) insurance policies through their jobs, carry their own coverage, or have these policies worked into their pension plans. Similarly to SSD, LTD compensates disabled employees for a portion of the income they would have received if they were working.
LTD has its own set of complicated rules and tests that determine eligibility and payout amounts, and, oftentimes, claimants are required to apply for SSD and LTD simultaneously. While SSD policies have a set of standardized rules and procedures, those which govern LTD policies can vary. Insurance companies have a history of routinely denying LTD policy claims and may stop payment prematurely even if the individual is still sick, injured or disabled.
If you have applied for long-term disability (LTD) assistance and have had your claim denied or had your benefits end prematurely, contact us today by filling out a free case evaluation for assistance. We may also be able to assist if you have not yet applied for benefits or have already been denied.