APPROVAL ON INITIAL APPLICATION
DDS typically makes a decision on an initial claim within 3-6 months, though that timeframe can be longer or shorter depending on different variables. Obviously, the decision will shake out one of two ways—approved or denied. If your case gets approved on your initial application, congratulations! Did you have a rabbit’s foot in your pocket? In a 2018 report, Social Security disclosed that the average rate of approval for initial claims was only 22% between 2008 and 2017. A few tips to keep in mind if you do receive that unicorn of an award on your initial application:
- Social Security keeps the DDS offices on their toes by randomly selecting some cases for quality review. If your initial claim gets approved but your case is then flagged for quality review, your benefits may be delayed for months or longer. The quality review office may decide that DDS did not do a very good job on your case and send it back for further evaluation. In a small percentage of cases, this can lead to the reversal of your award. This only happens in a very small percentage of cases but know that it is a possibility.
- IMPORTANT: THE FIVE MONTH WAITING PERIOD. Most people who get approved for SSD (worker’s) benefits are surprised to learn that they will not receive any money for the first five full calendar months they are out of work. Social Security has this waiting period in place presumably to make sure that people who are disabled for only a few months don’t get to draw benefits—remember the disability is supposed to last at least a year. In reality, the waiting period means that when you are found to be disabled, there is a five-month window where you will be entitled to zero dollars. If you file for disability relatively quickly after stopping work and are approved relatively quickly by DDS, there is a chance that the waiting period won’t have even ended yet and you therefore won’t get your first check for another month or two after that.
Example: Roy hurts his back and stops working on January 3. He files for disability benefits later that same day, alleging he became disabled when he stopped working on January 3. Due to his age, the support of his doctors, the strength of his medical records, and the good job he does filling out all of his paperwork, Roy’s claim is approved by DDS on March 27. Despite having been approved for benefits on March 27, Roy has to wait until he’s been out of work for five full calendar months to receive his first check. Roy receives his first check in July.
Clients absolutely hate the five-month waiting period and many lawmakers have criticized it as well. To me, the rule makes no sense. Social Security is supposed to have already evaluated your case to see if your disabilities have lasted twelve months or should be expected to last twelve months, so the risk of a claimant drawing the benefits for a short term disability seem fairly minimal when compared to the burden of going five full months without any income. The rule is particularly silly when considering that most people aren’t even awarded benefits until they have a hearing with a judge, which is almost always at least a year from the time the claimant stopped working. Lawmakers have introduced various bills over the years that would eliminate the waiting period, but as of this writing, none have been passed into law and the waiting period remains.
Another caveat to the five-month waiting period is that it does not apply to SSI claims. SSI claims are payable going back to the date the claim was filed. If you have filed a claim for both SSD and SSI as discussed in a prior post, you may be able to draw SSI for the first five months you are out of work before having your benefits convert over to SSD on the sixth month. But if you do not meet the strict income requirements for SSI, plan for no money during those five months.
- IMPORTANT: 29 MONTH WAITING PERIOD FOR MEDICARE ELIGIBILITY. Perhaps even more harsh than the five-month waiting period for getting benefits is the waiting period for Medicare eligibility. A claimant who gets approved for SSD benefits is only eligible for Medicare after they have been drawing the benefits for two years. Added to the five-month waiting period in order to draw benefits in the first place, this means a person has to be deemed disabled for a staggering 29 months before he or she can sign up for Medicare. That’s a long time to go without any health insurance. Sure, you can purchase some insurance privately or pay to stay on a spouse’s insurance plan during that time, but those costs can take a large dent out of the monthly benefit amount. We often see clients that struggle to make ends meet while they pay for their own costly insurance during this 29-month period.
As with the SSI waiting period caveat, an SSD recipient who also meets the income requirements for SSI is eligible for Medicaid immediately upon being deemed disabled, which can be a major lifeline during the long wait for Medicare. However, only a portion of SSD recipients meet the income requirements for SSI and Medicaid.
- Continuing disability review. If the deciders believe your condition may get better over time, they might flag your case for review in a couple of years. This is particularly true for younger claimants who they believe may recover and return to work in the future. It is extremely important that you continue to get medical treatment and take care of yourself once you are drawing benefits. If you aren’t treating your conditions when Social Security checks back in on you in a couple of years, they can decide to cease paying your benefits. We get calls all the time from people who have had their benefits cut off like this and they are understandably panicked. Be diligent about your medical treatment and taking care of yourself in order to minimize the chance of this happening to you.
- Returning to work. You may draw SSD benefits for a while, have that surgery you desperately need, and make a miraculous recovery a year later. You may get a job offer and decide you would like to give it a shot. But what if you go back to work and then soon realize you’re not really up to it? Is it worth the risk of being cut off from all your benefits when you’re not 100% confident that you will actually be able to do a job after all this time? What if you go back to work and your pain returns? Social Security actually has protocols in place for this exact situation—the Trial Work Period. If you do get better and decide you want to return to work, it is crucial that you notify Social Security immediately. Even if you decided to attempt full-time work, you will still be able to draw your regular benefits for up to nine months while you test your ability work. If you are still working full-time at the end of the nine-month trial period, you will no longer be able to draw benefits. It’s important to note that the nine-month trial period does not have to be consecutive months. Also, you are generally only eligible for nine months of trial work every five years, whether used consecutively or spaced out. Working while drawing SSD is a very complicated issue with many nuances to it. You should always consult with an attorney to make sure you don’t mess anything up with your benefits.
As always, this stuff is complicated and that’s what lawyers are for. Our office is here to talk to you about any and all of this, so don’t hesitate to reach out.
Navigating the complex Social Security system can be a stressful and oftentimes scary process without the help of an experienced Social Security Disability attorney. Social Security Disability Insurance (SSDI) claims are especially overwhelming when you are already dealing with an illness or injury. Our firm strives to take the legal confusion and stress away from you so that you can focus on your biggest priority–your health and recovery.
We can help you get the benefits that are rightly owed while providing compassionate guidance and professional representation at all stages of the Social Security Disability process for adult and child disability cases, including:
- Initial Application for Social Security benefits
- Reconsideration of denied Social Security Disability claims
- Hearing before a Social Security Administrative Law Judge
- Administrative Appeal
Our focus is not only on the legal aspects of the case, but also on the human elements. We are committed to treating you as an individual and will work to understand your specific case, situation, and physical needs. We are real people helping real people throughout Alabama and the Southeast.