Bone fractures do not often qualify people for disability benefits because they normally heal in several weeks to months. (You must have a condition that lasts a year or longer to qualify.) However, when there are complications with bone fractures, the bones do not heal correctly, and a person cannot return to work because of injuries, then disability benefits may be an option. There are a lot of potentially disabling conditions that can arise from bone fractures, such as:
- Injuries to nearby muscles, joints, and organs
- Blood clots
- Shortening of the bone
- Atrophy, pain, and stiffness
- Failure to heal
To determine if you qualify for Social Security benefits for bone fractures in Pittsburgh and for help with the application process, call a disability lawyer at Berger and Green for a free consult: 412-661-1400.
When does the SSA consider bone fractures a disability?
One of the ways to meet the Social Security Administration’s (SSA) definition of disabled is to meet all the criteria under a listing in the Blue Book. There are several listings that deal with bone fractures in Section 1.00 – Musculoskeletal System of the Blue Book:
- Listing 1.04 – Disorders of the spine (vertebra fractures)
- Listing 1.06 – Fracture of the femur, tibia, pelvis, or one or more of the tarsal bones
- Listing 1.07 – Fracture of an upper extremity
Merely having a fracture is not enough for the SSA to consider you disabled. You will need to meet the severity requirements for that listing. For instance, if you have a fractured tibia, the guidelines stipulate that you must prove the following:
- There is no solid union of the bone (must provide imaging tests);
- You are unable to ambulate (walk) effectively (The SSA defines ineffective ambulation as “an extreme limitation of the ability to walk; i.e., an impairment(s) that interferes very seriously with the individual’s ability to independently initiate, sustain, or complete activities”; and
- You have not been able to, or a doctor expects you will not be able to, ambulate effectively for 12 months or longer.
What if my bone fractures do not meet all the requirements of a listing?
If your bone fracture does not meet all the criteria of a listing, you are not necessarily disqualified from benefits. If you can prove to the SSA that your injuries prevent you from working, the SSA might still determine you are disabled.
For disability claims based on fractures that are not listing level, the SSA will review your medical files and perform an RFC, or residual functional capacity assessment, for your case. The claims examiner will evaluate your ability to perform simple tasks required for most jobs, such as walking, sitting for long periods, bending, pushing, pulling, and lifting objects.
If your RFC rating indicates that you there are no jobs you can do because of your injuries, symptoms, and/or complications, the SSA may still deem you as disabled under a medical vocational allowance.
What types of documentation do I need to prove my disability?
The SSA will want to see all your medical files since the time of your injury. This should include x-rays and other imaging tests, as well as all the treatments you have undergone since that time. It will also want your doctor’s detailed description of your condition, complications, reaction to treatments, prognosis, and limitations.
The claims examiner will also take non-medical evidence into consideration when reviewing your case. If might be helpful to collect and submit written statements of your own and from your family, your employer, your physical therapist, etc. about how your injuries are affecting your ability to work.
Lack of sufficient documentation is one of the primary reasons the SSA denies disability claims. This is one of the reasons why it is a good idea to have a lawyer assist you with the application process. We will review your files and make sure they are comprehensive and accurately portray the extent of your limitations.
What are the other criteria to qualify for disability benefits?
As aforementioned, the first requirement to qualify for disability benefits is to prove to the SSA that your bone fracture meets a listing or that it prevents you from working to any substantial degree. A doctor must expect your impairment to last a year or more, and you must not be capable of doing any type of work.
There will also be additional financial or work history criteria to win your benefits. The requirements depend on which benefit program you are applying for:
- Supplemental Security Income: SSI is for disabled persons with limited work background, limited income, and limited resources. To qualify, your income must be below a certain threshold ($733 a month for an individual in 2016) and the value of your assets must be below $2,000 (or $3,000 if married).
- Social Security Disability Insurance: SSDI benefits are for disabled workers who have sufficiently paid into the Social Security system via employment taxes. To qualify for this benefit, you must have a certain number of work credits on your record, depending on your age.
The SSA has denied my claim. What do I do now?
If the SSA has recently denied your application for disability benefits, know that you are not alone. In fact, the SSA initially denies about 70 percent of claims. You are not without hope, though. There are several levels of appeals you can use, each of which allows you to provide additional evidence and to restate your case.
It is highly recommended to have a lawyer assist you with the appeals. We know know how to navigate the appeals process and help those with disabilities pursue the benefits they are entitled to. You will need to act swiftly though, because there is a short, 60-day, federally imposed time limit on appeals.
Contact Berger and Green today and schedule a free, no-obligation consultation with a disability lawyer in Pittsburgh: 412-661-1400.