When You Can't Work

I Can’t Work! What’s Next?

If you are unable to work, you may be eligible to receive disability benefits. Every plan has a different definition of ‘disabled.” Some private plans even pay benefits if your disability is temporary or if you are unable to work in your previous job.

There are two types of disability benefits: private (paid by an insurance company or an employer’s benefit plan) and public (paid by the Social Security Administration). Whether you have public or private coverage, you must submit a written application for benefits, include medical documents that prove your disability, and provide information about how your work skills are limited. If you have disability benefits through your employer, contact the human resources department, which can help you with the application process.

Public benefits can be either permanent or for a specified period of time (a “closed” period). It is possible to qualify for closed period benefits event when you don’t qualify for permanent benefits.

Private Disability Benefits

To quality, you must:

►    Have purchased your own disability insurance or;

►    Have disability benefits through your employer and;

►    Meet the specific criteria for disability under your plan.

To apply, you must:

►    Follow the application instructions

To appeal a denial, you must:

►    Follow the appeals process set forth in your contract or benefit plan documents, and

►    Meet all time deadlines.

Public Disability Benefits

There are two types of public disability benefits available through the Social Security Administration, Supplemental Security Income (SSI) and Social Security Disability Income (SSDI). You can apply for both of them at the same time, and if you qualify, you can receive both of them. If you are approved, you start collecting benefits from the date of your application; SSDI benefits are not paid until six months after the on-set date of your disability.

To qualify for public benefits, you must:

►    Be unable to do any kind of work for which you are suited

►    Have a disability that will last at least a year or, eventually, result in death unless you qualify for the closed period of benefits;

►    Have worked and made Social Security contributions for a specific period of time in order to receive SSDI benefits;

►    Have very little income and few assets in order to receive SSI benefits, which have strict resource limits.

To apply, you must:

►    Get an application from your local Social Security Administration office; or;

►    Apply on-line.

►    Complete your application;

►    Include your complete medical records, and;

►    Include a doctor’s statement from your treating doctor that will include:

• When your condition began and how long it is expected to last; (Diagnosis, prognosis)
• How your condition limits your activities and, specifically, your work-related activities;
• What the medical tests indicate;
• What treatment has been provided and;
• A description of the side effects of treatment is also helpful.

To appeal a denial, you must:

►    Appeal within 60 days of your receipt of the denial letter;

►    Ask for reconsideration, and/or a hearing, depending on appeal level;

►    Follow the remaining appeal steps.

If your claim is still denied at the hearing level, you can request Appeals Council review. If denied by the Appeals Council, you can appeal to Federal Court.

Make and keep a record

Applying for disability benefits can be challenging.  The process may take longer than you have patience.  Do not get discouraged.  The following suggestions will help you succeed.

►    Keep a record of the names and numbers of all Social Security personnel who help in the case.

►    Save all notices/papers received from Social Security.

►    Keep a copy of all forms/papers that are sent to Social Security.

►    Keep a record of the dates of all visits to, or telephone conversations with, Social Security, and a summary of what was said.

►    Write down appeal deadlines.

►    Keep a record of the names and contact information of all health care providers.

►    Keep a record of all appointments with health care providers, treatment dates, therapy dates, hospitalizations, etc.

►    Keep a record of all medications and changes in medications.

►    Keep a diary of daily activities, including reactions to treatment, symptoms (pain, fatigue, etc.), and other pertinent details about your physical and mental condition and the limitations that have resulted.

Make certain your physical and mental limitations are known

Accurately presenting your limitations is important when filling out the Initial Application, Function Report, or Daily Activities Questionnaire. Be sure to include details about your condition and its effect on your functioning in daily life. For example, do not just list that you do house cleaning and cooking. You will want to add the details of how you pace yourself, take breaks, and make sure that you highlight the tasks you do not perform. State how your tasks/activities have changed in light of your condition. Include your rest periods in your description of your day. 

If you have good and bad days, state them on the forms. Describe your bad days and how limited your activities are on a bad day. For example, does pain, fatigue, or other side effects from treatment affect your mental focus? Is your concentration/mental focus different? Make sure that you add these details about your functioning to your Social Security forms.

Non-Permanent Condition (Closed Period)

While there is no short-term disability under Social Security, there is a closed period of disability. The disability must still last a minimum of 12 months but is of an anticipated duration. (For example an individual has a cancer diagnosis, surgery, physical therapy, treatments, and a recovery lasting 12 + months, but eventually returns to work). In a closed period case, Social Security benefits are paid only for that period of time prior to the return to work. No on-going benefits are paid. A closed period would be appropriate when an individual is severely impaired for at least a 12 month period but expects to eventually recover enough to return to work.