Disabled or Hurt? Only 800 Days to Wait for SSDI Rejection

BOSTON ( MainStreet) -- Tragedy often factors into shrewd financial planning.

Life insurance, perhaps with a long-term care rider, anticipates the medical hazards of aging. A trust, backed by a will, ensures that loved ones are supported after we die. We are advised to sock six months to a year of pay into an emergency fund.
It can take years to maybe, just maybe, collect those Social Security disability benefits you're relying on.

But all that is usually fueled by a paycheck. When an accident or debilitating illness strikes, aside from some specific insurance holdings, you may see all your foresight wasted.

The good news is that there is Social Security Disability Insurance, a government benefit provided through the Social Security Administration. A portion of FICA taxes funds the program, which was established in 1954. Benefits are paid out to those unable to work (for at least a year) until they either well enough to resume their job or traditional Social Security kicks in at age 65.

It may sound like a godsend to those who need it. The bad news is that it can take years to maybe, just maybe, collect.

According to the SSA, a 20-year-old worker has a 3-in-10 chance of becoming disabled before reaching retirement age. Approximately 3.4 million people applied for SSDI in fiscal year 2011, and the majority were rejected -- by nearly a 3-to-1 margin.

Even getting to the point of rejection can be a challenge. The backlog of cases has grown to more than 1.8 million people across all levels of the five-step evaluation process, and the cumulative wait time can be more than 800 days. That logjam is expected to worsen in years to come as government cutbacks trim the SSA's staff, even as newly allowed medical conditions and mental disabilities increase the number of applicants.

"The SSA has acknowledged that they are really strained as far as resources," says Rebecca Ray, a spokeswoman for Allsup, a nationwide provider of Social Security disability and Medicare compliance services. "They are doing what they can, but it is a very difficult situation for the agency. Hopefully you can get through it as quickly as you can, but it's a very restrictive program. It's not as simple as Social Security retirement when you turn a certain age, file and just start getting your benefits."

Ray makes a pitch for those seeking SSDI to consult with a firm such as hers, or other specialists, at the start of the application process. Going it alone can be frustrating and lead to additional delays if the application is flagged, and therefore denied, for any reason.

"You have to demonstrate that you had earnings, that you had a work history and that you have become insured through the program because you paid your FICA payroll taxes," Ray says. "You have to medically document that you have some impairment, condition or chronic illness that's going to keep you from working for a year or longer ... all of that makes it much more difficult."

Ray says it is important to file for SSDI as soon as it's apparent you may face a long-term disability.

"There's sometimes this thought: 'I'll just wait and when I know for sure this is my situation then I'll apply.' There is some risk if you wait too long to apply. It's possible if you haven't been working for a long enough time you may not be insured for SSDI benefits," she says. "You really want to look at your options as soon as you can, especially if you are limited with other alternatives for sustaining yourself while you are dealing with the effects of your disability."

There are also benefits not all potential applicants are aware of.

"Twenty-four months after you start receiving SSDI, you become eligible for Medicare coverage," Ray says. "You may be able to extend your COBRA health care coverage until you receive that Medicare coverage. There are other possible benefits for your dependents who are under the age of 18."

A successful SSDI application also freezes your earnings, preventing those non-earning years from dragging down the salary average Social Security retirement benefits are based on.

Beyond going into the process uneducated or without support, common mistakes include underestimating and understating the impact of a disability, Allsup says.

"A good example is a 50-year-old grandmother who tells the SSA that she takes care of her grandchildren," according to a company-produced guide. "If the woman doesn't explain that the children are adolescents and self-sufficient, the claims representative may deny her claim because he believes that if the woman can watch her grandchildren, she's capable of working in a day care center."

Just as bad is exaggerating a condition.

"For example, a man who uses a cane at a hearing before an administrative law judge but doesn't normally use a cane would be over-representing his condition," Allsup warns. "Using this example, the judge may ask to look at the cane and sees the tip is not worn. The claim is immediately suspect, even though the claimant may have had a legitimate case if he'd just stuck to the unexaggerated truth. It is important to elaborate, but not exaggerate."

Other damaging miscues are being vague about your work history, incomplete paperwork, missing deadlines and, perhaps worse of all, letting initial discouragement lead to just giving up.

-- Written by Joe Mont in Boston.

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