The Initial Application

Welcome to Season 1, Episode 8 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into the complicated topic of "The Initial Application."

Join host Nancy L. Cavey, an experienced disability attorney, as she demystifies Form SSA-16 - the application for disability insurance benefits. This form is the foundation of your claim, and while completing it may feel overwhelming, it’s a necessary step toward securing your benefits. Like any disability form, it’s filled with potential pitfalls that could lead to costly mistakes and delays. In this episode of Winning Isn't Easy, Nancy is joined by Cavey Law associate attorney Krysti Monaco to break down the form into clear, manageable sections, ensuring you understand the crucial details needed to navigate the process successfully. 

In this episode, we'll cover the following topics:

1 - Basic Information about the Initial Application

2 - Exploring Pages of the Initial Application, and Answering Questions

3 - Okay, Let’s Say We Got Our Initial Application Summary, Reviewed It, Signed It, and Sent It Back - Now What?

4 - What Are Some Crucial Mistakes an Individual Can Make When Filling Out the Application for Disability Insurance?

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


Need Help Today?:

Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.

Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Nancy Cavey [00:00:00]:
 Foreign. Welcome back to Winning Isn't Easy. The Social Security Disability Benefit Version. This is a podcast where we break down everything you need to know about navigating the Social Security disability system. I'm your host, Nancy Cavy, and today I'm joined by my associate, Christy Monaco. Now, before we get started, we've got to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar association says I've got to say this.
 
 Nancy Cavey [00:00:36]:
 So now I've said it. Nothing will ever prevent me from giving you an easy to understand overview of the Social Security disability claims process, the games that are played, and what you need to know to get the Social Security disability benefits you deserve. So off we go. Now, in last week's episode, we talked about what it costs to file a Social Security disability claim and what you might get if you win. Today we're going to be focusing on how to fill out form SSA 16. That's the application for disability insurance benefits. I will tell you that this form is really crucial in getting your Social Security disability benefits, and completing it correctly can significantly impact your chances of approval. We're going to talk today about four things.
 
 Nancy Cavey [00:01:23]:
 The first is the basic information about the initial application that you need to know. Second, we're going to explore the pages of the initial application and how to answer questions. And we're going to talk about reviewing that initial application and then ultimately submitting it. Lastly, we're going to talk about what are the crucial mistakes that you can make when filling out this application for disability insurance. Got it. We're going to take a quick break before we jump into this week's episode. Welcome back to Winning Isn't Easy. You ready to get started? Let's first talk about the basic information about the initial application to start.
 
 Nancy Cavey [00:02:22]:
 This application for disability insurance benefits is known as SSA 16. Now, it's designed to gather information about your medical condition, your work history, and how your disability affects your daily life. But before you dive in, you've got to gather the necessary documents, including tax records, medical records, employment history, and and any documentation that's related to your disability that is going to make this application process sooner. Now, I'm often asked, as is Christy, where do you suggest we start on this form? Well, you're going to have to have, I think, all your relevant documents before you begin this form. And I think that you should give yourself at least 30 minutes to make sure you complete this form accurately and and completely. Now, to begin with, this first page is pretty simple. It's basic demographics Your name, the date of birth, language you speak and write, the country or state of birth, your Social Security number, and importantly, your date of disability. Christy, let's talk about the date of disability and why it's so important.
 
 Christy Monaco [00:03:31]:
 Sure. Nancy. The date of disability is the day that your condition became severe enough to keep you from working. If you're working part time, then it's the first day that your disability kept you from making over what's called substantial gainful activity by adding that date to the application. That becomes what Social Security then calls your alleged onset date. Nancy, what do we tell people if someone's unsure of their date of disability?
 
 Nancy Cavey [00:03:55]:
 Well, often it can be unclear what the date of disability might be, particularly if you have attempted a return to work. Now, if you're unsure and you've been working, we suggest that you look at your pay stubs to see where your wages fell below that SGA number. Remember that SGA number changes every year. The next thing you need to look at is look at your medical records to determine where and when your symptoms became severe enough to prevent you from working. Now, if you've had an accident, we actually know what that date is, Right? So if you're in a motor vehicle accident or a worker's computer accident, we know that that's the specific date that you're going to be claiming as your date of disability if you were unable to work as of that date. But if you have a progressive disease like Ms. Or pd, it can be hard to pinpoint that right date to claim that you're disabled. If this seems too much, please call us, and we will help you with this application process, including help you determine the date of the onset.
 
 Nancy Cavey [00:04:58]:
 Now, Christy, I've used some language called Substantial Gainful activity as you did. What on earth does that mean?
 
 Christy Monaco [00:05:06]:
 Sure. So Substantial Gainful activity, or sga, as you'll hear us call it, is a monetary amount that Social Security believes that if an individual can make over, then they're not disabled. As Nancy discussed, that number goes up every year with the cost of living increases. This year, 2024, it is 1,550. But. But you're going to want to check Social Security's website in 2025 to see how much it's increased.
 
 Nancy Cavey [00:05:31]:
 Got it. Well, let's take a break, and we're going to come back and continue our discussion about the application and what you need to know about submitting a winning application.
 
 Speaker C [00:05:44]:
 Have you been robbed of your peace of mind by your disability insurance carrier? You owe it to yourself to get a copy of Robbed of your Peace of Mind, which provides you with everything you need to know about the long term disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Nancy Cavey [00:06:09]:
 Welcome back to Winning Isn't Easy. Let's explore the pages of an initial application and answering questions. This is page two, so let's move on to this page two. And I'm often asked, well, what's really important about what's on the questions on page two? And I'm glad that you've asked. Now page two is going to ask you information about your spouse, when and where you were married, whether the marriage is still legal, and information about any divorce. But most importantly, there's a section at the bottom of page two that is going to ask you to list your children, the names of your children who are either under age 18 or who are between age 18 and 19 and attending elementary or secondary schooling or whether they're disabled or handicapped. And that can be important ultimately as you're going to learn because of benefits. So Christy, can you explain why it's important to include this information? Because sometimes we have people objecting to answering the question about their children and we have to explain why it's so important.
 
 Christy Monaco [00:07:13]:
 Sure. We actually do get that objection quite a few times actually per day. And adding this is very important because it provides what's called a protective filing date for your dependent benefits. When an individual is approved for disability benefits, if they have an eligible dependent, that dependent is also eligible for disability benefits under their parent. So you want to make sure that you put their birth date on there because that is the filing date. Social Security is then notified that there is a dependent and you will get back benefits back to the date of the application if you fail to put the date on there and you get awarded benefits. If that took you three years and then you let Social Security know you have a dependent, your protective filing date becomes the day you let them know. So you have just missed out on the back pay for those dependents and.
 
 Nancy Cavey [00:08:03]:
 That can be a huge financial hit. So when we or when your lawyer or Social Security asks you about that information, give it to them because otherwise you'll be costing you and your family money. So let's move on to page three. Page three is where the Social Security Administration starts to ask a little bit about your work history. Now in this particular form they don't want too much detail, but in our subsequent podcast we're going to talk about the work history and why it's important to fill out that information in a detailed manner. So at this point, as I said, they don't want a lot of detailed information, but they want enough information to get a sense of what your occupation might have been. Now, recently, the Social Security Administration has changed step four of the five step sequential evaluation. And at step four, they have to determine whether or not you can go back to your past relevant work.
 
 Nancy Cavey [00:09:01]:
 The past relevant work is now defined as the lightest and simplest job you had in the five years before. Before your claim has been decided. Used to be 15, but now it's five years. So this section is going to ask you, well, who did you work for? What's the address of that employer? When did you start with the company, and when did your employment end? Now, again, this is really important because Social Security is going to use this information to determine what jobs you had that were the lightest and the simplest in the previous five years before the onset of your disability. Now, the questionnaire also wants to know about your earnings for the past and current year. And that's why it's really important to have your tax documentation with you prior to completing the documents. Because, in part, the answer to that question can impact the SGA issue. Got it.
 
 Nancy Cavey [00:09:52]:
 Now, the last page looks scary, but it's full of basic information and. And it's a governmental form, and it asks questions in a way, I think that's designed to throw you off course. And that's why our firm, and that was Christie's project, created our own version to send to you electronically to gather the same information. Now, the last page has, I don't know, any specific rhyme or reason to it. It's five questions, and they're not really organized in any fashion. But the questions are important. And the questions include, have you filed for other public benefits, such as VA disability benefits, workers comp, or even ssi? They want to know, did you receive any other money from your employer after you stopped working? And do you have a dependent parent living with you? So, Christy, let's talk about why Social Security is asking about whether you've been paid money from your employer after you stop working and any other public benefits, because our listeners need to understand the importance of this.
 
 Christy Monaco [00:10:59]:
 Yeah. So Social Security can see your earnings on their end. However, they cannot delineate where those earnings came from. So if you received short or long term disability benefits, salary, continuance, or a severance package after you stopped working, Social Security cannot tell that those monies you received were not earned income. So it is very smart to provide that documentation that establishes what those Earnings are so that you can show them that you did not work after your alleged onset date. They're asking about other public assistance benefits like workers compensation and VA benefits because they want to know what income you have and what they're going to see in your earnings. And workers compensation benefits oftentimes provide an offset to your Social Security Security benefits. You want to make sure they're aware of any other benefits you received because you don't want to get a technical denial, which is where Social Security says, well, you're technically making over sga, so we're not even going to look at your medical conditions.
 
 Nancy Cavey [00:11:59]:
 And I will tell you that's a big issue, not only at the front end, but at the back end, because we don't want to get a technical denial after waiting potentially a year for them to look at the application to say, hey, by the way, your earnings in quote, are over sga. And on the other end, potentially you're going to have to deal with offset issues in the context, particularly of a workers comp case and sometimes from a VA standpoint where VA can consider the value of your Social Security benefits. So full disclosure is really, really important. So let's talk about what happens once the application is completed and the claim is filed. Now, in my view, in our view, this is the most important point of the episode. If you weren't following along, shame on you. But you nearly need to pay attention. Now, once the claim is filed, the claim will go to your local Social Security office that's closest to your residence and that's called the Office of Disability Determination Services.
 
 Nancy Cavey [00:13:06]:
 What they're going to do is they're going to open the file and they're going to send you what's called an Internet application summary. This is Social Security's way of detecting fraud. And the Internet application summary will say if a third party applicant, sorry, a third party, filed the application on your behalf, like us or a claims representative, please review these answers, change any incorrect answers, sign and return to the Social Security administration. Now, I quite frankly think this is a bit silly, but it is what it is. This is something that you should be on the lookout for because if Social Security does not get your executed Internet application summary back within six months, they will close your claim and you're going to have to start all over and get back in line. So as silly as this may seem, please, please complete this executed Internet application summary and send it back. We've actually had a case where the claimant ignored it and we got the local Social Security office to kind of weigh in, give him an opportunity to do it again. He ignored it, and then ultimately his claim got closed and he was mad at us, which I think is obviously misplaced.
 
 Nancy Cavey [00:14:21]:
 Christy, do you have any comments about that before we take a break?
 
 Christy Monaco [00:14:25]:
 Yeah, actually post Covid Social Security also started doing telephone calls to confirm that the individual wanted the claim to be filed. So one thing that we do tell our clients is to keep an eye out on your mail for the Internet application summary, but also pay attention to who's calling you sometimes. And there's no rhyme or reason to who they call or who they send the Internet application summary to. But sometimes they will simply make the call to confirm the information over the phone. So it's important during that, you know, first four or five months of your claim that you're paying attention to your mail and your phone calls just so that you make sure that your claim doesn't get abated and closed.
 
 Nancy Cavey [00:15:00]:
 Great. So let's take a quick break. Welcome back to Winning Isn't Easy. So let's say you got your initial application summary. You reviewed it, you signed it, and you sent it back. So what happens next? Now, the Social Security Administration is very backlogged. And when your claim is submitted, as I've said, it goes to the Disability Determination office service office to review your claim and render a decision about whether or not you are disabled. Once the local office sends this to the DDS office, your file is probably not going to be touched for at least six to eight months.
 
 Nancy Cavey [00:16:01]:
 Politics aside, we are anticipating during the beginning of the Trump administration that there are going to be some significant budget challenges. And the Social Security Administration has also already anticipated that. They have issued announcements that they are laying off workers at the local office. In fact, in the Clearwater office just this week, they gave notice to over 30 employees that they will be laid off at the end of January. As I said, politics aside, budgetary issues aside, what that means for you practically is that the delay is going to get worse. And we are certainly urging everyone to call their local congressman and complain and ask that they restore funding for the Social Security Administration so that the applications can be handled quickly. They were not quick to begin with. Social Security has been historically underfunded, so it's not only kind of restoring what we had, but give us more money so that we can make a decision.
 
 Nancy Cavey [00:17:05]:
 In my view, and I think this is a quote from Roosevelt, a measure of a society is how it treats its disabled population. And unfortunately, Social Security disability applicants have not been on high on the list as have veterans. So this is an opportunity for you to actually get involved and make your voice heard in your local to your local congressman's office. Got it. So, Christy, what should you be doing while you're waiting and twiddling your fingers, hoping for a decision?
 
 Christy Monaco [00:17:40]:
 Sure. So during that time, you should be continuing to see your doctors and following all of their recommendations. Social Security does require that you have medical care, and quite frankly, your medical records is exactly how we're going to establish what your restrictions and limitations are and how we're going to approve your case. If you're a client of ours during this long wait time, we work with you to make sure that we have all of the physicians that you're seeing and we work diligently to gather all of your medical records to ensure that by the time somebody at DDS picks up your file to begin their review, they have all of the medical records and there's no more further delay.
 
 Nancy Cavey [00:18:13]:
 Christy has nailed it. So what's the advantage of working with an attorney? Now, aside from the knowledge and experience with the Social Security Administration rules and intimate knowledge of the five step sequential evaluation, we at the KV Law understand that doctors did not go to medical school to write medical records for the Social Security disability claims process. And as such, we lawyers have created residual functional capacity forms that we provide to our clients and they take these forms to their physicians. Why are these forms important? Well, the forms address at step three, whether or not you meet a medical listing and medical listings are for very specific medical conditions and require very specific medical criteria be documented in your records. More often than not, because doctors didn't go to medical school, you don't see that in a traditional medical office note. The residual functional capacity form tries to get at the elements of the listing. Now, there are also some more important reasons that we want residual functional capacity forms completed by your doctor. At step four, as we've suggested, the issue is, can you go back to your past relevant work? And at step five, the issue is, is there other work in the mythical, hypothetical, not real world national economy that you wouldn't want to do and doesn't pay a living wage in view of your age, your education, your skills, and your restrictions and limitations? Once again, we find that doctors do not address restrictions and limitations.
 
 Nancy Cavey [00:19:49]:
 If you think that getting a note from your doctor that says you're disabled and unable to work is going to cut it, it won't. What will cut it is having your doctor complete the residual functional capacity form that will address how long you can sit, stand, stoop walk, bend. How much can you lift? Do you need to take breaks? Are you going to be off task? Are you going to miss time from work? Those are the kinds of information that DDS and ultimately, if we have to, a judge will look at in determining your functional physical and psychiatric restrictions, limitations. And we have psychiatric restrictions and limitations forms that we submit to our clients to get their physicians or providers to fill out as appropriate. So you can see that these forms are going to help the DDS people understand the nature of your medical condition, the nature of your restrictions and limitations, and why you can't do your past work or other work in the national economy. Christy, this sounds exhausting. There are lots of things to look out for on the application form that aren't really explained. So I want you to explain what they need to know.
 
 Christy Monaco [00:21:00]:
 Sure. And this is one of the advantages of consulting with an attorney before you file is that we have experience with these forms. We've dealt with the Social Security process, and we know what to look out for and what to avoid. Now, one of the questions that we get almost daily is, can we make the claim move faster? And the simple answer is no. There is nothing that anybody can do to make your claim move faster aside from you meeting specific qualifications from Social Security for a compassionate allowance. But we can use our experience to ensure that by the time it gets to somebody at Social Security, that we've essentially handed them your claim on a silver platter. We've. We've collected the residual functional capacity forms from your physicians.
 
 Christy Monaco [00:21:43]:
 We've made sure that we have all of your treating physicians listed on your application and in your file, and we've requested and received all of the records so that by the time somebody at DDS picks up your file, they're not saying, well, this file has been sitting on my desk for eight months, but now I have to go request medical records. If you have any experience with requesting records, you know that can take 30, 45, sometimes 60 days to get get. So we help avoid unnecessary delays and make sure that the file is complete, that the application and all the other forms are filled out accurately and completely so that we leave no questions on the table by the time somebody at Social Security is looking at the file.
 
 Nancy Cavey [00:22:20]:
 That's fantastic, Christy. That's absolutely the way to do it. Let's take a break, and when we come back, we're going to talk about the crucial mistakes that you can make while filling out your application. Got it.
 
 Speaker C [00:22:35]:
 Struggling with your Social Security disability case? The right attorney can make all the difference. Get our booklet the key to hiring a great attorney for your Social Security disability case. Discover how to find an experienced attorney who will fight for your rights and navigate the process with ease. Don't leave your future to chance. Request your free copy@kvlaw.com today and ensure you have the expert support you deserve.
 
 Nancy Cavey [00:23:07]:
 Welcome back to Winning isn't easy. So Christy, what are some of the crucial mistakes that an individual can make while filling out that application for their disability insurance benefits?
 
 Christy Monaco [00:23:17]:
 Sure. The first mistake that is crucial is picking a date of disability that coincides with a time that you made more than substantial gainful activity. Like we spoke before, Social Security will look to see if you've made over substantial gainful activity and if you did, after your onset date, they will give you what's called a technical denial. This means they're not even going to look at your medical records. The bad thing about a technical denial is you have to appeal that technical denial, which means we are only appealing at that point point that you made under sga. If we have to take that all the way to a hearing and we win, we then have to go all the way back to then argue the medical conditions. And as we've discussed, this is a three year process. So you just made it a six year process.
 
 Christy Monaco [00:24:05]:
 So picking the correct date of disability, paying attention to your earnings, super crucial.
 
 Nancy Cavey [00:24:12]:
 What's next?
 
 Christy Monaco [00:24:13]:
 Oh, I got it. Leaving dependents off of the application. This is a huge mistake that could cost you a lot of money. Remember, putting your dependents on that application is your protective filing date. You are notifying Social Security you have dependents, they're on notice and if you're awarded, you will get the back pay for those dependents back to that date. That is also true if you are pregnant at the time of applying for disability. You should put on there that you are pregnant in the dependent spot, the estimated time of delivery. But that is the notice.
 
 Christy Monaco [00:24:46]:
 Now if you become pregnant after applying, you should still contact Social Security and let them know. So that way you are protecting that filing date and not costing yourself a lot of money.
 
 Nancy Cavey [00:25:00]:
 So the third mistake is failing to complete and return that Internet application summary or pick up the phone when Social Security calls. Remember that Social Security's way of detecting fraud and they should be sending you an Internet application summary or make a call to ensure that you in fact filed this claim. If you don't respond to either the call or complete that Internet application summary within six months, it's hasta la vista baby, you're out of there and your claim is going to be closed, so that means you have to start all over again. You can see after watching this episode and listening to our podcast that this initial application can be complex and can be confusing. We hope that this episode has cleared up any questions you have, but if not, feel free to contact us at 727-894-3188. We do offer complimentary consultations. If you found this episode to be helpful, as I hope you have, please share it with someone who might need it. And we welcome you back next week when we tackle the issue of Adult the Disability Adult Reports, another crucial form in the Social Security claims process.
 
 Nancy Cavey [00:26:08]:
 Thanks.