Jeffrey S. Monaghan

Should you consider applying for Social Security Disability?

Do you have medical conditions that prevent you from working?

Should you consider applying for Social Security Disability?

Social Security Disability provides a monthly benefit from the Social Security Administration to individuals who have applied for and been found to have met the eligibility requirements for Social Security disability payments.

Eligibility requirements.

To be eligible to apply for Social Security disability benefits, an individual must have worked for at least five of the last 10 years, ending with the year your disability begins. The applicant for Social Security disability must be unable to work for one year.  Applicants do not have to wait for a full year before applying for Social Security disability and a potential applicant should apply the first month that they are out of work if they expect their disability or illness to prevent them from returning to work for a least 12 months.

What is meant by disability?

The definition of disability under social security is different from other disability/ income replacement programs. Social security disability is paid only for individuals found to be totally disabled.  No benefits are payable for a partial total disability.

How does social security decide if you have a qualifying disability?

The Social Security Administration uses a 5-step sequential process to determine if an individual is disabled and entitled to SSDI Benefits under their eligibility requirements.

1.   Are you working?

At step 1 of the 5-step sequential evaluation, it must be determined whether the claimant is in engaged in substantial gainful activity as that term is defined under the code of federal regulations.  Substantial gainful activity is defined as work activity that involves doing significant physical or mental activities.  Gainful work is work that is usually done for pay or profit whether or not a profit is realized.  If an individual is in engaging in substantial gainful activities, he or she is not disabled regardless of how severe his physical or mental impairments regardless of his age, educations, and work experience.

2. Is your condition severe?

At step 2 of the process, it must be determined whether the claimant has a medically determinable impairment that is “severe”.  An impairment or combination of impairments is severe within the meaning of the Social Security Administration regulations if the impairment significantly limits an individual’s ability to perform basic work activities.  If the claimant is not found to have a “severe” medically determinable impairment or a combination of impairments, then he is not disabled.  If the individual has been found to have a severe impairment or a combination of impairments, then the analysis proceeds to the next step.

3. Is your condition found in the list of disabling conditions?

Under step 3 of the process, it must be determined whether a claimant’s impairment or combination of impairments is of a severity to meet or medically equal the impairments listed in the code of the Federal regulations. Under the third step of the evaluation process, the claimant’s residual functional capacity must be determined. An individual’s residual functional capacity is his or her ability to do physical and mental work activities on a sustained basis despite limitations from existing impairments.  It must be determined whether the claimant has the residual functional capacity to perform the requirements as his or her past relevant work.  The term past relevant work means work performed within the last 15 years or 15 years prior to the date that disability must be established.  If the claimant has the residual functional capacity to do his past relevant work, then the claimant is not disabled.

4. Can you do the work you did previously?

At this step of the process, it must be determined whether the applicant’s medical impairments prevent him or her from performing the requirements of their past relevant work. If it does not, then the applicant does not have a qualifying disability.  If it is determined the medical condition or impairments prevent the applicant from performing their past work, then you proceed to the fifth and final step.

5. Can you do any other type of work?

If it has been determined that the applicant cannot do their past work, it must be determined whether or not the claimant is able to do other work despite their medical impairments.  Factors which are to be considered include the medical conditions the applicant is experiencing, the age, and the education history of the applicant, their past work experience and any transferable skills that the applicant may have. If the claimant is found able to perform other types of work separate from the claimant’s past relevant work, then he or she is not disabled.  If the claimant has established there is an inability to work and meet duration requirements, then the applicant is considered disabled.

Although under this step, the claimant continues to have the burden of proving disability, a limited burden of going forward with the evidence does shift to the social security administration.  To support a finding that an applicant is not disabled at this step, the Social Security Administration is responsible for providing evidence that demonstrates the existence of other work in significant numbers in the national economy that the claimant has been found able to perform given their age, education, and work experience.

How to apply for Social Security Disability Benefits.

Individuals who meet the requirements of having worked full time for 5 of the last 10 years can initially apply for Social Security disability benefits online through the social security administration website. The applicant fills out an application and should also obtain and provide the Social Security Administration with copies of all applicable medical records and medical reports and copies of operative and diagnostic records explaining and setting forth the nature and extent of the medical treatment the claimant has received.

Given the large number of applicants that file for Social Security disability benefits each year, nearly 70% of social security disability applicants are denied in the initial application stage.  Applicants who are denied at the initial level have the right to take a second level appeal entitled “a request for reconsideration.”  Once again, the claimant can request a reconsideration of their initial denial for Social Security disability benefits through an online application.  During this process, the claimant may be required to undergo medical examinations arranged by the Social Security office with medical doctors who specialize in the particular medical disabilities the claimant is alleging in their application.

The denial rate for Social Security disability applicants at the request for reconsideration level remains very high.  Claimants who are denied at the second level are then entitled to request a live hearing before an Administrative Law Judge, who will hear testimony from the applicant and who will question and hear testimony from an occupational expert, who has reviewed the claim and the treatment records covering the treatment the applicant has received in connection with the medical conditions for which the applicant is claiming disability.

Since COVID-19, many of the hearings are being held through Zoom hearings.  It is normally at this level when the case is considered before an Administrative Law Judge that we encourage the applicant to obtain legal representation.  Your attorney will appear with you in whatever form the hearing before the Administrative Law Judge takes place and has the right to ask questions of the claimant regarding their medical history, the medical treatment that they have undergone, the day to day problems that the claimant is experiencing and why the claimant believes they are unable to engage in their prior employment and the attorney can also present pertinent information concerning the applicant’s level of education and ability or inability to transform into other lines of employment other than the work that they had previously engaged in. 

Applicants who are awarded Social Security disability benefits at whatever stage of the process become eligible to receive Medicare Benefits two years after the date that the disability has been granted.

There is a five-month waiting period after an individual has been found eligible for Social Security disability benefits with the first monthly benefit being paid the sixth month after the date the applicant’s disability has begun.  When individuals who are receiving Social Security disability benefits reach their full retirement age, their disability benefits convert to retirement benefits, but the amount of the monthly benefit remains the same.

Jeffrey S. Monaghan - New Jersey Attorney

Jeffrey S. Monaghan

Workers’ Compensation

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