Why Was My Social Security Disability Case Placed On A Medical Hold?

September 6, 2016

In order to be found disabled by the Social Security Administration, you must be unable (or expected to not be able) to work for at least twelve months or more. While this definition may seem simple enough, the problem often lies in how this requirement is portrayed to those needing disability benefits. For a person who is unable to work due to a medical condition, he or she may know they will not be able to work for at least the next twelve months. But, for a person examining the case to make the same determination, the answer may not be so clear. 

 

The Social Security Administration will only consider those for benefits that are at least expected to be out of work for 12 months or more. However, what this requirement fails to explain is that Social Security will usually not consider a claim which is less than five months old.

 

Now, be sure and do not wait for five months after you stop working to file for benefits, that is not what I am saying. What usually happens is that a person files for benefits the day after he or she stops working, and then does not understand why his or her claim is not moving forward. The reason may very well be Social Security has placed that person on a "medical hold" until the required five months of short-term disability have passed. Often, when this is the case, a representative from the Administration will make contact with the claimant and ask if he or she is still not working. At that time, if there has been no work performed during that period, the case is then moved to the state Disability Determination Service to continue processing the claim.

 

So, when is the best time to file your disability claim?

 

If you know you are going to stop working on a certain date, the best time to file is about three months later. This allows Social security to collect additional information required for their records and seamlessly transfer the case down to the state DDS office after the short-term disability period has expired. Be sure and make your alleged onset date the day after your stopped working. That way, it shows your disability period is closely coming up on the five month period. 

 

But, as with all matter pertaining to Social Security disability, this issue can get even more complicated. There is always the issue of the alleged onset date. If this date is more than five months old (and most of the time it is), then the five month medical hold for short-term disability does not apply.

 

If the last time you worked was (for example) one year ago, and you have not engaged in Substantial Gainful Activity (grossing more than $1,130.00 for 2016 in one month's time), then you can establish an onset date of one year prior (again, for example, your own onset date would apply in your own circumstance) and the five month medical hold will not stop your case from moving forward.

 

Also, there are other times in which your claim will be placed on a medical hold. If, during the time in which your claim is being processed you are admitted into the hospital, then often Social Security will place you on a medical hold for a certain period of time in which to evaluate whether or not your condition has grown worse or improved. This is usually determined by follow-up visits to your doctor after a surgery or hospitalization. After doing so, Social Security will request your records and reevaluate your case. 

 

If you don't understand why your case is moving so slowly, you can always contact your case manager at the state Disability Determination office.  If you are told you case has been placed on a medical hold, you will at least be told why and when you can expect your case to start moving forward again. 

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