Get Answers to Your Legal Questions in Our FAQ
Dealing with a legal issue whether it be applying for and receiving disability benefits, fighting for a personal injury claim, or navigating through a divorce, can be a challenge, and many people are left with questions about what they can do to get the help they need. At the law offices of Loyd J. Bourgeois, we understand how hard it can be to get the answers you need. That’s why we’ve put together the following list of Frequently Asked Questions (FAQs) and answers dealing with family law, personal injury, disability benefits, claims, and appeals and the related law in Louisiana.
The following are some FAQs that I receive as a Louisiana attorney. They may answer some of the questions you have regarding your Social Security Disability appeal, your long-term disability insurance denial, your personal injury claim, or your Louisiana divorce. If you have a question that is not answered here, please call the legal team of Loyd J Bourgeois, LLC at 985-240-9773.
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Can I receive SSDI for fibromyalgia? Tips for application
WHAT IS FIBROMYALGIA?
Fibromyalgia is a chronic condition that affects about 5 million Americans. The hallmark of fibromyalgia is muscle pain throughout the body, typically accompanied by:
- Sleep problems
- Anxiety or depression
- Specific tender points
Symptoms can also include joint stiffness, difficulty swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction. The American College of Rheumatology (ACR) defines fibromyalgia as “widespread pain in all four quadrants of the body for a minimum duration of 3 months and at least 11 of the 18 specified tender points which cluster around the neck and shoulder, chest, hip, knee, and elbow regions.”
CAN I RECEIVE SOCIAL SECURITY DISABILITY BENEFITS FOR FIBROMYALGIA?
Fibromyalgia pain and fatigue can impact your ability to work. Social Security Disability benefits may be available to you.
If you are not engaging in gainful activity due to Fibro, the Social Security Administration must determine if you have an impairment that is “severe.” This is step 2 of the evaluation process. (Visit my prior blog post explaining the steps of Social Security’s Sequential Evaluation Process.) The SSA has accepted that fibromyalgia can constitute a medically determinable impairment. (See my previous post on Social Security Ruling 12-2p concerning the evaluation of disability applications for Fibromyalgia.)
Generally, to establish fibromyalgia as a medically determinable severe impairment, you must show:
- Widespread pain for at least three months.
- Pain on palpation in at least 11 of the 18 tender point sites (as identified by the American College of Rheumatology).
- Morning stiffness or stiffness after sitting for a short period of time.
At step 3 of the Sequential Evaluation Process, the SSA determines if your condition meets a listing. There is currently no listing for fibromyalgia, but it is possible that your related symptoms/conditions meet a listing.
If your related symptoms do not equal a listing, the Social Security Administration will next assess your residual functional capacity (RFC) (the work you can still do, despite your fibro), to determine whether you qualify for benefits at steps 4 and 5 of the Sequential Evaluation Process. The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.
TIPS FOR SSDI APPLICATION FOR FIBROMYALGIA
- Make sure a fibromyalgia diagnosis is in your medical records. We’ve mentioned this before for long-term disability, but it is also true for SSDI, “know your medical records.”
- Make sure your medical records document ALL of your symptoms and limitations. Your medical records should not just document your pain. Let your doctor how often you feel the symptoms, how severe each symptom is, and how long each episode lasts. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms.
- See a specialist. A fibromyalgia diagnosis from an orthopedist, rheumatologist, or a chronic pain or fatigue specialist will carry more weight than the same diagnosis from a family physician or internist professional.
- See a mental health professional. If you are suffering from depression or anxiety, see a mental health professional to diagnose, treat, and document these conditions. Fibro is often accompanied by or is the cause of mental health conditions. However, it is important that the actual fibromyalgia diagnosis comes from a specialist and not your counselor, therapist, or psychiatrist. (see above)
- See your doctor regularly and keep your appointments.
- If you can, provide evidence of a long work history.
- Provide examples of unsuccessful attempts to return to work and/or unsuccessful attempts to work in a decreased capacity.
- Include information from nonmedical sources to support your medical claims. Gather Information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time. These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
- Keep a journal. Make regular notes about your impairment, level of function, and treatments.
- If you get denied, know if you should appeal the decision or reapply for disability.
- If you need assistance, contact an attorney who specializes in Social Security Disability and has experience obtaining SSDI benefits for Fibromyalgia. Call Loyd Bourgeois at 985-240-9773
Which is better for people with diabetes, bypass surgery or stents?
According to The American Heart Association, death rates from heart disease among diabetics are two to four times higher than those who are not diabetic. Not surprisingly, researchers have been focusing on care for diabetic patients with cardiovascular diseases. A recent editorial published by Dr. Mark Hlatky in the New England Journal of Medicine argues that patients with diabetes fared significantly better when treating clogged arteries with bypass surgery than with stent implants.
Dr. Hlatky, a cardiologist, argues that recent research found that bypass surgery was more beneficial for diabetic patients than newer drug-eluting stent technology to improve blood flow. The research indicated that the five-year rate for suffering a major cardiac event or nonfatal stroke was 26.6 percent for those whose arterial blockage was treated with a stent, while bypass patients had an 18.7 percent rate—a reduction of approximately 8%.
This is important news for a New Orleans Social Security Disability attorney to pass onto his clients, since Louisiana ranks 4th worst for heart disease related deaths and has the 7th most people with diabetes in the country. Diabetes is one of the many diseases that can create several related disabling health conditions and magnify other health problems.
When you have been diagnosed with a disease such as diabetes, the potential for developing disabling health conditions may be a key factor in filing for social security and long-term disability benefits. It is important to discuss your health care and some of the latest studies with your doctor to help you stay in good health even with a disabling health condition.
Can I get Social Security disability benefits for chronic liver disease?
Chronic liver disease is listed under SSA Medical Listing 5.05, the category of impairments known as the Digestive System (5.00). Many Louisiana Social Security Disability claimants live with a chronic liver disease and may be entitled to benefits. When considering an application for Social Security Disability benefits based on chronic liver disease, the severity and duration of your disease along with prescribed treatments are evaluated. This includes effects of medication, therapy, surgery, laboratory results and any other form of treatment you receive, as well as any side effects of your treatment that further limit your functionality.
What Is Chronic Liver Disease?
Chronic liver disease is characterized by liver cell necrosis, inflammation, or scarring (fibrosis or cirrhosis), due to any cause that persists for more than 6 months. It may result in portal hypertension, cholestasis (suppression of bile flow), extrahepatic manifestations, or liver cancer.
Significant loss of liver function may be manifested by hemorrhage from varices or portal hypertensive gastropathy, ascites (accumulation of fluid in the abdominal cavity), hydrothorax (ascitic fluid in the chest cavity), or encephalopathy. There can also be progressive deterioration of laboratory findings that are indicative of liver dysfunction. Liver transplantation is the only definitive cure for end-stage liver disease (ESLD).
Examples of chronic liver disease include but are not limited to, chronic hepatitis, alcoholic liver disease, non‑alcoholic steatohepatitis (NASH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis, hemochromatosis, drug‑induced liver disease, Wilson’s disease, and serum alpha‑1 antitrypsin deficiency. Acute hepatic injury is frequently reversible, as in viral, drug‑induced, toxin‑induced, alcoholic, and ischemic hepatitis. In the absence of evidence of a chronic impairment, episodes of acute liver disease do not meet 5.05.
Symptoms may include, but are not limited to, pruritis (itching), fatigue, nausea, loss of appetite, or sleep disturbances. Symptoms of chronic liver disease may have a poor correlation with the severity of liver disease and functional ability.
Signs may include, but are not limited to, jaundice, enlargement of the liver and spleen, ascites, peripheral edema, and altered mental status.
Laboratory findings may include, but are not limited to, increased liver enzymes, increased serum total bilirubin, increased ammonia levels, decreased serum albumin, and abnormal coagulation studies, such as increased International Normalized Ratio (INR) or decreased platelet counts. Abnormally low serum albumin or elevated INR levels indicate loss of synthetic liver function, with increased likelihood of cirrhosis and associated complications. However, other abnormal lab tests, such as liver enzymes, serum total bilirubin, or ammonia levels, may have a poor correlation with the severity of liver disease and functional ability. A liver biopsy may demonstrate the degree of liver cell necrosis, inflammation, fibrosis, and cirrhosis. Imaging studies (CAT scan, ultrasound, MRI) may show the size and consistency (fatty liver, scarring) of the liver and document ascites.
SSA guidelines regarding chronic liver disease are extremely detailed. If you have a chronic liver disease and are in need of disability benefits, you should consult with an experienced Louisiana Social Security Disability Benefits attorney who can work with your doctors and your medical records to build your case.
How will Social Security's new ruling SSR 12-2p affect my Fibromyalgia claim?
The Social Security Administration (SSA) issued SSR 12-2p which concerns evaluation of disability applications for Fibromyalgia (FM). This SSR is important to FM patients in Louisiana because SSA finally acknowledges this severe and debilitating disease is a valid diagnosis and a potential basis for disability.
Quick summary of SSR 12-2p:
- SSA acknowledges Fibromyalgia is a medically determinable impairment that can be the basis of disability;
- Guidelines are established for treating physicians to follow to document the diagnosis;
- This ruling does not really change the system already in place to determine the severity of the symptoms from FM when determining total disability, but it reminds SSA adjudicators and ALJs of the value of non-medical observations.
- The medical records of the treating medical specialists remain the primary source of evidence.
SSR 12-2p – Proving the Diagnosis
The Ruling provides two means of proving the diagnosis of Fibromyalgia. Both are dependent upon the content of your treating physician’s medical charts. Both focus on tests established by the American College of Rheumatology (ACR). The alternatives for proving diagnosis are:
- Proof of 1990 ACR Criteria, including all three of the following:
- History of widespread pain in all four quadrants of the body (both left and right, above and below the waist) along with a history of spinal pain, which has persisted for at least 3 months at varying levels of intensity: and,
- At least 11 positive tender points found bilaterally, and above and below the waist. The physician must document the positive tender point findings and indicate the use of approximately 9 pounds of force;
- Medical exclusion of other disorders that could cause these symptoms.
- Proof of 2010 ACR Preliminary Diagnostic Criteria, including all three of the following:
- History of widespread pain as noted above;
- Repeated evidence of 6 or more FM symptoms, or co-occurring conditions. Some examples include:
- Cognitive or memory problems (“fibro fog”)
- Unrefreshing sleep
- Irritable Bowel Syndrome (IBS)
- Muscle weakness
- Cognitive problems
- Reynaud’s phenomenon
- Bladder issues
- Medical exclusion of other disorders that could cause these symptoms.
These criteria are not new or surprising. Many ALJs in New Orleans Social Security Disability hearings are aware of the variety of symptoms related to FM. The Ruling, though, may cause ALJs to require more careful documentation from the treating physicians. This ruling does provide fibromyalgia patients who want to apply for social security disability a guideline for discussing symptoms with their doctor.
Some issues that may result from this Ruling include, but are not limited to documentation of “9 pounds of force” in tender point testing. How many tests will be enough? How often do these symptoms have to be noted to satisfy SSA? What if other comorbid conditions do exist?
SSR 12-2p – Proof of Symptoms and Disability
This Ruling reinforces the idea of a “longitudinal” review of the records. Generally, the more consistent the treatment and complaints of pain and other symptoms, the more credibility will be given to your doctor’s medical records. A longer treatment history with increasing pain and other symptoms along with decreasing functionality can be very helpful in proving your FM and disability.
While medical records are heavily considered and hold the most weight, other sources of medical information are often helpful. This ruling reminds SSA of the importance of these records, from other treatment providers such as counselors, neighbors, clergy, past employers, relatives, and friends.
The Ruling does acknowledge repeatedly that FM symptoms and signs may vary in severity over time. This is a helpful observation. Adjudicators and ALJs are reminded to review “all relevant evidence in the case record.” The point is made, however, that SSA can rely upon a one-time consultative examination if an FM applicant has no other probative records. Those one-time consultative examinations rarely reveal much to support FM claims.
The Ruling does note that symptoms such as pain and fatigue may preclude the ability to do even unskilled work. However, the challenge remains that there are no medical tests that can prove the existence of pain or fatigue, and, more important, no test that measures the severity of these symptoms. These symptoms must be clearly and consistently noted in the treatment records to be considered credible by an ALJ.
Therefore, it cannot be restated often enough: the critical evidence in any disability application is the treating records of the treating specialist. SSA generally gives greater weight to treating rheumatologists and pain specialists in FM cases than to general practitioners. The decision makers will read every note from every treating source. Make sure you are communicating your symptoms at every visit. Do not assume that because the doctor “knows” about your symptoms that they are being documented. If your limitations and problems are not in the medical charts it will still be difficult to persuade SSA of their severity. While SSA will have to consider other evidence, they will still primarily focus on the medical documentation.
SSR 12-2p eliminates any last vestige of doubt about the existence of Fibromyalgia as a severe medical problem which can cause a patient to be totally disabled under the Social Security Act. This is great news for Houma & Metairie Social Security Disability claimants. The Ruling does not change what you will have to prove to obtain disability benefits, but it does provide clear guidance that will prove useful in meeting your burden.
What Happens To Your Social Security Disability Claim If You Die Before Approval?
As a Louisiana Social Security Disability Attorney, I am sometimes asked by claimants and others “What if I die before my SSDI application is approved?” While many of us do not like to think of such things, this question does have an answer.
With the long wait times between initial applications and hearing decisions (or court decisions), if your claim is approved, there is often substantial back benefits due to you if and when your claim is approved. The first thing to know is that the claim usually does not die with you. If your claim is approved after your death, the benefits should be paid until the date of death. Anything owed to you at the time you die will probably be paid to someone else. The question is who.
In Social Security Disability Insurance, or “Title II,” cases, any payments due to you before you die are paid under priorities set forth in the Social Security Act. These benefits are not paid according to your will or your state’s law. This is the list of priorities:
- The surviving spouse of the deceased individual who either (i) was living in the same household with the deceased at the time of death or (ii) was, for the month in which the deceased individual died, entitled to a monthly benefit on the basis of the same wages and self-employment income as was the deceased individual;
- The child or children, if any, of the deceased individual who were, for the month in which the deceased individual died, entitled to monthly benefits on the basis of the same wages and self-employment income as was the deceased individual (and, in case there is more than one such child, in equal parts to each such child);
- The parent or parents, if any, of the deceased individual who were, for the month in which the deceased individual died, entitled to monthly benefits on the basis of the same wages and self-employment income as was the deceased individual (and, in case there is more than one such parent, in equal parts to each such parent);
- The surviving spouse of the deceased individual;
- The child or children of the deceased individual (and, in case there is more than one such child, in equal parts to each such child);
- The parent or parents, if any, of the deceased individual (and, in case there is more than one such parent, in equal parts to each such parent); or
- The legal representative of the estate of the deceased individual
There is an exception where back benefits are not paid according to the above and that is where the case is only Supplemental Security Income (SSI), or “Title XVI,” and you are not married or living with you spouse and you are not a child claimant living with a parent. In this case, the SSI benefit can be paid to the spouse living with the claimant or a parent with whom a child claimant has been living.
The family member who follows the claim will need to submit a copy of the claimant’s death certificate as well as a completed “Substitution of Party Upon Death,” HA-539 and SSA-174 “Claims For Amounts Due In Case of A Deceased Beneficiary”. If an attorney was representing the claimant, the Social Security Administration would follow its normal procedure of processing the attorney’s fee.
In addition, if the disability claim ends up being approved and the claim was for SSDI, surviving family members may be eligible for a continuing benefit. For more information, the SSA provides additional information to help when a family member dies. If you have specific questions about your claim, call disability attorney Loyd Bourgeois at 888-552-4773
What are skilled and unskilled occupations under SSDI?
An issue that you may face when you apply for Social Security Disability benefits, especially if you are over-50 and fall onto the Medical-Vocational Grid, is the subject of skilled versus unskilled occupations. An understanding of these terms is important because how your prior work is classified can be determinative of whether or not you will be entitled to disability benefits under the Grid Rules.
Unskilled occupations are the least complex types of work. Jobs are unskilled when persons can usually learn to do them in 30 days or less.
A simple example would be a dishwasher in a restaurant. Other jobs can also be learned in 30 days or less, such as product assembler, crossing guard and laborers—although these may not be as obvious.
In the Houma area, these unskilled occupations can be something like an assistant at a car wash.
Skilled occupations are more complex and varied than unskilled and semi-skilled occupations. They require more training time and often higher educational attainment.
Skilled occupations may require abstract thinking (chemists and architects, for example), or special artistic talents (an example is a school band instructor or pottery maker).
Practical knowledge of machinery and understanding of charts and technical manuals can indicate a skilled occupation. Other attributes include organizational skills, working extensively with people, making difficult decisions in short time frames, and developing data.
Jobs requiring a professional license are usually skilled—barber, lawyer, doctor, accountant, and even HVAC mechanics or automotive mechanics, too.
Skilled work can be broken down even further to semi-skilled. These are occupations such as heavy equipment operators, masons, and specialty machine operators.
Why Is Your Work Classification Important to your SSDI Claim?
Under the Medical-Vocational Grid rules, how your past work is classified can be the deciding factor into whether you get benefits. Let’s look at an example:
We will take a Thibodaux resident with less than a high school education and past relevant work as a painter (a semi-skilled occupation), which is a medium exertional job. This individual’s Residual Functional Capacity (RFC) is at the sedentary exertional level due to degenerative disc disease, arthritis, and a cardiac condition. He cannot perform his past relevant work and has no transferable skills.
If this person is:
45 – He is not disabled under the grids;
52 – He is disabled under the grids;
58 – He is disabled under the grids.
If the individual had an RFC of light, and was:
45 – He is not disabled under the grids;
52 – He is not disabled under the grids;
58 – He is disabled under the grids.
For this reason, understanding how your prior work is classified is important to the success of your Louisiana Social Security Disability Claim. If you have questions about your work classification or disability claim, call Loyd Bourgeois at 985-240-9773 for a free consultation.
Can I Get Social Security Disability benefits for COPD?
I am currently working on a New Orleans social security disability application for a client with chronic obstructive pulmonary disease (COPD). I thought it would be good to discuss how a disability claim for COPD is evaluated by SSA under the listings.
COPD is a listing level disease. It is a Respiratory Impairment. It is listed at Listing 3.02(A). This means that if your medical records establish the requirements set forth in the listing then your disability application should be approved at Step 3 of the Sequential Evaluation Process. This is important because if your COPD meets the requirements in the listing, then SSA does not have to evaluate whether or not your COPD prevents you from performing past relevant work or work generally available in the national economy.
What Is Required To Meet Social Security’s COPD Listing?
The listing provides as follows:
“A. Chronic obstructive pulmonary disease, due to any cause, with the FEV1 equal to or less than the values specified in Table I corresponding to the person’s height without shoes.
Height (w/o shoes) (cm) Height (w/o shoes) (in) FEV1 equal to or less than (L, BTPS) 154 or less 60 or less 1.05
FEV1 is defined as the forced expiratory volume at one second – that is – it is the amount of air a person can exhale (blow out) in one second.
If you are close to meeting or do in fact meet, the FEV1, you are in pretty bad shape health wise. The values SSA uses for the FEV1 analysis are considered low because SSA is erring on the side of caution.
Claimants who have COPD usually cannot tolerate dust, smoke, or fumes and can have problems with extreme temperatures or humidity. COPD usually results in an exertional impairment. The full extent of the exertional impairment will have an impact on whether your COPD qualifies for disability.
Many disability applicants with COPD are older than 50 and thus, fall onto the grids. Winning disability for a claimant younger than 50 with COPD is difficult unless the COPD is termed as moderate or worse (and often severe or worse is required) and results in significant exertional impairments.
Social Security will also look at your longitudinal medical record (your medical history over time) to determine whether treatment provides any functional recovery. If you do not have a regular doctor or receive regular medical care despite your COPD, you may not be able to meet the listing, but may be able to equal the listing or show functional limitation sufficient to qualify you for benefits.
Typically, if you apply for social security disability alleging Chronic Obstructive Pulmonary Disease or another respiratory ailment, SSA will send you for a consultative examination. At this CE, the doctor will perform a spirometric pulmonary function test. This test measures your FEV1.
SSA has developed detailed rules for interpreting the FEV1 results and uses your most stable state of health values for determining whether or not you meet the listing.
Even if you do not meet the listing for Chronic Obstructive Pulmonary Disease, your COPD may result in sufficient functional limitations to prevent you from performing your past work or any work in the national economy. At Louisiana Disability Law, we have experience obtaining disability benefits for clients with COPD. If you have COPD and need help applying for Social Security Disability benefits or need to appeal a denial, give us a call at 985-240-9773.
What Is The Any Occupation Review?
You have been receiving long-term disability benefits for about 12-18 months and then you receive a letter from the insurance company that says something like this:
According to the provision of your group policy, in order to be eligible for LTD benefits you must meet the following definition of disability:
Total Disability or Totally Disabled means you are prevented from performing the Essential Duties of:
1) Your occupation or a reasonable alternative job offered to you by the employer during the elimination period and for the 24 months following the elimination period; and
2)After the 24 month period, Any Occupation.
Your LTD benefits became effective 12 months ago. To continue receiving benefits after 24 months, you must be disabled from any occupation.
Please be advised that we have initiated an investigation to determine if you will qualify for benefits after the 24 months have elapsed. We will notify you regarding our determination.
What exactly does this mean? You were granted disability benefits because you couldn’t work. You still cannot work. What is the insurance company talking about here?
Almost all (at least that I have seen) employer-provided long-term disability policies have a change in the definition of disability after you have been receiving disability benefits for 2-years (or 24-months). I have seen some that change after 1-year (or 12-months).
The change is that you must be disabled from performing any occupation instead of just your own occupation.
This is a major change.
For example, if your occupation was a truck driver at a light-medium exertional level, your back injury may qualify you for long-term disability benefits initially. When the definition changes, the question is does your disability prevent you from doing ANY OCCUPATION – such as clerical work, inventory work, or other sedentary type occupations.
The disability company understands that if you are entitled to benefits after this point in time, then chances are you will be receiving benefits for a long time. The disability company does not want this. The “any occupation review” is done by the long-term disability insurance company at or around the time the definition of disability changes in your policy. The change in definition gives the insurance company an opportunity to deny perfectly valid disability claims under the guise of the claimant being able to perform some type of occupation. In doing their “any occupation review,” the insurance company will often use a vocational expert (VE) to opine on whether or not with your disability you can perform the substantial and material duties of another occupation.
In some policies, the definition requires that you be suited for the occupation by age, education, training, or skill while others require that the occupation results in you earning, at least, a certain percentage of your pre-disability gross income. However, many policies place no restrictions on the type of occupation the insurance company can say you are qualified for.
You can expect to receive a number of documentation requests and/or interviews in the months leading up to your 24th disability payment. They all have one purpose — finding out what you can do so that they can get you off of claim, and/or bombarding you with so many requests that you may fail to turn one in and then your claim can be dismissed.
You will be faced with a completely new inquiry into your disability. Basically, you will have to prove your disability again, but probably to a more detailed level.
You will probably need to collect additional evidence of your disability and of your inability to perform the tasks the disability company now claims you can do.
If you are lucky, the definition of disability in your policy will give you some added protections – such as you must be able to earn a certain percentage of your pre-disability earnings.
It is important to maintain a good relationship with your doctor. Keep your journal/diary up to date. Make sure your family and friends know of your continued disability and can support your claims if needed.
The unfortunate truth of the "any occupation review" is that many claimants are found by the disability insurance company to be capable of performing, at least, one occupation. Because of this, continued long-term disability benefits will be denied.
If you are faced with an Any Occupation Investigation or Denial, you do not have to fight the insurance company alone. Mandeville long-term disability claimants faced with such a denial can call me for help.
Successfully appealing any occupation denials takes creativity, hard-work, and a detail-oriented approach. If you live in Kenner, or anywhere in Louisiana, and are faced with an Any Occupation long-term disability denial, I may be able to help you. Give me a call at 985-240-9773 or use our simple contact form.
What's the difference between Short-term and Long-term Disability?
As a Louisiana disability lawyer, I have been asked to explain the difference between short-term disability benefits and long-term disability benefits on more than one occasion. This is my attempt to explain the differences and similarities as briefly as possible.
Short-term disability insurance is designed to pay you benefits quicker and for a shorter period of time. The elimination period (the period of time you must be disabled before benefits start) in a short-term disability policy is often from 0-14 days. This means that a short head cold would probably not qualify you for short-term disability. The benefit period usually ranges from 60-180 days (or 2-6 months). This means that you will be paid, if you are disabled, for that period of time.
The universe of ailments and injuries that can qualify you for short-term disability are greater than those for long-term disability because of this. For example, while a broken arm may not last long enough for you to claim a long-term disability, it could qualify you for a short-term disability benefit. For this reason, a short-term disability policy may be referred to as a sick-leave policy.
Short-term disability policies do have terms, conditions, and exclusions that you must be aware of. The number of policies and differences makes it impossible to point them all out here. For this reason, you need to read the policy.
Long-term disability insurance policies, on the other hand, are designed to replace a portion of your income over a longer period of time. For this reason, their elimination period (long-term disability waiting period) is usually longer – often 90-180 days (but policy specific). This means that you will not get paid for the first 3-6 months of your disability. Long-term disability policies can pay you a benefit for a very long time, as long as you are disabled – usually up to a certain age, like 65.
The policy terms, conditions, and exclusions of long-term disability policies are often more onerous (bad for you) than short-term disability policy conditions. Also, because the benefit period is substantially longer, insurance companies carefully review and manage their long-term disability claims.
Going from Short-Term Disability to Long-Term Disability
I should also point out that just because the insurance company approved your short-term disability benefits does not mean they will approve your long-term disability claim. Long-term disability claim denials are common for those coming from short-term disability.
From a legal perspective, I do not see many short-term disability disputes but they do exist. Long-term disability insurance disputes are more common. However, the legal principles applying to reviewing decisions of the insurance company under both short and long-term disability insurance are the same – if the benefits were provided by your employer. There may be a difference if you get one benefit through your job but paid for the other separately.
I hope this brief explanation cleared up some confusion. If you want to discuss your short-term or long-term disability case, call me at 985-240-9773 or use our contact form.
How Long Does It Take To Get SSDI Benefits After I Am Approved?
Congratulations! Your social security disability benefits claim was approved. If you are like most of my Louisiana disability clients after your SSDI claim has been approved – you want to know WHEN WILL I GET THE DISABILITY BENEFITS I HAVE BEEN AWARDED?
It will usually take a few months for your benefits to start – AFTER YOU RECEIVE A FAVORABLE WRITTEN DECISION.
How long after approval for disability do you get your money?
If you received a favorable decision on your initial application WOW – your benefits will start as soon as the paperwork is processed.
You probably won’t have to work to obtain back benefits.
Your benefits will probably start within 30-90 days, assuming that you have completed the 5 month elimination period.
If your claim went through a hearing with an Administrative Law Judge, you will have to wait longer.; Many ALJs in the New Orleans Social Security and Metairie Social Security hearing offices take about 1-3 months to issue their written decision.
When the decision is favorable, the claim file is then sent to the payment processing center, where it can take another 1-3 months for current benefits to start.
How long does it take to get back pay from Social Security?
In some situations, Social Security issues current monthly benefits, but not the back payments.
This is because they need to investigate if you received any Supplemental Security Income (SSI) benefits.
If you also have a claim for SSI benefits, you will need to call or go to your local Social Security office for an appointment before your benefits can be released.
Social Security does not have any specific rules on when they will pay you after being approved, but if you have not received your benefits 60 days after your hearing, give your local Social Security office a call.
If I am approved for SSDI benefits, do I get other benefits?
An SSDI beneficiary is automatically eligible for Medicare 24 months after the onset date or date they were found to be disabled.
Medicare coverage starts in the 25th month of your SSDI entitlement. SSA will automatically send you information approximately 3 months before you are eligible for Medicare.
Social Security disability recipients may be eligible for Food Stamps but must file a separate Food Stamp Program application. Requirements for eligibility vary.
A Social Security Disability (SSDI) recipient may also qualify for SSI, depending on the amount of your monthly SSDI benefit and your other assets.