Wednesday, January 05, 2011

Appeal Denied SSDI Claim at Application or Reconsideration

In almost all situations, if you want to win your Social Security disability claim you should request a hearing if you are denied at application in states that don't have reconsideration or if denied at reconsideration in states that do have it. This may seem obvious, but I have seen so many people come to me who did not appeal their denial at application or reconsideration in time and instead filed a new application either right after the denial or months or years later. This is a big mistake in most cases for several reasons. One reason, is that in an SSDI claim you can be paid benefits one year prior to your application and in SSI cases you can get paid benefits from the date of your application. Therefore, if you do not appeal you may be losing back due benefits that you would have been entitled to had you appealed instead of filing a new application. If you made this mistake, you may want to seek the help of a Social Security Disability lawyer, since depending on when you filed your new application it is often possible to reopen the prior claim and preserve the past due benefits that would be owed to you under the old claim. Another reason you should request a hearing, is that your chances of winning at the hearing stage is in most cases is better than your chance of winning on a new application. This was confirmed by a report done by the office of the Inspector General (OIG) for the Social Security Administration (SSA). They found that certain medical conditions were approved at significantly higher rates at the hearing level then at application or reconsideration. The medical conditions that stood out the most were diabetes mellitus, back conditions, osteoarthrosis and similar disorders, and medical conditions of muscle, ligament and fascia. One of the reasons appears to be that more claimants were represented at the hearing level then at application or reconsideration. The OIG report mentions other conclusions as well such as the claimant's age impacted disability determinations at application, reconsideration and hearing levels. Cases were approved at hearing based on a different medical condition then the medical condition that the application and reconsideration decisions were based on. They also found that hearing offices and administrative law judges had significantly different allowance rates with wide variations. The OIG based on this report plans to further investigate the causes of these differences. In my opinion, the fact that more people were represented at hearing is probably the biggest reason for the higher allowance rates at hearing then at application reconsideration. To see the full report by OIG for SSA you can find it at
I also want to note that just because the percentage of cases that win at hearing are higher than at application this does not mean that all cases are denied at application which is a widely held belief on the Internet. In fact, I believe if more people were represented at application this gap in approval rates between application and hearing would shrink significantly saving the claimant and Social Security a great deal of time and reduce overall processing times of claims in general.

Sunday, January 02, 2011

How Does Social Security Determine if You Are Working?

The first thing Social Security decides in a Social Security disability or SSI claim is whether or not you are working. If you are working then Social Security will find you not disabled at the first step of the five step test that determines if you are disabled. To see the rest of the five step test for disability you can visit my page from one of my websites that explains it in detail. Not all work is considered work for Social Security purposes under the rules. For Social Security to determine you are performing work they must find you are performing Substantial Gainful Activity (SGA). If you're an employee determining whether or not you are performing SGA is fairly simple. If you are not blind, then if you make over $1000 a month (year 2010) than you are working at Substantial Gainful Activity for each month you make over that amount. If you are not blind and you make less than $1000 a month (2010) then the work you are doing should not be considered SGA. If you are blind, it works the same as above except the amount is $1640 a month (2010). I will now discuss what determines SGA in a SSDI or SSI claim for someone who is self-employed. If you are self-employed and not blind then how Social Security will determine whether your work activity is SGA depends on whether you perform this work activity before or after you received SSDI benefits for 24 months. The Social Security Administration (SSA) will use a Three Step Test to evaluate your work activity when you first apply for Social Security disability and prior to receiving SSD benefits for 24 months. SSA will consider self-employment work activity as SGA if: you render significant services to the business, and you had over the SGA level ($1000 in 2010) average monthly income; or your work is comparable to work of persons without disability in your community engaged in the same or similar businesses; or your average monthly work is worth the SGA level earnings in terms of its effect on the business or when compared to what you would have to pay an employee to do the work. Social Security uses the Countable Income Test when a claimant has been entitled to and received SSDI benefits for at least 24 months. They only use this test to determine whether a claimant has engaged in SGA and if the claim is disability has ended as a result of that SGA. If the claimant's monthly countable earnings average more than $1000 (in 2010), SSA will decide that the claimant has engaged in SGA unless there is evidence that the claimant is not rendering significant services in the month. If we claimants monthly earnings average less than $1000 then Social Security will not consider the claimant to have engaged in SGA. If you are blind and self-employed SSA decides whether or not you are engaging in substantial gainful activity by looking to see if you have received substantial income from the business and rendered significant services to the business. SSA makes this determination using the claimant's countable earnings. SSA will also use the claimant's countable earnings to determine whether they have engaged in SGA and whether payments can be reinstated during the extended period of eligibility. There is yet another exception and that is if you are self-employed, blind, and you are age 55 or older. In this situation, if your earnings demonstrate SGA but you work requires a lower level of skill and ability than the work you did before age 55 or when you became blind whichever is later we will suspend not terminate your benefits. The claimant's eligibility for Social Security disability benefits continues indefinitely, and SSA will pay the claimant's benefits for any months where earnings fall below the substantial gainful activity amount. I know that much of this can be confusing and if you have any questions about this issue or any others feel free to contact me at 1-877-527-5529 or e-mail me from my Social Security Disability benefits website.

The terms Substantial Gainful Activity and SGA were used a lot in this post. Therefore, I decided to include Social Security's definition of Substantial Gainful Activity below.According to Social Security the terms substantial gainful activity is used to describe a level of work activity and earnings. Work is "substantial" if it involves doing significant physical or mental activities or combination of both. The work activity to be substantial, it does not need to be performed on a full-time basis. Work activity performed on a part-time basis may also be substantial gainful activity. "Gainful" work activity is work performed for pay or profit; or work of the nature generally performed for pay or profit, or work intended for profit, whether or not profit is realized.