One costly trap many people fall into is not filing a claim for disability benefits as soon as they should. Recently, we have spoken with too many people who have not filed a disability claim even years after they became unable to work! The primary reason seems to be a lack of education about how and when they are entitled to disability benefits.
Often times we are told, “I don’t want to live off the government or I don’t want welfare benefits!” If you learn one thing from this article please let it be this: your eligibility for disability benefits is based on the fact that you have paid taxes into the social security administration (SSA) during the years you were working.
Remember the taxes ole’ Uncle Sam takes from your paycheck? Everyone knows some of it goes to pay for the generous retirement benefit you may receive some day get from SSA (Please don’t count on it!). However, many people do not know the taxes also go to provide you with disability insurance benefits. Look at it as if you have a disability insurance policy with SSA. This insurance policy is no different than an auto, health, disability or life insurance policy you have with a private insurance carrier. Thus, you are eligible for disability benefits from SSA due to the fact you were forced to pay into the SSA system…the benefits are not a government handout or welfare!
Certainly you would file a claim and expect to be compensated by your auto insurance company if you were involved in an auto accident. You must view your SSA disability claim with the same sense of entitlement. In fact, if your disability claim is denied by SSA you should get angry and fight just as you would if a medical claim was denied by your health insurer!
When Should You File a Claim for Disability Benefits?
File a disability claim with SSA when and if one of three scenarios applies to you:
(1) you have already been disabled and out of work for one year, or (2) your doctors expect that you will be unable to work for a minimum of one year from the date you last worked, or (3) your medical condition is expected to result in death.
Too many people have told us that SSA employees often tell them they can’t file a claim until they are out of work for one year. This information is totally incorrect and if followed will almost certainly cost you benefits and medical (Medicare) insurance!
The information is incorrect because you can file a claim any time after you stop working due to disability. However, if a year has not passed since you stopped working then you must prove that your condition will prevent you from working for at least one year. But it is important to understand that a disability claim can be filed the day after you stop working due to a disability.
As a practical matter, we advise that you wait to file a claim for at least four (4) months after you last worked. The four (4) months will give you and your doctors an opportunity to assess how your condition responds to treatment and determine whether it is likely to prevent work for a minimum of one year.
The best advice is to apply for disability benefits as soon as you or your doctors believe your medical and/or psychological condition will prevent you from working for at least one year. Waiting to pursue your claim may cost you benefits that cannot be recovered if you are eventually approved.
Compelling Reason #1: Filing for Disability Benefits Protects Your Entitlement to Disability and Retirement Benefits!
As you may be aware, both SSA retirement and disability monetary benefit amounts are generally based primarily on your SSA earnings record and how much social security and/or self-employment tax have been paid into the system.
Any year or period of years that a wage earner is not working and/or not paying social security/self-employment taxes will have an affect (reduction) on their disability and retirement monthly benefit amounts. If a number of years pass without working or paying taxes into the SSA system, the consequence can be dramatic.
An individual who has an established period of disability will have their earnings record frozen during the period of disability. In other words, even though they are not working and paying SSA taxes, SSA does not use those non-earning years in calculating the retirement benefit amount. This preserves the SSA retirement benefit amount as of the time the individual last worked.
Filing a claim for disability benefits also preserves your entitlement to disability insurance benefits based on your own earnings record. In general, you will only be insured (at best) for five (5) years after the time you last worked. If it has been more than five years since you last worked, you probably are not insured and not entitled to disability insurance benefits (although you may still have a claim for supplemental security disability income). Thus, to make sure you have a claim for disability insurance, file a claim no later than five years after you stopped working.
Compelling Reason #2: Obtaining SSA Disability Benefits entitles you to Medicare Coverage!
If your disability claim is approved, you will automatically be entitled to Medicare insurance. Few people are aware of this significant added benefit.
Eligibility for Medicare parts “A & B” automatically begins on the 25th month after receipt of disability insurance benefits. Medicare “A” covers hospital visits and some follow-up care. There is no charge for Medicare “A” coverage. Medicare “B” covers doctor’s visits and other related care. If you want Medicare “B,” a premium (For year 2000 it is $45.50 per month) must be paid to SSA. However, even at that rate it is a real bargain. Some individuals file a claim for disability benefits primarily to obtain Medicare coverage rather than to obtain the monthly monetary benefit.
Remember, you have a lot at stake in filing a claim for disability benefits, try to do everything to maximize your chances for success
Best of luck in your pursuit of disability benefits and remember never to quit!
Scott E. Davis and Scott M. Harris are social security and long-term disability insurance attorneys in Phoenix, Arizona. They are the founding partners of Harris Davis, PLC. Although they have experience representing clients with a broad spectrum of physical and/or psychological disorders, the majority of their disability practice is devoted to representing individuals with FMS and/or CFIDS. Mr. Davis and Mr. Harris represent clients throughout the United States. In most cases a fee is charged only if their client obtains benefits. They invite your questions and inquiries regarding representation via email: email@example.com or telephone (602) 482-4300.