5 STEPS SOCIAL SECURITY USES TO DECIDE IF YOU ARE DISABLED

 

When you file a new application for disability benefits, Social Security will use a five-step sequential process to decide if you are eligible for payments.

1. Social Security will determine whether you are now working at "Substantial Gainful Activity" (SGA) - which is defined in 2021 as earning wages of at least $1,310 per month, gross. If you are, you are not entitled to a disability benefit.

2. Do you have a severe, medically determinable impairment? This impairment should have lasted for at least 12 continuous months, be expected to last for at least 12 straight months, OR to end in death.

3. Social Security will determine if you meet a listing in their Blue Book. These listings are very difficult to meet, so most claimants will not meet a listing. You may still get benefits, however.

4. In Step 4, they must determine whether you can perform any of your Past Relevant Work (PRW) -- defined as any job you performed in the past 15 years--and performed it long enough to do the job satisfactorily. They also only count jobs where you earned "Substantial Gainful Activity" wages for the years involved.

5. In the final Step, Social Security will decide whether you are able to perform any other work which exists in the US economy. This is the step that disqualifies most claimants. Even if you are not able to perform any past work, they may find that you can perform other "less demanding" jobs. This step works against younger individuals who are under age 50. If you are under age 50, you cannot meet a Medical-Vocational Guideline or " grid rule" which directs a finding of disability based on a combination of your age, education, skills, residual functional capacity and past work experience.

You may gather that Social Security disability is a rather technical, complicated matter that doesn't involve much luck. It uses a strict formula.

In the initial application process, only about 25 percent of claimants are approved. The first stage of appeals is called "Reconsideration," and the approval rate there is even more dismal. Your best chance will be at a Hearing level appeal before an Administrative Law Judge or ALJ. Claimants who are represented by an attorney are 3 times more likely to win at the Hearing level, compared to claimants who are not represented. And most claimants only get ONE HEARING.

Using an attorney or advocate who understands how to use medical evidence, vocational factors, skill levels, grid rules, and listings is crucial to success. There is a good reason why a large legal specialty has grown up around Social Security cases. The reason is: these lawyers get results for their disabled clients. ______________

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The Forsythe Firm

Huntsville, AL 35806

PHONE (256) 799-0297 FREE CONSULTATIONS. NO UPFRONT FEE 

Social Security Scams

About every 8 seconds a senior becomes victim of a Social Security scam in the United States.

 Millions of scam calls are made very day, all designed to steal your private information or rob you of your money.

Any of the following warning signs spell SCAM.......

If a caller.......

• Threatens to suspend your Social Security number, even if they have part or all of your Social Security number
• Warns of arrest or legal action
• Demands or requests immediate payment
• Requires payment by gift card, prepaid debit card, internet currency, or by mailing cash
• Pressures you for personal information
• Requests secrecy
• Threatens to seize your bank account
• Promises to increase your Social Security benefit
• Tries to gain your trust by providing fake "documentation," false "evidence," or the name of a real government official

...it is a SCAM!

CHANCES OF GETTING DISABILITY BENEFITS WITHOUT A LAWYER?

 

34 percent of claimants who don't have a lawyer get approved for Social Security disability benefits.

60 percent of claimants who have a lawyer get approved for Social Security disability benefits.

Thus, your odds virtually double with a lawyer.

You will never pay for legal assistance unless you are approved and receive a back-pay settlement. That's because your lawyer's fee must come from the back pay. If there is no back-pay there is no fee. No win - No fee.

__________

The Forsythe Firm

Social Security Disability Law

7027 Old Madison Pike NW

Huntsville, AL 35806

PHONE (256) 799-0297

 

Free Consultations with No Obligations   

WHAT NOT TO SAY TO YOUR DISABILITY DOCTOR

 When you apply for Social Security disability, you may be sent to a doctor for a consultative examination (CE).  This exam will be part interview and part exam.  The doctor will take a brief medical history from you and ask you some questions.

Here are things to do when talking to this examining doctor:

1.  Be polite.  

2.  Be cooperative.

3.  Listen to the doctor's questions and provide honest, concise answers without rambling.

WHAT NOT TO SAY TO YOUR CE DOCTOR

Do not say the following to a Social Security consultative doctor:

1.  When the doctor asks, "How are you?" don't say the usual, "I'm fine," or "I'm doing good."  The doctor may take this literally and may even put those words in his report.  Don't be afraid to say "I don't feel well" or "I'm afraid I'm not doing very well."  This isn't the time to be tough.

2.  "I don't think this exam is necessary."  You are there, so make the best of it.

3.  Don't ask the doctor if he/she thinks you are disabled.  This is not a conclusion the doctor is allowed to make and it may simply irritate him/her.

4.  Do not try to convince the doctor that you should get disability benefits.  The doctor does NOT make this decision.  He or she makes an objective medical exam, as requested by Social Security, then Social Security makes the decision.  Talk about your medical problems and, specifically, your symptoms.  

5.  Don't exaggerate.  For example, don't say "My pain is a level 13 on a scale of 1 to 10."  You just made your case incredible or outside the realm of possibility.  Don't say, "I can't do anything."  Instead you might say, "I have difficulty standing more than 15 minutes," or something of that nature.

6.  Avoid bragging about what you used to do or the work you once performed.  Avoid saying, "I worked for 32 years at the ABC Tire Company and was one of their best workers."

Your goal at a Consultative Exam (CE) is to let the doctor perform the exam and you answer questions truthfully and objectively.  Trying to "sell" the doctor on the fact that you are disabled will backfire every time.

SOCIAL SECURITY DISABILITY: YOUR BEST BET

 

If you need Social Security disability benefits (monthly income + Medicare), your best bet may lie in the grid rules. They are also called the Medical-Vocational Guidelines.

These guidelines form a "grid" combining your age, education, past work experience and exertion restrictions to determine whether you are disabled according to Social Security's rules. I estimate that 75 percent of the cases I win are based on the grid rules. They can work for you.

To qualify under the grids, however, a claimant must be 50 or older and have "exertional" restrictions--i.e., restrictions in things like walking, standing, bending, lifting, reaching or carrying. The guidelines do not work for psychological or mental limitations. So, claimants whose impairments result strictly from depression, anxiety, PTSD or other psychologically based illnesses won't benefit from the grids.

Individuals who are 50 or over and have never worked "sedentary" jobs are most likely to benefit from the grids. A sedentary job is one where an individual sits most of the day and lifts no more than about 10 pounds occasionally. Individuals with this type of work history are more difficult to get approved.

Grid rules are complicated. The first time I say them years ago, I said, "Does anyone understand this?" But after using the grids thousands of times to win disability cases, they have become my best friends. They are also my client's best hope!

https://www.ssa.gov/OP_Home/cfr20/404/404-app-p02.htm

YOUR CHANCES WITH SOCIAL SECURITY DISABILITY: WHO WINS?

 You've heard that Social Security disability is a tough nut to crack and that the government has made it difficult to be approved.  That is true.  But just what are your odds, based on national trends and averages?

Keep in mind that for most claimants, Social Security disability is a multi-layered process:  the application stage, the Reconsideration stage and the Hearing stage.  I want to discuss the national trends at each stage:

1.  APPLICATION STAGE. Approval Rate:  About 35 percent. You file a detailed application for benefits, which may have 60 or more pages.  You wait 6 to 8 months for a decision, likely to be a denial.  The most common reason for denial?  "You are not disabled according to our rules....You have some restrictions which prevent you from doing past work; however, there are other types of work in the national economy which you can perform."  

 2.  FIRST APPEAL - THE "RECONSIDERATION" STAGE.  Approval Rate:  About 10 percent.  This is your first appeal.  You disagree with the decision and ask the state agency to "Reconsider" your case.  You may submit new, updated evidence if you have any.  You wait about 4 to 6 months and get a new decision. 

 3. SECOND APPEAL- HEARING BEFORE AN ADMINISTRATIVE LAW JUDGE.

Approval Rate:  It varies but the national average is around 45 percent.  Here you appear (with your attorney) before a judge who will reconsider all the evidence, listen to your testimony, and hear your attorney's arguments.  A vocational expert will brought in by the Government to testify about how the claimant's impairments impact the ability to perform certain jobs.  A medical expert (doctor) may sometimes be called by the Government to testify about the claimant's medical record.  

 It's easy to see that your best chance to get approved is usually at the hearing.  Not everyone follows the appeal process all the way through.  Those who don't are the claimants who never get approved.  Most successful claimants will stay with the system and go all the way to that 3rd stage (the hearing).

Of course each case is different. Your case may not be typical or "average." Your personal chance of being approved is a bit more difficult to estimate--and it's based on many factors, including:

• Your Age
• Your Work History
• Your Education
• Your Medical Impairments and medical record
• Which judge presides over your hearing (Their pay rates differ). 

The motto we live by in Social Security disability is:

"Don't Stop Short of Court."

_______________________

The Forsythe Firm     *  7027 Old Madison Pike NW     *  Huntsville, AL 35806

(256) 799-0297

 

  

HOW TO ANSWER ALJ QUESTIONS IN YOUR DISABILITY HEARING

Disability hearings are conducted by special judges called Administrative Law Judges (ALJs).  It's a question and answer format where the judge will ask you all kinds of questions.

Questions will fall into 4 general categories, although other questions may be asked:

CATEGORY 1: PERSONAL QUESTIONS ABOUT YOU

CATEGORY 2:  QUESTIONS ABOUT YOUR PAST JOBS

CATEGORY 3: DETAILED QUESTIONS ABOUT YOUR IMPAIRMENTS AND SYMPTOMS.

CATEGORY 4:  QUESTIONS ABOUT YOUR ACTIVITIES, HABITS, DAILY ROUTINES, AND LIMITATIONS OF FUNCTION.

 After the judge finishes his questions, your attorney will be allowed to question you on the record.  The same rules apply.

So, what are the rules in answering questions at a hearing?

  1.  Be direct and don't ramble.  Answer the question without giving too much detail.  If the judge wants more details he/she will ask for them later.

2.  Be honest.  Avoid exaggeration.  Never, ever lie or give misleading answers. Probably the worst thing you could do.  It will get you a denial.

3.  Don't be offended by the questions.  You may be asked about drinking, smoking or if you have been arrested.  If the answer is no, simply say No.  These are "Yes" or "No" questions.  IF the judge wants more detail, he/she will ask for them.

4.  Try to use words that have defined meanings.  Avoid generalities, such as a little bit, a lot, once in a while, not very often, or occasionally. Better:  "About 20 minutes; twice a week," or "less than 10 pounds."

5.  Try to be consistent.  For example, don't say "I can't sit for more than 20 minutes," then later say, "I drove to Florida this summer on vacation."  That seems like a contradiction.

6.  Never, ever answer a question that you don't understand.  Ask for the question to be repeated or explained if it isn't clear to you. 

7.  Repeating Number 1:  DON'T RAMBLE. Rambling is the great enemy of effective hearing testimony.  Don't let yourself do it!

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The Forsythe Firm's advocates have assisted thousands of claimants in Social Security disability hearings with an excellent success rate.  We never charge a fee unless you win and also receive back pay.  Call for a FREE consultation.

(256) 799-0297