Tips for Arthritis Disability Approval

It can be tough to work when you are living with arthritis. Even the simplest movements may be painful. But with medical bills and the cost of medications to treat advanced arthritis, you may be concerned about your finances. You may wonder how you will make ends meet when you no longer have a steady paycheck coming in. How will it affect your family? Do you have any options? Read on to learn more about eligibility for RA disability and how to proceed if you get denied.

As it turns out, you do have options. People with severe arthritis, rheumatoid arthritis, and other types of arthritis may qualify for Social Security disability (SSD) benefits. However, the Associated Press has reported that people are flooding the Social Security Administration with applications — especially those who have been laid off and aging Baby Boomers. Applications are up nearly 50% from a decade ago, and it has been estimated that the government denies over three-fourths of claims, even for people who are entitled to SSD benefits.

Because so many claims are denied, it’s imperative to understand what SSD benefits are, how to apply, what to expect during the evaluation process, and what to do if your application is denied. Being prepared may mean the difference between ultimately receiving or not receiving SSD benefits.

What are Social Security disability benefits?

Social Security disability benefits are part of the Federal Social Security Act. The Act provides disability payments and other benefits for people who are disabled and can’t work, and in some cases for their families. Benefits are often referred to as Social Security Disability Insurance (SSDI) benefits and can include cash payments and medical coverage.

There are several types of benefits, and your circumstances dictate which type you may be eligible to receive.

SSD/SSDI. SSD benefits are available to those who are disabled and can’t work. You will need to have paid enough into the Social Security system and worked enough in the recent past to be eligible. How much is enough depends on your age.

Supplemental Security Income (SSI). If you haven’t worked long enough or recently enough to qualify for SSD benefits, you may be eligible for SSI. SSI benefits may include cash payments, medical coverage, or a combination of the two. These benefits are provided to help those who are disabled — and who are not eligible for SSD benefits — meet basic needs, such as food, clothing, and housing.

You may be eligible for SSI if any of the following apply:

  • You are disabled and have a low income and limited assets.
  • You are blind and have a low income and limited assets.
  • You are age 65 or older, and have a low income and limited assets.
  • You are a disabled minor (a person under age 18) and have limited income and resources or come from a home with limited income and assets.

A minor is considered disabled if he has a physical or mental health condition that causes severe limitations and the inability to complete daily tasks; has a combination of medical conditions that cause the same complications; has a medical condition that is expected to be fatal, or has a medical condition that is expected to last (or has already lasted) a year or more.

Eligibility for SSI benefits depends on your financial situation and whether you qualify under the Social Security regulations for SSI benefits. To qualify, you must meet one of the criteria above. You also must currently reside in the United States or meet other specific residency criteria. Both American citizens and legal residents of the United States may be eligible to receive SSI benefits.

Widows benefits. A widow or widower who is considered disabled by the Social Security Administration can receive benefits beginning at age 50 if he or she meets the guidelines for eligibility — especially if the deceased spouse was the primary breadwinner. The person’s disability must have started before the spouse’s death or within seven years after his or her death. These benefits are based on the deceased spouse’s earnings record, as opposed to SSD benefits, which are based on the widow’s or widower’s own earnings record.

Survivors benefits. Survivors benefits may be paid to certain family members if the person who died paid into the Social Security system and earned enough credits. Those who may qualify include a widow/widower at full retirement age; a widow/widower age 60+ (reduced benefits); a disabled widow/widower age 50 or older; parents age 62 or older who are dependents; a child who was disabled before age 22 and is still disabled; and people in certain other circumstances.

Generally, a widow or widower can’t receive benefits if he or she remarries before age 60 (50 if disabled), unless that marriage ends in death, divorce, or annulment. Getting remarried after age 60 (50 if disabled) does not affect a person’s eligibility for survivor’s benefits.

How do I find out if I’m eligible?

The Social Security Administration accepts many different mental health conditions and physical disabilities, including osteoarthritis and rheumatoid arthritis. The stipulation is that your medical records must “prove” that your condition is severe. In other words, it must affect your ability to work and earn a paycheck.

You may be eligible for SSD benefits if your arthritis (or any other medical condition you may have) can be characterized as follows:

  • It prevents you from working in any capacity or earning above a certain amount — not just from doing the job you held previously.
  • It has lasted — or is expected to last — for at least one year.
  • It is life-threatening.

Keep in mind that the Social Security Administration is going to review your medical records, work history, and other personal information. It’s critical that you have an official diagnosis, see your doctor or specialist regularly, and follow the prescribed treatment plan. Failing to do so may make you ineligible to receive SSD benefits.

Applying

To get started, contact the Social Security Administration, either by calling (800) 722-1213, visiting www.ssa.gov to apply online, or making an appointment at a local Social Security district office.

When you submit your application, the Social Security Administration will review your medical records for an official diagnosis and information on your treatment plan. They also will evaluate your age, education, and work history. It’s critical that you attend medical appointments and follow through with your prescribed treatment plan. Failing to do so could hinder your chances of receiving SSD benefits.

The claims process can take 120 days or more. Those approved receive SSD benefits after their sixth full month of disability. If approved, your SSD payments are retroactive from the date you were evaluated as disabled. Money you receive is based on your average lifetime earnings. Note, however, that your SSD medical benefits do not kick in until the 29th month from the date you’re considered disabled.

Denied claims

If the Social Security Administration denies your initial application, don’t give up. Remember, the government rejects over three-quarters of claims. But you must act quickly. You have only 60 days to either request a reconsideration of your case (a procedure available in most but not all states) or request an appeal. You can reapply after that period, but in that case the process starts all over again.

Hearing. If you decide to appeal a denial, you’ll first go to a hearing. You may have to wait anywhere from 12 to 18 months for a hearing. If you hire an attorney, he will meet with you prior to the hearing to talk about the details of your case and tell you what to expect. You’ll have an opportunity to ask questions.

The hearing doesn’t require formal dress, but you should look presentable. Some people wear T-shirts, button-down shirts, or sweatpants due to their medical conditions. Keep in mind that you’ll be appearing before a judge, and you’ll want to look respectful.

An administrative law judge will conduct your hearing. During the hearing, you’ll be asked for basic information about your education, work experience, and current medical treatment. You’ll need to explain how arthritis affects your life, the symptoms and limitations you experience, and how they prevent you from working.

Usually a vocational expert will testify at your hearing. He will talk about your work history and how arthritis keeps you from being able to work.

The administrative law judge will not issue a decision on the day of the hearing. He will evaluate all the evidence on record, as well as any additional evidence brought to the hearing.

You will receive a “Notice of Decision” anywhere from two to six months after your hearing. If you have an attorney, he will receive the notice at the same time as you do.

If you don’t agree with the administrative law judge’s decision, you can move on to the Appeals Council.

Appeals Council. The Appeals Council can choose to review your claim and give a decision, not review your claim, or give your claim back to the administrative law judge for further review.

The average processing time for the Appeals Council is 18–24 months. You (and your attorney, if you have one) will receive a copy of the decision or a copy of the order sending it back to the administrative law judge for further consideration.

If you disagree with the Appeals Council, or if the Appeals Council refuses to review your case, you can move on to the final level: the Federal Court. You will definitely need an attorney at the federal level.

Most attorneys specializing in SSD benefits cases work on a contingent fee basis, which means the attorney fees are deducted from any past-due benefits awarded on the claim. However, some attorneys still charge a fee for services even if the claim is denied.

A person looking for an SSD attorney should get information on how the attorney charges before signing any agreement. To find SSD attorneys or law firms, look for advertisements in local venues or publications, and visit their Web sites to learn more about their services. Be sure, also, to ask friends and family for recommendations; word of mouth is the best form of advertising.

Terminated benefits

SSD benefits are considered lifelong benefits, but the Social Security Administration may terminate your benefits — called “cessation” — if any of the following occur:

  • You go back to work or go to school full-time (called “substantial gainful activity”).
  • You go back to work part-time and earn over $1,040 gross per month.
  • Your condition improves.

If your monthly earnings rise above a certain amount, which changes every year and is $750 as of 2013, you may automatically enter a trial work period. If you are self-employed, a trial work period may start when you earn more than $750 a month, or you work more than 80 hours in a month. During a trial work period, you can return to work while still receiving Social Security disability benefits. If you earn more than the minimum amount necessary to trigger a trial work period during at least 9 months in a period of 60 months, Social Security may decide that you are no longer disabled.

If you begin working while on SSD/SSDI or SSI, you must report it to the Social Security Administration.

There are certain conditions under which you can expect the Social Security Administration to review your case to see if you still have arthritis, are still undergoing treatment, and are following the guidelines of that treatment. These conditions are as follows:

  • If you are “expected” to improve, the government normally will review your case within 6 to 18 months.
  • If you are “possibly” going to improve, the government normally will review your case after three years.
  • If you are “not expected” to improve, the government normally will review your case after five to seven years.

If the Social Security Administration reviews your case and determines that your condition has improved, they may terminate your benefits.

In addition to the reasons for cessation listed above, the Social Security Administration will likely terminate your benefits if you go to jail or are institutionalized against your will for over 30 days.

If the government terminates your SSD benefits and you feel the termination is unwarranted, you can appeal within 60 days — or within 10 days to continue receiving checks while the appeal is pending. Keep in mind, however, that if you don’t win your appeal to reinstate your SSD benefits but you continued receiving checks while the appeal was pending, you will have to pay back the money you received during that period.

Improving your chances

Applying for SSD benefits can be a long and complicated process. The odds are not on your side, but you can do several things to increase your chances of receiving SSD benefits.

First, read everything you can about the Social Security disability system. Learning the nuances of this complex system can help you avoid common mistakes and answer a lot of questions you may have about SSD benefits.

If the Social Security Administration denies your application the first time, be prepared to act quickly. You have only 60 days to appeal.

Last, be persistent. Remember, the Social Security Administration denies the majority of claims. Knowing when to file an appeal and understanding the appeal process could ultimately mean the difference between receiving or not receiving SSD benefits for your arthritis.

Dennis Liotta is a partner at the law firm of Edgar Snyder & Associates. He has over 20 years of experience helping people with physical and mental disabilities get Social Security disability benefits. For a comprehensive overview of SSD, with answers to commonly asked questions, download a free guide at www.edgarsnyder.com/pdf/SSD-brochure.pdf.

Learn more about the health and medical experts who who provide you with the cutting-edge resources, tools, news, and more on Pain-Free Living.
About Our Experts >>

Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.