North Carolina disability statistics

Definitions of Disability

There are different definitions of disability.  For Social Security Disability, disability is defined as the inability to engage in substantial gainful activity.  For workers’ compensation in North Carolina, disability is defined as “incapacity because of injury to earn the wages which the employee was receiving at the time of injury in the same or any other employment.”  A person can have a disability, but not be disabled from working or engaging in certain activities.

Disability Statistics

“There are an estimated 1,336,000 people in North Carolina over the age of five who have a form of disability.

Approximately 242,000 people, or 3.1% of the state’s population, experience difficulties with performing activities of daily living such as dressing, bathing, or getting around inside of their homes.

There are around 753,000 people in the state who have a form of work disability, and around 274,000 people with disabilities in North Carolina who are employed.

Around 45,000 people with disabilities in the state are unemployed, while 426,000 are currently not in the workforce.”

Citation: Disabled World News – Recent news stories and articles from North Carolina USA including medical related news and coming events: http://www.disabled-world.com/news/america/nc/#ixzz2Qlm2QCZj

 

Social Security Disability Processing Times

ODAR Processing Times

A hearing before an Administrative Law Judge is the second appeal in the Social Security Disability appeal process.  At a hearing, you appear in-person before an Administrative Law Judge or by video teleconference.

In North Carolina, there are hearing offices, called ODARs (Office of Disability Adjudication and Review), in Raleigh, Greensboro, Charlotte, and Fayetteville.  When you file a claim for disability benefits, you file at the local office in your area.  When you reach the hearing level and you file your Application for Hearing before an Administrative Law Judge (form HA-501), then your case is assigned to the ODAR closest to your reported residence.  (NOTE:  all requests for hearing must be filed online now).

When you file a request for a hearing, the ODAR office will schedule a hearing by contacting you no earlier than 20 days before the hearing date.  If you live more than 75 miles from the nearest ODAR, you case may be heard at a satellite hearing office either with a judge present or by video.

Depending on the volume of work for each office, staffing, budgets, etc., the wait time for receiving a hearing date varies for each office.  The Social Security Administration keeps track of the average time for final disposition of cases.  The Charlotte, NC ODAR has the best processing time for cases in North Carolina, with an average process time of 393 days.  Out of all of the hearing offices throughout the country, Charlotte ranks 121.  The Raleigh, NC ODAR is ranked 130, with an average processing time of 402 days.  The Fayetteville, NC ODAR is ranked 143 with an average processing time of 421 days.  The Greensboro, NC ODAR is ranked 162 out of 165 offices, with an average processing time of 466 days.

See http://www.ssa.gov/appeals/DataSets/05_Average_Processing_Time_Report.html

So obtaining a hearing date is just part of the disposition process.  Once you obtain a hearing date, you then need to attend the hearing.  If you do not have all of your evidence to present before or at the hearing, sometimes a hearing would be held open for a time to allow for submission of additional evidence.  Also, most administrative law judges do not make a decision regarding a claim at the hearing.  They will review the evidence, hear the claimant’s testimony and any other witnesses, then make a decision.  The judge’s opinion and reasoning are given to a decision writing unit.  This unit prepares the actual decision.  There is not a deadline or requirement for a specified time for the decision to be sent to a claimant after a hearing.  Some decisions take a few weeks, others a month or more.  This time is factored into the processing time for cases.  The longest time I have seen for a decision was 4 months after the hearing date.

Duration Requirement

These times seem long and they are.  However, the Social Security regulations provide that a claimant must be disabled for more than 12 months or expected to be disabled for more than 12 months.  Faster hearing times may lead to some denials because of this regulation.

Social Security Disability Case Processing Times

Social Security Hearing Office Processing Times

A hearing before an Administrative Law Judge is the second appeal in the Social Security Disability appeal process.  At a hearing, you appear in-person before an Administrative Law Judge or by video teleconference.

In North Carolina, there are hearing offices, called ODARs (Office of Disability Adjudication and Review), in Raleigh, Greensboro, Charlotte, and Fayetteville.  When you file a claim for disability benefits, you file at the local office in your area.  When you reach the hearing level and you file your Application for Hearing before an Administrative Law Judge (form HA-501), then your case is assigned to the ODAR closest to your reported residence.  (NOTE:  all requests for hearing must be filed online now).

When you file a request for a hearing, the ODAR office will schedule a hearing by contacting you no earlier than 20 days before the hearing date.  If you live more than 75 miles from the nearest ODAR, you case may be heard at a satellite hearing office either with a judge present or by video.

Depending on the volume of work for each office, staffing, budgets, etc., the wait time for receiving a hearing date varies for each office.  The Social Security Administration keeps track of the average time for final disposition of cases.  The Charlotte, NC ODAR has the best processing time for cases in North Carolina, with an average process time of 393 days.  Out of all of the hearing offices throughout the country, Charlotte ranks 121.  The Raleigh, NC ODAR is ranked 130, with an average processing time of 402 days.  The Fayetteville, NC ODAR is ranked 143 with an average processing time of 421 days.  The Greensboro, NC ODAR is ranked 162 out of 165 offices, with an average processing time of 466 days.

See http://www.ssa.gov/appeals/DataSets/05_Average_Processing_Time_Report.html

So obtaining a hearing date is just part of the disposition process.  Once you obtain a hearing date, you then need to attend the hearing.  If you do not have all of your evidence to present before or at the hearing, sometimes a hearing would be held open for a time to allow for submission of additional evidence.  Also, most administrative law judges do not make a decision regarding a claim at the hearing.  They will review the evidence, hear the claimant’s testimony and any other witnesses, then make a decision.  The judge’s opinion and reasoning are given to a decision writing unit.  This unit prepares the actual decision.  There is not a deadline or requirement for a specified time for the decision to be sent to a claimant after a hearing.  Some decisions take a few weeks, others a month or more.  This time is factored into the processing time for cases.  The longest time I have seen for a decision to be made was 4 months after the hearing date.

These processing times seem long and they are.  However, the Social Security regulations provide that a claimant must be disabled for more than 12 months or expected to be disabled for more than 12 months.  Faster hearing times may lead to some denials because of this regulation.

Social Security Disability and Long Term Disability Insurance: Good and Bad

You suffer a physical injury.  You are out of work.  You live paycheck to paycheck so you decide to return to work.  However, you find you cannot continue.  You have long term disability coverage.  You apply and you start receiving benefits. Great!  The insurance company tells you that you must apply for Social Security disability benefits.  They even have people who will represent you or at least help you with the application.  You get payments while you wait for your Social Security case to get to a hearing.  Considering it can take up to two years or more from the time you apply for Social Security disability benefits to get a hearing and possibly get approved, getting payments in the meantime sounds good, right?

Well, the problem is what the insurance company does not tell you.  Every long term disability policy I have read contains a reimbursement clause.  You agree to reimburse the insurance carrier for money they pay you if you are awarded a lump sum award of back benefits from the Social Security Administration.  They don’t give you your insurance premiums back though.  You paid for the insurance, should they not pay you back since you have to pay them back?   Why should you have to reimburse them?  You paid for the insurance coverage.  The insurance contract controls.

With the recent election and talk of excessive government spending why should you have to apply for Social Security disability benefits?  Well, for two reasons.  One, if you do not apply and you stay out of work for more than five years you will lose your insured status.  The Social Security Administration (SSA) makes its own determination of your disability.  The decision that you are disabled made by the insurance company is evidence in your Social Security case, but it is not dispositive.  It is possible that the SSA finds that you became disabled, but not until after your date last insured.  In that case, you would not qualify for Social Security disability benefits.  Two, if you wait more than one year to apply for Social Security disability benefits from the time you stopped working, you lose benefits if you are successful in your claim.  You can only get benefits up to 12 months prior to your application date for a Social Security disability claim.

I believe in situations where there is long term disability insurance in place, the Social Security Administration should change the regulations so that a person could retain their qualifications in order to apply for Social Security disability benefits at a later date, if needed.

Social Security Disability – Myth

Myth – I can work and still get Social Security disability benefits as long as I do not earn over the SGA limit

This is only partially true.  Substantial gainful activity (SGA) is defined as full-time work.  The Social Security Administration determines whether a claimant is engaged in substantial gainful activity by earnings.  The SSA sets an amount for statutorily blind individuals at a higher level than non-blind claimants.  In 2013, the amount a statutorily blind claimant can earn without being automatically disqualified for disability benefits is $1,740.  A non-blind applicant can earn up to $1,040 per month in 2013 without being automatically disqualified from claiming disability benefits.

Some people believe they can work and seek disability benefits as long as they do not earn over this SGA level.  This is a partial truth that could lead to a finding of not disabled by the SSA.  The earning level amounts listed above are only automatic disqualifiers.  If you are working, the regulations provide that even if you earn less than the SGA amount each month, the SSA can determine that you are capable of earning more based on the current work you are performing and still find you not disabled.  A finding of disability is determined by your residual functional capacity.  The Social Security Administration gets to determine your residual funcational capacity.

Social Security Disability Insurance Benefits

Disability Insurance Benefits (DIB)

In 2012, especially with the 2012 election, many people talked about “entitlement benefits”.  Some people consider Social Security disability benefits to be entitlement benefits.  However, unlike Medicaid or food stamps, you pay for your Social Security benefits.  You will notice that “taxes” are taken from your paychecks for Social Security benefits.

In order to qualify for Disability Insurance Benefits (DIB) you must have sufficient earnings to qualify.   You earn credits or quarters when you have earned sufficient earnings.  You may earn up to 4 credits each year.  You must have earned at least 20 credits within a ten year period in order to qualify.  This is called the 20/40 rule; 20 credits in the last 40 quarters.  So if you have worked consistently for at least five years then stop working due to a disability, you should be qualified to apply for DIB.  There is more to analyze than just this simplistic rendition, but this will give you an idea of what is required for DIB.  When you stop working, you begin to lose your insured status.  The SSA sets a “date last insured” time based upon your earnings and when you stop working.  In order to qualify for DIB, you must prove that you became disabled prior to your date last insured.  For most claimants, this is not a problem.   In some cases, the date last insured may prevent them from receiving DIB.

The good thing about DIB is that other income does not affect these benefits.  If you are married and your spouse earns an income, this money will not affect your benefits.   Likewise, if you receive other disability benefits, such as service-connected Veteran’s Disability benefits, this will not affect your ability to collect disability insurance benefits.

Your monthly DIB amount is determined by the amount of earnings you received over your lifetime.

Social Security disability application and appeal process

In order to be eligible to receive Social Security benefits you must file an application.  Sounds simple enough, right?  It used to be a complex, time consuming task, but filing a Social Security disability benefits application is a little easier now that a claimant can file online.  However, you still need to provide original documents to the Social Security Administration (SSA) office to complete your application.  If you still want to file in person, I recommend that you call your local SSA office and schedule a time to file the application.  Your application date will be the date you called to schedule the appointment, not the actual date that you file the application.  This is called your protective filing date.  This could mean an extra month of benefits depending on when the protective filing date is compared to the actual filing date.

Most claimants will be denied at the initial application stage.   Unless it is abundantly clear from your medical records that you cannot possibly work, you will be denied.

If you receive a denial of your application, you must file an appeal within 60 days of the date of the written denial.  The SSA assumes you received the denial notice within 5 days of the date on the notice.  Some people compute 65 days as the appeal time.  This is a potentially dangerous practice.  If you miss your appeal time, you must file a new application.  Only if there is good cause can you file a late appeal.  If you miss your deadline to file your appeal and file a new application, it is possible to reopen the previous application.

The initial appeal is a Request for Reconsideration in North Carolina.  Some states have done away with this appeal stage.  Another agency, Disability Determination Services (DDS), reviews the initial application, evidence and decision and decides if this determination was proper.  The DDS worker will update your medical records based upon the information you provide in your disability appeal report that must be filed with your Request for Reconsideration filing.

The DDS worker may schedule doctor appointments for you if they believe they need additional medical evidence in order to make their determination.  You are required to attend these appointments.

If you are denied at this level, you will receive a written denial letter.  Again, you have 60 days from the date of the denial in order to file your next appeal, a Request for Hearing before an Administrative Law Judge.   Again, the SSA assumes you received the written denial notice within 5 days from the date of the denial letter.  When the SSA is ready to schedule your hearing, they will send you a notice not less than 20 days from the date of the hearing.   The hearing office is called the Office of Disability Adjudication and Review (ODAR).  You will either appear in person before an Administrative Law Judge (ALJ) or appear by video.  This depends on how close you are to the nearest hearing office and which judge will hear the case.  You can object to a hearing by video, but this may mean you have to travel a longer distance for a hearing in person.  If a hearing office has a large backlog of cases, sometimes cases will be sent to hearing offices outside of North Carolina.  You will have a hearing at your local hearing office by video with a judge in a hearing office in another state.

The hearing is the best time to present all of your evidence.  If you receive an unfavorable decision at the hearing, you can appeal, but this appeal is generally limited to whether the ALJ committed any error in making the decision.   The appeal from a hearing is made to the Appeals Council in Virginia.

If you receive a denial from the Appeals Council, you may be able to file an appeal in Federal District Court.  The Appeals Council is the last level of administrative review of your claim.  By filing in Federal District Court, you are asking for judicial review of your claim.

This process can be lengthy and difficult.  An experienced attorney-representative can make a difference for a claimant.