Given the need to show that one will remain totally disabled from all forms of gainful employment for a year or longer, despite prescribed treatment (or that one’s condition is likely to result in death), it is important to avoid filing for benefits too early. Filing too early will in many cases cause the Social Security Administration (SSA) to issue a denial based on their determination that while one’s medical conditions may be severe and disabling presently, they are not expected to remain severe and disabling for what will be a year or longer.
With that in mind, there are a number of considerations your Social Security lawyer should be providing you when discussing whether proceeding with a Social Security disability claim makes sense. The first consideration one should take into account is just how long one has remained out of work as a result of their disabling condition: has it lasted the better part of a year and caused you to remain out of work during this period of time? If so, how clear is it that there will not be improvement inside of a year such that you’ll be able to return to some manner of gainful employment?
For example, if the surgeon is telling you that the recovery from a back surgery is 3 to 6 months, it may not be advisable to rush an application in for benefits. By doing so, SSA may very well deny the claim (noting that recovery is anticipated inside of a year) and that the medical condition does not meet the duration requirement of the Social Security rules and regulations.
However, it is important to consider the fact that SSA will pay a Supplement Security Income (SSI) benefit beginning the month after one applies if ultimately one is approved for benefits, and if it is determined that during the period following the application the individual otherwise remained in poverty circumstances. Thus, waiting to apply for benefits may cause one to lose out on SSI benefits that would otherwise be payable. This consideration needs to be weighed strongly against the strong likelihood that your case will be denied for failing to meet the duration requirement. Such a quick denial will, in turn, result in the need to undergo a rather lengthy appeals process: a reconsideration process that can take an additional 3-6 month (which is now required in New Hampshire, as well as Maine and Massachuetts, and a subsequent need to go through the hearing process can take up to an additional year or longer.
If, however, there is an income in the household (such as that of a spouse who is working, or short and/or long term disability income) that would cause one to be otherwise disqualified from receiving SSI benefits, as the income brings the household above the SSI income welfare guidelines, then there would be no reason to file early. Similarly, if there are assets that exceed the SSI guidelines, then there would be no reason to file for SSI in the first place. Given the 5 full month waiting period for SSDI benefits to be payable, and given SSDI benefits can be paid going back as far as 1 year prior to the date of one’s filing, benefits would not be payable in any event until the 6th month after going out of work in the first place. Therefore, an application in months 7, 8 or 9 will allow for an evaluation of one’s condition at right around the year mark.
The analysis for each individual case may be slightly different or may take into account nuance considerations that one otherwise would not know if they are not experienced practitioners in this area of the law. Always run your case by an experienced Social Security disability lawyer who can guide you through the considerations that need to take place in your particular case.