If you find yourself in a situation where you think it could be time to file for disability, you will probably have plenty of questions, many of which don’t have simple answers.
David S. Bary, a disability law attorney with Joyce & Bary Law in Roanoke, shared his expertise on some of the most important questions regarding disability.
1. Who is eligible for Social Security disability benefits?
There are a handful of basic requirements someone must meet to qualify for Social Security Disability (SSD):
- Have accumulated enough Social Security work credits.
- Not be engaged in any substantial gain activity (SGA).
- Meet the definition of disabled.
- Be unable to perform any job for which you are qualified.
If the above are not met, the claim will be denied.
The SSA conducts a thorough evaluation of evidence. However, many individuals lack the knowledge required to navigate the Social Security Disability application process. Even if you believe your application is comprehensive, it may still lack important details and expertise necessary for approval, which can lead to a denial.
“Disability claimants are required to complete numerous forms about their daily activities, work history and medical conditions,” Bary said. “Claimants may find these forms confusing and challenging to complete. My team works with our clients to ensure the forms are complete, accurate and informative.”
2. When should I apply for disability, and how long can it take to receive a decision?
Seek advice from a disability attorney as soon as you become disabled. Typically, it takes months for your application to undergo processing and assessment.
“The national average wait time is 220 days, and general wait times have gradually increased over the past four years,” Bary said.
If your claim faces denial and requires appeal, the process could extend for a year or longer before a decision is reached. For many Americans, sustaining a livelihood without a consistent income for an extended duration is unfeasible.
3. How can working impact my disability application?
With long wait times to receive a decision -- as medical bills stack -- many wonder if they may work while they wait.
Working while applying or collecting benefits can be problematic, so it’s important to understand the rules and limits.
The SSA assesses whether an applicant’s work constitutes substantial gainful activity (SGA): significant physical or mental activities that are performed for pay or profit. Even part-time or reduced-responsibility work can be considered substantial and gainful. Exceptions exist, but an individual must be incapable of engaging in SGA.
It’s important for applicants to understand what the monthly SGA limits in 2024 are. For statutorily blind individuals, the amount is $2,590. For non-blind individuals, the monthly SGA amount is $1,550.
[Related: Filing for disability? Here’s what you need to know.]
Once it’s determined that an applicant meets the non-medical requirements, the claim progresses to the Disability Determination Service (DDS), where a medical consultant reviews the case file to make a medical determination. This review entails assessing the claimant’s physical and mental functional capacity. The claimant will be asked to complete a function and work history report, along with other questionnaires. These reports are pivotal in this process.
“The disability process is extremely rule-driven and requires an excellent working knowledge of the system,” Bary said. “My team works closely with our clients to file applications, medical evidence, function and work history reports. We also deal directly with SSA and the DDS.”
4. What are SSA’s two main programs and how do they work?
Social Security provides disability benefits through two primary programs: Disability Insurance Benefits (DIB) under Title II and Supplemental Security Income (SSI) under Title XVI.
DIB is available to individuals who have achieved insured status through their payment of federal taxes, typically requiring 40 quarters of coverage (QCs), with 20 earned in the last 10 years before disability onset.
[Related: Which Social Security disability program is right for you?]
The concept of quarters of coverage (QCs) serves as the basis for determining insured status, with a maximum of four QCs obtainable per year. Insured claimants must establish disability before their Date Last Insured (DLI) expires, which marks the end of eligibility for DIB coverage.
DIB functions as an early retirement pension for disabled workers, offering benefits similar to full retirement benefits. Conversely, SSI provides benefits to disabled or retired individuals who haven’t acquired insured status due to various reasons. SSI eligibility is determined based on medical criteria and income or resource limits.
Some insured individuals with low earnings records may qualify for both DIB and SSI benefits.
5. How does medical evidence help my disability claim?
The SSA meticulously evaluates disability claims, with a focus on medical evidence to determine eligibility for benefits, recognizing its pivotal role in shaping the understanding of disability and providing necessary assistance.
The SSA employs a structured five-step evaluation process for disability determination, which begins with assessing the claimant’s engagement in SGA and progresses through scrutinizing medically determinable impairments that significantly affect work-related activities for at least a year or result in fatality.
[Related: The crucial role of medical evidence and legal expertise]
When assembling a case, it’s imperative to thoroughly document medical impairments with objective evidence like abnormal exams, lab results and surgical history.
Bary emphasized the importance of effective communication between clients and medical providers to convey symptom severity and resulting limitations. Key factors sought include specific diagnosis, date of diagnosis, symptom severity, prognosis, treatment history, medication regimen and physical or mental limitations.
“A decision-maker must consider several statutory factors when determining the credibility of a medical provider’s opinion. Therefore, objective medical findings must support the opinion,” Bary said. “A general statement from a medical provider that their patient is ‘disabled’ or ‘cannot work’ is not helpful.”
6. How can a disability attorney help?
The administrative journey from application to approval is complex, often overwhelming claimants with paperwork and procedural intricacies.
Bary said the importance of early intervention and expert guidance in the disability application process can’t be understated enough. Assistance from a seasoned attorney can significantly impact the outcome, ensuring completeness, accuracy and effectiveness in form submissions.
“Disability claimants are required to complete numerous forms about their daily activities, work history and medical conditions,” Bary said. “Claimants might find these forms confusing and challenging to complete. My team works with our clients to ensure the forms are complete, accurate and informative.”
[Related: Navigating disability law alone? Here’s when it might be time to seek help.]
Proactive legal representation facilitates prompt application filing and continuous support throughout the process, including interaction with the agency responsible for medical determinations.
Attorneys possess the expertise to navigate federal statutes, Social Security rulings and case law intricacies. Bary said they are equipped to provide comprehensive advocacy and legal representation, including representation in federal court, if necessary.
7. What should I ask when choosing an attorney to represent my disability claim?
An attorney who specializes in SSD understands the ins and outs and speaks the same language as the SSA. But there are questions to ask before deciding on a firm:
1. Does the firm file the initial application, appeals, relevant forms and questionnaires during the administrative claims process?
“Joyce & Bary Law prefers to take a case at the initial level,” Bary said. “We file applications and appeals, and review all forms required during the medical determination.”
2. Does the firm deal directly with SSA, DDS and hearing offices?
“We prefer to limit the contact our clients have with SSA and the DDS,” Bary said. “Most of the communication is handled through our office.”
3. Does the firm “outsource” cases to non-attorney representatives or contract attorneys?
“Joyce & Bary Law handles all its cases in house,” Bary said. “I deal directly with my clients and will represent them at the hearing level if necessary.”
Experience within a firm’s main practice area should be a key thing to consider.
“I have represented claimants for more than 23 years and attended thousands of disability hearings,” Bary said. “By filing the initial application and subsequent forms on behalf of our clients, we ensure the file is well-developed by providing accurate information and evidence that is relevant to the issue of disability.”
To learn more about navigating disability law, or to talk to an attorney, click or tap here.