Injured and disabled workers know the challenges of applying for financial benefits programs at a difficult time. A worker who becomes injured on the job may request workers’ compensation, or state benefits, and/or Social Security Disability Insurance (SSDI), a federal program that’s administered by Social Security Administration (SSA).
Time is money, and some injured workers must live paycheck to paycheck. They’re anxious about the future and want to understand the chances of getting approved for workers comp in their state and/or the chances of approval for SSDI. The injured worker is likely to consider the merits of hiring a disability lawyer to file for workers comp and/or SSDI benefits.
SSDI Benefits Approval Process
Social Security statistics say that about a third of SSDI claimants are approved for benefits. According to SSA, it’s difficult to explain the injured disabled person’s chances of getting approved for SSDI benefits.
If you’re unable to work because you’re injured or struggle with a medical condition, you may be eligible for SSDI benefits. In order to qualify for SSDI, you must pay into Social Security for a certain period. It’s important to have the minimum number of earnings quarters to qualify for SSDI benefits:
- Step 1: Most claimants need 40 quarters of earnings to meet the first qualification test. If you have 40 or more quarters of Social Security earnings, you may qualify for SSDI.
- Step 2: You must now demonstrate that the disabling condition presented within five years of the SSA date last insured. For instance, a disabled man who began work at 18 has worked without employment gaps over the past 12 years. He has 48 earnings quarters. Two years later, the man is permanently disabled in a car accident. Even though he’s just 32 years old now, his work history and disability date meet Social Security disability criteria.
- Step 3: The disabled person must convince SSA examiners that the disability prevents him from achieving gainful employment activity. This step involves subjective analysis of Social Security disability professionals.
It’s difficult for anyone, including an experienced disability lawyer, to estimate a client’s chances of SSDI approval. Some factors are beyond the lawyer’s control, including when the disabled client files for SSDI benefits, where he or she lives (and in what SSA region they’re located), and the Administrative Judge who will hear the client’s case if SSA denies SSDI benefits in the first round.
Although an experienced disability lawyer will advise that’s it is difficult to predict any client’s likelihood of SSDA approval, most know that having an experienced legal SSDI advocate is better than going it alone.
Factors Considered During the SSDI Evaluation Process
Other factors used by SSA in the Social Security disability evaluation process may predict the disabled claimant’s chances of approval:
- Claimant’s age: The older the claimant, the more likely he or she is to receive SSDI benefits. Perhaps SSA believes that an older person is less able in general to find another type of work.
- Physical and/or mental restrictions: The greater the severity of the claimant’s physical or mental condition, the more likely he or she is to receive SSDI benefits.
- For instance, if a 60 year old disabled construction worker requests SSDI because of pain and a back injury, he’s more likely to receive SSDI benefits than a 30 year old man with a similar medical condition.
SSA also considers the claimant’s educational degrees. If the claimant is less educated and disabled, he or she is likely to receive SSDI approval than a disabled person of the same age with a doctorate. Perhaps SSA believes that the less educated disabled individual has fewer opportunities to learn new skills or find new work. Of course, this isn’t always true and SSA’s evaluation process considers each claimant based on a variety of factors.
The claimant’s work history is very important. If he or she did heavy physical work for 40 years and suffers from bilateral shoulder injuries today, the claimant can no longer lift heavy objects. According to SSA, the claimant is now totally disabled because injuries prevent the ability to perform physical labor. However, if an office secretary presents with bilateral shoulder injuries, SSA might not say she is totally disabled. She has other skills that could allow her to perform additional duties in a similar or different job.
Workers Compensation Approval Process
A disability that’s due to a work-related injury can be a temporary or permanent condition. Many times, the worker doesn’t know how long it will take to recover. Most injured disabled workers express concerns about how to pay the bills. Workers comp is a state-administered program that’s designed to financially and medically support the injured worker when he or she can’t work.
After the onset of an illness or disability from injury, workers have immediate concerns. The period after an accident or work-related injury is also quite confusing. The worker must deal with the result of the injury and obtain medical care. Workers comp insurers also flood the injured worker with required forms and paperwork. That’s because the insurance company immediately initiates its defense against the potential insurance claim.
It is essential for the injured worker to mount a defense as well. The workers comp claimant should seek legal advice at this time. An experienced disability lawyer can help the disabled individual to prioritize next steps and avoid despair about costs of treatment and medical bills.
A disability lawyer might not need to actively defend the claimant at this point. Some professionals say that the disability attorney or law firm should remain in the wings because filing his or her appearance on the workers compensation claim form can cause communications between the employee and employer to break down.
Short-Term Disability Workers Compensation
Workers comp laws in many states support the worker’s right to pay without prejudice. For the first six months after the worker’s disabling injury, the insurer pays disability benefits to the injured employee. This period is intended to facilitate recovery and lessen the employee’s financial stress. The employee should take this time to seek counsel from an experienced disability law firm and remain in contact.
At this time, the employer and its insurer conduct an investigation of the disability event. The employer and the insurance company don’t wait to hear from the employee about workers compensation issues.
That’s why it’s important for the disabled worker to engage a qualified disability lawyer as soon as possible. The employer’s insurance company wants to pay as little on the claimant’s matter as possible. Don’t wait!