“Disability” and “pain” are not synonymous, but they do have a very close relationship. Part of a disability is intense pain that makes daily living difficult. If Social Security Disability claimants do not visit doctors, a Claims Examiner might later claim the victim’s pain level must not have been very bad. This problem comes up in other areas as well, mostly car crash and other personal injury claims.
The coronavirus pandemic has made it harder for people to see the doctor and thus build up their disability claims. During the peak of the outbreak, many doctors reduced their hours, opted for remote video tele-med style conferencing calls and many remote clinics were closed altogether. Most disabled people have a hard time getting around and these obstacles made it even harder. So, many Claims Examiners make limited accommodations in this area.
A lot is at stake. The maximum Social Security Disability payment is over $2,000 a month. Generally, this money is tax free. Additionally, most SSDI claimants are entitled to retroactive benefits dating to the time of their applications.
Since medical evidence is such a critical part of a disability claim, at Heermans Social Security Disability Law Firm, we can help you find resources to better understand your type of disability. Additionally, it’s important knowing that the physician you are seeing specializes in the condition you are suffering from and that your appointments are helping your doctor stay in tune with your daily routine. They must be able to fairly assess you and properly treat your pain and condition limitations. So, if you are having trouble with your back, you see a back doctor, and so on.
What is a Covered Disability?
First, unlike Social Security Income, SSD is essentially a modified defined contribution plan. In other words, to get money out of the system (disability benefits), the claimant must have paid money into the system through taxes. Generally, a person must have at least forty payment credits. At least twenty of those credits must have been earned in the past ten years. This means roughly, that the claimant must have worked about 5 years of the last 10.
Largely depending on the amount of taxes they pay, most workers earn about four credits a year.
So much for the first component, which is basically financial. The second component of a disability claim is largely medical. Typically, SSD Claims Examiners use a five-step evaluation process:
- Current Employment: Contrary to popular myth, people who are working can still be “disabled” under federal law. These individuals simply cannot earn income above the poverty level. Examples of positions which are not SGA (Substantial Gainful Employment) include school crossing guards and Walmart greeters.
- Severe Condition: Note that the first medical inquiry is directly related to pain levels. Even before the Claims Examiners determines whether you have a legal disability, the pain must be so severe that it substantially interferes with everyday activities. Usually, the Claims Examiner only cares about work-related activities. Personal activities, like combing one’s hair, may not count.
- “Disabling” Condition: The Social Security Administration’s “Blue Book” includes a long list of presumptively disabling conditions. Victims who have such a diagnosis and meet the aforementioned pain qualification are presumptively disabled. A Social Security disability lawyer at Heermans Disability can also establish that the claimant has a substantially similar condition.
- Previous Work Possibility: “Disability” is not just a medical term. The word also has vocational, educational, and other implications. For example, a severe respiratory problem might be disabling to a coal miner or other “blue collar” physical labor type of worker. But this difficulty might not be an issue for a writer.
- Any Work Possibility: Severe respiratory distress might prevent the victim from working in certain fields, but other work options might be available. If these options include the possibility of SGA (Substantial Gainful Employment), an SSA law firm can still help you to establish a valid disability benefits claim.
The qualified condition must be expected to last at least a year, and the pain level must be consistently high throughout this period. Essentially, the victim must have many more “bad days” than “good days.”
Medical Evidence in SSD Hearings
The central issue in this area is whether the professional providing medical evidence was an acceptable medical provider. Until 2017, a disability lawyer in Memphis also had to account for the professional’s evidentiary weight, but the SSA rescinded this rule. Acceptable medical providers include the following professionals:
- Licensed physicians (MDs and DOs),
- Licensed optometrists,
- Physician Assistants
- Nurse Practitioners
- Physical Therapists
- Certified or licensed school or other psychologists,
- Licensed podiatrists, if the disability involves a foot or ankle problem, and
- Qualified language or speech pathologists.
Note that this list does exclude some medical professionals so it is best to consult with Heermans Disability to make sure your medical professional will be qualified to support your claim.
Frequently, when people go to the doctor’s office, they do not see a doctor. Instead, they see a physician assistant or perhaps a nurse or nurse practitioner. Many “doctor’s offices” do not even have doctors in the building, at least on a full-time basis. So, a licensed doctor can testify that the claimant has a certain disability. But their attending office staff may or may not be able to testify as to the victim’s day-to-day pain level.
As mentioned above, the SSA recently changed the rules in this area to include additional medical professionals with the same weighted credibility as physicians. Before 2017, physical therapists and other “unacceptable” providers could testify. Their testimony simply did not have as much weight.
That’s why we help our clients understand the importance of using the right doctor for the right conditions. This process has been made more difficult during COVID-19 because it has become more difficult to see a doctor. Many medical offices have closed their doors, reduced their hours, or are now doing tele-med style video conference calls in place of office visits. But in many cases, it’s the stitch in time that saves nine.
When the matter goes to an appeal, medical records are usually admissible in lieu of live testimony.
If you live in the Mid-South area of the United States and want more information about the nuts and bolts of a disability claim, contact Heermans Social Security Disability Law Firm. At Heermans Law Firm specializes in the one-on-one personal touch and we are here to help you get started on a claim, or if you are in the middle of a claim, and even if you have been denied. Send us an email or give us a call today at (901) 244-0057.