Having represented clients in Social Security Disability/SSI claims for the past 31 years, I have had the opportunity to hear (and dispel) an endless amount of misinformation, misunderstanding, and misinterpretation about the way the Social Security system works and how disability benefits are actually awarded. This is understandable, given the complexity of Social Security’s rules and regulations.
In my last column, I reviewed some of the most common “myths” that invite rebuttal. Here are some others that deserve mention:1. You cannot work and also be eligible for Social Security Disability benefits.
This is only “partially”
true. Theoretically, you can work on a limited basis without disqualifying yourself for benefits. The Social Security Administration does require that you not be doing “substantial gainful activity (SGA),” which is defined as work which is both substantial and gainful; that is, work which involves doing significant and productive physical or mental duties and doing it or intending to do it for pay or profit. However, there is a presumption for an employee that, if she has earned less than $1,010.00 in monthly gross wages, then that individual is not
working at an “SGA” level. There are other rules for self-employed individuals. SSI guidelines are different as well. The “substantial gainful activity” issue can be intricate and confusing and strongly warrants the need for legal advice. 2. People get Social Security Disability/SSI for drug and/or alcohol addiction
. This is false.
Since the passage of the “Contract with America” Advancement Act of 1996, it is no longer true that disability benefits are awarded to individuals based on drug addiction and/or alcoholism. On the other hand, drug addiction and/or alcoholism does not necessarily disqualify individuals from disability benefits. For example, if you are suffering from chronic back pain and have become addicted to an opiate such as Oxycontin to deal with that pain, it is unlikely that your addiction will disqualify you. On the other hand, someone who suffers from and takes medication for a seizure disorder, yet uses alcohol–even if it is only on an occasional basis– may be disqualified from benefits on the basis that any alcohol consumption may be considered “treatment noncompliance.” The standard applied by the Social Security Administration is whether drug and/or alcohol abuse is a “contributing fact material to the determination of disability.” The issue of “materiality” can be rather subjective and complex.3. If I have a workers’ compensation or personal injury claim, I should wait until that claim is resolved before I apply for Social Security Disability/SSI. This is false.
I sometimes hear from clients that their workers’ compensation or personal injury attorneys advised them to “wait”–sometimes for years–before filing for Social Security Disability/SSI (assuming the attorney even mentioned Social Security benefits at all). With some exception, this is generally bad advice. First, workers’ compensation and personal injury claims can take years to resolve, during which time a Social Security Disability/SSI claim could be filed and completed, thus allowing an individual to start receiving much-needed disability benefits, including Medicare. Second, delaying the filing of a Social Security Disability claim can have serious adverse consequences in terms of basic eligibility. If you wait too many years to file, you may no longer be “disability insured” for these benefits, infinitely diminishing your chances of success. Therefore, if you have an attorney who offers the advice to “wait,” ask the attorney to explain the rationale, and then weigh your options carefully.4. If my doctor tells me that I should be eligible for Social Security Disability/SSI, then I should have no trouble qualifying for benefits. If it was only that easy!
Obviously, if your doctor makes a statement of this kind, that is certainly a “good sign” weighing in your favor to qualify for disability benefits. Nevertheless, however well-meaning your doctor may be, he/she is not an expert in the field of disability law and most certainly will not recognize many of the critical issues and complexities which arise in Social Security Disability/SSI claims. Further, your doctor may or may not “walk the walk” with regard to providing the proof necessary to help ensure a greater likelihood for a successful outcome. Conversely, many clients have told me that their doctor discouraged them from making a claim, with statements such as “yes, you’re sick, but you’ll never get Social Security Disability–it’s too hard.” Again, the doctor may be well-intentioned in his/her assessment, but the uniqueness and intricacy of the Social Security Disability/SSI system is poorly-understood by most people, including the most well-educated medical providers. In short, take such advice – not only from doctors, but also from friends, family, and even Social Security personnel – with a healthy “grain of salt.” For more information, please call (856) 795-8880 or (609) 702-0700. You may also visit www.davidsbross.com.
As seen in Camden County Woman and Burlington County Woman