Social Security Disability Claims (SSDI)
There are over nineteen million residents of the State of Florida. Of this population, approximately 561,000 receive Social Security Disability benefits (SSDI) from the federal government. Each year many more individuals apply for such benefits because of an unexpected long-term or permanent disability in addition to the Florida residents that already receive them. However, the Social Security Administration (SSA) denies many of the applications submitted for SSDI benefits in Florida. If you have applied for SSDI benefits, but SSA denied your claim, you have the opportunity to petition for an appeal or to ask for reconsideration of the agency’s denial. Often, SSA denies benefits at that stage of the process as well, and most people do not receive a positive adjudication of SSDI benefits until they get to the hearing stage of the appeal and reconsideration process when they appear and present arguments before a Social Security Administration administrative law judge.
However, reaching the administrative hearing phase in Florida can take a very long time. The Fort Lauderdale Social Security Administration branch office that manages the disability application process can sometimes take up to a year before it schedules a claim for a hearing before an administrative judge. Even after the hearing has taken place, it may take more time for the administrative judge to issue a final decision adjudicating an SSDI claim. Hiring an Social Security Disability Insurance Attorney to help you at the outset of the SSDI claim process and during the filing of the initial application is critical. An attorney at the start can raise your chances of getting your Social Security Disability Insurance benefits claim approved without having to ask for an administrative hearing with a judge or having to wait extended periods of time before you can receive your SSDI benefits.
Englander Peebles is a Fort Lauderdale SSDI benefits law firm. Our attorneys will collect your medical information and records, your vocational history, and any academic information if the claimant is a minor child, for the purpose of completing the initial application for Social Security Disability Insurance benefits. A lawyer who understands the Social Security Disability application process can assist you in presenting your claim for benefits to the Social Security Administration. In most instances, the Social Security Administration will require you to establish that your current and potential future mental or physical limitations are sufficiently serious. In essence, SSA will ask you to show that your limitations will prevent you from engaging in work activities at an adequate level where you have the ability to earn a substantial and gainful income. However, ultimately, the question of whether an SSDI disability benefits claim adequately meets the legal and procedural requirements for Social Security Disability Insurance benefits depends on the findings and decisions of the SSA disability examiner.
However, even if the Social Security Administration denies your Social Security Disability Insurance benefits claim at the initial application stage, getting the assistance of Social Security Disability Attorney to be your advocate can help you through the appeal and reconsideration process. An attorney can represent you at any potential SSA administrative hearing, can ultimately assist you with obtaining the SSDI benefits you deserve.
Social Security Disability Benefits Application Process
The SSDI benefits application process is a complex system of filing requirements and timeframes. The process is outlined below, which describes each step in a sufficiently detailed manner.
1. The first step after an applicant files an application for SSDI benefits with SSA is that SSA will transfer the case to the appropriate state agency responsible for making disability determinations. In Florida, that is the Florida Department of Health Division of Disability Determinations. That agency will assign the case to a disability examiner who will initially evaluate the validity of the claim.
2. The state disability examiner will next send a request for medical records and information to all the medical facilities and physicians listed by the claimant on his or her SSDI benefits application. After receiving the requested medical information, the state disability examiner will evaluate the information received. This stage of the process can take a significant period as it may take a while for the hospitals, doctors, and other medical facilities to respond to provide the medical information requested by the state agency.
3. The disability examiner will use the SSA’s disability listing manual, more commonly known as the blue book, to evaluate the mental or physical limitations claimed by the applicant. The impairments listed in the blue book have a strict list of criteria for qualified disabilities. However, even having a diagnosis of a listed condition does not necessarily mean that the examiner will favorably adjudicate a claim, particularly if the examiner believes the medical records provided do not satisfy the requirements of the blue book for that impairment.
4. With the vast majority of claims, a disability examiner will not approve an application for SSDI benefits merely on the basis of satisfying a disability listing in the blue book. If the disability examiner believes that the medical information he or she received in connection to a claim does not support approval of the application based on the blue book, then the examiner will use a method of evaluating claims called a sequential evaluation. A sequential evaluation entails the following considerations:
a. The examiner will first determine the claimant's residual functional capacity (RFC). RFC is simply an examiner’s assessment of what a claimant is still capable of doing regarding vocational opportunities. If the SSDI benefits claimant has one or more physical limitations due to existing impairments, then the examiner will make a decision as to the applicant’s physical RFC. In the same way, if the benefits claimant has one or more mental limitations due to existing impairments, then the examiner will make a determination as to the applicant’s mental RFC.
An examiner will most likely make a determination for both physical and mental RFC. In most claims, the examiner will need to consult with either a psychologist or a physician who is part of the Florida Department of Health Division of Disability Determination claim processing unit before the examiner makes the final RFC determination.
b. After the examiner makes a determination as to a claimant's physical or mental RFC, the disability examiner will compare the RFC rating to the physical and mental requirements of the jobs in the claimant's vocational history. The examiner will make this comparison to determine if the benefits claimant has the necessary ability to return to satisfy the requirements of those former positions.
If the examiner makes the determination that the claimant is unable to return to a former position, then the examiner will investigate whether it is possible for the claimant to switch to another form of work that he or she has never done before. The examiner will make this determination based on the benefits claimant’s work skills, education, age, and RFC.
c. If the claims examiner makes a determination that the claimant is unable to perform will likely approve the application for disability benefits. However, if the examiner decides that the claimant can do the duties of any position that he or she has held for a substantial period of time in the last 15 years, or is able to perform work in some other position, then the examiner will likely deny the application for SSDI benefits.
Many kinds of illnesses and injuries can obviously cause long-term disabilities, such as advanced cancer, congestive heart failure, or late stage kidney disease. However, other conditions such as chronic illnesses that become more acute with age, or progressive conditions that deteriorate over time that may eventually cause long-term disabilities even though there were not severe enough at their onset. For example, a claimant who may have possessed a prior back injury may have a condition that becomes aggravated enough in the future to the point that the work he or she performed in the past may become impossible to do. The claimant may then become eligible for SSDI benefits even though the initial injury or illness was not sufficiently disabling.
The SSA’s disability benefits program is administered by the federal government and is, therefore, governed by a set of complex federal regulations and policies. These regulations require that, for claimants to receive disabilities benefits, all of the following must be true:
1. The claimant must have a mental or physical impairment.
2. The physical or mental impairment must prevent the claimant from performing any substantial gainful work.
3. The claimant’s disability must have lasted, or be expected to last, at least one year or result in eventual death.
The terms above are subject to multiple interpretations and legal definitions, which highlights why claimants need to consult with experienced attorneys when filing for SSDI benefits. There are guidelines developed by SSA and the federal courts regarding the necessary qualifications for disability. Ultimately, proving a disability is a difficult undertaking. In preparing a disability claim, applicants must examine SSA’s guidelines carefully. Applicants must discuss the matter with their physicians and attorneys, and plan the particulars of the application accordingly.
Qualifying Mental or Physical Impairment
The foundational rule governing SSDI benefits is that the illness or injury that prevents the claimant from working must be discoverable and diagnosable by doctors, which SSA defines as medically determinable. For a claimant to prove he or she has a medically determinable condition, a claimant must be able to provide medical records and written statements from doctors or other treating medical facilities that sufficiently describes the medical condition preventing the claimant from performing substantial, gainful work. Additionally, these records and statements must describe with enough specificity how these limitations affect the claimant, and the length of time that the disabling condition is expected to last (i.e. for at least a year or result in death).
Ability to Perform Substantial, Gainful Work Activities
SSA will initially determine whether an applicant’s condition prevents them from doing the job that they had at the time that they became disabled, or the last position they had before acquiring a disability. If the disability prevents claimants from performing their usual work, SSA will then decide whether the disability prevents the applicant from performing any other type of substantial, gainful work activity. This kind of work activity is currently set by SSA in 2016 as a position that pays at least $1,130 a month.
SSA will consider a claimant’s age, work experience, training, and education in making this determination regarding the ability to perform gainful work, in addition to considering whether it is practical for the claimant to learn new occupational skills for another kind of position. SSA will evaluate whether a claimant can perform any work for compensation, regardless of whether there are any such jobs available in the area where the claimant lives.
Regardless of how severe the disabling condition is, SSA will not grant SSDI benefits to a claimant unless the condition has lasted for at least a year or is expected to last for that period, during which he or she is unable to do substantial, gainful work. SSA will also likely grant an SSDI claim if medical professional provide a qualified opinion that the disability is expected to result in the claimant’s death.
SSA will consider a claimant as qualifying for SSDI benefits as soon as a medical professional can provide a formal opinion that the condition will last for at least a year. If the disability does not end up lasting for a year, SSA is prohibited from asking for the disbursed funds back. SSA will not penalize claimants for recovering from an illness sooner than expected, as long as the SSA received a legitimate medical opinion that the illness was expected to last for at least a year. Nevertheless, SSA will perform reviews to confirm that the claimant’s disability is continuing, and can terminate benefits once the disabling condition no longer exists.
SSA’s Disability Freeze
SSA makes a determination regarding total retirement and disability benefits based on an individual’s average income over a period. An applicant may later receive a lower social security payment if he or she earns considerably less after a disability and over the years the claimant’s average income becomes lower. If this is the case, and SSA determines that a disability causes a claimant to work for significantly lower pay, then SSA may impose a disability freeze on a claimant’s income record. This disability freeze allows a claimant to work and collect lower income without it impacting his or her average lifetime income.
SSA’s Bluebook Listing of Disabilities
SSA maintains an extensive list of qualifying medical conditions that are sufficiently severe such that having that condition automatically means that a claimant is disabled, if confirmed. If a claimant’s condition is not on the bluebook list, SSA will have to make a determination if the impairment is equally severe to a medical condition that is listed in the bluebook. If so, then the SSA will find that a claimant is disabled.
The SSA’s bluebook list of impairments is a reference guide used by decision makers such as claims examiners at the Florida Department of Health Division of Disability Determination or the SSA administrative law judges. This bluebook is still available online, and its impairment listings are organized in several ways. The bluebook lists conditions by child and adult impairments and also by various body systems such as skin disorders, immune system disorders, lymphatic system disorders, musculoskeletal system disorders, respiratory system disorders, and cardiovascular system disorders. Below is a partial listing of physical and mental conditions that are listed and organized by specific bodily systems in the bluebook:
- Endocrine disorders – including hyperthyroidism and hypothyroidism.
- Musculoskeletal conditions – including fractures, osteoarthritis, degenerative disc disease, scoliosis, stenosis, and soft tissue injuries.
- Respiratory disorders – including emphysema, asthmatic illness, and sleep apnea.
- Immune system disorders – including inflammatory arthritis, lupus, HIV, scleroderma, and Sjogren's syndromes.
- Digestive system disorders – including inflammatory bowel disease, liver transplants, chronic liver disease, gastrointestinal bleeding, and hepatitis.
- Special senses and speech disorders – including speech pathology, hearing deficits, loss of visual acuity, and contraction of visual fields.
- Cardiovascular disorders – including arrhythmias, coronary artery disease, valvular defects, and chronic heart disease.
- Hematological or blood system conditions – including anemia, polycythemia, and granulocytopenia.
- Mental impairments – including major depressive disorder, anxiety, personality disorders, panic attacks, loss of cognition, bipolar disorder, somatoform disorders, and autism.
- Genitourinary System conditions – including kidney transplantation and other diseases.
- Skin disorders – Including ichthyosis and hidradenitis suppurtiva.
- Malignant neoplastic conditions – including cancers that may affect all body systems.
- Neurological conditions – including traumatic brain injuries, petit mal seizures, grand mal seizures, and ALS.
- Multiple bodily system conditions – including down syndrome.
Common Reasons for Denial of SSDI Claims
- Claimant fails to meet basic technical requirements. Often, SSA will deny claims due to technical issues, such as the claimant earns more than the substantial, gainful work activity limits or have inadequate work credits to receive benefits.
- The medical condition is not severe enough or will not last long enough. The claimant’s medical condition must prevent a claimant from working for at least one year. SSA will deny a claim if the claimant’s condition is expected to improve in less than one year or is not severe enough to keep the claimant from substantial, gainful work activity.
- The claimant fails to follow the prescribed treatment. SSA will deny a claim if a claimant fails to follow the prescribed treatment. A claimant’s behavior factors into SSA’s determination, and if a claimant fails to try to get better to return to the workforce, it would be difficult for an SSA examiner to grant benefits.
- The claimant fails to cooperate with SSA. If a claimant does not grant SSA with permission to gather medical files or fails to be present for SSA’s consultative medical examinations, SSA will likely deny benefits. SSA usually orders consultative medical examinations if there is insufficient medical evidence in a claimant’s file.
- SSA cannot get in contact with the claimant. SSA will deny a claim if a claimant fails to provide SSA with new contact information and cannot discuss the claim with him or her.
- The claimant’s disability is caused by alcohol or drug abuse. SSA will deny a claim if a drug or alcohol addiction is the primary factor that prevents a claimant from entering the workforce. Additionally, if the claimant’s disabling condition is caused by drugs or alcohol, and the condition would be resolved if the claimant stopped using drugs or alcohol, SSA will deny the claim.
- The claimant fails to provide sufficient medical evidence. Sometimes, SSA denies SSDI benefits claims because there is inadequate medical evidence that supports the conclusion it will prevent the claimant’s ability to enter the workforce. SSA may reconsider such denial if a claimant later provides sufficient medical evidence. If a claimant can provide evidence that shows a clear progression of a medical condition, or a definite beginning date for the disability, the greater the likelihood, that SSA will approve the claim.
- The claimant was convicted of a crime. SSA regulations prohibit incarcerated individuals from earning disability benefits. Once a person is released, SSA will allow him or her to earn disability benefits again. Additionally, incarcerated individuals can receive SSDI benefits while imprisoned. Additionally, if a claimant’s medical condition is the result of, or was worsened by, the commission of a felony, he or she will not be eligible for benefits. If a claimant is on probation or parole, he or she is not entitled to SSDI benefits for any month a claimant violates the terms of his or her release.
If you believe that you are entitled to Social Security Disability benefits, it is critical that you contact an experienced disability lawyer in South Florida right away. The attorneys at Englander Peebles based in Fort Lauderdale can assist you in navigating the Security Disability benefits claims process. We provide a free and confidential initial consultation. Contact the law firm of Englander Peebles at (954) 500-4878 or through our online form today to schedule your free consultation.