Social Security Disability Lawyer Blog

Compassionate Allowances for SSDI Claimants in Massachusetts and Elsewhere

Published on: October 10, 2015 | Russell J. Goldsmith, Esq. (Law Offices of Russell J. Goldsmith)

The process of applying for benefits through the Social Security Disability Insurance (SSDI) program can be complicated and time-consuming. For a variety of reasons, including the sheer volume of SSDI claims, a claimant can wait months or even years for a decision. By law, a claimant must wait at least five months from the onset of their disability before they can receive benefits, but many claimants must wait much longer. Some conditions that cause a person to qualify for SSDI, however, are severe enough that the person cannot wait months or years for benefits. In response to complaints about long waiting periods for SSDI decisions, the Social Security Administration (SSA) created the Compassionate Allowances (CAL) initiative in 2008.

The SSDI Application Process

A claim for SSDI benefits requires a claimant to prove that they are “disabled” within the meaning of Social Security laws and regulations. This typically involves establishing that the claimant is suffering from an impairment that prevents them from working, and that this impairment is likely to persist for a year or longer. A claimant can present medical evidence of one or more conditions included in the SSA’s listing of impairments, known as the Blue Book, or the claimant can establish disability based on the SSA’s medical-vocational guidelines, known as the “grid rules.”

Preparing an application takes time, and as mentioned earlier, SSA’s processing time for applications can be quite lengthy. CAL cases, however, are eligible for expedited processing.
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Understanding the SSDI Grids

Published on: September 26, 2015 | Russell J. Goldsmith, Esq. (Law Offices of Russell J. Goldsmith)

An individual may qualify to receive benefits through the Social Security Disability Insurance (SSDI) program in several ways. One way is to demonstrate that they are suffering from one or more medical impairments identified by the Social Security Administration (SSA) in its official listing of impairments, commonly known as the Blue Book, and that their condition meets the criteria set forth in the particular listed impairment. Even if a claimant cannot point to any of the Blue Book impairments that they either “meet or equal in severity,” the Social Security Administration will undertake the next steps in their sequential evaluation process. Step 4 of the 5 step evaluation process requires the Social Security Administration to determine whether one is capable of performing any of their “past relevant work,” which is defined as any of the past types of work they had performed in the 15 years prior to becoming disabled. If one is determined to be capable of performing their past relevant work, they would be deemed to be not qualified for disability benefits (and would be denied benefits). Assuming, however, the SSA determines one remains incapable of performing their past relevant work, they are required to turn to step 5 of the sequential evaluation process and determine whether the claimant is capable of performing any jobs that exist in the national economy that exist in significant numbers in either their region or other regions of the country. As part of undertaking this analysis, the Social Security Administration will turn to a set of rules called the “SSDI grids” to help them determine in what way one’s age may play a role in making a transfer to other forms of gainful employment unlikely (thereby calling for a finding of disabled under Social Security’s rules). The grids establish guidelines for determining whether a person is disabled based on five factors: age, capacity to work, education, skill level, and transferability of skills.

The Blue Book and the SSDI grids are the two methods used by the SSA to determine whether a claimant meets the “disability” criteria for SSDI eligibility. The two systems are laid out in the SSA’s regulations in Title 20 of the Code of Federal Regulations, in Subpart P of Part 404. Appendix 1 to Subpart P contains the listing of impairments. Appendix 2 describes the grids, formally known as the “Medical-Vocational Guidelines.”

Age Groups

The SSA divides claimants into four age groups for purposes of the SSDI grids:

– Younger individuals: ages 18 to 49;
– Closely approaching advanced age: ages 50 to 54;
– Advanced age: ages 55 to 59; and
– Closely approaching retirement age: ages 60 and up.
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SSDI Work Credits: What Are They?

Published on: September 26, 2015 | Russell J. Goldsmith, Esq. (Law Offices of Russell J. Goldsmith)

In order to be eligible to receive Social Security Disability Insurance (SSDI) benefits in Massachusetts and other states around the country, you must be able to demonstrate that you meet the work history requirements established by the Social Security Administration (SSA). You must have worked, and paid into the Social Security system through payroll taxes, for a certain length of time over the course of your life. The SSA assigns “work credits” to people, which enable it to determine whether a claimant is eligible for benefits. The number of work credits a claimant needs varies based on age. The SSA periodically adjusts annually the income requirements necessary to earn a quarter of coverage.

How the SSA Measures Work Time

The SSA measures people’s work history in three-month periods known as “quarters.” These are the same quarters used in business planning and accounting, with January through March being the first quarter of the calendar year, and October through December being the fourth.

People receive “work credits,” also known as “quarters of coverage” or “QCs,” from the SSA for each quarter they work and earn above a certain amount. They may receive a maximum of four work credits per calendar year. The maximum number a person will need over their lifetime is 40 work credits, or 10 years of qualifying work. Claimants can demonstrate their work and payroll tax history with copies of tax documents such as a Form W-2.

Am I Eligible for SSDI if I Am Self-Employed?

Published on: September 24, 2015 | Russell J. Goldsmith, Esq. (Law Offices of Russell J. Goldsmith)

In order to receive benefits through the Social Security Disability Insurance (SSDI) program, a person must establish both (1) that they are eligible for benefits, and (2) that they have a disability that precludes gainful employment for at least a year. Eligibility is based on the amount of time a person has been employed and has paid into the Social Security system, usually through payroll taxes. People who are employed by a business, organization, or individual can often establish the amount of time they have worked with documents such as W-2 forms, pay stubs, and tax returns. Self-employed individuals do not always have the same documents to establish their employment history, but they can still demonstrate eligibility for SSDI benefits. Likewise, they can meet the second main requirement for SSDI by showing that their disability precludes them from either their normal gainful self-employment or other forms of gainful employment.

How Payroll Taxes Fund Social Security Benefits

When a person has an employer, they typically only pay one-half of their payroll tax liability. The employer withholds payroll taxes from their paychecks and matches that amount. It then pays the taxes directly to the Internal Revenue Service (IRS). At the end of each tax year, the employer reports the person’s wages and taxes to the Social Security Administration (SSA). A self-employed person is responsible for paying their entire payroll tax liability.

New Regulation Requires SSDI Applicants in New Hampshire and Around the Country to Submit All Evidence to the SSA

Published on: September 13, 2015 | Russell J. Goldsmith, Esq. (Law Offices of Russell J. Goldsmith)

When filing a claim for benefits from the Social Security Disability Insurance (SSDI) program, a claimant has a duty to provide honest and accurate information to the Social Security Administration (SSA). An attorney representing an SSDI claimant has a duty to provide diligent and competent professional services in accordance with the rules of the state in which they are practicing law. SSA regulations also place duties on the attorney to deal openly with the SSA, to promptly respond to requests for information, and to generally comply with the agency’s rules.

A new regulation, which took effect in April 2015, changes the duties placed on both SSDI claimants and their legal representatives, essentially requiring claimants to provide all evidence related to their claim, regardless of whether it supports or detracts from the claim. It also modifies the duties of a claimant’s legal representative to reflect these new duties.

New Evidence Requirements

The new rule modifies numerous SSA regulations, but one of its most important changes is to the regulation regarding evidentiary requirements in SSDI claims, found in Title 20 of the Code of Federal Regulations, Section 404.1512.

What Do I Do if the SSA Overpays Me?

Published on: September 13, 2015 | Russell J. Goldsmith, Esq. (Law Offices of Russell J. Goldsmith)

The Social Security Administration (SSA) processes benefits for millions of people in Massachusetts and all over the United States through programs like Social Security Disability Insurance (SSDI). With so many beneficiaries to serve, errors are probably inevitable, but it is also important for beneficiaries to provide the SSA with necessary information about changes in address, employment, or health condition. If a beneficiary receives more money from the SSA than they should, known as an overpayment, the beneficiary is responsible for repaying the excess amount to the SSA, regardless of who made a mistake.

Avoiding Overpayments

Some overpayments result from the SSA’s errors, but the public rarely, if ever, knows how such mistakes might occur. A more useful analysis looks at how errors and omissions by SSDI beneficiaries can result in overpayments and how they can be avoided.

Recent Changes to the Listings of Impairments for SSDI Claims in Maine and Beyond

Published on: September 9, 2015 | Russell J. Goldsmith, Esq. (Law Offices of Russell J. Goldsmith)

As an agency of the federal government, the Social Security Administration (SSA) has the authority to determine which illnesses and injuries qualify for coverage under the Social Security Disability Insurance (SSDI) program. It maintains a list of impairments, known as the “Blue Book,” which examiners use to determine if an applicant meets the SSA’s definition of “disabled.” The Blue Book offers an important guide to SSA examiners’ methods for evaluating SSDI claims and making decisions.

The Blue Book

Officially titled Disability Evaluation Under Social Security, the Blue Book is the product of administrative rulemaking by the SSA. The complete list is codified in Title 20 of the Code of Federal Regulations, as Appendix 1 to Subpart P of Part 404 of the SSA’s regulations. It is also published in book form and on the SSA’s website.

Medicare and SSDI for Claimants in Maine and Other States

Published on: August 25, 2015 | Russell J. Goldsmith, Esq. (Law Offices of Russell J. Goldsmith)

Medicare is a national health insurance program administered by the Centers for Medicare and Medicaid Services (CMS), an agency of the federal government. Unlike the programs administered by the Social Security Administration (SSA), which mainly make payments to beneficiaries, Medicare is a form of health insurance coverage that helps people manage healthcare costs. Older Americans who have paid above a certain amount into the system through payroll tax deductions are Medicare’s main beneficiaries, but coverage is also available to disabled people who receive benefits through the Social Security Disability Insurance (SSDI) program.

What is Medicare?

Medicare provides health insurance coverage to:

– Individuals who are 65 years old or older, who have been U.S. citizens or legal permanent residents for at least five years, and who worked and paid into the Medicare system for at least 10 years;
– Disabled individuals under the age of 65 who have received SSDI benefits or Railroad Retirement Board benefits for at least 24 months;
– Individuals who are eligible for SSDI and have been diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease; and
– Individuals who are receiving dialysis treatment or are waiting for a kidney transplant because of end-stage renal disease. Continue Reading ›

Common Reasons for Denial of SSDI Benefits in Massachusetts and Nationwide

Published on: August 24, 2015 | Russell J. Goldsmith, Esq. (Law Offices of Russell J. Goldsmith)

Anyone who has worked for a long enough period of time, and contributed enough in payroll taxes, could be eligible for benefits through the Social Security Disability Insurance (SSDI) program. This is a federal program that offers support to people who are unable to work because of a disability (or what is categorized by the Social Security Administration (SSA) as a medical diagnosed severe medical impairment). Applying for SSDI benefits is a lengthy and complicated process, but a knowledgeable Social Security attorney can help you prepare your application in order to present your claim in the best way possible.

An SSDI application requires a substantial amount of information about your medical conditions, ongoing medical treatment, work background, financial circumstances and daily activities. The number of reasons the SSA might deny a claim is nearly infinite, but some reasons are quite common for workers in Massachusetts and around the country.

Failing to Follow Your Doctor’s Prescribed Therapy When Making an SSDI Claim in Massachusetts and Around the Country

Published on: August 21, 2015 | Russell J. Goldsmith, Esq. (Law Offices of Russell J. Goldsmith)

In order to obtain benefits from the Social Security Disability Insurance (SSDI) program, a claimant must establish that they have been diagnosed with a medical condition or injury (or, what is otherwise referenced in the regulations as a severe medically determinable impairments) that prevents them from undertaking any manner of gainful employment for which they are reasonably suited. The Social Security Administration (SSA), utilizing the assistance of state agency offices referred to as Disability Determination Services, reviews SSDI claims, and generally only approves about 30 percent of claims. A rejected claim is not the end of the road, though, since claimants may request reconsideration of their application or a hearing before an administrative law judge (ALJ).

Understanding the most common reasons for claim denials can help claimants prepare their initial applications. The SSA rejects many SSDI claims based on findings that the claimants are not following the treatment plan prescribed by their doctor or doctors.