Child SSI Claims

Like with adults who apply for Social Security benefits, the Social Security Administration has strict rules for finding a child disabled.

• The child must have a physical or mental condition(s) that very seriously limits his or her activities; and
• The condition(s) must have lasted, or be expected to last, at least 1 year or result in death.

The disability evaluation process is similar to that of an adult’s, with a few exceptions.

First, Social Security must verify if the child is working. Obviously younger individuals probably are not, but it might be an issue for a teenaged claimant. If the child is not working, Social Security must also check the income and resources of the child’s parents or guardians. Too much household income may disqualify a child from receiving SSI benefits.

Second, it must be determined as to whether a child medically meets or equals one of Social Security’s Medical Listings, either separately or in combination. You can read about Child Disability Medical Listings here: http://www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm .

Along with the medical records, school records are also very important in a child’s case, as they are essentially the child’s work record. Social Security wants to see how the child performs in school with the disabilities alleged. Not only do schools give grade reports and administer tests that evaluate the child’s functioning and cognitive abilities, but they are also a valuable source of information as far as how a child functions socially. Social Security looks at incident reports, detentions, and notations of phone calls home that are often included in school records.  Even if a child changes schools, the records always follow the child to the new school. However, it is important to remember that items provided to the parent by the school, such as notes home or teacher’s notes on a test on which the child did poorly, are not always included in the school records. It is then the parent’s responsibility to provide these documents.

Third, if the child’s condition does not meet or medically equal a listed impairment, Social Security must determine whether the child has at least two marked or one extreme limitation among the six functional domains in order to consider the child disabled under their rules. “Marked” refers to a limitation that may arise when several activities or functions are impaired, or even if one is impaired, as long as the degree of limitation is such as to interfere severely with the ability to function independently, appropriately, and effectively on a sustained basis. “Extreme” refers to the worst limitations and means that the impairment interferes very seriously with the child’s ability to independently initiate, sustain, or complete activities.

The domains Social Security uses are: acquiring and using information, attending and completing tasks, interacting and relating with others, moving about and manipulating objects, caring for self and health and physical well-being. Please visit: http://www.ssa.gov/OP_Home/cfr20/416/416-0926a.htm for more details regarding these domains. 

Proving disability in a child can be a daunting task, but it is possible as long as parents and representatives are diligent. By making sure Social Security has all of the pertinent information regarding the child and his or her disability, they can see the “whole picture” and make a decision accordingly.

Written by Anna Westfall & Attorney Andrew November

Returning to Work: How Does That Affect My Claim?

While waiting for a Social Security claim to be decided, a person might return to work for different reasons. Bills that need paid might be piling up exponentially, or a person might feel their condition has improved to a point where they can return to work permanently. You might think this would end the claim, but not necessarily so. The Social Security Administration has specific regulations in place that allow someone to try to return to work without affecting their pending claim or benefits they may already be receiving. This article will discuss the two most common issues:

Unsuccessful Work Attempt

While a person’s claim is pending, they may try to return to work but find they are unable to do so because of their disability, or because their disability is not being accommodated in the work place. When this occurs, Social Security calls it an Unsuccessful Work Attempt.

An Unsuccessful Work Attempt (UWA) is defined by Social Security as:

An unsuccessful work attempt is an effort to do substantial work in employment or self-employment which was discontinued or reduced to the non-SGA level after a short time (no more than 6 months) because of the individual's impairment or the removal of special conditions related to the impairment that are essential to the further performance of work.

In order to be considered an UWA, however, there must be a significant break in the continuity of the person’s work (at least 30 days between jobs). There must have also been another significant change to have taken place that would end work attempt: “…the impairment or the removal of special conditions related to the impairment that are essential to the further performance of work causes the work to be ‘discontinued’” as defined in DI 24005.001D.2. This must be proven to Social Security so that it does not count against the claimant. If a claimant missed a lot of days or work, did a poor job, or relied heavily on coworkers because of his or her disability, these would be factors of an UWA.

Social Security has different criteria for the varied amounts of time of a claimant’s UWA, which you can read about here: https://secure.ssa.gov/poms.nsf/lnx/0424005001. Overall, it is important to remember that a work attempt cannot be considered an UWA by Social Security unless it was ended because of a disability or accommodations for a disability were taken away.

Trial Work Period

This is an option for Social Security Disability Insurance claimants only. It does not apply to SSI. Social Security defines the Trial Work Period as:

A beneficiary receiving Social Security disability benefits may test his or her ability to work and still be considered disabled. We do not consider services performed during the trial work period as showing that the disability has ended until services have been performed in at least 9 months (not necessarily consecutive) in a rolling 60-month period. In 2011, any month in which earnings exceed $720 is considered a month of services for an individual's trial work period. In 2012, this monthly amount remains at $720. (please visit http://www.ssa.gov/oact/COLA/twp.html for more information regarding how Social Security comes up with this figure)

There are several factors to keep in mind regarding the Trial Work Period. First, if a claimant is working and making under $720 per month, they can still be considered disabled and this does not trigger a Trial Work Period. Along those same lines, if a claimant continues to earn over $720 per month consistently for nine months over a 60 month period, Social Security will re-evaluate the claim and possibly stop benefits if they feel the person is well enough to return to work permanently.

When the Trial Work Period ends, the claimant enters the 36 month re-entitlement period, or “Extended Period of Eligibility” (EPE). During the Extended Period of Eligibility, Social Security may continue claimant’s benefits in any month that his or her gross earnings were not at the SGA level.

Conclusion

Much credit should be given to a disabled individual who wants to return to work. Contrary to popular belief, most people who receive disability benefits want to work and will return to work if it is possible. Because Social Security understands this, these regulations exist to protect disabled people from losing the benefits they are either fighting for or have already won, in case the return to work is unsuccessful.

Written by Anna Westfall and Attorney Andrew November

Continuous Medical Treatment – The “Meat” of your Social Security Disability Claim

To be found disabled under Social Security’s rules, a claimant must:

• Be unable to do any substantial work because of his/her medical condition(s); and
• The medical condition(s) must have lasted, or be expected to last, at least 1 year, or be expected to result in death.

Disability must be proven with medical records documenting current treatment. Past medical treatment or bare minimum medical treatment is not enough. Social Security must see that your disabling condition exists and is continuing through the present.

In order to achieve this, it is important to establish a relationship with a doctor who treats your disabling condition(s). Keeping follow-up appointments with your doctor and following his or her treatment plan is very important. Each time you miss an appointment or fail to comply with treatment, it is noted by your doctor’s office staff, which is then seen in your medical records.

Social Security must also see that the medical evidence “jives” with the disabilities you are claiming. Remember when we talked about credibility and the role your medical records play? Doctors often take SOAP notes (Subjective, Objective, Assessment, Plan), which record what the patient feels (Subjective) as well as the doctor’s findings (Objective). These records are reviewed alongside your allegations of disability to see whether there is a correlation between the two. Because of this, it is important to be honest with your doctor and to make sure you express all of your concerns to him or her.

Along those same lines, medical records are a valuable source of information regarding how your disability worsens or improves. Because your disabling condition must last, or be expected to last, twelve months or more, your medical records will outline the progression of your disability for Social Security. By keeping follow up appointments with your doctor, as stated earlier, it is easier to track the severity of symptoms as well as uncover any new symptoms that may have developed since you became disabled.

Overall, the most important point to take away from this blog is to make every effort to continue your medical treatment. Even if you have a test, appointment or procedure scheduled for the future, let Social Security or your representative know. By helping to assure Social Security has all of your pertinent information, it could mean the difference between an approval and a denial.

Written by Anna Westfall and Attorney Andrew November

“What is taking so long?” The Levels of Adjudication Explained

Anyone who has applied for Social Security benefits has probably wondered why it takes so long for the Social Security Administration to make a decision. A claimant’s first impression is that Social Security just doesn’t care about their disabling conditions or their situation. This is not the case. Rather, evaluating a disability claim requires a lot of work, time and care in order for the right decision to be made.

Initial Application

After you complete your application at your local Social Security office, a claims representative will request medical records from all of the treating sources your provided. Because oftentimes it will take a doctor’s office or hospital a month or more to fulfill the request, some of the wait time comes from Social Security waiting for your records to arrive so that they may be reviewed. Reading through these documents, which sometimes can be hundreds of pages, is also a time-consuming process.

In the meantime, you may be asked to complete forms regarding your daily activities, symptoms, or past work history. Completing these forms to the best of your ability and returning them to Social Security before any deadline they may give you helps the evaluation process move more smoothly.

You may also be asked to attend a physical or mental exam, where you will be evaluated by a doctor employed by Social Security. After the appointment is completed, the doctor who examined you must take the time to write a report, which is subsequently sent to Social Security to be reviewed and considered along with your medical records and any forms you completed.

Typically, this initial process takes 3 to 6 months, but sometimes longer in more complicated cases.

Reconsideration

If your initial application is denied, you may file an appeal called the Request for Reconsideration. Afterwards, Social Security will do just that: they reconsider their first determination, alongside any new medical evidence, forms you complete, or further exams you may be sent to.

When you appeal the first decision, you are asked to fill out form SSA-3441. This form asks you if there have been any changes in your condition, any new conditions, and for more information about your treating sources and how recently you may have treated with them. As in the initial application, Social Security will request any updated medical records that may exist. You may be asked for clarification in some of your answers.  It is important that Social Security is aware of any new treatment.

As with the initial application, reconsideration of the first determination also takes approximately 3 to 6 months, depending on your claim’s circumstances.

Hearing

Once all of the evidence is reviewed alongside the initial determination, and you are denied again at the Reconsideration level, you may request a hearing in front of an Administrative Law Judge (ALJ). You will be asked to complete another SSA-3441 when you appeal, however, updated or missing medical evidence must be provided either by the claimant or the claimant’s representative to be added to the file.

At this stage of your claim, the file that has been created for you thus far in the determination process is organized and exhibited in preparation for a hearing. Once the hearing staff has prepared your file, either you or you and your representative will be asked to attend a hearing. By law, you will be notified at least 20 days prior to the hearing date so that you can make suitable arrangements to attend.

In the past, the wait time for a hearing in the state of Ohio was at least two years! Fortunately, with the opening of a new national hearing center in St. Louis, Missouri as well as new hearing offices opened in the state of Ohio, that wait time has been greatly reduced. However, the exact wait time still varies from claim to claim, as some people may have more complicated claims than others that require extra time to prepare.

Conclusion

When you are unable to work and you have no income, you want answers fast so you can be certain of your future. Fortunately, the Social Security Administration understands the plight of the disabled person and will make every effort to make a timely determination for you, but it cannot happen overnight. Understanding the process helps a claimant make sense of all the time he or she must wait for an answer. The wait can be daunting, to be sure, but taking an active role in making sure Social Security gets all the information they need in a timely manner, such as completing forms accurately and attending state-sponsored exams, is the best course of action for a claimant.

 Written by Anna Westfall & Attorney Andrew November