Tuesday, March 29, 2011

If my doctor states I can’t work because of my disability, why doesn’t the Social Security Administration (SSA) automatically approve my claim?


Your doctor’s medical decision is just one thing the SSA considers when evaluating your disability claim.
What does the SSA have to determine in order to find me disabled?
The SSA needs to determine that you have either a physical or mental condition that is expected to last at least 12 months or result in death. Your condition has to prevent you from working at your prior job and prevent you from performing any other type of work in the economy based on your health, education and work experience.
I was seen one time by a SSA doctor, how important is that doctor’s opinion?
Usually, the one time medical evaluation done by a SSA doctor will not be given more weight than your treating doctor’s opinion.
How important is my doctor’s opinion to the SSA?
The SSA has guidelines, which dictate how much weight can be given to your doctor’s medical opinion. The SSA will give more weight to your doctor’s opinion if your doctor has been treating you over a long period of time. In addition, your doctor’s opinion will be given controlling weight (most important medical opinion in the record) if:
§ Your doctor has been treating you over a long period of time,
§ Your doctor’s opinion is supported by clinical and laboratory tests, and
§ Your doctor’s opinion is consistent with the other substantial evidence in the record.
What happens if my doctor’s opinion is not consistent with other medical evidence in the record or not supported by objective tests?
In this situation the SSA can decide not to automatically give controlling weight to your doctor’s opinion. The SSA will evaluate each medical opinion in the record and use the following factors to determine the weight given to each opinion:
  1. The length of time the doctor has been treating you and how often this doctor saw you. The longer and more frequent that a doctor has treated you increases the weight the doctor’s opinion receives from SSA.
  2. The nature and extent of the treatment relationship. The more the doctor knows about your condition increases the weight of this doctor’s opinion.
  3. Supportability. Opinions supported by medical signs and laboratory findings, are assigned more weight by the SSA. The SSA is more likely to consider a doctor’s opinion if there is a well written explanation for the opinion.
  4. Consistency. The more consistent the doctor’s opinion is with the rest of the medical evidence record, the more weight the SSA will assign to the opinion.
  5. Specialization. The SSA will assign more weight to the opinion of a specialist provided the opinion given is within the doctor’s area of specialization.
  6. Other factors. The SSA will give increased weight to a doctor’s opinion, if that doctor is familiar with the SSA’s disability programs and requirements. Additional weight is given to a doctor’s opinion if that doctor has extensive knowledge of your case record.
How can a disability attorney help me?
A disability attorney can request medical records so your file is complete. The SSA can only base their decision on the medical evidence provided. An attorney can also provide medical source statements (questionnaires) for you to take to your doctor so your disability limitations are documented.


Thursday, March 24, 2011

SSDI Benefits for Family Members


Once you are approved for Social Security Disability Insurance (SSDI) benefits, certain members of your family may also be entitled to payments; auxiliary benefits may be available for your spouse, your former spouse, and your children.

Auxiliary Benefits for Your Spouse
Your spouse may be eligible for payments upon your award of SSDI benefits, if the spouse is (i) caring for your child, or (ii) age 62 or older. 
To receive benefits for caring for your child, the child must either be under age 16 or disabled and receiving Social Security benefits.  Benefits for a spouse caring for your child under age 16 will end once that child reaches age 16. 
Similarly, when your spouse reaches age 62, he/she will be eligible for benefits based on your earnings record.  However, the monthly amount your spouse will receive at age 62 will be less than if he/she waits until full retirement age to receive the benefit. 
If your spouse is eligible for SSDI benefits based on his/her own earnings record, your spouse will receive either that amount or the amount based on your record, whichever is higher. 

Auxiliary Benefits for Your Former Spouse
A spouse you have divorced will be eligible for SSDI benefits based on your earnings if he/she is (i) at least 62 years old; (ii) unmarried; (iii) was married to you for at least 10 years; and (iv) is not eligible for a higher benefit amount on his/her own.

Auxiliary Benefits for Your Children
Your child will be eligible for SSDI benefits if the child is unmarried and (i) under age 18; or (ii) 18 or 19 and a full-time elementary or high school student; or (iii) 18 or older with a disability that began before age 22. 
For the child under age 18, the benefit will stop when he/she reaches age 18.  For the full-time student, the benefit ends upon graduation or 2 months after the child’s 19th birthday, whichever comes first.  For the disabled child, the benefit will last for the duration of the disability.  An eligible child may be biological, a step-child, adoptee, or dependent grandchild.
As far as the amount of SSDI benefits your family members are entitled to, each may receive up to half of your benefit amount, but there is a limit on the amount SSA will pay family members in total.  The limit depends on your benefit amount and the number of family members who qualify based on your record, but the total is generally around 50 to 80 percent of your benefit amount.


Wednesday, March 23, 2011

What You Need to Know in Order to Win Social Security Disability Benefits for a Back Injury


In order to receive Social Security Disability benefits for a back impairment, your condition needs to be severe.
What does SSA consider a severe back impairment?
SSA considers a serious lumbar (lower back) or cervical (neck) spinal impairment to include the following diagnosis: osteoarthritis, spinal stenosis, herniated disc, and degenerative disc disease. The spinal impairment needs to affect the spinal cord nerve root causing pain, reduced range of motion, reduced sensation, weaken reflexes, inflammation of your spinal membrane, and/or narrowing of the spinal cord resulting in weakness and the inability to walk effectively.    
I’m in a lot of pain, why do I have to go in front of the administrative law judge?
Most people applying for disability due to a back injury are required to appear in front of an administrative law judge.  A back injury is a commonly reported disability and involves pain assessment. Back pain and the associated limitations are subjective findings.  If you have a back injury even if accompanied by sciatica, expect to have a hearing in front of an administrative law judge.
What can I do to prove to the administrative law judge my back injury is severe?
1.      See your doctor regularly. This will ensure that sufficient medical records exist to substantiate your back injury and subsequent limitations. An administrative law judge can only base their decision on the medical evidence provided. Your doctor’s treatment notes should include your limitations; reduced range of motion, reduced muscular strength, poor gait, and positive straight leg raises.
2.      See an orthopedist. You should see a back specialist because he/she will have a better understanding of your condition and will order specialized testing.
3.      Have objective tests done. It is imperative that you have objective tests done (x-rays, MRI, CT- scan) because the derived impression is universally accepted. If the MRI says “severe bone on bone with disc space narrowing and degeneration” the judge understands your condition to be just that.
4.      Do not see a chiropractor exclusively. The SSA does not give the same weight to chiropractic treatment notes compared with a treating orthopedist or even the notes of your primary care physician.
5.      Have your doctor fill out a medical source statement documenting your functional limitations. A disability attorney can furnish this medical source statement, which is a questionnaire for your doctor to fill out regarding what you can/cannot do. This form is one of the most important documents in your file. Social Security doctors use similar forms and if your doctor does not fill one out, the administrative law judge’s decision will be based on the Social Security doctor’s assessment.
6.      Do not give up. The SSA does not give great credence to the pain caused by your back injury or to the side effects caused by pain medication and muscle relaxers.
If you file for Social Security disability benefits on the basis of a back impairment, make sure your doctor documents your limitations in his treating notes. Better yet, hire a disability attorney and have your doctor fill out the medical source statement.