Artificial Intelligence and Healthcare
June 15, 2017
The Social Security disability program is perhaps the most confusing of all federal bureaucracies that a citizen may ever be required to confront, either as a person filing a claim for benefits or as a healthcare professional required to provide medical evidence to support such a claim. According to the Social Security Administration (SSA), the definition of “disability” is the inability to engage in “substantial gainful activity” as determined by the SSA. Generally, if a physical or mental condition makes a person unable to do any kind of work for which he or she is suited (given his or her age, education level, and work experience) and the disability is expected to last for at least one year or result in death, then that person will be considered disabled for Social Security purposes.
The SSA administers four separate benefit programs for individuals with disabilities:
The medical requirements to prove disability, as well as the process for making disability determinations, are the same in each program. The primary difference among the programs is their non-medical eligibility requirements. SSDI eligibility requirements, as well as the calculation of SSDI benefits, are based upon the applicant’s prior participation in the Social Security system (i.e., working and paying Social Security taxes).
DWB and DAC benefits are based on the Social Security payment record of another person: a deceased spouse for DWB and a parent who is deceased or receiving disability or retirement insurance benefits himself or herself for DAC. Eligibility and benefit calculation for SSI, on the other hand, depends upon financial need.
A person who is eligible to receive SSDI will automatically be enrolled in Medicare after receiving 24 months of benefits. Medicare has two parts – hospital insurance (which is free for SSDI recipients) and medical insurance (which requires a monthly premium). A person who is eligible to receive SSI payments qualifies for Medicaid.
A person who becomes ill or injured and unable to work based on the criteria above should apply for Social Security disability benefits. Applications may be filed by phone, mail, or in person. If you have questions about completing the application or about the claims process, please contact our office for assistance. Based on the information in the application and the medical data available, SSA will decide whether the applicant qualifies. If the information provided to the SSA is insufficient, the applicant may be asked to undergo a consultative medical examination. Once the SSA makes a decision, the applicant will receive a written notice. If the claim is approved, the
notice will show the benefit amount and the monthly payments will begin. If the claim is denied, the notice will state why.
In many cases, an initial claim for benefits is denied. Three levels of administrative appeal are available:
After exhausting all of the above options, you may file an action in federal court. The time limit for each level of the appeals process, including administrative appeals and court actions, is 60 days from the date an applicant receives an unfavorable decision.
The Social Security disability program is governed by complex rules and regulations. Applying for disability benefits can be a frustrating ordeal, but it need not be overwhelming. Seeking the advice of a competent Social Security disability lawyer can reduce your anxiety, present your story in a thoughtful and respectful way, and increase your chances of getting approved for disability benefits. You don’t have to go it alone. Tarutis | Legal Solutions can guide you through the application and appeals process, helping you present a strong claim and win the benefits to which you are entitled.
"Thanks to both of you (Gerry & Monica) for your help with this case. It was a very difficult thing to go through for my wife and myself. Your support and direction were incredibly helpful."
Mr. S. - - Bothell, WA