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An ALJ decison regarding TItle II disability usually contains a sentence like this:

The claimant’s earnings record shows that the claimant has acquired sufficient quarters of coverage to remain insured through December 31, 2024.

A successful disability claimant may read that sentence and think that it means that the Social Security disability benefits will terminate on December 31, 2024. But that is not what the sentence means at all.

This language in the decision simply refers to the date last insured, which is the date by which disability must exist to qualify for disability benefits under Social Security’s rules. The date has nothing to do with continuity of benefits once a claim is granted. Do not worry if you see this language in your fully favorable ALJ decision.

If you receive a fully favorable ALJ decision, your disability benefits will continue until you get better, or return to work at the SGA level, or reach retirement age, or die.

Substantial Gainful Activity (SGA) is the amount of money that one can earn and still qualify for Social Security disability benefits. The amount is adjusted each year for inflation, as shown by this table. In 2022, the amount is $1,350. For 2023, the amount goes up to 1,470.

The SGA amount is important for two groups of people:

A person applying for disability benefits must have (or be expected to have) a period of 12 consecutive months with wages below SGA (subject, of course, to the rules for unsuccessful work attempts and Impairment Related Work Expenses).

A person receiving Title II disability benefits can earn up to the SGA amount and still receive benefits (be sure to also take a look at the trial work rules).

 

Last month, my hearings with an administrative law judge (ALJ) to determine medical eligibility for Social Security disability benefits followed the usual, familiar pattern: opening remarks by the judge and then the claimant’s lawyer (me), the claimant’s testimony, and then testimony of a vocational witness regarding the claimant’s past relevant work, and whether various functional limitations would preclude that past relevant work and/or other work. This, broadly speaking, is pretty much the course of most hearings. At the close of the hearing, the judge often will say something like “Thank you for coming today. I will review the record and issue a written decision soon.”

In two of my hearings last month, however, the judge said this, instead: “Based upon my review of the file, your testimony, and the testimony of the vocational witness, I will be issuing a Fully Favorable decision.”

What a difference that makes! While we all have to wait for the written decision to be issued, it gives tremendous relief for the claimant to hear from the judge that the claim for Social Security disability benefits will be granted. There is no uncertainty or worrrying while waiting for the decision. It is an act of grace, really. I wish judges would follow this example more often.

 

 

 

When a concurrent Title II and Title XVI case is awarded, the claim goes to the local Field Office for a determination of SSI benefits. This process takes some time, because the claim specialist at the field office needs to make an appointment to call the claimant to document the claimant’s income and assets to determine financial eligibility (SSI is a need-based program). Then the claim gets sent to the Payment Center, where Title II benefits are calculated, and then the SSI benefits offset the Title II benefits. Therefore, concurrent cases typically take several weeks longer to get paid than straight Title II-only disability claims. This is frustrating, because the SSI claimants are the ones who often need to money the most.

The monthly Title II disability benefit (PIA) is usually greater than the monthly Title XVI SSI amount. And while the SSI benefits begin to accrue on the filing date of the claim, the disability benefit is not paid until after the 5-month waiting period after the onset date. To evaluate these payment issues, you need to compare the filing date with the onset date, and know that the eligibility date for Title II is 5 full calendar months after the onset date.

Continue Reading Title II Offset When a Representative Fee is Involved

When one of my clients is awarded disability benefits, I like to write a short letter to the local Social Security field office, asking them to quickly process the disability claim. I want the local office to send the claim promptly to the Social Security Payment Center for payment.

When the person  awarded Social Security disability benefits is a parent of a minor child (or children), that minor child is entitled to auxiliary benefits. I always provide the child’s name, date of birth, and Social Security number in my letter, to assist the processing of the auxiliary benefits claim.

Represesentation does not end once your client is awarded disability benefits. Making sure that they are paid correctly, and as promptly as possible, is part of the job.

There is article in a national magazine enititled Inside the Kafkaesque Process for Determining Who Gets Federal Disability Benefits. It is most definitely worth reading.

The article begins by describing a (fairly typical) hearing before an Administrative Law Judge, and concludes: “A disability appeal hearing can seem surreal to an outsider.”

Fact check: True

The Social Security Processing Centers calculate and pay a claimant’s disability benefits, once a favorable decision or determination has been made.

The SSA has posted on its site the telephone numbers for the various processing centers. These numbers are for attorney and non-attorney Representatives to call, rather than individual disability claimants.

Disability cases are broken up into two different groups for processing: claimants under age 54 and claimants age 54 and over. From there, you can find the phone number for the correct processing center with the claimant’s Social Security number.

The numbers are invaluable when tracking down a retroactive payment for a client or a Representative’s fee that is overdue.

I frequently talk with people who have applied for Social Security disability. When I ask them why they are unable to work, they often respond “I have been diagnosed with _____.”

Sometimes the diagnosis is just a quick answer to my question. But often, as the conversation continues, there is a belief that, given the diagnosis, it is self-evident that they have symptoms preventing ongoing employment.

But that is not at all how a Social Security disability claim works. Social Security will not “connect the dots” from your diagnosis, to your symptoms, to your functional limitations.

The person claiming disability benefits has the burden to prove the links between the diagnosis, the symptoms, and the resultant functional limitations that prevent employment.

Each element (diagnosis, symptoms, limitations), must be proved.

A client with long-haul COVID symptoms was recently awarded Social Security disability benefits at the initial stage of review. That was great news. But when Social Security allows a disability claim at the initial or reconsideration level of review, they don’t tell you why; they just pay the disability benefits.

I wanted to know why the claim was granted. Specifically, I wanted to know how the claim was analyzed by the disability examiner and the medical reviewer, so that I could use that information in future cases. I requested a copy of the Disability Determination Explanation from the local field office. It just arrived.

This particulary client was 61 years old at the time of his application, with past relevant work at the Medium exertional level. His long COVID symptoms included chronic fatigue, joint pain, and severe, near-daily headaches.

Social Security issued an Emergency Message last year, entitled “Evaluating Cases with Coronavirus Disease 2019 (COVID-19).” The emergency message was recently revised (see EM 21032 REV). If you have a client with long-haul COVID, that Emergency Message is a good starting place when putting your case together.

I was wondering if, due to the my client’s long COVID symptoms, DDS had assessed an RFC for complete inability to do sustained work-related activity (see POMS section DI 24510.057B.2.b). To me, that would be the most appropriate resolution of the claim, and a similar finding could be made in most long-COVID cases.

But no. DDS assessed a straight Light exertional RFC and made a Medical-Vocational determination, with a detailed analysis of potentially transferable skills. A younger claimant, or one with less demanding past relevant work, would have been denied.

Social Security has started sending a paper booklet along with the Notice of Award letter to those whose claims for Social Security disability benefits have been granted. The booklet is entitled “What You Need to Know When You Get Social Security Disability Benefits

It is a good practice. People are (almost always) receiving disability benefits for the first time. They do not know what to expect, and may not understand their responsibilities when receiving disability  benefits.

Hopefully the booklet will help.