Verbal approval........now what?

[-Mimi-]

I have been working on SSDI for 3 1/2 years and finally got a verbal approval. My lawyer said the next step is getting the award letter.

While I have researched many hours trying to understand the process, there are just some things I can't figure out and hoped to get an "idea" vs. waiting who knows how long for the award letter to tell me.

"IF" they back pay to the time of disability (entitlement date), is that the date the monthly benefit is based on? The reason I ask is because there is a difference of about $150 a month for me if I was disabled then vs. if I am disabled now.

This was my 2nd time for applying. I gave up the first time around and didn't have an attorney. I got an attorney this time and the process took less than a year. To determine back pay, I have seen an array of answers to this. Is back pay based on the disability entitlement date, application date, 12 months prior to the application or WHAT? lol

Also, I have seen reference to direct deposit of payments. How does one go about setting that up? Is it something I am supposed to wait for the award letter to figure out?

Medicare........I know there is a 2 year waiting period for medicare BUT does that waiting period begin at the time of approval or is it retro back to the entitlement date? Is Medicare automatic or do we have to apply?

I am sure I have more questions but these are the ones I am trying to figure out first

Thanks for any input!

[trynhard]

I will try to answer a few of your questions and if I'm wrong maybe someone will come along shortly and correct me.

Your backpay will be determined by when they decide that you are disabled. For instance if you signed up in October 2007 and your medical records prove you were disabled 12 months prior to signing up they will go back 12 months but then they add back on 5 months waiting period. So basically they will go back 7 months before you signed up. They will not go back to when you initially signed up since you gave up, had you not given up and kept appealing then it would have went back your 3 1/2 years that you said you had been trying, except for the 5 months waiting period.

As for the direct deposit, that would have been in the forms you filled out when you signed up for SSDI.

The 2 year waiting period for the Medicare begins when they determine that you were disabled. When you get your letter it will tell you when they determined that you were disabled. Medicare is automatic.

[-Mimi-]

Thanks for the reply tryn. I thought that is how it worked until a friend of mine told me last night that she applied, was denied twice like I was, waited and got a lawyer to start a new application for her. They approved her and she gets backpay all the way back to the date of disability which was when she applied the first time (6 1/2 years).

My lawyer told me if I tried to work on my original application, I was putting myself at risk for a whole different can of worms. If I completed the application process and appeal with certain verbiage, it could have hurt my case more than it helped it. Apparently, she knows what she is talking about. She got my case approved in 10 months. I just hate knowing that 1, it will affect my medicare date and 2 that I am losing out on backpay that was much needed. *sigh* By the way, the new application was only a month after my 60 day time frame to appeal my 2nd denial.

The oddest part of it all is that when my case was under review, I had to get a statement from my employer verifying my last day worked. They needed to know that before they approved my case. Why I don't know, when they had a copy of my neurosurgeons statement that I couldn't work as of what date. This made me wonder if they were going back to my last date worked as my entitlement date. They easily could have just approved it 12 months prior to my application date which was December 2007. My last date worked was 7/15/05.

As far as the direct deposit, my lawyer completed all the paper work for me and I did nothing as far as forms went. I will go to my local social security office once I receive the notice of approval from the ALJ to fill out that form. I don't know how else to set it up.

Have a great week!

[peaches]

Until the decision is written and a date of onset of disability established in the written decision, any answers here are no more than a guess.

SSA and ALJ's do not always accept your alleged date of onset of disability because the regulations and the medical evidence do not always support your statements. Starting a new claim instead of appealing further, can close off the prior period forever, unless there is new and material evidence that proves that the first decision was wrong at the time it was made and the evidence is provided in a reasonable time frame.

The established date of onset and the date of application that is being adjudicated has to be known before anyone can give you a reasonable response to your question. And, SSA will not do anything to start to pay a claim until the decision is in writing. The ALJ does not write his/her own decisions. There is a staff of writers who have to make sure that the written decisions uses correct legal and regulatory language. And there is also a backlog with the decision writers. It can take weeks. It can take months.

[-Mimi-]

I received my letter today just a few short days after receiving my verbal approval.

They did reopen and revise my prior application and stated "Because the initial determination on the prior application was issued within 4 years of the filing date of the current application and good cause for reopening is established with the submission of new and material evidence."

The onset of my disability is established as of 7-15-05.

[heythere]

So your date of disability CAN be the date you became ill or injured not necessarily the date you applied or quit work?

[-Mimi-]

Yes, it CAN. It all depends on when SSA deems you were disabled by their "regulations".

My lawyer was worth every penny. She knew the right terminology, forms and required info that I obviously didn't use when I applied. I guess in my particular case, I helped it more than I hurt it because she obtained info that I must not have submitted. This is why my original application was reopened and why they went back to what I felt was my original disability date.

I kept seeing they only go back as far as 12 months prior to the application date. This isn't always true.

[peaches]

You had two applications and because the ALJ decided to reopen the prior application using the 4 year adminstrative finality rule that applies to SSDI initial determinations. The SSI program only has a 2 year rule that applies to initial determinations. There are pages and pages of information defining what is considered new and material evidence and what is considered an initial determination.

You had two applications and apparently the ALJ reopened the first. You said the prior application was 3 1/2 years ago which if taken literally, would be 4/05. It doesn't seem like a correct date if your onset is established as 7/15/05. Perhaps your application date from your first application was 7/05 which is about 3 1/2 years ago.

Assuming first application 7/05 with onset 7/05. First month of entitlement after the 5 month waiting period would be 1/06, which would have been paid in 2/06. It is now 10/08. I am going to assume that the Pyment Center will get you your first check 12/3/08 (could be sooner, but I sure wouldn't count on it). You would then be owed money from 2/06 through 11/08.

For HeyThere, the date of onset of disability would be when your condition prevented you from being able to work which could days, weeks, months, years, decades after you were first diagnosed with your condition or after your accident. Date of onset can also be established as years before application. But the retroactivity of PAYMENT is no earlier than 12 months before filing a claim. Mimi filed a prior claim that got reopened.

Delay in filing a claim can mean lost benefits.

You need to distinguish between onset of disability and application date for SSDI. Both dates determine when payment begins.

[heythere]

Mimi,

would you mind telling me what type of disability you have? Only if you don't mind. Congrats on the approval and the backpay!

[Robin0203]

Mimi, Congratulations! An approval for one is a small victory for us all.

[-Mimi-]

Mimi,

would you mind telling me what type of disability you have? Only if you don't mind. Congrats on the approval and the backpay!

Sorry for the delay, I just happened to see this.

I don't mind at all. I have had 2 back surgeries and neck surgery. Because of the back issue, I now have nerve damage in my left leg. I had 2 discs fused in my back on the first surgery and another ruptured from taking the brunt of the work which resulted in a 2nd surgery fusing another disc. I also had 3 ruptured discs in my neck which were fused 9 months after my back surgery. Based on my last MRI, I have another ruptured and one bulging now because of those discs doing the work of the ones fused. I have alot of scar tissue, bone spurring and now arthritis. When they do my next neck surgery, all but the top 2 discs will be fused. They will have to remove all the hardware in my neck and redo it to fuse all the discs then add the plates and screws for all discs. My neurosurgeon is anticipating this to happen within the next 1 - 2 years.

As weird as it sounds, all of this developed after having pneumonia. I coughed hard one night, got out of bed and hit the floor in pain. I had 2 ruptured discs. It has been a nightmare since then. Apparently, I have had degenerative disc disease for a while and it was just waiting for something to trigger it. I was 43 when this happened.

I played softball just a few days prior to all of this happening, worked out 4 days a week and was very active. I just thought the back pain was from over doing it and the neck pain was from stress.

I am much too young to feel this damn old lol

[heythere]

yes! you are much too young to feel that old. how awful for that to have happened! Thanks for sharing - I was 42 when my illness started 4 years ago. I have a muscle disease. Your age must have really kept you from receiving your SSD. Congrats again - take care.