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Shelly Mark, Senior Attorney

Video Blog – Request for Reconsideration – Part 2

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Natalia Jofre: Hello, and welcome to Hill & Ponton’s Disability Blog. This is Natalia Jofre. I am the Social Security Section Director here for our firm.
Shelly Mark: I am Shelly Mark. I am the Senior Social Security Attorney with the firm.
Natalia Jofre: In our last blog we talked about if you’re denied you can file an appeal. It’s called a Request for Reconsideration. We made some recommendations regarding how to actually submit that appeal to Social Security and pitfalls that you should basically avoid when doing that. So, now once it’s actually submitted, your local law office is going to forward it to your disability determinations office.
There, it’s going to get assigned to an examiner, and that examiner’s going to look at whether they feel that you are now disabled. So, in other words, they’re going to reevaluate your claim and whatever information you have submitted since the initial application. They’re going to ask you a series of questions. They may send you for a doctor’s evaluation. They will definitely send you forms to complete, which are basically an update of everything you gave them the first time around.
One of the issues that we see a lot of our clients encounter is that they don’t want to complete those forms. They feel like nothing has changed. This isn’t important. Social Security’s playing games. They’re trying to compare what I said now to what I said before and so they’re trying to trick me, and nothing has changed, so I’m not going to fill these out.
Shelly Mark: Right.
Natalia Jofre: Huge mistake.
Shelly Mark: Right.
Natalia Jofre: Right.
Shelly Mark: Yeah. It’s a huge mistake because there’s, the likelihood is that it’s going to be another denial unless there’s some information that would change the examiner’s opinion as to why this decision should now be a favorable decision, when at the initial level it was unfavorable. What happens at that point is that if it is a denial we have to go to the third level of Social Security or the hearing level and request a hearing with an administrative law judge, which is fine; however, there’s a very lengthy wait to actually get the hearing.
Natalia Jofre: Yeah. So, whether it’s a very slim chance that you’re going to be approved at the reconsideration, and that is a reality. On average, 95% of cases are denied again, but the thinking behind that is that I don’t want to complete this because nothing has changed. You really should still complete those forms and submit them, for a couple of reasons.
One being that the longer you take to submit them, the longer Social Security is going to take to issue a decision, so it’s going to increase your wait time. Secondly, if you either don’t fill it out and don’t submit it or don’t respond to their request for contact, they’re going to put in your decision that you were either noncompliant or that you were denied because you didn’t basically give them the information that they wanted, or that you were a contact problem. All of those things will reflect negatively on you and your claim once you have to go before a judge at the hearing level.
Shelly Mark: Definitely. Those forms at the initial and the reconsideration level, they stay part of the file the entire time. Even when we go to hearing, during the hearings on several occasions, judges have referenced them specifically as to whether why didn’t this person go to their examination or why didn’t they complete these forms, or why are their forms different than what they’re saying now at the hearing. So, it’s really important that they are accurate.
Natalia Jofre: I have seen claims where basically the person gets to the hearing level, and if the judge feels that the claim wasn’t evaluated properly or thoroughly at the reconsideration level, we’ve seen them send them back.
Shelly Mark: Mm-hmm (affirmative). Yeah.
Natalia Jofre: I mean, it’s not common but it has happened a few times, and so you should just avoid all that by cooperating with them and giving them what they want at that level.
Shelly Mark: Yeah. Definitely. If you’re represented by an attorney, then if it were our client, we would definitely be encouraging them and advising very strongly to complete the forms or ask us for any assistance with the forms.
Natalia Jofre: Yeah. So, once you submit all of that information, the disability examiner will make a decision. They’ll then send it back to your local office. Your local office will actually issue you the decision, and that’s when you’ll know if you were either approved or denied. Like I said, 95% of cases are denied. So, if that happens, you then need to file another appeal, and I think we’ll talk about that some more in our next blog.
Shelly Mark: Great.
Natalia Jofre: All right. Well, thanks for joining us. If you have any questions, please feel free to contact our office or visit our website. Otherwise, we’ll see you next time.
Shelly Mark: Thank you.
Shelly Mark, Senior Attorney

Video Blog – SS Request for Reconsideration – Part 1

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Natalia: Welcome to the Hill & Ponton Disability blog. I’m Natalia Jofre, our Social Security Section Director.
Shelly: And I’m Shelly Mark, I’m our Senior Social Security Attorney.
Natalia: We wanted to talk to you today about what happens if you’re denied at the initial level, which we talked about in our last blog, and what your basic options are. If you’re approved, congratulations. It is somewhat of a rarity, because 85% of cases are denied, but if you’re denied then you can file an appeal and request what’s called reconsideration. That will now basically put you at the second level of the social security claims process.
In order to file an appeal, you have to complete very specific forms. You can get these online, you can submit your appeal online, you can go into your local social security office, or you can mail in your appeal. We recommend probably that you file it online because it is the fastest way to submit your appeal and cuts down on your wait time. That’s what we do for our clients. If you go to your local social security office, make sure you get their really early, or perhaps you can try and make an appointment.
If you mail your appeal, we strongly recommend that you send it certified return receipt so that way you have proof that it was actually received by the social security office because-
Shelly: They have a history of not receiving things that are actually sent to them.
Natalia: Right. They lose things a lot, and you don’t want it to come down to your word against there’s because the only options gonna be for you to start all over again. You have 60 days to file an appeal, plus five mailing days. That sounds awkward but it can come in very, very handy because let’s say you get your denial, you get sick, and time sort of passes you by, you had a total of 65 days then however, you want to make sure that it’s actually in their office within that time period because it’s technically 60. Go ahead.
Shelly: One thing that I don’t know about you, but I’ve noticed before is some of our clients may be aren’t at a permanent address while they’re filing their disability claim, and a lot of times at this point in their claim their correspondence may be sending to an address that they’re not at all the time, so they run into issues where they’re not getting the decision in a timely manner so that they can file an appeal.
Just a point to remember, make sure whichever address you’re using with social security is either your address, or if it is a different address, that it’s somewhere that someone’s gonna be notifying them as soon as the documents come in.
Natalia: That’s a really big deal. If you are having your denials or your mail in general sent to a relatives home, or a friends home, make sure that you are checking in with them frequently because social security is not going to accept, “My friend didn’t tell me that I got this denial.” As a reasonable explanation for why you didn’t file an appeal on time.
What they would accept would be something like you were hospitalized and you couldn’t, you physically weren’t able, or you mentally weren’t able. You know, if you were in a psychiatric facility, or if you were in a coma clearly you couldn’t file your own appeal. If it’s basically, “Well you know, my mom got it and she didn’t tell me, or they were on a twiddy house vacation fro two weeks and when we got back the mailbox was full.” None of that’s gonna be a legitimate explanation for them in order to file your appeal late.
I think next we’ll talk about what you actually do, and what actually happens once you file that appeal and where it goes, and what you can expect to happen next in our next blog.
Shelly: That sounds great.
Natalia: All right, great. Well thanks for joining us. If you have any questions feel free to call our office or visit our website.
Shelly: Thank you.
Shelly Mark, Senior Attorney

Video Blog – Filing an Initial Level Claim

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Natalia Jofre: Welcome to the Hill and Ponton Social Security Disability blog. I’m Natalia Jofre I’m our social security director.
Shelly Mark: My name Shelly Mark I am the senior social security attorney.
Natalia Jofre: We’re going to talk to you today about the initial level. The initial level is basically when you file a claim for social security disability benefits what you need to do, where you need to go and what all that entails.
Shelly Mark: Exactly. The initial element of social security is when the person first decides to and then actually files the claim of disability benefits.
Natalia Jofre: In previous blogs, we’ve talked about what are the basic prerequisites in order to file for benefits and you shouldn’t be working and all sorts of stuff like that. So when you’re actually going to file, you’re either going to call social security’s 1-800 number or you can visit your local office. The waiting periods are going to vary depending on where you live.
What I will say when it comes to waiting periods is social security will give you a pamphlet that says they have to give you a decision or that they will give you a decision in about 90 days and this is nationwide, they send this to everyone and they’re under no obligation to actually render a decision within that time period. They’re just basically trying to give you a ballpark idea of how long it’s going to take.
Shelly Mark: Right.
Natalia Jofre: We know a lot about ballpark time frames.
Shelly Mark: That’s correct. They like to give ballparks but not actually have any deadlines.
Natalia Jofre: Yeah. When you file the application if you do it by phone, they’ll then send you the actually application in writing for you to then review, make any corrections regarding any information they either recorded wrong or maybe you have rethought and might need to change. You make those corrections, you sign that written application and send it back. Obviously if you do this in the office, they just keep it while you’re there.
We normally recommend that people file online because it is much, much quicker. And you can do that by going to their website ssa.gov dot gov. It’s just faster and you’re giving all the information directly whereas to if you need to wait for an appointment with social security to actually talk to you and take this information either by phone or even going to their office. We’ve seen backlogs of two months just to get an appointment.
Shelly Mark: Wow.
Natalia Jofre: So you’re application’s going to be taken at the local office. Whichever local office and the way your office is basically assigned to you is based on your address and your zip code specifically. Once they’ve actually taken your application at the local office then they’re going to send it onto the office of disability determinations also in your local area. And then they’re going to evaluate your claim to see whether you meet the medical requirements to qualify for benefits. At the local office.
So let me go back a little bit. At the local office they’re going to look at do you meet the technical requirements. In other words, have you worked enough or is your income low enough, depending on which benefit you’re applying for. If you’re a widow, has it been within, all sorts of technical requirements. And then they send it to the office of disability and normally they send them forms, right?
Shelly Mark: Right.
Natalia Jofre: To fill out.
Shelly Mark: Definitely.
You’re going to receive forms about your functional ability to perform activities, very simple activities as far as cooking and cleaning and maintaining hygiene and then you’re also going to be sent forms about the work history. Really important to make sure when they fill these forms out that they’re very accurate. If you’re represented by someone, we would recommend that if they have any questions whatsoever they should definitely ask about those because the forms will become a part of the file and they’ll still be referenced and used all the way at the hearing.
Natalia Jofre: Which is super critical because if they start finding discrepancies in between what you said when you initially applied and what you’re now saying when you’re before a judge, they’re going to hone in on that and try to use it against you.
After you submit all of your forms and they get all of your medical records then they’re going to send it to a medical person and that person’s going to review your claim medically. Then they’re going to render a decision. If there’s a recommendation for you to be approved, they’re going to send it to another office out state and they’re going to either uphold that decision to approve it or if they’re just going to deny it, they’ll deny it locally and then the actual local office will send you the written decision.
And we’ll get into more about what you do after that happens.
Shelly Mark: Right. What would you say, Natalia what percent of cases do you think are approved at that very initial level?
Natalia Jofre: Here in Florida, well I think that this pretty much applies nationwide. I would say that 85% of cases are denied at the initial level. A very high percentage. The ones that you see get approved are the ones that meet some strict compassionate allowance or it’s expected that the person is going pass away in the very near future. Pretty extreme cases. But 85% of cases are denied on average.
Shelly Mark: And maybe we’ll discuss what to do if you’re actually denied at the initial level next.
Natalia Jofre: Yeah, we’ll do that in our next blog. So thanks for joining us, if you have any questions, feel free to call our office or visit our website.
Shelly Mark: Thank you.
Shelly Mark, Senior Attorney

Video Blog – SSDI Benefits – Additional Information

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Natalia Jofre: Hi and welcome to the Hill and Ponton Social Security Disability blog. I’m Natalia Jofre, I’m the director for our social security section.
Shelly Mark: I’m Shelly Mark, I am the senior social security attorney.
Natalia Jofre: We just wanted to give you a little bit of additional information. We previously talked about disability insurance benefits, otherwise known as regular disability benefits, and we told you the onset date and other benefits that can work in conjunction with that one. We just wanted to give you a little bit of additional information because, first of all, we have a lot of clients get confused with SSI, which is income based, but we wanted to let you know that disability insurance benefits are not affected by income for the most part.
Shelly Mark: That is correct. You can receive a private pension or a county retirement or the state retirement or some other form of income, and it’s not going to affect your disability, nor will family income, so your spouse’s income or anything like that will not affect it.
Natalia Jofre: You can be a millionaire and qualify for disability insurance benefits. There are a handful of benefits like workers comp, federal retirement benefits, it has to be that specifically, that can affect disability insurance benefits, but that has more to do with like, state/federal offsets than it has to do with household income and that that’s why it’s affecting your benefit.
Then the other thing we wanted to tell you is that with disability insurance benefits you also get Medicare. That is a huge medical benefit, and like we told you before, there’s a 24 month waiting period from the date you became entitled to that benefit. You do have to pay for it. The premium is somewhere in the ballpark between $100 and $200 a month, but you are able to get private healthcare or treatment with your Medicare benefits.
Shelly Mark: That is correct.
Natalia Jofre: That’s another huge bonus.
Shelly Mark: Definitely, and Medicare is very widely accepted. It’s very good insurance, and you will receive that 24 months after your entitlement date. It’ll be from when you’re found to be disabled, minus that five month waiting period we talked about.
Natalia Jofre: Yeah. All right, so that’s it for today. If you have any questions feel free to call us or visit our website, and we’ll see you next time. Thank you for watching.
Shelly Mark: Thank you.
Shelly Mark, Senior Attorney

Video Blog – SS Disability and Unemployment

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Natalia Jofre: Hi, and welcome to Hill & Ponton’s Social Security disability blog. I’m Natalia Jofre, the Director for our Social Security section.
Shelly Mark: I’m Shelly Mark. I’m the Senior Social Security Attorney.
Natalia Jofre: So, the last time we talked about onset date, and we briefly touched on unemployment benefits, and we wanted to talk to you more about unemployment, because we have a lot of clients that call us and say, “I’m getting unemployment benefits. I can’t work. I wanna get Social Security as well,” or are not working because, you know, “I got fired,” or, “I got laid off because of my disability,” and so they wanna know, can they file for Social Security disability benefits as well or not.
Shelly Mark: And our firm … Here, we usually tell people that we would prefer them not be receiving unemployment benefits at the same time that they’re alleging disability from Social Security. We do understand that, as a necessity, sometimes people have to take their unemployment benefits, and they are still looking for work, but due to their disability they’re not getting calls back, they’re not finding work, and so they do need to pursue their disability claim.
But this would probably be one of those situations where we would tell them, “It’s fine that you got your unemployment for three months, but we are gonna go ahead and change your disability date to when that’s stopped.”
Natalia Jofre: And the reason that poses a problem is because, when you file for unemployment benefits, you sign a waiver, and that waiver says that you’re ready, willing and able to go back to work at any time. When you get, or when you file for Social Security disability benefits, you are also alleging that you are unable to do any type of work or be retrained to do any type of work, and so what happens is, if you get to a hearing and you’re before a judge, and they’re looking at this, and the examiner’s before them, and they’re like, “Wait a minute. THere’s a discrepancy here. There’s a direct contradiction. You’re telling us you can’t work, and then here, to get this benefit, you are actually looking for work, and saying that you’re ready, willing and able to go back to work at any time.” That contradiction poses a real problem for your disability claim.
So, like Shelly said, you can file for Social Security benefits, and technically you can continue to get your unemployment benefits. Just know that it’s very probable that it’s gonna present a significant problem, and that it’s either going to preclude you from getting approved or, at the very least you’re going to have to explain … And we do that all the time.
Shelly Mark: Right.
Natalia Jofre: We’ll explain to the judge, “Look, it was either this or homelessness.”
Shelly Mark: Right.
Natalia Jofre: But, like you said, they normally don’t want to grant benefits for the same period of time that you are getting unemployment, because if you do that, then it’s almost as if you’re double dipping. The government is basically paying you twice for months where didn’t work.
Shelly Mark: Exactly. They see it as, you know, the government’s paying you for a period of time not to work, and then they’re paying you to work, or to seek work, so it is definitely a contradiction. It is one that can be clarified, but usually, at least with our cases, we do change it so that we’re not asking Social Security to pay someone while they’re receiving unemployment benefits.
Natalia Jofre: All right. Great. Well, that concludes today’s blog. If you have any questions, feel free to visit our website or call our office. Otherwise, we’ll see you next time.
Shelly Mark, Senior Attorney

Video Blog – Onset Date – Additional Information

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Natalia Jofre: Hi and welcome to the Hill and Ponton Social Security Disability blog. I’m Natalia Jofre. I’m the Director for our Social Security section.
Shelly Mark: And I am Shelly Mark. I am the Senior Social Security Attorney.
Natalia Jofre: So the last time we were talking about onset date. What that is, what its importance is, when you’re filing for social security disability benefits. And Shelly, you wanted to share some more about what that is, and what effects it.
Shelly Mark: Yes. That’s exactly right. Your onset date, like we discussed, is really the day that you’re saying you became disabled due to your medical conditions and unable to work. In theory, this would be the day that you stopped working due to your medical conditions. There are a lot of different things that can affect adjusting that onset date. This can happen at any time during your claim. One of the big issues that we see as attorneys, is that someone may have became disabled and stopped working in 2013, but they had no insurance and they didn’t start treatment until let’s say 2014.
Natalia Jofre: Right.
Shelly Mark: So when you’re working with an attorney, you may have them come to you and say, “Look, I think we need to amend your onset date, because you don’t have any evidence to support your subjective complaints of pain or whatever it may be.” The reason that they’re telling you that is because the judge’s decision can’t be based on how you feel. It’s got to be based on whether it be MRIs in the file, or evaluations from a psychiatrist. There has to be some piece of evidence in the file to support your personal allegation that you were disabled and unable to work. So while we may counsel you to change your onset date, it’s not that we’re saying you weren’t disabled when you stopped in 2013. It’s just that we know that the judges will not be able to grant your claim, until the evidence actually supports that.
Natalia Jofre: So it’s not just what you say, what you feel, what you allege. But more importantly, what you can prove.
Shelly Mark: That is exactly correct. Because really, your medical records are really the only proof that we can use in a disability claim.
Natalia Jofre: So if you didn’t have any treatment or any evidence per se during the period of time when you were actually disabled, you should probably reconsider when you became … Not when you became disabled, but when you started your medical treatment.
Shelly Mark: Right.
Natalia Jofre: When you can prove that your disability began.
Shelly Mark: That’s exactly right. As attorneys, that’s what we’re here to help you with. We’re here to … I always tell clients we want to package this claim as nice as we can, so when the judge looks at it, he doesn’t give it a second guess. It’s clear. This is supported by evidence in the file. This is clearly a person that’s disabled. Go ahead?
Natalia Jofre: Nope, that’s it. Did you have anything else regarding onset date?
Shelly Mark: Yeah. There’s a couple of other situations when we will usually amend onset date, and one is if you’re receiving unemployment compensation. A lot of people start working on a certain date, they stop working that date due to their disability, but they may be receiving unemployment compensation. We normally will proactively amend the date past any unemployment compensation so that the judges don’t have to go back and forth on their own to figure out, “Well, they’re saying that they’re able and available to work, and they’re getting these benefits, but then they’re also saying that they’re disabled, and that they’re not able to work.” So once again, in that situation, we just want to eliminate any situation to where the judge is going to be questioning your claim, basically.
Natalia Jofre: Yeah.
Shelly Mark: And in one other situation, is when you’re going to be moving into a more favorable age group.
Natalia Jofre: Oh.
Shelly Mark: So you may become disabled, again, let’s say 2014. And let’s say in 2015 you turn 55. So we may counsel you at that point that your claim becomes much more favorable once you reach that advanced age group that we talked about earlier.
Natalia Jofre: Right.
Shelly Mark: We may counsel you that you may lose six to twelve months of benefits, but that once again, when this goes before a judge, he’s going to be able to see … He or she is going to be able to see the claim and know right away that you were disabled.
Natalia Jofre: Yeah. So it’s in your best interests to have a much better shot at being approved, and lose a handful of months worth of benefits, versus going for that earlier date and potentially not being approved at all.
Shelly Mark: Absolutely. I think that this is one of the benefits, really, of having an attorney really review the file and review the evidence, and just make sure that the date that you’re alleging you became disabled is, one: supported by the evidence; two: supported by the fact that you weren’t working; and then three: also supported by the age group that you’re in.
Natalia Jofre: Yeah.
Shelly Mark: It’s really important.
Natalia Jofre: Okay. So next time we’re going to be talking a little bit more about unemployment benefits and disability, and how that works together or doesn’t. So if you’ll join us next time. For now, if you have any questions, feel free to visit our website or call our office.
Shelly Mark: Thank you.
Shelly Mark, Senior Attorney

Video Blog – Alleged Onset Date

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Natalia Jofre: Hi. Welcome to Hill & Ponton’s Social Security Disability website. I’m Natalia Jofre, the Director for our Social Security section.
Shelly Mark: And I am Shelly Mark. I’m the Senior Social Security Attorney here.
Natalia Jofre: The last blog we were talking about disability insurance benefits, and what some of the basic technical requirements are for that benefit.
  One of the biggest factors, when you’re applying for any disability benefit, is what’s called your onset date. Shelly’s going to explain a little bit, what your onset date is.
Shelly Mark: You’re going to hear your ‘alleged onset date’ the whole time after you’ve filed your claim with social security, and a lot of different definitions to what an onset date really is.
  Your onset date is the day that you became disabled and unable to work due to your medical conditions. That’s really when your onset date is. It’s not when you got laid off from your job. It’s not when you got fired. It is when your medical conditions prevented you from working on a substantial basis any longer.
  We see a lot of errors made when people are asked what their onset date is. I think a lot of that is because, usually when people file their initial claims they do it unrepresented. So they’re just talking to social security on the phone, and social security usually asks them, “When is the last time that you worked?” And ‘when’s the last time that you worked’ becomes their onset date, when, in fact, it may have absolutely nothing to do with their disability or why they stopped working at all.
  What happens is, if you allege the wrong onset date, and there’s no evidence to support that onset date, you’ve pretty much just sealed the deal that you’re going to be over 24 months wait, because you’re going to have to go to a hearing.
  You’re going to have to wait. You’re going to have to go before a judge, and you’re going to have to clarify this onset date at a hearing. When we’re involved, we amend onset dates all the time with our claims.
  The onset date has to meet the evidence. You can be disabled for a very long time, but if you don’t have the medical evidence in the file to support that onset date, then it’s not an accurate onset date.
Natalia Jofre: And social security, or the hearing office, will sometimes do that. They’ll have a claimant, and they’ll say, “Well, we don’t believe,” and that’s why they’re always saying ‘alleged’ onset date. Because until you’re actually approved, it’s not set in stone that this is really the date you became disabled. This is the date that you’re claiming, that you’re alleging you became disabled.
  We’ve had clients where they’ll get to the hearing office, and they’ll say, either the judge or the attorney advisor … whoever is reviewing the case will say, “I don’t believe that this is really the correct onset date.” Then they can call us and negotiate that.
Shelly Mark: Absolutely.
Natalia Jofre: And say, “Well, this is why I don’t like it’s right. This is what I do feel is right, and this is why.” Shelly many times can have this banter with them, and basically present evidence, but this is all a phone conference. They can many times make a decision based on that.
  They told us at our last conference. They were like, “If the person isn’t represented” … they’re not going to call you and have the conversation with you.
Shelly Mark: That’s true.
Natalia Jofre: You basically then have to wait until you go to a hearing, present your case before the judge. If you haven’t changed that date, and you’re sticking to that date, and the judge just doesn’t find that you meet their requirements based on that date, they’re going to deny you.
Shelly Mark: That’s correct. I feel like I could go on and on about the onset date, because it is truly one of the most important things to your disability claims as far as the judges being able to grant the claim.
  I don’t know. Maybe we should do another video, and go a little more in-depth about it.
Natalia Jofre: Yeah. It’s a pretty long topic, so we’ll go ahead and do another video on that. In the mean time, if you have any questions, or just want some additional general information, feel free to visit our website, or call our office.
Shelly Mark: Thank you.
Shelly Mark, Senior Attorney

Video Blog – Disability Insurance Benefits Overview

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Natalia Jofre: Hi and Welcome to Hill & Ponton Social Security Disability blog. I’m Natalia Jofre. I’m the director for our Social Security section.
Shelly Mark: And I am Shelly Mark. I’m the senior Social Security attorney.
Natalia Jofre: Today we’re going to talk about one of the benefits that you can potentially qualify for under the Social Security Disability Program, and that is disability insurance benefits. The acronym is DIB, and a lot of people like to refer to it as “regular disability.” It’s because disability insurance benefits people think that that encompasses all of the benefits, this insurance is almost as good as insurancepartnership.org/motor-trade-insurance/ but with a different purpose. In reality, that is the name of the one regular benefit.
Shelly Mark: Right.
Natalia Jofre: One of the basic criteria to qualify for regular disability … It would be that you have to have worked and paid into Social Security taxes …
Shelly Mark: Right.
Natalia Jofre: … for at least five out of the last 10 years.
Shelly Mark: That’s a really big one, Natalia, because I’ve had friends, family, clients that have needed to file for disability, and for the right reasons. They’re very sick or whatever it may be, and they really did not realize that they had to have worked five out of the past 10 years. They thought maybe because they had worked 20 years, and they had stopped, that they would still be eligible, and that is not the case. So it is really important to realize that you have to have worked five out of the most recent past 10 years to be eligible.
Natalia Jofre: What you do is when you’re working and paying into Social Security taxes, you’re earning what are called earnings quarters. You have to make a certain amount, so it can’t just be, “Well, I worked from January through March. That’s a quarter of the year. I should get a quarter for that year.” No. If you made $500, you’re not going to have enough for an earnings quarters … an earnings quarter. You need to make somewhere in the ballpark of let’s say $1,300. But if you work, and let’s say you make $8,000 for the whole year, and you make that money just in one month … Like we see this all the time with real estate agents. Let’s go get a nice hefty commission check in November, and maybe it’s for like $8,000 and that will pay for their quarters for the whole year.
  So it doesn’t have to be that you worked the whole year, even if you made the amount in one particular month, but it was high enough and you paid Social Security taxes on that money, it could give you earnings quarters for the whole year. So that when you’re talking about working five out of the last 10 years, that’s what they’re looking at … how many earnings quarters do you have? The other thing is that there’s a five month waiting period.
Shelly Mark: That’s correct too. Basically, Social Security is going to owe you benefits from your onset date or the day that you’re alleging you became disabled, until when they’re actually paying you, but there is a five month waiting period. That’s a rule that’s across the board. It’s for everyone that is approved for disability benefits. It just means that for the first five months, you’re not going to be entitled to payment.
Natalia Jofre: The other alternative would be … Let’s say you waited to apply. They’re going to apply … It’s either going to be a five month waiting period or one year prior to your date of application. That’s in order for them to start paying you. Why do they do that? One of the most important things … and it will be the note that we end on … You will be penalized by Social Security if you wait to apply. The specific reason they have that rule in place is … Let’s say you became disabled in 2011. Let’s say maybe you were a housewife, and your husband was doing well, and you didn’t really feel the need to apply for benefits, and he was making more than enough money. So even though you were disabled, you just didn’t apply for benefits. Now his situation has changed. Maybe, he got another job. He’s making a lot less money, so now you’re like, “Now we need that extra income. Let me go ahead and file for my disability benefits.”
  Well, Social Security isn’t going to pay you all the way back to 2011 because you chose not to apply. They’re going to look at when did your disability actually start, when did you apply for benefits, and then even if you were disabled since 2011, they’re only going to pay you one year retroactively from the date of your application.
Shelly Mark: This is something just to note that we have to explain to our veteran clients as well. This is a big difference with the VA and Social Security, so we have to explain to not only our veteran clients, but to all clients, that if you allege you were disabled back in 2009, and you have the evidence to support that … If you didn’t file until 2014, you’re only going to get paid back the 12 months prior to your file date.
Natalia Jofre: We have a lot of cases for veterans that they’re no longer insured now. A lot of them come back from war with severe PTSD, so they don’t want to have to do anything with anyone, so they don’t apply for benefits. Several years pass, and then by the time they file, they’re past their date last insured. We’ll do a whole other blog on that because that’s a very complicated topic, but all of this to say that they won’t get benefits all the way back. But as long as we can prove that they were disabled prior to that date, they can still qualify for benefits. So that’s a really good point.
Shelly Mark: A lot of the things … The reason that I see veterans say that they don’t apply for Social Security is because their VA is pending. What we want to encourage them to do is to go ahead and apply for Social Security while your VA is pending, and let both process through.
Natalia Jofre: You don’t have to apply for one or the other. You can apply for both at the same time. All right, great. We will talk more about different benefits and their entitlement dates, and onset date. I think we’re going to do our next one on onset dates because that’s a really important topic.
Shelly Mark: Very.
Natalia Jofre: So we’ll see you next time. If you have any questions in the meantime, visit our blog or call our office.
Shelly Mark: Thank you.
Shelly Mark, Senior Attorney

Video Blog – Veterans and Other SS Benefits

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Natalia Jofre: Hi, and welcome to Hill & Ponton Social Security and Disability Blog. I’m Natalia Jofre, the director for our Social Security section.
Shelly Mark: And I’m Shelly Mark. I’m the senior Social Security attorney.
Natalia Jofre: As you may know if you’ve been watching our blogs, we’ve been talking about veterans’ disability benefits in conjunction with Social Security disability and how they can help each other and things like that. One of the things that we were discussing is applying for Social Security if you’re a disabled veteran and how that can help.
Shelly Mark: Right. You’re gonna kind of have a situation where it’s gonna depend on which one of your benefits is approved first to which is going to have the favorable use of the evidence from the other, meaning if your Social Security is approved and you’re found to be disabled and unable to work, then we will use that evidence in your VA claim to prove that you are disabled and unable to work. Although the government agencies aren’t required to agree with one another, they are required to give a certain weight to the evidence that the other agency has found you to be disabled. So it’s not an automatic shoo-in. Just because Social Security says you’re disabled, the VA can disagree. And just because the VA says you’re disabled, Social Security can certainly disagree, and they do that frequently.
Natalia Jofre: And we have people tell us that all the time. “One’s a federal agency and the other’s a federal agency. How can one say I’m disabled and the other one doesn’t?” And it’s like, “Listen, we agree with you. You know, we feel the same way, but we don’t make up the laws and we don’t decide who wins and who doesn’t.” But it’s a really good point and it is real favorable evidence for whichever case is still pending.
Shelly Mark: Exactly.
Natalia Jofre: One of the other things is not just benefits for the veteran, but benefits for the veteran’s dependents. If you’re a disabled widow or if you’re a disabled adult child or even a disabled child, a dependent child, any other person that’s potentially eligible for DIC benefits, sometimes we’ve had situations where the widow will say, “Well, I’m already getting this from DIC, so I can’t pursue that.” And what we wanna tell you is, don’t make that decision on your own.
Shelly Mark: Right, let us try to at least take a look and see, because like you said, there are a lot of situations to where, as a widow or a disabled child you may be entitled to benefits from the Veterans’ Administration as well as the Social Security Administration.
Natalia Jofre: And there are a lot of rules and regulations that go into that. I mean, it is not an easy read where, “Oh, let me just figure this out and see if I can get benefits.” I always tell people, “Apply for benefits. If you’re not gonna qualify, let them deny you and find out what you’re technically dealing with.” Because I will tell you, people are commonly denied for medical reasons, and that’s what we specialize in, is appealing those medical denials, but I am also seeing, more and more now, technical denials where they’re telling people, “You technically don’t qualify. You don’t meet these parameters.” And it’s actually an incorrect decision.
Shelly Mark: That’s very, very true.
Natalia Jofre: Yeah, so we can appeal those as well. And then in addition to that, there are other benefits that you can sometimes qualify for as a disabled veteran, just in a much grander scale, much grander scope. Like in the state of Florida, you can get …
Shelly Mark: The property taxes annu- there’s a property tax exemption, I think with certain recreational fishing license, hunting license, and things like that. And I think there’s more out there than that, but it’s definitely something to look into if you are and have been found to be a disabled veteran.
Natalia Jofre: Yeah. A lot of those depend on whether you’re 100% service-connected. I know that the- I believe. I shouldn’t say I know. I believe. And this is why we don’t like to specifically advise on those things, is because they can change. Sometimes if you’re 100% service-connected, sometimes if you have a lower connection. What we always recommend is that people talk to their VSOs and let them tell you the scope of what you can qualify for in your area, because sometimes it does depend on the state you’re in, what you can qualify for, for free. But added benefits are added benefits.
Shelly Mark: Absolutely. One pattern that I tend to see a little on the Social Security side of things are a lot of denials of veterans that are 100% service-connected but are under the age of 50. So we wanna really encourage those veterans not to give up on the claim. Definitely, seek out help. Come to us or someone else to see if there is an avenue to have you approved. If you are under 50 and you’re 100% disabled through the VA, very, very common to be denied at those first two levels, but it can be a very different outcome once you get before a judge. So just keep pursuing it.
Natalia Jofre: That’s good. All right, that’s all for today. We’ll see you next time. If you have any questions, feel free to visit our website or call our office. Thank you.
Shelly Mark, Senior Attorney

Video Blog – Veterans and Medicare

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Natalia Jofre: Hello and Welcome to Hill & Ponton’s Social Security Disability blog. I’m Natalia Jofre. I’m the Director for our Social Security Section.
Shelly Mark: My name’s Shelly Mark and I am the Senior Attorney with the Social Security Division.
Natalia Jofre: Recently married. Hence, the little hesitation on the last name. Shelly and I were talking and the last time we did a video, we talked about Veterans benefits and how a Veteran can also qualify for Social Security Disability and we realized that there’s other benefits to pursuing a Social Security claim, not just the monetary benefits. One of those being Medicare.
Shelly Mark: Definitely. When someone is approved for Social Security Disability, they’re also going to be eligible for Medicare benefits. There is a waiting period for Medicare once you’re approved for disability. That is 24 months but that is a retroactive waiting period. Once that waiting period’s over, the individual will be entitled to Medicare. So if they have the VA then they can still use the VA at the Veteran’s Administration and then use their Medicare if they want to see any private doctors.
Natalia Jofre: A lot of people get confused with the waiting periods. They’re like 24 months. It’s 24 months from when you became entitled to benefits. So, let’s say Social Security finds that you’re disabled as of January 12th of 2014. There’s a five month waiting period you’re not paid for and they don’t start counting that in January. They start counting it the following month. So it’ll be February, March, April, May, June, July. July of 2014, you become entitled to Social Security so July of 2016, you would become entitled to Medicare.
Shelly Mark: Right.
Natalia Jofre: The other thing and one of the reasons that we find, sometimes, Veterans don’t elect to take the Medicare when it’s offered is because it’s not free.
Shelly Mark: That’s true.

 
Natalia Jofre: Right?
Shelly Mark: Right.
Natalia Jofre: There’s a premium. It’s somewhere between 100 and 200 dollars a month.
Shelly Mark: Right.
Natalia Jofre: I think it’s like 140 or 160 at this point.
Shelly Mark: I think so. I know it fluctuates.
Natalia Jofre: Yeah.
Shelly Mark: That’s true because some Veterans feel like they have enough care through the VA and it’s free.
Natalia Jofre: Mm-hmm (affirmative).
Shelly Mark: So they don’t really feel the need to have the Medicare. I think it’s probably nice for people to have the option in case they are seeking out any private treatment.
Natalia Jofre: Yeah.
Shelly Mark: But it is definitely just a personal decision.
Natalia Jofre: We do talk to a lot of Veterans that are unhappy with the doctors that they’re able to see through the VA.
Shelly Mark: That’s true.
Natalia Jofre: So it is a really good benefit to have if you’d like to have private care. You know, go to your own doctors, go to a hospital of your choosing and whatnot.
Shelly Mark: Right.
Natalia Jofre: So it is a pretty big benefit. I do want to say, though, that if you decline Medicare, you are not able to just take it whenever you want it. So in other words, there’s an open enrollment period. When you become entitled to disability benefits, they’re going to offer you Medicare. You can take it then and there. But if you decide not to take the benefit and then three months down the road you’re like, “Well, you know what? Kind of made a mistake. I should have taken it.” You can’t just jump on Medicare whenever you want. You then need to wait until the following year’s open enrollment period to be able to elect those benefits and get on the plan at that point. So, just keep that in mind if you’re a Veteran or any other person getting Social Security Disability. That you can’t necessarily get on or get off of that benefit whenever you want.
Shelly Mark: Right. Yeah, that’s definitely a good reminder. I think that a lot of people with the VA go ahead and do take the Medicare just to have a secondary insurance policy. You never know what might happen and you may be somewhere where you need to go to a private hospital or have some imaging done that maybe the VA is not able to pay for. In that case, Medicare will step in and pay for that for you.
Natalia Jofre: All right, great. Well, we’re going to be talking about some other Veterans benefits in our next blog so be sure to join us then. Otherwise, if you have some questions regarding Social Security Disability or Veteran’s Disability benefits, feel free to contact us at our website or call our office.
Shelly Mark: Thank you.