Am I Disabled?

Am I Disabled?

A claimant is a person who has applied for Social Security disability or SSI disability benefits. Many claimants are denied benefits even though they are eligible for them. The fact that you have been denied once or even twice does not mean that your claim does not have merit. All the claimants that we help get benefits have been denied at least once before coming to us for help.

Social Security Disability (Title II or SSD) benefits, are part of the entitlement program which also includes Social Security Retirement benefits. You may be eligible for Title II benefits prior to your retirement age if you are determined disabled. The monthly benefit amount varies, depending upon your work history and how much you contributed in Social Security taxes. You must be determined disabled, and you must be “insured” for benefits. Usually you are “insured” for Title II benefits if you have worked and paid taxes for 5 of the 10 years prior to the onset of your disability.

Supplemental Security Income (SSI) is a federal welfare program, available to anyone who is determined disabled and meets the income and resources criteria. No work history is required, but you must have little or no income or financial resources. The individual SSI benefit amount in 2011 in Washington is $674/month. The disability rules are the same for Social Security Disability (SSD).

Proving Disability: Many claimants are turned down because they have not established that they are “disabled” as that term is defined by the Social Security Administration (SSA). SSD and SSI claims are resolved using a variety of rules which have been established by Congress and SSA, as interpreted by the federal courts. These rules establish the framework within which the unique facts of each individual claimant are adjudicated.

As a claimant, you must produce evidence of a medical or mental health condition that causes symptoms and limitations. You must establish that these limitations prevent you from performing all jobs, for at least 12 consecutive months. The discussion below is set out so that you can see some of the issues confronted in this process. It is not intended as a substitute for experienced, qualified representation.

Credibility: Although every claim is factually different, there are common issues running through many disability claims. The single most important factor in resolving a Social Security disability claim is the credibility of the claimant.

Credibility is usually determined by comparing subjective complaints (a person’s symptoms and their understanding of their limitations) with the medical evidence which helps explain why the symptoms and limitations are present. For this reason, it is extremely important that you pursue treatment for all of the medical and/or mental health conditions which might cause limitations. It is also important, of course, to comply with the treatment recommendations of your medical providers and to be open and honest when discussing symptoms and limitations with your doctors.

It is often helpful for lay witnesses (for example, spouses, significant others, friends, former employers, etc) to testify or provide sworn statements about their knowledge of your abilities and limitations. This can help bolster your credibility and give the SSA a better idea of what it is like to walk in your shoes.

Medical Opinion: It has been our experience that the relationship between a claimant and his or her doctors is very important to the outcome of the disability claim. It is important that your treating physician believes that you are honestly reporting your symptoms for treatment purposes and are complying in good faith with treatment recommendations. This includes taking medication as prescribed, engaging in physical therapy and home exercise programs, and attending counseling sessions, where appropriate.

When a doctor, therapist, PA-C, or ARNP knows a patient well, believes the patient is honestly reporting his or her symptoms, and is trying hard to get better, the medical provider is usually supportive of the disability claim. There is no better evidence in a disability claim than the well-reasoned opinion of a medical provider.

It is not uncommon for disability claimants to have medical insurance issues that make it very difficult to maintain treating relationships and to follow treatment recommendations. For example, you might not be able to see a doctor because you do not have medical insurance. Or you might not be able to obtain the medications that have been prescribed for your conditions. Our staff is familiar with medical insurance issues, especially available state and federal medical assistance programs, and we may be able to help you obtain necessary medical coverage.

Sometimes it is necessary to schedule a physical or psychological evaluation with a non-treating physician or psychologist in order to fully describe a claimant’s abilities and limitations.