Violent Crime and Qualifying for Disability Benefits

Summary: Can I get disability benefits if I am suffering from effects of a violent crime injury?

Every day in the United States someone is impacted by a violent crime. Some of the injuries an innocent victim might experience include gunshot wounds, knife wounds and brain injuries, as well as mental disorders resulting from the trauma. A victim’s injuries may heal in a matter of months or linger for years causing long-term disabilities; in the meantime, a victim may not be able to work and lose much needed income. If you are suffering from the effects of a violent crime you may qualify for disability benefits.

If you have been injured during a violent crime you may qualify for disability benefits depending on the severity of the injury and your work history.

Qualifying for Disability for Violence Related Injuries

If you have been injured during a crime, whether or not you can qualify for Social Security Disability Income (SSDI) will depend on the severity of your medical condition and if you meet Social Security’s basic eligibility requirements:

•   You must have worked long enough and recently enough in a job that paid Social Security taxes;
•    Your disability must last, or be expected to last, 12 months or result in death; and
•   You must not be earning more than Substantial Gainful Activity (SGA), which in 2024 is $1,550 per month for non-blind applicants and $2,590 for blind applicants.

Contact a Social Security disability attorney at 512-454-4000 for a free consultation and see if you can get disability benefits while suffering from injuries as result of violent crime. If you have been denied disability don’t give up!

Social Security doesn’t care how you were hurt, but you will not be eligible if your injury occurred while you were committing a felony.

You may qualify, however, if you are hurt while someone else is committing a crime. Traumatic injuries result in a wide range of medical issues; damage to skin, muscles, tendons, and ligaments can severely limit a person’s range of motion, strength and flexibility. Sometimes these impairments are not apparent until years after the initial injury occurs. Many people may recover enough to return to work in a period of weeks or a few months while others later develop physical and psychological problems that last for years.

A crime-related injury must be evaluated separately as a disability.

The Social Security Administration lists impairments that automatically qualify for SSDI in its Blue Book. In order to qualify for SSDI, an applicant’s injury or impairment must match or equal one of those listed impairments. As an example, gunshot wounds are not listed as an impairment in the Blue Book, but the serious physical and cognitive limitations resulting from gunshot wounds could be evaluated under many other listings such as Joint Dysfunction (Section 1.02), Spinal Disorders (Section 1.04), Neurological Disorders (Section 11.00), Soft Tissue Disorders (Section 1.08), or Mental Disorders (Section 12.00).

When you apply for SSDI you will be expected to provide documented medical evidence to Social Security that proves your condition is so severe you cannot work. This documentation should include:

•    Records of medical treatment related to your medical condition, from the initial care you received (for example, at an emergency room), to ongoing care.
•   Records of surgeries, physical examinations, imaging tests such as x-rays and MRIs
•   Records of regular mental health treatments for anxiety, depression, PTSD.
•   Statements and opinions from all medical providers.
•   A Residual Functional Capacity (RFC) form completed by your doctor which details your functional limitations in lifting, carrying, sitting, standing, walking, balancing, and how they impact your ability to perform your job.

A doctor should also note whether you are able to work around loud noises and whether certain work settings might trigger anxiety.

A mental RFC form completed by a psychiatrist or psychologist can greatly increase your chance for success. In this form, your doctor will be asked to give their opinion on your ability to:

•   Maintain attention for long periods of time;
•   Understand and remember instructions and carry them out;
•   Interact appropriately with supervisors, coworkers and the public;
•   Work together with others;
•    Work a full workday without interruptions from psychological symptoms;
•   Maintain reasonable attendance and punctuality.

If your condition does not match a Blue Book listing, you may still be eligible for Social Security Disability benefits if you have another impairment; for example, high blood pressure or diabetes.

Applicants often have more than one illness or injury that prevents them from working full time. While one disorder may not meet Social Security’s requirements of an impairment as stated in its 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. Social Security will also conduct its own RFC to evaluate how your limitations affect your ability to work, taking into account whether or not you are able to drive, your age, and level of education.

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:

1.    File a Request for Reconsideration with the Social Security Administration to completely review the case.
2.    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 benefits. 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.
3.    If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
4.    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.

The Texas Crime Victims’ Compensation Program

Applying for SSDI can be a long process.

Some victims with a crime-related injury may not be eligible and some may need help immediately. Every state, including the District of Columbia, offers assistance to victims of violent crime. The Texas Crime Victims’ Compensation Program was created to help crime victims and their immediate families with the financial costs of crime such as medical treatment, counseling, funerals and loss of income. The two main goals of this program are to encourage victim participation in apprehending and prosecuting criminals and to reimburse victims for certain costs related to crime.

Under this program, a victim is a person who was injured or died because of a crime, a person who came to the aid of a crime victim and was injured or died, or a first responder who was injured or died while responding.

An injury can be physical or mental, and the crime must meet the following criteria:

•    The crime must occur in Texas to a U.S. resident; or the victim is a Texas resident and the crime occurred in a country not offering crime victims’ compensation.
•   The victim did not participate in the crime, commit illegal activity at the time of the crime, or share responsibility for the crime due to their behavior.
•   The crime must be reported to an appropriate law enforcement agency.
•   The victim must cooperate with the law investigation.
•   The victim must apply within three years from the date of the crime unless good cause is shown (for example, the age of the victim or the victim’s mental and physical capacity).

The following crimes or attempted crimes are covered by the program:

•    Assault
•   Robbery
•   Hit and Run
•   Kidnapping
•   Homicide
•   DWI
•   Human Trafficking
•   Family Violence
•   Child Abuse
•   Child Sexual Assault
•   Elder Abuse
•    Sexual Assault
•   Stalking

Costs covered are limited to $50,000 total compensation, but may be further reduced by other sources used to cover crime-related costs, such as medical insurance and Medicaid/Medicare.

Crime Victims’ Compensation is the last source of payment and all other resources must pay before any payment by the program. Treatment must be necessary, reasonable and directly related to the crime.

Some of the medical costs covered include:

•    Hospital and emergency room expenses
•   Ambulance services
•   Doctor’s expenses
•   Prescriptions
•   Nursing care
•   Medical appliances such as wheelchairs
•   Treatment by a psychologist or psychiatrist

Compensation may also be paid for loss of earnings when a victim must miss work for a crime-related disability period, to attend medical and mental health appointments, and to participate in criminal justice proceedings.

For more information on the program see : The Texas Crime Victim’s Compensation Program

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.