Depression and Qualifying for Social Security Disability
Can I get disability benefits if I am suffering from the effects of Depression?
Author: Attorney Lloyd Bemis
Approximately 25 percent of adults over the age of 18 will experience an episode of major depression at some point in their lives. Depression is different from periods of sadness and despondency a person may feel in response to challenges at work or home. In some individuals, depression is a serious condition causing a person to function poorly at work, school or home. Women are twice as likely to suffer from depression as men, but depression affects both men and women and children as well as adults. If you are suffering from the effects of depression you may qualify for disability benefits.
Depression is often characterized by irritability or feelings of being misunderstood, as well as poor work attendance or performance.
Older adults may exhibit personality changes or memory problems. Depression may occur when a person experiences an emotionally painful event, but to be diagnosed with clinical depression, symptoms must continue for at least two weeks.
The most common symptoms of depression include:
- Feeling sad or hopeless;
- Anhedonia (loss of interest in people and activities that previously were rewarding, like visiting with friends or a hobby);
- Insomnia or oversleeping;
- Feelings of worthlessness or failure;
- Difficulty in concentrating and making decisions;
- Changes in eating habits resulting in weight loss or weight gain;
- Physical symptoms such as headaches or digestive problems that do not subside with treatment;
- Suicidal thoughts.
These symptoms can cause you to miss work and jeopardize your ability to maintain employment.
Depression is not curable, but it is treatable.
Medications can reduce symptoms, but are most effective when used in combination with therapy that focuses on developing social skills as well as problem solving and changing behaviors. Unfortunately, some anti-depressants have more side effects than others and 30-40% of patients have only a partial response to drugs. There are also steps an individual can take on their own to relieve depression;
- Develop a routine; a set schedule reduces stress.
- Exercise, eat a healthy diet, and get enough sleep.
- Set daily goals to give you a sense of accomplishment.
- Get involved in a project, such as volunteering or part-time work.
- Try something new; take a class in a subject that interests you or visit a museum.
- Find time for people and things you enjoy.
Following your doctor’s treatment plan is an important part of qualifying for disability benefits.
Qualifying for Disability for Depression
Depression can seriously interfere with an individual’s ability to work and is the second most common medical condition listed on applications for Social Security Disability Income.
To be eligible for disability benefits, in addition to supportive medical evidence, you must show that your depression has lasted or is expected to last at least 12 months and your condition prevents you from working and earning over $1,550 per month (in 2024). The Social Security Administration lists depression as an impairment in its Blue Book under Section 12.04.
To qualify under this listing, you must meet the following criteria:
- Medical documentation of depression and at least five or more of the following:
- Depressed mood;
- Decreased interest in almost all activities;
- Appetite disturbance resulting in weight loss or weight gain;
- Insomnia or sleeping excessively;
- Slow physical movements or agitation;
- Decreased energy;
- Feelings of guilt or worthlessness;
- Difficulty concentrating or thinking; or
- Thoughts of death or suicide.
- Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:
- Understanding, remembering, or applying information;
- Interacting with others;
- Concentrating, persisting, or maintaining pace;
- Adapting or managing oneself.
There is also another set of criteria under this listing which acknowledges that some individuals with depression may not show serious symptoms because they live in a highly supervised or protected environment, such as a nursing home or group home.
They may seem to have better functional abilities than if they lived in a different, real-world situation, but are not expected to perform in a work environment.
To qualify for disability under these criteria, you must have a medically documented history of depression over a period of at least two years, and evidence of both of the following:
- Medical treatment, mental health therapy, psychosocial support, or a highly structured setting that is ongoing and that decreases the symptoms and signs of your mental disorder; and
- You have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life.
Social Security will expect you to provide detailed medical records. These records should include:
- Names and addresses of all medical providers.
- Dates of medical appointments and doctors’ exam notes.
- Dates of hospitalizations and emergency room visits. This is important to prove the severity of your depression.
- Mental testing results.
- Medications and treatments you are taking as well as any side effects.
Ask your doctor to complete an RFC form.
This essential form will evaluate your ability to focus, concentrate, remember instructions and your social skills, describing what you can do and not do physically and mentally. You must show that you have followed your doctor’s plan, but are still disabled. If you are still working, keep track of absences. This will establish that your productivity at work is declining. You must prove that your medical condition has reduced your work productivity by at least 15 % of the acceptable level. If you consistently need to stop work because of an inability to focus or headaches, or miss work several days per month, you will not be able to maintain full-time employment.
Once Social Security determines the limitations caused by your condition, they will employ a vocational expert to assess whether a person with these limitations is employable.
Most vocational experts will find a person to be unemployable if their condition or the treatment rendered for the condition causes the person to regularly be absent two or more days a month or be “off-task” 15% or more of the workday.
If you don’t meet the specific criteria of Social Security’s listing – and this may be quite difficult – you may still be approved for disability benefits through a medical-vocational allowance.
Social Security will conduct a Residual Functional Capacity assessment (RFC) to consider the following:
- your ability to carry out instructions;
- if you can make simple work-related decision;
- if you respond appropriately to supervision;
- how you get along with coworkers; and
- how you handle changes in routine.
Social Security will then rate your ability to perform skilled, semi-skilled or unskilled work, taking into account your age, whether or not you are able to drive, and your level of education.
Your chances for approval are better if you have another impairment; for example, high blood pressure or arthritis. Applicants often have more than one illness or injury that prevents them from working full time. While one disorder may not meet the requirements of an impairment as stated in Social Security’s Blue Book, if you have multiple medical conditions, Social Security must consider how those health issues, combined together, limit your ability to hold a job and perform necessary daily tasks.
If you are 55 or older or have another medical condition you may get approval.
Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.
Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.
Social Security also has basic financial requirements.
Before you are eligible for Social Security disability benefits, you must satisfy some basic financial requirements.
You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,550 per month in 2024 for nonblind applicants and $2,590 per month for blind applicants.
What if I don’t qualify for SSDI?
If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.
SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.
I have long-term disability insurance – should I file a claim?
Yes, you should file a claim as soon as you become disabled.
Long-term disability insurance (LTD) is coverage that protects your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. However, LTD coverage is good only as long as you are employed, so do not quit your job before you file a claim, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.
How do I file for Social Security Disability benefits?
You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.
If your initial application is denied, don’t be discouraged. Approximately 65% of initial applications are denied, but you will have the opportunity to appeal.
There are four steps to the Social Security appeal process:
- File a Request for Reconsideration with the Social Security Administration to completely review the case.
- If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI cases and either uphold or overturn decisions to deny SSDI. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
- If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
- Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.
Do I need a disability attorney for SSDI?
Qualifying for Social Security Disability benefits is problematic because the requirements of Social Security’s impairment listing are very difficult to decipher.
Your chances for approval are increased significantly if you have an experienced disability attorney who can gather your necessary medical evidence and even write a brief explaining why you qualify. At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.
Do I need a disability attorney for a long-term disability insurance claim?
Whether you have a long-term disability insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance is a complex process.
The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.
Disability benefits are an important source of income for those who are unable to work. If you are not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.
Author: Attorney Lloyd Bemis has been practicing law for over 35 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Bemis obtained dual board certifications from the Texas Board of Legal Specialization. Lloyd is admitted to practice in the United States District Court – all Texas Districts and has argued before the U.S. Court of Appeals, Fifth Circuit. Mr. Bemis is a member of the Travis County Bar Association. He has been active in the American Association for Justice and is a past Director of the Capital Area Trial Lawyers Association. Mr. Bemis and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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