Fairbanks Disability Group
Fairbanks Disability Group
Fairbanks Disability
Fairbanks Disability

FAQ

FREQUENTLY ASKED QUESTIONS

 

What is SSDI? (Title II benefits)

Social Security Disability Insurance (SSDI) is a federally mandated insurance program for people who are unable to work because of a disability. Like other insurance, you must have paid into it to qualify. Your FICA contributions come out of your paycheck and go into the Social Security Trust Fund. To qualify, a certain dollar amount from your income taxes must be paid into the trust fund, and in return, SSA gives you work "credits" if you work full-time you get one work credit every quarter (4 per year). You must have accumulated 40 work credits (20 in the last 5 years) to qualify. A worker remains fully insured up to 5 years after the date last worked. Once 5 years passes without contributing to FICA, a worker loses all work credits and is no longer insured for disability benefits through SSA.

 

How do you qualify for SSDI?

You must meet several criteria in order to qualify for SSDI. You must be insured, which means you must have worked and paid federal payroll taxes (FICA) for five of the last ten years. You must also apply before reaching full retirement age (65-67), and you must meet Social Security’s definition of disability.

 

What is SSI?

Supplemental Security Income (SSI) is a different program also through Social Security that is funded by tax revenues. It pays monthly benefits to people with disabilities who have not worked during their lives or those who have not worked for a cumulative five out of the last ten years. In calculating your SSI benefits, Social Security generally considers all of the combined income of every member in your household. Children may receive SSI in some situations.

 

What is SSA's definition of disability? SSA's definition of disability is: 1) a medically determinable impairment, that; 2) is sufficiently severe to keep a person from working full-time (paid or volunteer), and; 3) has lasted or is expected to last 12 continuous months.

 

How do I apply for Social Security disability benefits? There are two ways to begin the application process. The easiest way is to go to the Social Security website (www.ssa.gov) and apply. The website is user friendly and will guide you through the process. The other way is to go to your local Social Security office and have an SSA claims agent help you. Both have advantages. The online method results in a faster response. The "face to face" method is better for people who have a difficult time with computers.

 

My doctor says I am disabled. Why was I denied benefits? To be found "fully favorable" (disabled) a claimant must meet SSA's definition and requirements for disability. An impairment that could get you benefits through another government agency may not get you benefits through SSA. A doctor's note or letter to SSA stating that you are disabled will be given little weight by SSA if there are no medical records to verify your impairment(s).

 

What is SSA's definition of disability? SSA's definition of disability is: 1) a medically determinable impairment, that; 2) is sufficiently severe to keep a person from working full-time (paid or volunteer), and; 3) has lasted or is expected to last 12 continuous months.

 

Why do I have to see a doctor for treatment on a regular basis to get approved? The government feels that if your impairment is severe enough to keep you from working, you need to be doing as much as you can to treat your symptoms. SSA wants to see your doctors' diagnoses, prognoses, clinical notes, progress notes, lab tests, radiological findings, etc.  SSA wants all questions answered before making a decision on your claim. The development of MEDICAL RECORDS is the most important part of your claim.

 

What if I don't have health insurance and can't afford medical treatment ? SSA is not concerned whether or not you can afford healthcare. There are several reasons for this. First, Congress has mandated that all hospital ERs must treat a patient regardless of their ability to pay. Second, because of the number of no-cost and low-cost clinics that treat low income patients. There are over 50 in the greater Sacramento area. Third is because of the new programs available through the Affordable Care Act (ACA, or "Obamacare").

 

Social Security sent me to one of their doctors. Doesn't that count? The physicians and psychologists that SSA sends claimants to are only for evaluating a claimants' alleged impairments. These doctors are called "consultative examiners", or CE's. They are not your treating doctors. A treating doctor is a doctor that you have been seeing for your impairments over a period of time, and have developed a doctor-patient relationship. Because your own doctors have personally examined you, prescribed medicine to you, watched your progress, and can refer you to specialists, their opinions about your condition are normally given "controlling weight" by the ALJ at hearing.

 

SSA's doctor said my impairments were not severe and I can work, even though I can't. Should I worry? This is a typical scenario. Not surprisingly, SSA's examining doctors (CEs) almost always report that a claimant's impairments are not severe. However, there is an heirarchy in the SSA ladder of doctors. The ALJ is bound by law to give the opinions of your treating doctors, that is, their diagnoses, prognoses, and opinions the most weight when making a determination on your case. If your treating doctors' opinions are more restrictive than the CE's, the ALJ will give little weight to the CE's opinions if the medical records verify your doctor's findings. In other words, the ALJ is more likely to give the opinion of a doctor who has been treating you over a period of time more credibility than a doctor who has only seen you for once for a 30 minute (or less) "evaluation".

 

I see a chiropractor and an acupuncturist for pain. Do they count? Unfortunately, SSA does not recognize chiropractors, acupuncturists, certified nurse practitioners, physician's assistants, or other non-doctors as "acceptable medical sources". To get controlling weight in a disability decision, the treater usually must be an MD, DO, or state licensed psychologist or psychiatrist. SSA terms the non-doctor sources as "other" sources. The ALJ will usually give less weight to the opinions of "other" treating sources.

 

Social Security wants to conduct my hearing by video conference. Is this any different than a live hearing? When the ALJs' calendars fill up, SSA will ask you to allow a video hearing. Our clients are advised to deny any SSA request for this type of hearing. SSA sometimes attempts to pressure a claimant into a video hearing by threatening a long delay to a live hearing, but it is your right to chose a live hearing. Yes, your hearing may be delayed by several months, but it is our opinion that video hearings fall short in several areas. First, it is common to experience equipment malfunctions during a video hearing. If an ALJ misses something important or misunderstands any testimony, it could be detrimental to your case. Second, the ALJ will only see you in one-dimention.  It is easy to miss nuances relating to your condition. How you walk into the room, how you may be uncomfortable because of a postural impairment, whether you are shaking, crying, or in any way not able to handle the stress you might be having due to a mental condition. We feel that it is important for the ALJ to see all these things in order to get an accurate picture of your overall condition.

 

How long will it take my claim to be approved or denied? Most claims in the Sacramento region take from 12 to 18 months from start to end. The current time is longer due to the government shutdown in October 2013.

 

PLEASE EMAIL YOUR QUESTIONS TO sacparalaw@gmail.com. Tim will personally answer any questions you have about your disability claim.

Timothy E. Fairbanks, ADR, EDPNA

at Fairbanks Disability

 

2740 Fulton Ave

Suite 106

Sacramento, CA 95821

 

 

Phone:  (916) 480-1268

Cell:  (916) 747-1069

Fax:  (916) 481-2230

Email: sacparalaw@gmail.com


Or use our contact form.

Office Hours

We can be reached during the following hours:

 

Monday - Thursday 9:30am-5:00pm

Friday-10:00am-4:00pm

Sat-Sun off

 

Mobile notary services available on weekends and holidays by appointment.

 

 

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