To quote an old lottery slogan, “you can’t win, if you don’t play.” It may seem obvious, but you cannot receive Social Security disability benefits if you do not apply.

If fact, many Social Security regulations about Social Security eligibility start with this simple requirement:

Step 1: You apply.

As I have written about before, Social Security uses the protected filing date (PFD) to decide how far back your benefits can go.

From time to time, I receive a phone call like this:

I’ve been disabled since 1994, but Social Security only wants to pay me 12 months of back benefits!

I see. When did you apply for benefits?

Last month…

I then explain how Social Security pays back benefits using the protected filing date as the starting point.

Here is what it comes down to: if you want Social Security benefits, you have to apply!

San Francisco disability attorney Geri Kahn wrote about her experiences with providing records to Social Security:

Before filing a new initial claim I always order the records and then submit them directly to the Social Security field office immediately after I have filed the claim electronically.  I recently was at an interview in one of the field offices in San Francisco and the claims representative told me that he could not accept the records I was submitting because he was only permitted to fax 15 pages to the state agency disability  examiner.

Since you need to prove that you are unable to work to win a Social Security disability claim, Social Security often uses disability examiners to get a medical opinion of what a person can and cannot do.  Disability examiners use the medical records Social Security provides to make this decision.  

Then, Social Security uses the disability examiner’s opinion to decide if your condition(s) make you disabled.  

Limiting the number of pages sent to a disability examiner, and to 15 pages no less, is ridiculous. 

That is barely a sliver of the amount of information in most cases.  It’s like deciding whether an individual is disabled by seeing if they can walk down a hallway. 

Fortunately, most cases get a much better review with judges at the hearing level. If you are denied on your initial application, do not give up. Appeal!

via California Social Security Lawyer Blog.

How long after you complete your application for Social Security disability benefits (or Supplemental Security Income – SSI benefits), does it take to get a decision?

In Colorado where I practice, it usually takes between four and six months after you apply to get the initial decision. Sometimes, Social Security will describe this as between 120 and 180 days.

Before you put yourself through the drudgery of going down to your local Social Security office, check the Social Security website to see if you can take care of your problem without going in.  

There are a lot of things you can take care of online.

Did you know you can do all of the following at the Social Security website?

• Apply for retirement benefits.
• Apply for disability benefits.
• Check your application status.
• Appeal a recent decision / denial.
• Find out what benefits you can apply for.
• Find out if you can get extra help with your Medicare prescription drug costs.
• Estimate your future retirement benefits.
• Find your full retirement age.
• Estimate your disability and survivors benefits.
• Request a Social Security Statement.
• Change your address or telephone number.
• Get a replacement Medicare card.
• Request a Proof of Income letter to verify Social Security benefit information.

Click for more information about what you can do online at Social Security.

I hear a lot of horror stories about going to the Social Security office.

If you need to go to the Social Security office to get a replacement card, change your name, or try to straighten something out with SSA, here are a few tips:

• Don’t go!  Before you put yourself through the misery, check the Social Security website to see if you can take care of the problem without going in.  Here is a list of things you can do online without going to a Social Security office!
• Call first! You may be able to resolve the problem with a phone call.  
  • Call the national toll free number at 1-800-772-1213.
  • If you are deaf or hard of hearing, call the toll-free TTY number, 1-800-325-0778, between 7 a.m. and 7 p.m. Monday through Friday. 
  • Click here for the phone number for your local office.

If you still need to go to your local office, here are some tips to help you survive:

• Get ready to wait. Depending on how busy it, you may be there a while. Seriously. You may be there the entire morning or afternoon. 
• Consider bringing the following:
  • Bring a book, newspaper or magazine.
  • Bring water (note some offices may not allow this).
  • Bring a snack.  Even if you are not allowed to eat at the office, you usually can eat just outside the office. This is especially important if you have diabetes or have problems with low blood sugar.  However, everyone should consider this as you may be there for more than 3 or 4 hours. 
  • Bring a cushion if you have trouble sitting for extended periods.
  • Bring a friend. It will help pass the time and you have someone to make sure you are not skipped while in the bathroom or on a cigarette break.
  • Bring a walkman, or mp3 player.
  • It can get noisy, so consider bringing earplugs.  BUT, don’t miss your name or number being called!!!
• Show up early.  Many offices open at 8:30 but some do not open until 9:00 AM.  Use the office locator to find out the opening and closing times for your office.
• Show up late. Many offices have a policy that if you are in the door before closing, you have to be seen. The flip-side of this is that if you have a difficult problem or you need someone at Social Security to be in a good mood and want to help you, showing up late may not help. 
• Ask the security officer for the best days or times to come back. If you cannot get your problem resolved, the security officer often knows the best times to return to minimize your wait.
• Do not bring a weapon (even if it is otherwise legal). This includes the pocket knife you bring everywhere or pepper spray. Going to the Social Security office is enough of a chore without getting arrested too.

Do you have any tips for surviving a trip to Social Security?  Tell us in the comments!

If you wonder if you are eligible for Social Security benefits, Social Security has an interactive website to help you answer this question.

Visit Social Security’s BEST (Benefit Eligibility Screening Tool). 

BEST checks if you are eligible for the following benefits:

• Medicare
• Social Security Disability
• Social Security Retirement
• Social Security Survivors
• Special Veterans
• Supplemental Security Income

Have you tried BEST, share your experiences in the comments!

Social Security has a fact sheet answering common questions about Supplemental Security Income (SSI) benefits for disabled children:

• How does Social Security decide if a child is disabled?
• How can I get ready for the disability interview?
• How does Social Security decide if a child can get SSI?
• How will I know what Social Security has decided?
• Will my personal information be kept safe?
• What if I am more comfortable speaking in a language other than English?

The fact sheet also has information about:

• Medicaid.
• State Children’s Health Insurance Program (SCHIP).
• Other Health Care Services.
• Work Opportunities for Young People Who Are Getting SSI.

You can get the factsheet as a pdf here.

There are several ways to start an application for Social Security benefits:

At your local Social Security office

While this make take the longest amount of time (depending on the wait times at your local office), applying in person has the advantage of having a live person to ask to if you have a question.  The downside of applying in person is that if you are missing a critical piece of information, you may not be able to complete the application.

If you need help finding your local Social Security office, click here.

Online

If you prefer to work at your own pace, you can apply online.  Start here and follow the three steps to get an application started.

If you are applying for a child, start at the children’s disability page.

By telephone

If you need help or if you cannot complete the application online, you can call Social Security toll-free at 1-800-772-1213. If you are deaf or have hearing problems, you can call the toll-free TTY number, 1-800-325-0778.  Social Security representatives are available Monday through Friday between 7 a.m. and 7 p.m.

When you are ready to apply:

Don’t forget to check out this article about the documents you need to apply for Social Security disability benefits.

Also, check out all the articles on applying for Social Security.

Do you know what to bring to your interview when applying for Social Security?

Here is the list of information Social Security will need:

• Medical Information including the names, addresses and phone numbers of all doctors, hospitals and clinics.  Your patient ID number(s), and dates seen.
• Name(s) your of medications.
• Any medical records you have.
• An original or certified copy of your birth certificate. If you were born in another country, Social Security also needs proof of U.S. citizenship or legal residency.
• If you were in the military service, the original or certified copy of your military discharge papers (Form DD 214) for all periods of active duty.
• If you worked, your W-2 Form from last year; or if you were self-employed, your federal income tax return (IRS 1040 and Schedules C and SE).
• Workers’ compensation information, including date of injury, claim number and proof of payment amounts.
• Social Security Number(s) for your spouse and minor children.
• Your checking or savings account number, if you have one.
• Name, address and phone number of a person Social Security can contact if they are unable to get in touch with you.
• Kinds of jobs and dates you worked in the 15 years before you became unable to work.

Social Security has all this information is a handy list so you can check off items as you get them ready.

Do you know what to bring to your interview when applying for Social Security?

Here is the list of information Social Security will need:

• Medical Information including the names, addresses and phone numbers of all doctors, hospitals and clinics.  Your patient ID number(s), dates seen.
• Name(s) of medicine(s) you are taking.
• Any medical records you have.
• An original or certified copy of your birth certificate. If you were born in another country, Social Security also needs proof of U.S. citizenship or legal residency.
• If you were in the military service, the original or certified copy of your military discharge papers (Form DD 214) for all periods of active duty.
• If you worked, your W-2 Form from last year; or if you were self-employed, your federal income tax return (IRS 1040 and Schedules C and SE).
• Workers’ compensation information, including date of injury, claim number and proof of payment amounts.
• Social Security Number(s) for your spouse and minor children.
• Your checking or savings account number, if you have one.
• Name, address and phone number of a person Social Security can contact if they are unable to get in touch with you.
• The kinds of jobs and dates you worked in the 15 years before you became unable to work.

Social Security has all this information is a handy list so you can check off items as you get them ready.

Are you struggling with working because of physical or psychological impairments?  Have you stopped working because you just could no longer do the job?

You may be going back and forth on whether to apply for Social Security:

Maybe I will get better.  But, what will I do if I am not able to go back to work?

Filing for Social Security benefits is not something to rush in to.  But, if you are disabled, you should file as soon as you can. 

If you wait, you may loose several critical advantages. These include health insurance, access to medical care and financial support including savings, family or spousal assistance.

All Social Security disability cases require medical evidence.  The longer you wait to apply the greater the chance that your health insurance will run out or that you will be in a worse financial position to get the medical evidence you need.

• If you have health insurance, take advantage of it.  Make sure to take every opportunity to develop severity of your condition:  talk to your doctor about your disability, get tested, and obtain treatment.  The longer you wait after you stop working to treat, the greater the chance that your treatment options will be diminished.
• Tell your doctor that you are thinking of applying for Social Security and see what she or he says.  Having a supporting physician is often a critical part of a Social Security case.
• Get legal help early on.  Once you have started the application, start talking to attorneys.  A skilled attorney can help you gather evidence including statements from your doctor(s) in support of your disability.
• Get your medical records.  While Social Security may get most of the necessary records, you will not know what records they received until the initial decision is made.  If the decision is a denial, you do not get to obtain the missing records and ask for a new initial decision.  Your only option is to appeal and get your case ready for a hearing in front of a judge.  That may take an additional 6 – 18 months (based on my experience in Colorado).

Did you know that Social Security has a fact sheet on “What You Should Know Before You Apply For Social Security Disability Benefits?” 

• How does Social Security decide if I am disabled?
• My doctor says I am disabled.  Is that enough to qualify me for disability benefits?
• I am getting disability payments from my job or another agency, can I automatically get Social Security disability benefits?
• How long does it take to make a decision?
• Can I do anything to speed up the process?
• How does Social Security make the decision?
• If Social Security decides that I am disabled, what type of benefits can I receive?
• Can I apply for disability benefits online?
• Will my personal information be kept safe?
• What if I am more comfortable speaking in a language other than English?
• Where can I get more information?

The fact sheet is available as a pdf document here.

A lot of people ask me how Social Security decided if they are disabled.

I can’t do the work I have done for 35 years.  Am I disabled?

I stopped working to take care of a family member, but now I am sick.  Am I disabled?

I got hurt at work, then they fired me.  I keep applying for jobs, but there just isn’t much work around here.  Am I disabled?

The doctor tells me I will probably need serious surgery later on.  Am I disabled?

I will need to be on medication for the rest of my life.  Am I disabled?

Social Security focuses on ability to work to test for disability.

Under the Social Security system, in order to be disabled you have to have a physical or psychological impairment that is expected to keep you from being able to engage in a “substantial gainful activity” (SGA) – typically some type of full time work, for 12 months or longer.  Or, simply put:  do you have a condition that keeps you from being able to work?

Social Security does not consider “hire-ability.”

An impairment which keeps you from being able to work is not the same as being unable to get hired for a job.

• You may be applying for jobs but you do not get any calls.
• There may be no jobs in your area.
• Or, you may have a felony charge which keeps you from getting work.

While these are all examples of an inability to get a job, none of these, by themselves, show that you are physically or psychologically unable to to work.

Being unable to do prior work is usually not enough to prove disability.

What if you have condition that keeps you from doing the work you have done in the past?  Usually, that is not enough to prove disability.  There are some exceptions to this, but generally, if you can still do some other type of full time work (even minimum wage work), you are probably not disabled.

Needing medical care or even surgery in the future is typically not enough to prove disability.

What if your doctor has diagnosed you with a serious medical condition, or told you will need to be on medicine for the rest of your life, or told you that you will need major surgery later on?

In these circumstances, you have to look to the test for disability:  do you have a physical or psychological condition which keeps you from engaging in a substantial gainful activity (such as full time work) for 12 months or longer.

• Does the condition keep you from being able to work? If the answer is, “no,” then the condition might not be enough make you disabled.
• Does the medicine keep you from being able to work? You may respond that without the medication you would be disabled — the medication is the only thing that keeps you from being disabled.  Unfortunatly, this is the catch-22 of Social Security.  If you have a medical condition that is not disabiling with treatment, you are probably not disabled, even though you require the health insurance that comes with Social Security to be able to afford the treatment.
• Does the probability of future surgery keep you from being able to work? You may say, “no, but I will not be able to work after the surgery.”  That may be the case, but you also have to ask whether your period of recovery will be expected to be 12 months or longer.  While Social Security accepts that many surgeries are disabling for a time, the disability from the surgery has to be expected to last for 12 months in order to qualify for Social Security.

There are exceptions which go beyond the scope of this article.  Social Security has Listings of Impairments which discuss various medical and psychological conditions and these Listings do not discuss an inability to work.  However, this is because it is assumed that the level of severity required for any of these listing would automatically preclude any type of substantial gainful activity.

If you think you are disabled, get more information.

This is just a quick review of Social Security’s definition of disability.  There are exceptions and circumstances where these general guidelines would not apply.  Additionally, there are other requirements you must meet to qualify for Social Security benefits.

If you think you may be disabled, speak to Social Security and call a lawyer for a consultation.

I recently came across this advice on Gather about keeping copies of all the forms Social Security asks you to fill out.

Make sure everything is consistent the whole way through all of your paperwork and conversations. Keep copies for yourself …. they do read all of the forms. That is why I am saying that you must be consistent the whole way through. It is all logged in and if you have to go before a judge he goes over all of it, too. He will actually refer to certain sections that were filled out, etc.

This is spot on! I have seen this happen many times. If you say something at your hearing that is inconsistent with your answer on a form, the judge may call you on it.  Even worse, the judge may find that you are not credible.  One of the main purposes of your hearing is to let the judge see you in person and make a credibility assessment.  If the judge does not think you are credible, well… that is not good for your case.

If you can, it is useful to have a lawyer read over the forms and point out inconsistencies and show you how your words may be misinterpreted to mean something completely different from what you intended.

I hear this one with some frequency. I am meeting with a client and they tell me that someone at Social Security told them that if they want to appeal, they have to wait sixty days before starting a new claim / filing a new application.

That’s just not true.

You do not have to wait any length of time after a denial before starting a new claim. You can start a new application the same day as you receive the denial.

I think the confusion comes from the 60 day (actually 60 + 5 day) time period you have typically have to file an appeal. That is the deadline by which you have to get your appeal submitted to Social Security. But the appeal deadline does not have to expire before you can start a new claim.

My Colorado clients sometimes tell me that they waited years to apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. When I ask them why, I get a number of reasons:

• I did not want to appear needy.
• I did not want to believe I was disabled.
• I did not want to look like I was trying to scam the system.

Some people do not want to take a handout; even if this means not drawing on a benefit program they have paid into. Others do not want to label themselves as disabled because they view it as a sign that they will not get better.  Some of my clients want to keep trying to work. They want to test themselves, and they feel that applying for benefits will make them look like they are giving up and Social Security will look down on them.

I respect the pride, individualism, and self reliance that this demonstrates.

Unfortunately, waiting too long to apply for Social Security benefits can severely reduce their chances of winning.

Most Social Security disability cases are won or lost on the medical evidence available. Having high quality medical treatment, especially treatment with specialists, can make all the difference in a case. Social Security primarily focuses on current, regular, and on-going medical treatment and evaluations. This shows the existence and severity of an individual’s impairments.  

If you wait until after you you lose your insurance to apply, you may no longer be able to see a doctor, let alone a specialist on a regular basis. Your prior records have become historical records rather than reflecting your current status.  

Historical medical records may be important. However, while past medical records may show that an individual was disabled in the past, they often cannot show Social Security whether someone is disabled today.

Also, an individual will often need a medical opinion of what they can and cannot do in the workplace (a statement of limitations) to show that they are disabled.

Sometime, this can be obtained from a prior doctor, but that can cause its own set of problems. Generally, an individual will need to obtain a statement of limitations from a current medical provider.

I have seen a number of cases where a person had a team of doctors working with them at one point. But, by they time they applied for Social Security, they are only seeing a general practitioner or nurse for a few minutes at the public community health center.

Do not wait until your medical coverage runs out before applying for Social Security.

If you find yourself in the situation of applying after you lose your insurance, don’t despair. You still may be able to win your case. For a number of my clients, the only treatment option is the local health center or charity clinic. But, I still believe in them, and in their chances of winning.

Subject to Complete Defeasance has a great article about how Long Term Disability (LTD) insurance companies make you apply for Social Security benefits, including this snippet of a conversation with an insurance company:

Insurance Company [agent]: “Have you applied for Social Security disability benefits?”

You: “No.”

ICJ: “When do you plan on applying?”

You: “I don’t.”

ICJ: “Why not?”

You: “Well, I thought about that soon after my accident and talked it over with a lawyer. He said that filing a Social Security claim would be a waste of time, effort and money. Seems I don’t meet the agency’s rather stringent criteria for disability benefits, and in any event I’ll probably be back to work long before the agency rules on my claim. The money I’m getting under my disability policy will do me just fine until I’m back on the job.”

ICJ: “We disagree.”

You: “‘Scuse me?”

ICJ: “We disagree. We’ve reviewed your medical records and feel you have a good chance of getting Social Security benefits.”

Yup, long term disability insurance companies may make you apply for Social Security as part of your contract with them.

Why? Every dollar you get from Social Security, is a dollar the LTD carrier does not have to pay.

Even though you paid the insurance company to cover you, they may end up not having to pay you anything if you get Social Security benefits.

Also, if you are paid LTD benefits while you are waiting for your Social Security case to be decided, and you later win, you may have to pay back the LTD insurer for the money they paid you.

Keep in mind that all insurance policies are “creatures of contract.” That is, while there may be some regulation regarding what the policy has to say, it is difficult to generalize about policies. You have to read the policy to know what it says. You cannot just assume it says one thing or another.

I encourage you to read  the entire article.  But as a warning, the language gets a bit salty (maybe PG-13) when discussing the author’s frustration with the insurance company.

Are you looking for a specific Social Security form? Social Security has a page where you can find it.

You can search for a form or browse by category:

• Prepare for Your Interview
• Benefits Claims Supporting Forms
• Medicare Prescription Drug Help Forms
• Other Forms
• Forms for Other Agencies
• Forms You Can Complete and Submit Online

Listed below are the most frequently used appeal forms:

• SSA-61 Request for Review By a Federal Reviewing Official
• SSA-561-U2 Request for Reconsideration
• HA-501-U5 Request for Hearing by Administrative Law Judge
• HA-520 Request for Review of Decision/Order of ALJ

Please note that certain appeals require more than just the correct form. For example: an initial denial on a claim for disability benefits normally requires a Request for Hearing, Disability Report-Appeal, and an Authorization to Disclose Information. Check your Social Security notice, contact your local Social Security office or speak to an attorney to determine the appeal requirements in your case.

Here are some more useful forms:

• SSA-1696 Appointment of Representative
• SSA-11 Request to be Selected as Payee
• SS-5665-BK Teacher Questionnaire
• SSA-3441-BK Disability Report-Appeal
• SSA-827 Authorization to Disclose Information to the Social Security Administration