Chronic Fatigue Syndrome and Fibromyalgia Patients: Should You File a Disability Claim?

By Scott E. Davis, Esq., © 2002 All Rights Reserved

Without debate, we can agree the past two years in the stock market have been financially unbearable. But if you think the stock market has been bad, let’s discuss another scenario that may be the “mother of all bear markets.” Unfortunately, this financial fiasco commonly occurs to people just like you.

How do I know it occurs? Because I listen to the stories literally daily. Indeed, the severity of this financial decision makes the stock market meltdown of 2000 to 2002 look like a walk in the park.

Whether intentional or unintentional, falling into this trap will cost you disability income, retirement income and pre-retirement Medicare health insurance. The total financial loss varies, but I have seen this scenario cost people as much as $90,000 in past-due benefits alone! To be sure, that amount does not count the lost future benefits which easily dwarfs the past due benefits.

I have commonly seen the amount of lost past-due benefits exceed $40,000. Query…how many financial decisions do you make in your life carry that carry an opening price tag of $40,000 with the amount escalating as you age? My guess is not very many.

Perhaps most heartbreaking is that a small amount of education makes this problem entirely avoidable!

What in the world am I referring to? Answer…Not filing a social security disability claim with the Social Security Administration (SSA).

Without exaggeration, the decision to file a social security disability claim could be the most important financial decision of your life.

I am not trying to melodramatic, rather, I would like to have your undivided attention for a few minutes. Reading this article and sharing it with family members and friends should insure that no one you know will make this mistake. Indeed, this article is also relevant to those who are still working because one never knows what the future may bring; nobody ever plans on becoming unable to work.

Mistake #1: Not filing a claim because of your own denial

Many people do not file a disability claim because often they are in denial about their inability to work. I am not suggesting you should file a disability claim the day after stopping work, in fact you shouldn’t. However, after being off work for 6-12 months you should be in a position to know whether you can return to and sustain full time work. Many people wait to file a claim hoping they will recover and return to work. Fortunately, people often need a few weeks or months to recover fully.

However, the “wait and see” strategy often lacks direction and becomes clouded due to our denial mechanism. America was built on perhaps the strongest work ethic in the world. Americans often take pride in driving themselves into the ground despite what their body or mind tells them.

We don’t want to believe we can’t work; it’s not fashionable in this country. Thus, most people hope for years they will get better and delay or forget to file a disability claim. All the while, they struggle financially when they could be receiving disability benefits which would significantly ease their stress making it easier to recover.

Instead, try this strategy…Make a decision to file a disability claim the moment you or your doctors believe you will be unable to work a minimum of 12 consecutive months. This could occur the day after you stop working, or within 6 or 12 months of your last day at work. However, I generally recommend waiting a minimum of 5 months to file a claim to allow sufficient time for you and the doctors to see how your condition progresses while not working.

This strategy also parallels the eligibility requirement for SSA disability benefits. In order to be eligible, you must be unable to work for a minimum of 12 consecutive months – you do not have to be permanently disabled. Thus, when you expect to be off work for 12 consecutive months, file your claim with SSA by calling (800) 772-1213 or by visiting a local SSA office. There is no charge to file the claim and it takes only minutes to do.

Mistake #2: Not filing a claim because “I don’t want to live off the system”

Another common reason people do not file a disability claim (when they should) is they “do not want a government handout or to live off the system.” For those who have worked at least 5 of the 10 years (the years do not need to be consecutive) before they became disabled, this notion is pure nonsense.

It is critical to understand that you have a disability insurance policy with SSA and the federal government. How did you obtain it? Remember all the money you paid in for W-2 withholding or self-employment taxes to Uncle Sam? Some of the taxes went to pay for SSA retirement and disability insurance. Thus, you have already paid Uncle Sam the premiums for a disability insurance policy. This insurance policy is no different than your health, life, auto or home insurance…the disability policy just happens to be with SSA.

Indeed, filing a disability claim is not living off the system – it is collecting benefits from an entity that forced you through mandatory withholding to pay for the insurance in the first place! You wouldn’t dream of losing your home to a fire and then not filing a claim with your insurance company. Similarly, with regard to disability insurance, SSA is just another insurance company.

The sooner you get over the “living off the system” frame of mind, the sooner you will be in a position to file your disability claim and make a smart financial decision that is in you and your family’s best interest.

Tip #1: At the very latest, file your SSA disability claim within 18 months of becoming disabled

The financial meltdown I referenced earlier invariably occurs because people wait too long to file a disability claim with SSA. Why does it matter when you file? SSA will only pay monetary benefits for a maximum of 12 months prior to the date of your application. This is true regardless of what date you became disabled.

Because there is a six calendar month waiting period before you are eligible for SSA monetary benefits, you can wait a maximum of 18 months to file a claim before it starts to cost you money each month.

By way of example, let’s assume you became disabled on February 1, 2001, but did not file a disability claim in 2001 because you thought you would get better and return to work. You finally decide to file your claim in August 2002. However, the most SSA will pay in retroactive benefits is 12 months prior to your application date, or back to August 2001.

Assume SSA agrees with you and finds you became disabled on February 1, 2001. The 6 month waiting period means you are first eligible for benefits beginning August 2001. Since August 2002 is 18 months after February 2001, August 2002 is the absolute latest month you could wait and still obtain all the monetary benefits you are entitled to.

The financial fiasco begins when you wait more than 18 months after becoming disabled to file a claim. Why? Again, because SSA only pays retroactive benefits for 12 months prior to your application date, regardless of the date you became disabled.

To see how quickly you can lose benefits, assume this time you decide to wait until August 2004 to file your claim. Let’s again assume SSA finds you became disabled on February 1, 2001. Like the prior example, after the 6 month waiting period, you remain eligible for monetary benefits beginning August 2001.

But since SSA only pays benefits 12 months prior to your application date, the first month you are entitled to receive monetary benefits is August 2003. The difference between when you were first eligible to receive benefits (August 2001) and when you actually are (August 2003) is 26 months. If we assume your monthly benefit amount is $1,000, your decision to wait two years to file your claim cost you $26,000 in retroactive monetary benefits. Of course, you would continue to receive the $1,000 per month into the future as long as you remain disabled, but the $26,000 is forever lost.

The prior example illustrates how expensive it is to wait beyond 18 months to file a disability claim. Imagine how staggering the loss can be if your family’s monthly benefit is $2,000, or if you never filed a disability claim with SSA.

Conclusion

In summary, hopefully you understand that you do have disability insurance with SSA and how critical it is to file a claim in a timely manner. By waiting 5 months to file your disability claim with SSA, you will give yourself and your doctors adequate time to determine if you will likely be unable to work for a minimum of 12 consecutive months. You will also protect all the monetary benefits you are entitled to when or if your claim is approved by SSA. Finally, you will avoid a financial trap that unnecessarily claims too many victims.

Remember to never quit and keep fighting for the benefits you deserve!

Scott E. Davis is a social security and long-term disability insurance attorney in Phoenix, Arizona. Mr. Davis represents clients throughout the United States. Although Mr. Davis has experience representing clients with a broad spectrum of physical and/or psychological disorders, the majority of his disability practice is devoted to representing individuals with chronic pain and chronic fatigue disorders. In almost every case, a fee is charged only if his client obtains benefits.

Mr. Davis invites your questions and inquiries regarding representation via telephone (602) 482-4300, or email: info@scottdavispc.com.

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13 thoughts on “Chronic Fatigue Syndrome and Fibromyalgia Patients: Should You File a Disability Claim?”

  1. onesassylady says:

    What resources are there for a homemaker[never paiworked outside the home], that now has Lupus / FM / degenerative disk disease, plus other problems? How do I get Medicare?

    1. annavirgil says:

      There are not resources for someone who is a housewife if you have not worked in the last ten years. I went back to work at a small part time job that I eventually could not work. That is the only way that I received Social Security Disability. I was able to get a much needed divorce which lessened some of the severity of my symptoms. Type in Social Security Disabilty on the web and see what needs to happen. Keep in mind your work does not have to be continuous or full time. If you get fired just keep getting another part time job. Your work does not have to be full time. It is worth taking the time to read the requirements for yourself.
      Wondering if someone is giving you the right information is not the way to go about it. Read it for yourself on the SS website.
      The information is correct there.

    2. jonig35 says:

      I have Fibromyalgia and I am a 42 year old college student, I have not worked in 2 years, but I do go to school in hopes that I can get a degree and be able to work in a counseling office, but I do not know if that keeps me from getting SSA.

    3. charming says:

      I am 41 female been diagnose in 2003 for fibromyalgia but been a state tested nurse assistant since 1995 and been working since then been with my present employer since 2001 and made some adjustments to keep working but now I’m feeling worst but I make believe and put on a front around my kids to make it seem like I’m hanging in there when I really want to stop but have finacial stability. I know that I will be denied and don’t want to go through the stress of being denied and in the mean time not wanting to loose the income I been getting by working hard taking care of other ill people.should I still apply for SSA or SSD?

      1. shellyMS says:

        did you apply while working? i have MS am still working but have to stop.. can I apply while i work?

      2. charming says:

        Hi Shelly I really don’t know how to apply while I’m still working I sure will find out!

      3. shellyMS says:

        I am 53 & have MS & probable fibromyalgia.. I am working but only scattered hours. My boss has been paying me a salary worth more than my work, because I have worked here for 25 years. My neuropsyc said I should think about applying for SS, because I have some cognitive issues, and is makes me basically incompetent to do my secy job. He was trying to keep me so that I could get disability, but still have an income till approval.. my neurologist said I can work 16 per week maximum, but basically Im getting almost full pay. I cant understand the SS.gov site, it doesn’t really answer the question of this situation. I went to the local SS office, and they said in order to talk to a person I had to req an appointment for applying for SS. I donn’t want to apply & get turned down.. I don’t know what to do. I have no income if I just leave my job. I am getting a divorce, & my 2 grandsons live w/me. (15, & 12) If anybody knows what I am to do.. PLEASE help me figure this out. I am on tons of medicines, my copays run me about 400.00 per month. If I leave work, I leave insurance. I am just totally overwhelmed.

      4. charming says:

        I am a nurse assistant at a hospital I just left one hospital to transfer to another but both hospitals are still the same but I had to leave my medical behind because the hospital dosen’t carry it anymore so now I have to find a new Dr. and make a new physician and patient relationship and scared that this Dr. wont care about my on going condition and when its’ time to file for SSD I’m scared that this Dr. can’t help me because of lack of history. So I just have to take the pain and tuck my tail behind me an kiss ass just to keep a paycheck comming. I don’t own my home I rent it and makeing financial changes will jeopardize my living arrangements. I have a boyfriend which is the father of my youngest lil girl who’s 10 and my 2 oldest 21 and 16 from an previous relationship. Even though I have boyfriend we only got back together in March from being broken up for 2 years, He can’t help with the bills cause he has his own bills and I don’t want to live with him not yet I don’t trust him quite like that ,but he do help a little with food and my oldest do work and my 16y/o just got a job last week but all my 3 children live with me and I don’t mind because the way a cost of living is now I won’t make my baby(21y/o) tough it out on her on So they are all depending on moms to give them a safe home to live in, So then I don’t file I have no help from a Doctor.I been searching for new doctors today and its so frustrating to find one but today is only day 1 . So I have to wait for a few more years to build a patient physician relationship to file for SSD. I don’t know how to go about it but people here on prohealth are so helpful and you learn a lot from reading the post ,So read all the post about applying for SSI/SSD ok and lets keep intouch I think we can become good friends Thanks for replying to my post ShellyMs:)

    4. snlittlered says:

      I was told back in the 80’s that I had chronic fatique sydrome. I was doing better as long as I kept active. Now I am 57 and started feeling pain all over 7 years ago. It has been 8 years now since I have worked and I just found out 3 weeks ago that I have fibromyalgia. I have to get more points for work in order to get disability. I don’t know how I can go back to work with this pain in order to get enough points to file for disablitly. Can I still file without the points I need. I did’nt apply for it before because I did’nt know what was wrong. Does anyone have an answer?
      Thank you
      Sandra

  2. pcynthia says:

    The article I just read was the second best I’ve ever read on filing for disability. The other was from a man who used to work on the SSD board and knew all the rules and ins and outs of the system. The 75% who get turned down, and those are the figures, have not done their homework. There is a lot of paperwork that can cut down your waiting time. The thing that really rang a bell in the other article I read was DO NOT REFILE. Once you are in the system, only APPEAL. He said appeal, appeal, appeal. Because that way you keep your name in the same line that it came into the office. Otherwise, each time you REFILE you go back to the bottom of the list. That is the problem most people have with these horror stories of waiting 5 years to get didability. NEVER refil, always appeal. And paperwork. Go to the office with bushels of paperwork. You have to spend at least 5 months of being treated to show that you and the doctor have done everything possible to cure you, make you better and you are’t going to get better before they will approve you for disability.
    GAther up and save every scrap of paper you can get your hands on. Keep everything. Get copies of every report for every test you have had taken. The more information the office has the better your chances are. Many people of the 75% walk in with a statement from their doctor that they saw the day before and expect to get money that day. Not going to happen. Pay for copies if you have to but get those reports. Actually you should not have to pay for them but some doctors offices will try to stick you for them too. Tell them the day you have anything done that you want copies of reports right away. If you wait months and go back and want your whole chart copied you will pay. But if you want only a copy or two they will give them to you.
    This man also said you do NOT have to hire a lawyer. A lawyer does you no good at all. All the lawyer does is send his secretary around to all your doctors and test facilities and get the copies that you should have gotten in the first place and then if you win, which you should, they get 25% of your back pay off the top. For doing nothing but what you should have done in the first place. But as this article stresses most of us don’t come out of a doctor’s office thinking “I’m disabled, I’ll never work again, I need to go file for disability right now”.
    I met one of my old doctors one day as I was trying to get down the hall without falling down and he spoke to me and then asked if I were getting disability. I said no, and he said you should have. I was shocked because as the man says here I was sure i would be cured and this would be over soon. That was 6 years ago. Two months ago I admitted to my husband that I am now disabled. I will never get better. I will never be able to do anything I did before. It was a hard let down for me. I still have not filed because of this and because my husband takes care of me even though it took all we had to pay for drugs, insurance and doctors.
    You aren’t giving up on life when you file. You can possibly get better, get off disability and go back to work. Some can work part time. Your life is not over but you do need some help with the extra bills and that’s what SSD is for. You can’t live on it but you can go into debt without it. It’s there for you and you worked for it. Now work to get it. JUST remember the keywords. PAPERWORK. APPEAL not refile.
    Don’t pay a lawyer to do what you can do for yourself. Remember if you hire one when you pay him, he didn’t do anything you couldn’t have done yourself and he didn’t do it anyway. He told his secretary to run down and pick up those papers. So do it yourself. Wait the 5 months and in that time you can be getting yourself prepared for the first visit to the SSD office.

    1. charming says:

      Thank you! pcynthia I will remember all the information you said and it helped a lot so when I file I’ll no not to refile once my name is in the system. I will appeal:)when i’m denied.

  3. packers1 says:

    In this article it say take 5 months to let doctor treat you ive been treated for 1 month but still working, but its getting hard, should i no longer work for 5 months the file.

  4. flaca1218 says:

    Mr. Davis would you take my case i have bee trying sence July 1, 2013. and I am pending that’s what social security say and my so call lawyer that i never talk to the only thing my so call lawyer office calls every two months to ask if i have received anything from social security and i say but your my lawyer your supose to know before i do that’s why you my lawyer there office is in PA, NJ this is my seconded lawyer that i never meet or talk to why can’t i get a normal lawyer that would help me if i didn’t have a partner who loves me and my two babies my doggies and my partmer daughter i would of left this world already i don’t want to lose my faith but i have worked all my life and with me not being able to work because also my carpal tunnel is so bad on my hands that i can’t wash dishes can’t dry my hair is hard to get dress ect ect. please help me or get me the help i need 3 years with out a penny and now with no insurance i can’t see my doctor that i finally open up to her after two years and feel comfortable because she care and has tried to help me by listening letting me cry when i go for my monthley visit and she is consern that i can’t get my medience and my visit because i no longer have health insurance because i don’t have any income and can’t buy one and my partner is only getting disablity $733.00 she pays the bills and rent with out her we would be in the street’s sorry for all the long letter but i need help. God Bless you for liseting.
    sorry but my spelling is bad can’t remember how to spell.

    Maria Garcia
    954-702-1320

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