Why does it take so long to get Disability benefits when I start over?
WOW! This question comes up a few times. Here’s how it usually plays out:
1) You have applied and you got denied. So you decided to reapply, OR
2) You went all the way to a Judge and got denied. So you decided to reapply, OR
3) You went all the way to an Appeals Council Decision and you got denied. So you decided to reapply, OR
4) You were receiving disability benefits and you were cut off. So you decided to reapply, OR
5) You got a closed period of disability benefits. So you decided to reapply!
In any event, most people ask the same question “Why does it take so DAMN long to get Disability when you reapply??” And trust me, DAMN, is usually thrown in there somewhere.
Unfortunately, the short answer is “Just because you went through the process once, doesn’t mean you get preferential treatment when you go through the system again.” In other words, every time you go through the system, a new set of hands and eyes will be evaluating your case. As such, your case is treated as if you are filing for the very first time.
Now, I know what you’re thinking. You’re thinking “What about those earlier applications?”, “Do they check those records?”, or “What about the fact that I was disabled before?”. All of those are good questions so let’s go through the scenarios I provided:
1) You have applied and you got denied. So you decided to reapply, OR
OOOOOO, please don’t do this. SO many times, people think that if they just keep reapplying, they will ‘hit it’. Ladies and Gentlemen, this is NOT LOTTO!!! You have to go through the system to get the best results. Now, I’m not saying that you shouldn’t reapply. I’m saying that you should be mindful of the fact that you are starting over every time you reapply. They will go and get the info from your previous application (depending on how soon you reapply) but you are still starting over.
2) You went all the way to a Judge and got denied. So you decided to reapply, OR
I’ve said it to people a million times that you don’t usually get your best opportunity unless you actually go through the process. The process usually means from initial application to a Judge. Now, for Social Security’s purposes, your disability period is the day after the judge’s decision. Why? In their eyes, the Judge has already determined that you are NOT disabled up to the date of his or her decision so even if you were found disabled, SSA is probably not going to back beyond that date (Sometimes they do but most times they don’t).
3) You went all the way to an Appeals Council Decision and you got denied. So you decided to reapply, OR
Sometimes, people want to wait until they go all the way through the administrative process. Most representatives will probably tell you that while your case is pending before the Appeals Council, you should start a new application. In any event, if you reapply, the earliest date of benefits would be the day after the judges decision.
4) You were receiving disability benefits and you were cut off. So you decided to reapply, OR
This situation comes up a lot. You’ve been receiving benefits for an extended period of time. Then, for whatever reason, SSA determines that you are no longer disabled or no longer entitled to benefits. So you decide to reapply. Now, in your mind, you’re thinking that since you were receiving benefits before, you should have a leg up. NOT SO FAST, my good friend (in the words of ESPN’s LEE CORSO). You don’t get preferential treatment just because you were receiving benefits before. Remember, a determination was made that you no longer need the benefits so you have to prove the you do.
5) You got a closed period of disability benefits. So you decided to reapply!
This one is tricky. A closed period is a clearly defined start and stop. You were determined to have been disabled from one point to another. Let’s say from Jan. 1, 2008 through Jan. 1, 2009. Now, you decide to reapply. The same rules apply. You’re treated as if you have started from scratch.
Please remember that you are not entitled to any special privileges or opportunities just because you started over. You still must go through the process as if you are starting from scratch.
Two magical points in Social Security: 18 years old and 65 years old
One of the toughest things to explain to people regarding Social Security is helping them understand that there are two points where Social Security takes significantly different turns. One, is when you turn 18 and the other is when you turn 65 (or 66 or 67 depending on when you were born). Here’s why:
The 18th YEAR
1) Child to Adult
Under the Social Security Regulations, a person is considered an adult at the age of 18. As a result, this means that your child is no longer considered a child under Social Security standards.
2) Benefits may end right away MAYBE
Most people don’t realize that the standards for disability is different for adults than it is for children. So if your child is getting disability benefits, you shouldn’t be surprised if Social Security makes the decision to either cut off your child’s benefits or review the file to determine if the child should continue receiving benefits at 18.
3) Benefits may continue
Under some circumstances, the benefits may continue. If the child is still in high school, the benefits may continue for a brief period. In addition, if Social Security determines the child meets the criteria for a disabled adult, the benefits may be continued as well.
4) Rep Payee Stops
Depending on the condition your child, once they turn 18, Social Security may determine that the child has the ability to manage their own funds. As a result, if a Representative Payee had previously been assigned, they may discontinue the Representative Payee services.
5) Parents may lose rights
The toughest part of the process is usually for the parents who have been used to having complete access to their child’s information. However, once the child has been determined to be an adult, the access to that information may ceases..
The 65th YEAR (or 66 or 67)
1) Disability and retirement is from the same pool of money
Most people don’t realize that once the person reaches retirement age (65, 66, or 67), the money you receive for disability automatically changes to retirement. Same money, different name.
2) You can apply for Disability even if you retired early
Some people decide to retire early but it is important to remember that if you retire early, you may be eligible to receive disability. It’s important to remember that when you retire early, you typically will only receive 80% of what you would have received had you reached full retirement age. Applying for disability before you reach retirement age may give you the ability to apply for the remaining 20%.
3) No more extra money
Sometimes people who retire think that they can get extra money by applying for disability. As stated above, if your application for disability benefits is for the period of time when you are eligible for retirement benefits, you are probably not going to get anything more than you have.
4) Disability reviews stop
Most importantly, the reviews stop. As most people know, Social Security can review your benefits to determine if you are still disabled. Once you hit retirement, it stops.
It’s tough because some people don’t realize that Social Security has different cut off points during the course of the Social Security Disability process. Understanding them, may make a difference.
Explain to me about the Social Security Administration “APPEALS COUNCIL”
Alot of time, claimants spend a great deal of time and energy dealing with the Local Social Security Administration office and the Hearings Office. Very few people have even heard of the APPEALS COUNCIL (AC) until they get denied for Benefits by an Administrative Law Judge.
For those of you who have never heard about the Appeals Council, here’s some information to help you:
1) What is the “APPEALS COUNCIL”
The Appeals Council is the administrative appeal body within the Social Security Administration that is responsible for reviewing the decisions of the Administrative Law Judges. They are responsible for handling appeals of Administrative Law Judge decisions and handle reviews of decisions on their OWN motion.
2) What does it mean to be ‘Reviewed by the Appeals Council’ on its OWN Motion?
Most people don’t realize that even if you get approved by an Administrative Law Judge for benefits, that decision is subject to review by the Appeals Council. In any judicial process, every judge must answer to a judge who is higher than he/she. The Appeals Council reviews all decisions (randomly) to ensure that the judges are rendering the proper decision.
3) What happens after this review by the “Appeals Council”?
Four things can happen after their review. One, the Appeals Council can determine that the Judge made the right decision. Two, the Appeals Council can determine that the Judge made a PARTIALLY right decision and send the decision back to the Judge to correct it. Three, the Appeals Council can determine that the Judge made a wrong decision and send the decision back to the Judge to correct it. Four, the Appeals Council can make its own decision and not send the case back to the judge.
4) If the Appeals Council pulls the case for review on its own, how long do they have to make a decision?
Typically, the AC will indicate that they must make their decision within 110 days. During those 110 days, your ability to obtain any benefits approved by the SSA will be held until they make their decision.
5) How long after getting a Favorable decision from SSA will you have to wait in order to determine if the AC will pull it for review?
The AC can pull a case for review at any time. However, the AC recognizes that people have waited for a long time to obtain benefits so they tend to move quickly in making their decision.
6) What happens after 110 days if they haven’t made their decision?
After 110 days, the claimant has the option of requesting the SSA to go ahead and process their favorable decision from the Administrative Law Judge. This way, the claimant can receive their benefits while waiting for their review from the AC.
7) Can the AC reject the ALJ decision and take the benefits back?
It is possible. If the AC determines that the ALJ was wrong and sends the case back to the ALJ, the ALJ can reverse his/her decision. Unfortunately, this means that you may have to reimburse Social Security for any benefits that you may have obtained.
What if the Judge denies my case, can I appeal to the AC?
The AC is the final administrative decision maker. If the judge denies your case, the next level is to ask for a Review of the Judge’s decision with the AC.
9) How long will it take to get a decision from the AC regarding my appeal of my denial from the judge?
Unfortunately, this question doesn’t have a simple answer. Most people don’t realize that the Appeals Council handles decisions for the entire country. As a result, it takes a while (6 to 12 months) for the Appeals Council to make their decision.
10) If the AC denies my appeal, is that the end of my case???
No, you can file a Civil Action in the United States District Court. In essence, you would be suing the Social Security Administration for getting the decision.
The process regarding Social Security can confusing but these extra tidbits can go a long way to helping you under.
The little things that may affect your Social Security Benefits AFTER you win your case
Watch out dere now! It’s PARTY TIME! You’ve applied for disability benefits. Now, after several months or several years of forms, doctor’s appointments, questions/answers, and waiting, you have FINALLY been approved. YAAAAY!! It’s amazing how people are so dedicated to doing what it takes to get their benefits. After a long and stressful process, you have finally arrived.
Now here the comes the song you’ve been waiting for, “MONEY, MONEY, MONEY!!!”.
However……………………….
Here’s the part of the process that usually throws people off. People don’t realize that there are ALOT of ‘little things’ that may effect not only HOW MUCH money you will get but it may also effect if you get any AT ALL!!!
Before you get ‘Coo Coo for Cocoa Puffs” and start counting all that “CHEDDAR” you THINK you’re going to get from the Disability process and all of that back pay, here’s a few things that you need to remember so you don’t get your feelings hurt:
1) WARRANTS. Most people know that if you’re in jail or incarcerated, you’re not entitled to benefits. What most people don’t know is that if there is a WARRANT for your arrest, this warrant has the same effect as if you were arrested. So what does that mean? That means if there is a warrant for your arrest, the Social Security Administration may not administer your benefits until you get that Warrant resolved. Get it fixed or no money for you.
2) CHILD SUPPORT. Please don’t sit over and think that just because you are disabled, you are exempt from paying your child support. Even more so, if you owe BACK child support, most states have arrangements through their Department of Revenue and the Social Security Administration to garnish some of your back pay. So if you’re thinking you’re going to get a JAMMING back pay check but you owe child support, your check may be smaller than you think.
3) WORKERS COMPENSATION. Workers Compensation cases and Social Security Administration cases tend to go hand and hand. However, in some instances, if the combined amount of mothly amount of your WC benefits and your SSA benefits is greater than 80% of your Average Current Earnings, you may see a REDUCTION in your benefits to compensate for the difference.
4) VETERANS BENEFITS. Veterans benefits fall into two separate categories: Service Connected and Non Service Connected. If you are receiving Service Connected benefits, you may not see an impact on your Disability Insurance Benefits (SSI is totally different. Go to Bullet 15 for a discussion). However, if the benefits of the VA are NON service connected, these benefits may possibly reduce the amount of DIB benefits you’re entitled to receive.
5) LONG TERM / SHORT TERM DISABILITY BENEFITS. This portion is usually very tricky because every Long Term / Short Term Disability policy is different. It’s important to ask your disability carrier what impact receiving SSA benefits will have on your LTD/STD policy. For some policies, it’s a one to one reimbursement. This reimbursements means if they were paying you during months when SSA should have been paying you, they want their money back for that period. So, for instance, if your LTD/STD carrier was paying you $1000 a month from Jan. 2008 to Jan. 2009 and you get SSA benefits retroactive from Jan. 2008 in the amount of $1200, your carrier MIGHT require a reimbursement for the same time period. Check your carrier just to make sure.
6) WORK & SSA don’t always mix. I always have at least one or two people who want to be slick and try to draw a disability check and work a little bit at the same time. The SSA does allow for what is called “A trial work period” (Please comment if you want me to discuss that in greater detail). However, after a certain period of time, SSA may wonder if you are REALLY disabled or not.
7) MEDICARE. If you’re getting Social Security Disability, you may be entitled to receive MEDICARE. Medicare is NOT free. A small portion of money is taken out of your check every month in order to pay for your medicare. If you choose to NOT take it and ask for it later, you may face a penalty.
CDR. For those of you who don’t recognize this acronmym, it’s called a CONTINUING DISABILITY REVIEW. It’s like this, Social Security doesn’t expect you to be disabled FOREVER so they are going to come back at some point in time (Usually more than once) to determine if you are STILL disabled. If you’ve gotten better, your check may STOP!
9) FEDERAL DEBTS. Recognize, if you OWE the federal government some money, they gonna GET their money. Don’t think that the government will totally excuse your debt because you’re on disability.
10) SOCIAL SECURITY FRAUD. Most people bust their butts in order to properly demonstrate that they are disabled. However, there are a FEW people out there who are trying to get their HUSTLE on! Recognize that Social Security has a department dedicated to investigating fraud. As such, if you are attempting to defraud Social Security, don’t think you won’t get caught.
11) WINFALL. Now, this particular point really applies more to Supplemental Security Income. A WINFALL is when you get a big lump sum of money unexpectantly. This money could be an inheritance, a settlement, or even the lottery. Now, you’re sitting there with a monthly check and a big sum of money and you’re thinking, BOOM, I’ll just live on my monthly SSI check and ride out with my money in the bank. Unless you have your LUMP SUM of money in some type of special needs trust, that money will be counted against your SSI. What does that mean? THis means until you spend the money down to a particular amount, SSI won’t pay you a DIME!
12) SUSPENSION / TERMINATION. Some of the things that I am addressing may result in your disability benefits being temporarily discontinued. This process is called SUSPENSION. SSA may suspend paying your benefits until you have resolved whatever issue that is effecting your case. However, this suspension is not permanent. If you have not resolved your siutation after a certain period of time, SSA may terminate your benefits. What does that mean? You have to start over!
13) REPRESENTATIVE PAYEE. This portion doesn’t have to focus so much on how much you get paid as much it focuses on WHO is responsible for your money. If you’ve had issues with money in the past, or some psychological issues, or some cognitive issues due to significant pain medications, or you’ve had problems with drugs and alcohol, SSA may determine that someone else needs to handle your money.
14) DEDICATED ACCOUNTS. These accounts are typically utilized in kids ‘ cases. These accounts are tricky because if SSA determines you need to set one up, the requirements for maintaining these accounts are very detailed. You have to be very careful as to what you spend the money.
15) SSI & everything. Most people don’t realize that SSI is a “NEED BASED PROGRAM”. In other words, if you have money coming from other sources, you don’t NEED the money from SSI (and this includes other SSA disability programs).
16) LUMP SUM MAY NOT BE LUMP SUM. Ok, here’s the tricky part. Most people don’t realize that even though you may win your case, you may not get as MUCH money as you think. Here’s an example. Say, you applied for SSI benefits on Jan. 1, 2009 for the first time but you said you had been disabled since Jan. 1, 2005. So SSA approves you. So you think you’re getting all the way back to Jan. 1, 2005, right? WRONG! SSI only pays from the date of the application so your lump sum would be from Jan. 1, 2009 to the present. Let’s use the same example but you applied under DIB. Under the DIB program, you’re entitled to go back before the date of the application. So you think you’re getting all the way back to Jan. 1, 2006, right? WRONG!! DIB only pays up to one year before the application so at best, you’re going to get money from Jan. 1, 2008 to present.
17) COUNTY REIMBURSEMENT. Some Counties, in an attempt to work with those persons who are unable to work, have arrangements with the Social Security Administration. As a result, if you find yourself receiving some type of housing assistance, SSA may automatically deduct money from your benefits (typically the SSI benefits) in order to ensure the County is reimbursed.
18) JAILS / PRISONS. As I stated above (Bullet #1), if you’re incarcerated, you are not entitled to receive SSA benefits. This point gets tricky if you find yourself being arrested because you may not have time to notify SSA. It’s important that your loved ones notify SSA as soon as possible because if you come out and you are still getting benefits, you may owe the government for the time you were incarcerated.
19) APPEALS OF PARTIALLY FAVORABLE DECISIONS. Partially Favorable Decisions or PFD are decisions by the Social Security Administration. These decisions are the governments way of saying that you are disabled but not for the length of time or time period that YOU think you are. You have the right to appeal this decision if you don’t agree. If you do, 3 things can happen. One, you can win and get the entire period you asked for in the beginning. Two, you can lose and SSA and social security will leave your benefits the way they are. Three, SSA can determine that they were wrong and that you were never entitled to benefits. This part is really tricky because if SSA thinks you should have been awarded benefits to begin with, you may have to reimburse SSA for everything they gave you.
I know I covered alot of information but I spend alot of times explaining to people why their benefits are impacted after they’ve gone through a lengthy process to get them. I hope this helps you.
-
Brought to you by:
