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What is Social Security Disabilty?
What is Supplmental Security Income (SSI)?
How are claims decided by the SSA?
What happens if my initial aplicaiton for SSD/SSI is denied?
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Social Security Disability Benefits Social Security Disability benefits are administered by the Social Security Administration. (“SSA”) If you have a regular work history and become unable to work because of your medical condition, you may be eligible to receive Social Security Disability benefits. Generally, your eligibility is tied to your prior payment of FICA taxes. Persons over 31 years of age must have worked for at least five of the past ten years from the quarter in which they became disabled. The SSA has access to all of your prior earnings information and will determine your initial eligibility.
The SSA defines a disability as “an inability to perform substantial gainful activity by reason of a medically determinable physical or mental impairment, or combination of impairments, which has lasted or is expected to last at least 12 consecutive months, or end in death, taking into account the individual's age, education, and work history.” The inability to work or to engage in substantial gainful activity is further defined as the inability to earn in excess of $860.00 per month. You should note that this standard does not refer to your actual work status (i.e. ability to locate employment). Rather, SSA evaluates your hypothetical ability to qualify for gainful employment in consideration of your physical limitations, age, education and prior work experience.
The SSA forward you an annual statement regarding your work history and estimated disability and retirement benefits. See Sample. You should always save this brochure as it identifies your estimated disability benefit based upon the number of credit you have in the system. If you do not have this paperwork you may retrieve the information online.
Even if you do not have a regular work history to qualify for Social Securoty Disability Benefits you may be eligible for Social Security Income Benefits (SSI) if you are disabled and meet certain financil need requirements. You may find additional information on how to apply for SSI benefits by accessing the following SSA link. http://www.ssa.gov/notices/supplemental-security-income/text-apply-ussi.htm/ Eligibility for SSI is based on financial need. The amount of your benefit was be restricted by factors such as your assets and other household income.
You should file your application as soon as you become aware of your permanent disability, as there is a waiting period before you can become eligible to receive disability payments and the potential that you will have to participate in a prolonged appeals process. Initial determinations are made by a state agency and can take months to complete. You do not need an attorney to file your initial application, though in complex cases an attorney may assist you in obtaining the medical documentation necessary to prove your medical limitations. In most cases, claimants obtain attorneys for the appeals process after their claim has been denied. If you are substantially and unquestionably disabled, beware of flashy out-of -town services or websites that simply process your initial application and then collect 25% of your initial benefits. If you are interested in obtaining an attorney from the onset, I would recommend that you always consult a local attorney first. When your financial stability is at stake you need the assurance that you can visit and confer with your representative in person.
You may file an initial application for benefits by several means:
1) Visit your local SSA office;
Downtown Richmond: 1834 West Cary St. Richmond, VA 23220 or
2) Call the SSA at 1-800-772-1213 to make an appointment; or
3) Apply directly online.
How are Claims Decided? The SSA Definition of Disabled
First, SSA refers initial claims to a state disability determination service. It is important that you be able to identify each and every medical provider that has treated you for conditions relating to your impairment. They will request for medical records and in some cases refer you for a medical assessment examination. The purpose of the exam is to determine your residual functional capacity (“RFC”). However, the most important medical assessment comes from your treating physicians, who is your primary medical resource in any SSD application. Under SSA guidelines, multiple factors go into the consideration of one’s disability, including their medical condition, age, education and work history. To qualify for disability benefits, you must have "a physical or mental impairment that is expected to keep you from doing any substantial work (less than $860 per month) for at least a year" Generally,the SSA applies a five-step evaluation process to decide whether you are disabled. 1. Are you working? You only can receive benefits if you are not substantially employed, which means that you average less that $860 per month. 2. Do you have a severe medical condition? Your medical condition must be significant enough that it impairs your ability to perform basic work activities. Minor or temporary injuries do not provide a basis for a SSA disability determination. 3. Does the SSA list your condition as a disabling conditions? Some conditions are already listed by the SSA as disabling, which in most cases means that you automatically qualify as disabled. 4. If you have a severe medical condition that is not listed by the SSA as a disabling condition, can you still perform your prior work position? If you can still perform your position, then you cannot receive benefits. If you cannot perform your prior position then you proceed to the final step 5, which is where must cases are argued on appeal. 5. Can you do any other type of work? Most contested SSA Disability cases revolve around this question, whether based upon your medical condition, age, education and training, you are reasonably able to transfer your skill to less strenuous work.
First, know that you are not alone. A large percentage of first time applications are denied. Many people who ultimately qualify for benefits are turned down at the initial application stage. In some cases the SSA may have incomplete information about your medical condition or limitations. In other cases, your disability could be recent and may have worsened over time. If you feel that you still cannot work after your benefits have been denied, there are several levels of appeal within the application process, including Reconsideration, an Administrative Judge Hearing, and Court Review. In each circumstance you must act promptly. Generally, you must note your appeal within 60 days of the adverse decisions. Qualified attorneys will know exactly how to process the paperwork necessary to initiate your appeal. Your failure to meet this deadline may force you to file a new claim and potentially lose benefits from the initial filing period.
If he SSA denies your initial application for benefits you must first appeal by filing for reconsideration. You should, at a minimum, to consult with a local attorney prior to filing to assess the strengths and weaknesses of your application. If the SSA again denies you disability benefits at Reconsideration, it would be highly advisable to obtain a representative prior to your next appeal, which is an Administrative Judge Hearing.
How Long Does the Hearings Process Take?
There is no simple answer to this question. In recent years it has taken claimants as long as a year to get a hearing date after their appeal. However, the Richmond office has recently added additional administrative judges to its staff, substantially decreasing the waiting time for a hearing. At present, you should expect your hearing to be scheduled approximately 6 months from your appeal.
An attorney can assist you in collecting and organizing the medical and employment records necessary to evidence your disability. Most importantly, an attorney will present your case at the hearing before the Administrative Law Judge. In most cases, the attorney, in addition, to questioning you and your witnesses will have to cross-examining the Government’s vocational expert who provides testimony about your supposed work opportunities. Usually, your attorney will charge a contingency fee of 25% of your past due benefits, meaning that you do not have to pay an attorney fee unless you prevail. Again. I stress the benefit of a local counsel, who will be able to meet directly with you to prepare your case.
What Happens If You Receive a Favorable Decision? Upon receiving a favorable SSD award from the Administrative Law Judge you become entitled to a retroactive award for the disability period prior to the hearing. If your application is approved, your first Social Security disability benefits will be paid from the sixth full month after the date your disability began. The SSA pays you this benefit as a lump sum, less any amount withheld for an attorney’s contingency fee. Additionally, you are entitled to receive your monthly insurance amount for as long as your remain disabled and not receiving full Social Security Retirement Benefits. As stated above, the amount of your monthly disability benefit is based on your average lifetime earnings. Note that if you are receiving workers’ compensation benefits or a government pension, the amount of amount of your monthly benefit may be reduced. Successful claimants become eligible for Medicare coverage after receiving disability benefits for two years
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*This website of D. Scott Gordon, Attorney, is prepared solely for informational purposes and is not to be construed nor relied upon as legal advice. The information contained herein likewise does not create an attorney-client relationship, nor is it intended to serve as an invitation for an attorney-client relationship. Any written or electronic communications to lawyer or this law office shall be received only as a request to schedule an initial consultation. A request for an initial consultation does not create an attorney-client relationship and no legal advice can be offered in direct response to any such communications. |
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