social-security-disability

Social Security Disability

Social Security Disability Programs

The Federal Social Security Administration has two programs for people who are disabled, unable to work, and need benefits to replace the wages they have lost due to their inability to work and earn a living:

  1. Social Security Disability Insurance (SSDI): SSDI is the program designed for those who have worked and paid their Social Security taxes for years prior to becoming disabled. If you are found to be disabled under Social Security’s rules, and qualify for SSDI because you have earned enough “work credits,” benefits will be paid regardless of your assets or family income.

  2. Supplemental Security Income (SSI): SSI is a means-tested or “needs-based” program. You do not need to have worked or paid Social Security taxes in order to qualify, but you do have to be “poor enough,” meaning you cannot have family assets or income over a certain limit.  The amount of the SSI monthly benefit is limited, because this program is designed to assist disabled individuals with only very basic living costs.

The Disability Rules:

In general, a person is “disabled” under Social Security’s rules if they are unable to work for a period that has lasted, or is expected to last, at least 12 months in a row, due to a severe medically determinable physical and/or mental impairment or combination of impairments, that prevents them from performing either their past work or other work that exists in the regional or national economy in significant numbers, or is expected to result in death.

The disability must be proved with medical evidence.  Social Security also looks at whether you are working, what other activities you are engaging in, and what people who know you have to say about your condition, when deciding whether you are disabled.

The rules are strict, it can be difficult to prove that you meet all the requirements, and it can take a long time, depending on a number of different factors.  Individuals who have certain very severe medical conditions that clearly meet all the medical criteria of Social Security’s Listings, or are on the Compassionate Allowance List, may be awarded benefits earlier in the process, but for most it can take 1-2 years, or even more if there are multiple appeals.

The Process:

The following describes the process for obtaining benefits in very general terms. There are many factors that can influence the way your case proceeds that are not discussed here, because they are complex. A representative who specializes in Social Security can help you to navigate the agency roadblocks.

The first step is to determine if you are eligible. The Social Security Administration provides a toll-free ‘hotline,’ but often the individuals manning these lines are not the best source for information about your particular situation. It is always in your best interests to speak with a professional in the field:

If you believe you may qualify for disability benefits from Social Security, then you can begin the process of obtaining them by filing an application. You can do this by contacting either your local Social Security office, or calling the “hotline” (1-800-772-1213).

An online application process is also available to some applicants  www.socialsecurity.gov/disabilityssi/apply.html

It can take anywhere from 3-6 months before you get a decision on your initial application.  Unfortunately, most claims are denied at this stage.

If you are denied, and you disagree with that decision, the next step (in Michigan cases) is to Request a Hearing in front of an Administrative Law Judge (ALJ), no later than 60 days from the date on your denial letter.  If you have not already contacted an attorney who specializes in Social Security Disability, this is the time to do so.

Sometimes Social Security wants to hold these hearings by videoteleconference, instead of live. You may be asked to choose which way you want to have the hearing, and the choice must be made within 30 days of being asked. Your choice can be important to the outcome, so it is a good idea to consult with your attorney about whether or not to have your hearing by videoteleconference.

It is usually to your advantage to attend the hearing (whether it is held by videoteleconference or live). You and your attorney (if you have one) should appear at the hearing and explain your case with witnesses and other evidence.

If the ALJ denies your claim after your hearing is held, the next step is to Request Review with the Appeals Council, within 60 days of receiving the ALJ Decision.  The Appeals Council may decline your request for review if it believes the ALJ Decision was correct.  If it does so, then the next step is to file a civil action against the agency in Federal District court.  If the Appeals Council grants your request for review, that could involve a return to the ALJ for another hearing.

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Do I have to be permanently disabled to qualify for Social Security Disability?

No.  To qualify under the definition of disability, you must satisfy one of the following:

  • You have been disabled (unable to work) for at least a year, or
  • You expect to be disabled (unable to work) for at least a year, or
  • You have a condition that is expected to result in death.

           
Also, while there are some types of programs that pay benefits for partial or short-term disability (such as workers compensation or disability insurance policies), Social Security does not.  It only pays if the disability keeps you from performing your past work, and other work, for at least a year.

How long does it take for SSA to decide my initial application?

There are many factors that can influence how long it takes, but generally speaking, it can take Social Security anywhere from 3 to 6 months to rule on your initial application.

If my application is denied, how long does it take to get my hearing before the ALJ?

If your initial application is denied, and if you file your hearing request (appeal) on time, it could take 1 to 2 years before your hearing is actually scheduled, with some exceptions. This is because the Social Security agency has a very large backlog of cases and not enough resources to move them quickly.

Is there a difference between appealing my denial and filing a new application?

Absolutely, and the difference could affect your right to receive benefits. If you do not know whether to appeal or to start over with a new application, you should consult with an attorney who specializes in Social Security practice before your time for appealing (60 days from decision) expires.

How is my attorney paid?

Attorney fees for representing disability claimants before the agency must be approved by the agency. When you hire Charters, Heck, Tyler & Zack, P.C. we will prepare a fee agreement for your signature that will be filed with the agency. This will allow them to pay our fee if your disability claim is approved. Our fee agreement is on a contingency basis which means we will only be paid if your disability claim is approved and you are awarded past due benefits, or back-pay.

Social Security limits the amount of the fee to 25% of the past due benefits awarded to you (and to all beneficiaries on your account), but the maximum fee is $6000.00.

Our attorney fee can only come out of the back-pay. If no back-dated benefits are awarded, we will not receive a fee unless approved by the agency.

When do I have to pay the attorney fee?

Usually the agency withholds our attorney’s fee from your first check (the back-pay award) before they send it to you, so you normally do not need to pay our attorney fee directly out of your pocket. There are some exceptions to the way that happens, and if necessary we will discuss that with you.

What costs or expenses do I have to pay?

Our fee agreement that you are asked to sign will describe your obligation to pay costs or expenses incurred by our law firm. This is money we might have to pay to develop your case. Most often, such costs are incurred to request your updated medical records, vocational reports, and school and work records. In some cases, we may need to obtain independent medical or psychological examinations, which can be quite expensive. Other costs may include postage and copying. You will be asked to pay the costs in your case directly to our office, as they are separate and apart from our attorney’s fee.

Sometimes an attorney will ask for money in advance to pay for such costs. However, our law firm of Charters, Heck, Tyler & Zack, P.C. does not do so. We advance these costs for our clients, and only request that they reimburse us after the decision on their claim.

Before hiring an attorney, you should ask whether you will be charged for out-of-pocket expenses in addition to the lawyer’s fee, and what types of expenses might be included.

What can I do to help win my case?

There are several things you can do to help win your own Social Security Disability case:

  • Keep a list of all your treating doctors, physical therapy clinics, emergency room visits, and/or mental health providers, including names, addresses, phone numbers, what you see them for, and visit dates. Be sure to update the list periodically.  Social Security and your attorney will both ask for this information.
  • Continue to get medical treatment.  You should be in contact with your doctor(s) at least every 3 months, try to follow their treatment recommendations, and try not to miss any scheduled appointments.
  • Keep a journal of your day-to-day life (sometimes called your Activities of Daily Living) describing things like activities you are having difficulty performing, activities you no longer perform due to your condition, side-effects from your medications, and how your daily routine has been changed by your disability.
  • Every few months, check the status of your case with your attorney, or with the local Field Office where you filed your disability application.  
How do I get medical treatment for my disability if I have no insurance or money?

The lack of money or insurance is a legitimate excuse for not obtaining treatment, but unfortunately this excuse does not carry a lot of weight with many Social Security judges. Part of the reason is that affordable health care is now available to many people who make the effort to obtain it. So you should look into the following options before relying on that excuse with a Social Security judge:

How much money will I receive if I win my Social Security Disability case?

The answer depends on many factors, but primarily comes from calculations based on what you have paid into the system in Social Security taxes over the years.

You can get an estimate of benefits payable to you and your dependents by downloading your Social Security Statement from the agency website at http://socialsecurity.gov/ .  (If you do not have a computer, you can call or visit your local Social Security office to request your statement, but in-office services are limited)

If you have not already visited this website to create a “My Social Security” account, then you will need to do that:  Go to the bottom of the page and click on “My Social Security,” then click on “Create an Account,” then follow the steps to verify your identity and create an account.  From there, you can download your Statement, which will contain information about your benefit amounts if you retire or become disabled.

Monthly payments for SSI recipients are not based on what you have paid into the system.  The amount depends on your living arrangements, income, assets, and other changes affecting your financial resources – both at the time you apply and after you are awarded the benefits.  There is also a monthly maximum that applies each year. When you apply for SSI at your local Social Security office, ask the claims representative there to explain the amounts of SSI available to you.

Can I work while collecting Social Security Disability payments?

Once you are on Social Security Disability, you should report any work you do to the agency. There are special rules that allow you to work temporarily without losing your monthly Social Security disability benefits. One example is the trial work period.  This allows you to test your ability to work for at least nine months without losing benefits.

Consult the agency website (http://socialsecurity.gov/), or talk to a claims representative in your local office in order to avoid running into an overpayment situation.

Will I get my disability benefits for the rest of my life?

Not necessarily. Every person awarded Social Security Disability benefits is subject to review. When the agency will review you depends on several factors, including your age at the time the benefits were first awarded, the nature of your disability, and/or whether you are performing work activity that appears to be more than what the agency’s special rules allow for working while disabled. 

You may continue to receive your benefits as long as you continue to be disabled under Social Security’s rules (meaning, generally, that your condition does not improve), and you do not continue to work beyond the limited situations allowed by the agency’s special rules for working while disabled. 

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