Are You Disabled? Get the Facts.

Still Working But Considering Social Security Disability?

You cannot file a claim for social security disability yet, but if you are in trouble and know you cannot hold out much longer, now is the time to prepare:

  • Find out if your company has long-term disability insurance. If it does, get a copy of the policy immediately, and determine what it would take for you to qualify, and how much money you would be entitled to. Be sure to check about any pre-existing condition provisions that would exclude your illness, and look for an minimum time period you need to work for the company before you could qualify for benefits.
  • Adjust your lifestyle now to anticipate the long delay in getting social security benefits.
  • Check the COBRA benefits at your company (extended medical benefits) and determine how much you would have to pay to keep your medical benefits.
  • Stay on the job as long as you can. Do not quit your job until you simply cannot go on.

Definition of “Disabled” and Eligibility for Social Security Disability Benefits

We all have an idea of what we think it means to be “disabled”: we generally believe we know it when we see it. This is not always the case. One might look at Stephen Hawking, if you did not know Stephen Hawking is a world renowned astrophysicist and professor, and easy conclude he is “disabled”. On the other hand, many of us know a person legitimately receiving social security disability that to us appear anything but disabled.

Disability is defined under the Social Security Act as follows:

“The inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

Simple enough, it would seem.  But we are dealing with Federal Government, don’t you know!  More about that a little later..

 

Legalize-free Definition of Disability

  • You have a real honest-to-goodness physical or mental condition or disease (i.e., recognized in the medical world as legitimate) supported by medical testing and findings .
  • This condition or disease has been diagnosed by the appropriate medical specialist.
  • You are receiving ongoing medical treatment.
  •  Even though you follow your doctor’s orders and don’t abuse alcohol or drugs your medical condition prevents you from doing ANY  8 hour, 5 days a week job on God’s green earth.

Who decides if I am “Disabled”?

As you have already guessed, the social security administration determines whether your medical condition imposes such significant restrictions on your ability to perform work-related activity that your condition fits the definition of “disabled” under the Social Security Act. Folks here in Texas are often confused if not angry when they file a claim for social security disability benefits at the suggestion of their physician and still get turned down.  “My doctor says that I am disabled – how can they say that I am not”!

Other sources and decision determining disability do not necessarily mean that social security will find someone disabled under the social security act.  Those sources include:

  • Favorable disability finding under a Short Term or Long Term Disability Policy;
  • Favorable disability rating from the Veteran’s Administration;
  • High workman’s compensation rating;

It should be noted, however, that these other favorable disability finding, and the supportive opinions of treating physician’s is very important evidence for social security.  Social security regulations provide that they must consider these types of evidence and get good reasons if they disregard them.

Key Social Security Disability Regulations: How the Social Security ACt definition of “Disabled” is  Really Determined

Those not familiar with administrative law might assume  that the language from the Social Security Act defining “disability” that I cite in quotes above would be what social security decision-makers and Administrative Law Judges refer to day-in, day-out in deciding disability cases. That assumption would be wrong.  Social security has created pages and pages of regulations designed to implement the Social Security Act.  In determining disability, social security uses the regulation at CFR § 404.1520. “Evaluation of disability in general” referred to as the 5-step  Sequential Evaluation Process. Take a look at this graphic.

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