Applying for Disability [In America]

Today Julie Whitehead is going to share with us her experiences on Applying for Disability in America and any tips that might help you!

By 2007, it was becoming increasingly obvious that my condition was not improving to the point that I could return to work. It had been about nine months since I had turned in my last assignment for my freelance work—fifteen profiles of the various community colleges in the state for a publication aimed at graduating high school students. I had a great deal of difficulty writing this assignment, and not because it was boring or uninteresting. I simply could not write with the facility I had before. I finally developed a formula I followed for each profile and collected just enough information to fill out that profile to the required word count for each and sent it off with relief.

Because my husband was still working, we were not in any kind of financial straits, but I was used to having my own money and paying my own expenses. Since I had worked for the Social Security Disability Insurance program for seven years, I was intimately familiar with the process, and I decided to file for benefits.

I had a few reasons for doing so. One was simply to have my own money to spend on my share of the household bills. Another was that if I stayed off work too long and didn’t pay into the system, I wouldn’t be able to get benefits later on. I also wanted to be able to take advantage of Medicare in case my husband’s work ever dropped their insurance benefits. His insurance had been very good to pay for my bills thus far, but it had a lifetime limit to benefits, and I wanted to have a backup insurance in case I maxed it out. I was also thinking about protecting myself—I knew that in case anything ever happened to Bob, I needed to have a steady income outside of his salary.

The first step was to call the local Social Security office and file my claim. I believe all my information was taken over the telephone at that point. You can also go to the office personally and be interviewed or you can request forms be sent to you by mail. Two sets of information are collected—information about your financial state and information about your condition. The financial information is to see if you also qualify for benefits under Supplemental Security Income, the disability program for the poor and people who are not covered by the Social Security Disability Insurance. The medical information, including the doctors and hospitals you have seen, is used to collect your medical records to aid in determining if you are medically eligible for benefits.

An important element in the financial determination is your earnings. I was not working at all at the time I filed for benefits. Some part-time workers are eligible for benefits as long as the pay does not exceed a certain threshold. This threshold is called “substantial gainful activity”. The idea is that if you cannot work enough to earn a certain amount of money due to your condition, you may be eligible for benefits. If you had to cut back to part-time because of your condition, you may be found eligible at the point that you had to reduce your hours or pay. This finding can increase your back payment benefit and can make you immediately eligible for benefits without having to fully quit work and without having to go through the five-month waiting period for benefits to start. In my case, I was found eligible as soon as my earnings ended in July 2006.

Social Security goes through a step-by step process to determine if you are medically eligible for benefits. The first step is to collect your medical records. If you have been treated for your condition, you need to turn that information in. List all doctors, counselors, hospitals, mental health centers, and other treatment facilities you have been in. Social Security pays those entities to send your records in to them. If you haven’t been able to afford regular treatment, Social Security can send you to a medical professional for a complete evaluation that they pay for. This doctor cannot treat you; they simply do an evaluation that they then send to Social Security.

With bipolar disorder, a key factor in being allowed for benefits is the frequency of your episodes. I was found eligible because I had experienced both manic and depressive episodes at a certain frequency. Other disorders, such as mental retardation or schizophrenia, have different criteria that are used to determine eligibility. You can also be found eligible depending on the type of difficulty you are having working. You can be allowed on what is called your “mental residual functional capacity” which is Social Security’s term for what kinds of work functions you are still able to perform. If you are found unable to do skilled or unskilled work, you can be allowed for benefits. If you have restrictions in being able to interact with people, you can be found eligible as well.

When reporting your symptoms, particularly if you do not have regular treatment, be as specific and honest as possible. If you are taking medication and have side effects, make sure you report those as well, particularly if you have had to discontinue certain medications because of the severity of the side effects. If you are noncompliant with treatment, that can affect whether or not Social Security will allow you for benefits, depending on the situation. If you have co-existing diagnoses, be sure to include those in your information as well.

I was sent on an exam by Social Security, but since I had regular treatment, I was able to schedule the appointment with my treating psychiatrist. The exam consisted of my doctor asking me about my current functioning day to day and about my difficulties working. Depending on your diagnosis, you may also do psychological testing, such as IQ testing and memory testing.

If you are allowed for benefits, you will get a notification from Social Security telling you your onset date (when you became eligible) and how much you will receive in benefits. Keep this letter for your records. If you are denied, you have avenues to appeal this decision.

If you are denied the first time, tell the Social Security office that you want to appeal this decision. Your case will be reviewed again by the agency that issued the denial, depending on if you were denied because of medical or financial considerations. IF you are denied again, you can appeal that decision as well, going before a judge versed in Social Security law. Contrary to what some may tell you, you do not need a lawyer to appeal to the judge—you can handle your own appeals. Avenues for appeal exist even after this level—Social Security can inform you about your options at that point.

The process can take a while, depending on how quickly the agency can collect your medical records. Call all your medical providers and alert them to the fact that Social Security will be requesting your records. Always fill out forms promptly and send them back so that you can get a decision as quickly as possible. Go to all appointments that are scheduled for you and be as honest as possible about your condition.

If you do not have insurance and cannot work full-time, filing for benefits can be a big help in both realms of needing treatment and income. If you are found eligible for Social Security benefits, within two years if the condition persists, you can become eligible for Medicare, which will pay most of your hospital and doctor bills. If you meet the income threshold for Supplemental Security Income, you can be immediately eligible for Medicaid, which will also cover prescriptions for your condition as well as medical bills. Be persistent in pursuing your claim and as honest and open about your problems as possible so that you can be found eligible if your condition is severe enough.

Julie Whitehead currently writes and blogs from Mississippi at her personal blog.   She has been a university lecturer, a disability examiner, and a freelance writer.  She carries a diagnosis of bipolar disorder and blogs to create awareness and help others understand the disease and its effects.