Steps disabled workers in Georgia can take to maximize their odds of an approved claim

Steps disabled workers in Georgia can take to maximize their odds of an approved claim

Social Security disability (SSD) benefits are intended to improve the livelihoods of injured workers who can’t work due to an unforeseen permanent medical condition or disability.

Research from the Centers for Disease Control and Prevention shows roughly 27.2 percent of adults in Georgia suffer from some form of disability. Furthermore, only 3.9 percent of the 6 million residents living in Georgia receive adequate Social Security disability benefits, with thousands applying for coverage this year.

Unfortunately, only the lucky few manage to secure compensation while the remaining workers have their Social Security disability claims nullified or denied by the Social Security Administration (SSA).

What’s more, many applicants who are denied have to file yet another application in the form of a request for reconsideration in the hope of having their claims accepted. While this can be a frustrating and tiring effort, at Westmoreland Law, our team of Social Security disability lawyers can help you through the process of filing a successful disability claim.

If you or your loved one has a permanent disability, this article will take you through the guidelines on how to apply for disability in Georgia and how an attorney can aid your case.

Do you qualify for disability benefits in Georgia?

Qualifying for SSD benefits will provide compensation starting at $1,054 monthly. This can help alleviate the financial burden of coping with medical bills, house payments and living expenses while suffering from a permanent disability.

However, to receive compensation through the SSA, you need to qualify for the Social Security Disability Insurance (SSDI) program, which will require having the following:

Social Security Disability Lawyers in Macon, GA
  • A disability that hinders your ability to work or seek employment.
  • A disability that has been incurred recently and is expected to last 1 year or is medically diagnosed as permanent.
  • Sufficient credits in the Social Security Administration system.
  • Past employment in a job that was paying Social Security taxes during your time there.
  • Earnings less than $1,170 monthly for SSDI and $735 for Supplemental Security Income (SSI).*

*Figures may fluctuate.

Nonetheless, the most important factor in determining your eligibility to qualify for SSD benefits is your overall number of credits, as there is a minimum required. These credits are based on the number of years you worked. For example, having an employment history record of 10 years will earn you 20 credits.

For some individuals, the minimum credits are 40 while younger adults qualify with less. If you’ve consistently paid your Social Security taxes, you can earn up to 4 credits yearly in Georgia. Therefore, having sufficient credits increases the success of your disability benefits claim drastically.

What to know about getting approved for disability benefits

Possessing the relevant qualification is one thing, but getting approved is a different story. The SSA utilizes specific guidelines through which your inherent application may be approved or denied.

For starters, any mild injuries will be denied. Therefore, your injury has to be severe enough for the SSA to qualify it within the disability category. For this to happen, your current medical condition will be analyzed with the SSA impairment listing.

Furthermore, the condition must prove to negatively affect your work capability, such as moving, holding objects, sitting or standing. Your disability should prevent you from performing these mundane activities for at least 1 whole year.

In legal terms, this will prove a limitation in performing a Substantial Gainful Activity (SGA) or work, which allows a person to earn more than their fixed monthly salary. The SGA amount will influence the compensation received towards your disability as the specific amount varies annually.

What is Substantial Gainful Activity?

To be eligible for disability benefits, a person must be unable to engage in substantial gainful activity (SGA). A person who is earning more than a certain monthly amount (net of impairment-related work expenses) is ordinarily considered to be engaging in SGA. The amount of monthly earnings considered as SGA depends on the nature of a person’s disability. The Social Security Act specifies a higher SGA amount for statutorily blind individuals; Federal regulations specify a lower SGA amount for non-blind individuals. Both SGA amounts generally change with changes in the national average wage index.

For example, in 2021, the number of earnings a blind person can receive indicated by SGA is $2,190 per month, while those with other disabilities can earn $1,310 monthly. In 2020, the amount was $2,100 and $1,260, respectively.

Furthermore, this doesn’t include any other additional income you may receive besides employment like earnings through interest or investments. If your current or former job is paying you more than the designated SGA amount each month, you will not be considered disabled by the SSA committee.

Monthly substantial gainful activity amounts by disability type

Year

Blind

Non-Blind
1975
$200
$200
1976
$230
$230
1977
$240
$240
1978
$334
$260
1979
$375
$280
1980
$417
$300
1981
$459
$300
1982
$500
$300
1983
$550
$300
1984
$580
$300
1985
$610
$300
1986
$650
$300
1987
$680
$300
1988
$700
$300
1989
$740
$300
1990
$780
$500
1991
$810
$500
1992
$850
$500
1993
$880
$500
1994
$930
$500
1995
$940
$500
1996
$960
$500
1997
$1,000
$500
1998
$1,050
$500
1999
$1,110
$700
2000
$1,170
$700
2001
$1,240
$740
2002
$1,300
$780
2003
$1,330
$800
2004
$1,350
$810
2005
$1,380
$830
2006
$1,450
$860
2007
$1,500
$900
2008
$1,570
$940
2009
$1,640
$980
2010
$1,640
$1,000
2011
$1,640
$1,000
2012
$1,690
$1,010
2013
$1,740
$1,040
2014
$1,800
$1,070
2015
$1,820
$1,090
2016
$1,820
$1,130
2017
$1,950
$1,170
2018
$1,970
$1,180
2019
$2,040
$1,220
2020
$2,110
$1,260
2021
$2,190
$1,310

What’s the process for filing for Social Security benefits in Georgia?

After determining your eligibility for an SSD benefit, you need to know how to file for disability. Even though Social Security is a federal administrative program, your verdict will be determined by the relevant state agency. In Georgia, this will be determined through the Disability Adjudication Services (DAS).

Here are some important things to know about the disability adjudication process:

  • You can fill out your application online at SSA.gov or call their number 1-800-772-1213 and have a representative assist you.
  • After completing your disability application, your claim will be forwarded to the Georgia DAS board. The main challenge comes with accepting your claim as the Georgia DAS only approves 23 percent of the overall applications received.
  • Getting approval can be an obstacle to your efforts. To strengthen your claim, we recommend contacting our attorneys to help improve your chances of success. We can help smooth the process and increase your likelihood of success during your disability application.
  • If your claim has been denied, you can’t reapply until 60 days after your previous application. After this, you can request an appeal through the Office of Hearing Operations (OHO), which is part of the federal SSA.
  • It takes anywhere from 400 to 540 days (13-17 months) for a disability applicant to be granted a court hearing in Georgia. From here, your claim will be reviewed by an administrative law judge (ALJ), and a decision will be made 45 to 90 days after the hearing.
  • The chances of being awarded disability benefits from a hearing are much more favorable than the DAS board as ALJs grant 54 percent of overall disability applications presented in court.

It is important to have a grasp of the 4-step disability adjudication process. This way, you can begin to understand how the SSA makes its decision in your claim, as well as how to approach your claim moving forward. Of course, each step listed below can raise questions that can get complicated, particularly as it relates to those clients who are currently working, which is why it’s important to consult with a disability attorney near you.

Step 1: Determining eligibility and securing representation

The first step of the disability adjudication process is ascertaining whether you (the individual filing the claim) are working. If the answer is no (the individual is unemployed and not looking for work), then the application process moves forward.

During this step of the process, the SSA’s inquiry should focus on which types of claims are available for the applicant—namely:

  • Disability Insurance Benefits (and its subsets of Disabled Adult Child)
  • Widows/Widowers Survivor benefits
  • Supplemental Security Income benefits

While most SSA field office workers are diligent in helping applicants determine which benefits they are eligible for, sometimes the applicant is not properly informed of all the programs they are eligible to file.  Thus, when we speak with new clients it is important for us to know your work history over the last 10 years in detail to ascertain DIB eligibility.

Our disability attorneys also need to ascertain your current income from non-employment sources (i.e., workers’ compensation, short or long-term disability, VA disability, etc.) in order to determine whether you are eligible for SSI benefits. At this point, your household income should be assessed—including spousal earnings, or those of other individuals living in the household.

We find that many applicants are unaware of what they have filed for and don’t understand the differences of the potential benefits available. For this reason, it’s vital you bring all documents that they received from SSA to your attorney to review, that way your attorney can give you an idea of whether all claims are in play or if there are past, unappealed denials that can be reopened.

It is important to note that if your initial contact with a disability attorney is over the telephone, it is important to provide them with the most recent denial date so that there is no risk of missing an appeal date.

There may be times when it’s in your best interests to immediately file the appeal yourself with SSA prior to meeting with an attorney. Once you have hired an attorney and filed your appointment of representation paperwork, your attorney should contact the SSA to ascertain the status and location of your claim file in order to assure that no deadlines are missed.

If, on the other hand, you are still employed, your attorney will need to determine what you are earning on a gross level (your income before taxes). If you earn over the Substantial Gainful Activity (SGA) amount, then you’ll need to provide your lawyer with information on the length of time you have been earning at this level and whether you intend to stop working.

If you do not intend to stop work, then you essentially have no claim. If the work at this level has only been sporadic or if you intend to stop working because of health-related reasons, then a claim may be possible.

Additionally, depending on how long the claim has been pursued, there may be a closed period of benefits available even if ongoing benefits are unlikely.

Presuming that you are eligible to file a claim and that you secure representation, you can proceed to the next step of the adjudication process.

Step 2: Defining the impairment

In the next step of the disability adjudication process, the government must determine if the individual has a “severe impairment(s)” that meets the definition under SSA law. The law defines a “severe impairment” as one that has more than a minimal effect upon a person’s ability to work, and has lasted (or can be expected to last) for at least 12 months or reasonably end in death.

This definition is the threshold examination to determine whether or not a disability claim exists.

Like many applicants, you might think that meeting this threshold is an easy one to make. However, many disability claims receive ALJ dismissals because the applicant amended their onset dates due to earnings that resulted in the onset date being less than 12 months prior to the hearing date. In such cases, the ALJs maintain that the 12-month durational requirement was not met.

It’s important to have a basic understanding of how the ultimate decision is made when it comes to determining “severe impairment” so that you and your attorney can focus on those impairments that are most relevant when seeking medical attention (perfecting the record).

Some impairments are permanent but cause only minimal effect on work capabilities, while other impairments cause extreme degradation of working ability but do not meet the durational requirements.

Here are a few examples:

Case example: Skier Lindsey Vonn

Another example of a tremendous injury that is quite limiting but doesn’t quite meet the SSA’s duration requirement involves Olympic downhill skier Lindsey Vonn.

Ms. Vonn suffered severe leg injuries after a crash on the slopes in 2013. These injuries left her movements quite restricted and if they were permanent they certainly would have fallen within the definition of “severe impairment.”

However, Ms. Vonn was able to begin training on the slopes within 7 months of the injury. Thus, her injuries did not meet the requirement.

Case examples: Guitarists Django Reinhardt and Tony lommi

For example, take the cases of gypsy guitarist Django Reinhardt and heavy metal guitarist Tony Iommi, from the band Black Sabbath. Both musicians have garnered worldwide acclaim for their guitar playing skills. And significantly, both sustained extensive injuries to their fretting fingers.

Reinhardt suffered significant burns to the ring and pinky fingers of his left hand, limiting his ability to fret with both. However, despite these injuries, he was able to play the guitar like few before or after him, and he set standards that remain today. Thus, while his injuries were permanent, it cannot be said that they caused more than minimal effects on his ability to work.

Similarly, Tony Iommi also suffered injuries to his fretting hand. In his case it was an industrial accident that crushed several fingertips on his fretting hand. To overcome these permanent injuries, he modeled thimble-like devices—prosthetic tips, if you will—that allowed him to continue playing guitar at a high level.

Case example: Robert T. on Ironside

Lastly, take the case of Robert T. on the classic television show Ironside, played by the late Raymond Burr. In this case, the fictitious character became a wheelchair-bound paraplegic after being wounded by a sniper.

Thus, all the requirements can be seen to be easily satisfied in that the injury lasted (or was expected to last) 12 months or end in death, and the impairment had more than a minimal effect on Robert’s ability to perform basic work activities.

Moving forward, it may be helpful to think of your claim as more than just: “I’m hurt and I can’t work.” While this sentiment is prevalent and may be the ultimate distillation of your experience, it can result in failures in communication and perfecting the record.

Disability applicants often limit their medical reasons for seeking disability to an abbreviated list of the impairments they face. During step 2, an experienced attorney will help you sound out the full range of impairments affecting you.

Often, our attorneys will discover that a whole host of severe impairments exist that were not of primary concern to the client. For example, perhaps you only recently started suffering from acute congestive heart failure (CHF); however, we might discover that you have had long standing musculoskeletal problems.

It’s vital you receive medical treatment for ALL the impairments affecting your function—at least as much as possible given your resource constraints. Or, as we put it: “Head to toe, let your doctor know!”

The goal is to discuss all of the injuries and maladies that affect your well-being with your treating doctor—not only so you receive proper care, but also to form a well-developed medical record. Acknowledge your health problems every single time you receive care. Don’t assume that your treating doctor is cognizant of your problems simply because you told them once or twice before.

The SSA gives little consideration to a medical condition unless the patient frequently references it and there is an indication of treatment of that condition in the patient’s medical record. Thus, you should communicate with your doctor the entirety of your medical problems every time you are being treated or examined.

You or your attorney should also ask your treating doctor questions about the medical condition. This is important for 2 reasons:

  • You need to have a good understanding of your impairments to better maintain your health, and
  • Asking detailed questions can result in a more thorough medical record.

Of course, there are roadblocks.

Treating doctors are often rushed and may provide little time to give you an overview of all of your health issues. This challenge is particularly true in low-cost and/or no-cost community clinics, whose singular goals are often for just health “maintenance.” These facilities might not have the time or resources to treat “non-threatening” health concerns.

And even specialty care can be equally frustrating. Generally, each visit is scheduled for the treatment of a singular condition, and discussions of other concerns must wait until another appointment date. For many folks with few resources, these roadblocks makes obtaining the full care they require extremely difficult or impossible.

Lastly, don’t be too intimidated by the doctor (“white coat syndrome”) to explain how you are feeling and how the injury is impacting your life. Some people are naturally introverted in unfamiliar environments.

Nevertheless, it’s vital that you be detailed, specific and inquiring when meeting with your doctor. We also urge you to share how your impairments are affecting your function in completing “activities of daily living.” Such references to these limitations in your medical record is important to filing a disability claim.

Once again, we can’t over-emphasize the importance of obtaining as much medical care as you can, while trying to communicate as much as possible with your treating doctor as frequently as possible so that both impairments and limitations are contained in your medical records.

Step 3: Ensure your impairment meets the criteria

The SSA has a group of criteria based on body part or function for which significant negative changes are determined to be severe enough as to be disabling without further inquiry. The SSA has drawn up its Listing of Impairments in such a way that the listings often require medical findings and tests results that are not normally found in treatment notes.

For this reason, the remaining 2 steps often must be completed prior to a finding of disability for most applicants. (That is not to say that the listings should not be considered for all clients initially.)

Step 4: Determine individual function

Since the Medical Vocational Guidelines are ultimately very helpful in most disability applications, it is helpful to have a basic understanding of why they are important and how they operate—especially if you are age 50 and above.

At this point, your past work history becomes important—including the specific job tasks that were required for job performance and any acquired skills. Most folks consider only their inability to perform the jobs they have most recently done. And reasonably so. However, the concept SSA focuses on is Residual Functional Capacity.

To understand how the SSA breaks down individual functions and how those functions relate to your ability to work, consider a brick wall.

If you take 1 brick out of the wall, that wall still performs its specific function. But if you keep taking bricks out of the wall, eventually it will no longer serve its purpose. One brick may be your ability to lift 100 pounds. Perhaps another brick is being able to stand for 6 hours, while another brick may be sitting for 6 hours.

The SSA examines your individual function in this fashion. Only when enough bricks are missing will they conclude that enough functions are lost – that the wall falls down –and that the disability threshold is met.

To further understand individual functions, consider these 2 contrasting scenarios of jobs that both require highly skilled individuals:

Scenario 1: Computer worker

The computer worker performs all facets of computer work, from pulling new lines, to building and installing servers, to installing software and removing viruses. Many aspects of this job can be quite physically demanding, but the software work generally requires little lifting and little standing or walking as it is primarily sedentary work.

If this individual could no longer stand for more than a few hours or lift more than 10 pounds, the computer job could still be performed. Thus, while the job itself requires more physicality, the skills acquired would allow for that person to do a less physically demanding job and therefore disability might not be awarded.

Scenario 2: Brick mason

The brick mason’s work is classified as a medium skilled work job. However, unlike the computer job, these skills are both industry and job-specific, and they do not readily transfer to jobs performed at a lighter exertional level.

It is common for folks to ask the question:

Who’s going to hire me with all these problems?

To be sure, we have won cases where the ALJ has stated in post-hearing conversation that they ruled in favor of our client for the sole reason that they personally would not have hired them. This is a tacit recognition that, while the records were lacking, the judge found the claim credible.

However, we urge you to refrain from asking this type of question at your disability hearing as it can be misconstrued by the judge as a suggestion that your only real problem is an inability to find work—not the disability itself.

When to hire a Georgia disability lawyer

Over the years, we have found that many folks have little to know understanding of the disability process. Many believe that being diagnosed with a condition that sounds horrible means they are automatically disabled. And many individuals know that they feel horrible most days, which should be enough to be found disabled.

Unfortunately, this “feeling” is never quite enough. Instead, the disability application process can be grueling and unnecessarily imbalanced against those seeking benefits. Much of the imbalance stems from agency rules that require evidentiary showings that can be unduly burdensome. This is particularly true when considering the changes made in the Listing of Impairments over the last decade, as well as the changes made in the domains relevant to childhood disability.

And as you may already know, medical record-keeping leaves much to be desired. Treating physicians and caregivers are often not diligent in accurately noting a patient’s specific complaints in their charts. Another obstacle in this regard since the shift from handwritten notes to software-managed electronic files is the repeated boilerplate charts that see very little revision of patient complaints and clinical findings over time.

While our Georgia disability attorneys clearly have no control over the SSA, nor can we change how treating physicians write their notes, we can help guide our clients in the way they communicate and interact with their doctors in order to result in more written observations and possibly even better care.

At Westmoreland Law, our team of professional lawyers can help guide you through applying for disability benefits while adhering to optimal DAS protocols with uttermost efficiency. Even in the face of adversity, we will stand by you with expert legal representation to sway the odds to your favor.

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