Social Security Disability
Social Security Disability Insurance (SSDI) is a federal insurance program by the United States government that is funded through our payroll taxes. The program is managed by the Social Security Administration and is designed to provide supplemental income to people who become physically restricted from working. SSDI is different from Supplemental Security Income (SSI) in that it does not depend on the income of the disabled individual receiving it.
Supplemental Security Income (SSI) is a United States government program that provides stipends to low-income people who are either 65 or older, blind, or disabled. As mentioned previously, one of the requirements to be approved for SSI is that your income and resources are within certain limits.
How do I determine if I am eligible for Social Security Disability benefits?
The Social Security administration only pays benefits when you are are totally disabled, meaning that you cannot engage in substantial gainful activity. In order to prove that you cannot engage in substantial gainful activity, you must: not be able to do the work that you did before; not be able to do other kinds of work because of your medical condition(s); and have a disability that has lasted or is expected to last for at least one year or to result in death.
Social Security has a Compassionate Allowances program that allows the Social Security Administration make quick decisions and pay benefits on claims that automatically meet the disability standards of serious diseases and medical conditions.
There are several ways to start your application process. If you have access to a computer, we recommend first visiting the Social Security Website at www.socialsecurity.gov/applyfordisability. (Please note that Social Security may change the website address. If this link does not work go to www.ssa.gov and search “apply for disability”).
Social Security will walk you through the initial application process through the website. It is helpful to have certain information available ahead of time. You will likely need:
- The date and reason that you became disabled;
- Your date and place of birth and Social Security number;
- The name, Social Security number and date of birth or age of your current spouse and any former spouse;
- The dates and places of marriage and dates of divorce or death (if applicable);
- Names and dates of birth of your minor children;
- Your bank or other financial institution’s Routing Transit Number and account number, if you want your benefits electronically deposited.
It is also helpful to have information regarding your medical conditions available. Including the names, addresses, phones number, patient ID numbers, and dates of treatment for all doctors, hospitals and clinics. The names of current medications and who prescribed them. The names of medical tests performed (eg X-ray, MRI, EMG) and the doctor that ordered them.
Social Security will also require information regarding your work history. If you worked recently you will need to provide your income for the last several years. Social Security will also ask for a list of the last five jobs that you had in the 15 years prior to becoming disabled.
Social Security occasionally sends out a pamphlet that lists your benefit rates if you were to become disabled or retire at certain ages. While this number is frequently changing, the amount that you would receive if you became disabled provides an approximate monthly figure for your Social Security Disability benefits. You can also create an account at www.SSA.gov and receive more detailed information regarding your potential benefits.
If you are awarded Social Security Disability benefits, you will begin receiving a monthly payment according to your disability benefit amount. The date that you became disabled is known as your Alleged Onset Date (AOD). When you are awarded benefits you are paid a back-payment in the amount that you would have received during the time period from the AOD and the date you are approved for disability benefits. However, there is always a 5 full month waiting period before you accrue benefits.
If your AOD is more than one year prior to the date that you apply for benefits then you may only be entitled to one year of retroactive benefits. Basically, Social Security limits the amount of your back-payment and effectively punishes you for not applying within one year of the beginning of your disability. If you have questions regarding when your benefits will begin you should gather all the information available to you and contact an attorney who practices before the Social Security Administration.
If your disability is the result of a work accident, you may be entitled to receive both SSDI benefits and workers’ compensation temporary or permanent disability benefits. It is recommended that you have an attorney who practices in both of these areas of law to maximize your benefits. These two areas of the law affect each other, and an attorney can assist you in receiving the most benefits for you and your family.
For example, your Social Security Disability benefits may be reduced to offset your workers’ compensation benefits. Your benefits could be reduced if the total benefits payable to you and your dependents under Social Security, plus your workers’ compensation payments exceed:
– 80 percent of your “average current earnings” before you became disabled; or
– Your family’s total Social Security benefit
An experienced attorney can work to minimize the amount that your Social Security Disability benefits are offset by workers’ compensation benefits received through a settlement.
Your average current earnings are the highest of:
- Your average monthly wage that your disability insurance is based;
- Your average monthly earnings during the highest five years in a row; or
- Your average monthly earnings based on the single calendar year of highest earnings. This single year can be the year that your disability began or any of the five years before your disability began.
Social Security will look at the first month that you receive both Social Security Disability and Workers’ Compensation benefits. Social Security will calculate your “applicable limit,” which is the higher of either: 80% of your “average current earnings” before your disability began; or the total amount of SSDI benefits you and your family receive. If your SSDI benefits and workers’ compensation benefits combined exceed your “applicable limit” then your SSDI benefits are reduced by that amount.
I was denied Social Security Disability Benefits…now what?
If you are denied Social Security Disability benefits for any reason, it is important to take action immediately. You may file a Request for Reconsideration yourself but we recommend that you contact our office upon receipt of the letter notifying you of Social Security’s initial determination. In most cases you have only 60 days to appeal the initial determination. If you do not appeal in time then you may re-apply for Social Security Disability but you may miss out on additional back-payments as described in the previous section. You will also have to wait while Social Security makes a determination on the new application before you can move forward in the appeals process.
Obtaining Social Security Disability benefits is typically a lengthy process and we recommend that you promptly take action at each step in order to receive your benefits as soon as possible. Our office will need the initial determination letter as soon as possible in order to promptly appeal your claim.
Do not worry, the national average for cases being denied at this stage is typically between 85 – 87 percent. It is important to file the next appeal as soon as possible, because like the prior stage, you only have 60 days to do so. You now have to file a Request for Hearing before an Administrative Law Judge. After the request is filed, the Office of Disability Adjudication and Review will begin processing your file and will eventually schedule your hearing.
If you have an attorney, this is the stage that the attorney can provide the most assistance. For instance, our office will file the request for hearing (so you never have to worry about missing the deadline), assist in filling out and filing some of the many forms requested by Social Security, we can help obtaining any missing medical records, and answer any questions that you have along the way.
If you have not yet contacted an attorney by this stage, we highly recommend that you do so. There are numerous forms that Social Security will request of you. Additionally, it is important to ensure that the Judge is able to review your complete medical history. It can be advantageous to have someone experienced with the process assisting you.
While every case is different, the hearing is always your opportunity to tell the Judge your story. It is your last and best chance to win your case. It is important to show them how your disabilities affect your everyday life and limit your ability to maintain employment.
The preparation of exhibits, review of medical records, and preparation of your testimony is critical at this stage. These are all areas in which an attorney can assist you. Prior to any hearing, our office prepares a pre-hearing memorandum for the Administrative Law Judge who will be deciding your case. This memorandum serves two purposes: it requests the Judge to make a favorable decision based on the medical records (sometimes preventing a need for the hearing) and it explains some of the issues and main arguments to the Judge helping the hearing proceed more efficiently.
Participants in a hearing include the Judge, the Claimant (yourself), your attorney, a court reporter, and often a vocational expert and doctor. Hearings typically begin with your testimony. Once that is complete, the doctor will testify as to what listings he or she believes you meet and what your functional limitations are. If you meet a listing, you may automatically be approved for Social Security Disability benefits. If not, your restrictions are discussed with the vocational expert who gives his or her opinion on what jobs are available in the economy for someone with your restrictions and limitations. Your attorney is afforded the opportunity of asking questions of every witness during the hearing. Do you think that a claimant is professionally qualified to cross-examine a medical doctor or a vocational expert?
Once the hearing is complete, the Judge will issue a written opinion that will be mailed to yourself and your attorney.
Attorneys are paid on a contingent basis, meaning they are paid a fee as a percentage (usually 25%) of your back-payment, up to a maximum of $6,000.00 (attorney fees are limited by Social Security and occasionally change). Therefore, if you do not win your case, there is no fee. Additionally, expenses such as copying of medical records are usually advanced by your attorney so that no money has to be paid out of your pocket.
Common sense ideas when it comes to hiring a lawyer for your Social Security Disability case:
- Ask questions and expect intelligent, easy to understand answers. Remember, you are the boss and the decision-maker. The lawyer works for you, not the other way around.
- There is no fee for the initial conference. Sit down with a lawyer and find out what rights and benefits you are entitled to. When someone whose time is very valuable is willing to talk to you for no charge, you should listen.
- Bring a family member or friend with you. Another person to listen and ask questions can only help you.
- Consult with a lawyer sooner rather than later. Since the fees are a percentage whether the lawyer works for you two weeks or two years, why not let him earn his fee by representing you as soon as possible.
- Bring your paper work with you to an appointment. It will make the conference more productive and allow the lawyer to provide better advice and counsel.
Remember: Your case is going on right now and evidence is being created right now. It is easier to avoid a mistake now than to fix a mistake later.
When you do not have a lawyer representing you, you are representing yourself. While you certainly have the right to do so, you also have the right to do your own surgery.
Is that a good idea?
And remember, there is no fee unless we win your case.
Ask before you decide to hire them:
(The answers from our office are in parentheses)
- Do you concentrate your practice in the field of Social Security Disability Appeals?(YES)
- What is the percentage of your practice devoted to injured persons? (100%)
- How many years of experience do you have in Social Security Disability? (OVER 35 YEARS COMBINED EXPERIENCE)
- Do you have attorneys in your firm to assist me in a workers’ compensation claim, if my injury occurred at work (YES)
- Do you have attorneys in your firm to assist me in a civil claim, if my injury was caused through the negligence of an outside company or person?(YES, WITH OVER 60 YEARS COMBINED EXPERIENCE)
- Will I be provided with information in writing, such as fee agreements and the forms I sign?(YES)
- Will I receive a copy of my medical records as they are received?(YES)
- How do we maintain contact? Do you have an “open door” policy when it comes to setting appointments to discuss my case?(YES and home or hospital visits as needed)
- How do the telephones work and will I receive return calls when you are in Court? (We make every effort to return calls the same day. Our telephone system allows us to retrieve messages off site and after hours)