If you become disabled and are unable to work, what rights do you have? Is there any governmental assistance to which you are entitled?
The Social Security Administration administers two (2) kinds of disability programs -- which provide monetary assistance for people in different situations. Title II provides disability benefits. Title XVI provides Supplemental Security Income, known as "SSI".
When are you entitled to receive social security disability benefits? What do you have to do to qualify for social security disability payments?
First, you must meet the Social Security Administration's definition of being "disabled". That means that you must have a physical or mental impairment that causes you to be unable to engage in any kind of substantial gainful employment for a continuous period of 12 months or which is expected to result in your death. Being "disabled" is a requirement for both Title II social security disability benefits and SSI.
To be considered "disabled", you must be unable to engage in "any substantial gainful work". Your condition must be severe enough that it prevents you not only from being able to do your normal job, but also prevents you from being able to do any other substantial gainful work. In deciding whether a person is "disabled" or whether they can work, the Social Security Administration considers factors including a person's age, education, training and work experience.
To qualify to receive Title II social security disability benefits, in addition to being disabled, you must be fully insured under the social security program. That means that you must have worked for a certain period of time before you became disabled. Your financial resources are irrelevant. You will not be disqualified from receiving social security disability benefits based upon your financial assets. You do not have to show "financial need" to qualify for these benefits.
To qualify for Title XVI SSI benefits, you must be disabled and your financial resources cannot exceed a certain maximum amount. The asset limitation is $2000.00 per individual and $3000.00 per couple. However, there is no requirement that you had been working for any particular period of time before you became disabled.
If you qualify to receive Title II social security disability benefits or SSI, how much are you entitled to receive and for how long?
There is a formula that is used to calculate the amount of monthly Title II social security disability benefits to which a person is entitled. However, each case is different. The amount of the monthly social security disability benefit varies depending upon how much money the disabled person has paid in to the social security system. That is, it depends upon the disabled person's earnings history.
The amount of the monthly SSI payment to which a person is entitled is set by Congress. The amount of the benefit varies depending upon the disabled person's living arrangement.
How do you apply to begin receiving social security disability or SSI benefits?
You should go to your local Social Security office. A claims representative will help you fill out the form that is necessary to apply for Title II social security disability benefits or SSI. Or, you can call your local Social Security office and ask them to mail you a form which you must then fill out and file at your local social security office. After you have filed your application form, you will receive a letter from the Social Security Administration, telling you whether your application for benefits have been approved or denied.
You have been working all your life and you are now unable to work because of a physical or mental impairment. You would work if you could. Why has your application for Title II social security disability or SSI benefits been denied?
After you file your application for Title II social security disability or Title XVI SSI benefits, the Social Security Administration obtains medical records and reports from your treating doctors. In most cases, when your application is denied, you need additional medical information to support your claim that you are disabled.
Your doctor says that you are disabled and that you are not able to work. How can the Social Security Administration ignore your doctor's opinion?
The fact that your doctor supports your claim and believes that you are disabled is very helpful. However, your doctor's opinion is not binding on the Social Security Administration. Rather, it reviews your medical records and reports and has its own doctors decide whether they think that you are disabled.
What can you do if you apply for Title II social security disability or Title XVI SSI benefits and the Social Security Administration denies your claim?
You have 60 days to file an appeal after the Social Security Administration sends you a letter telling you that your claim has been denied. When your claim is denied for the first time, you ask for a "reconsideration" of the denial of your claim. When you ask for a reconsideration, a different individual at the Social Security Administration, who did not participate in making the decision to deny your initial application for benefits, reviews your entire file, looks at all of the evidence that was considered when the original decision to deny your claim was made, and looks at any additional evidence that has been submitted since the first denial of your claim. Generally, most "reconsiderations" involve a review of your file without you being present and without any kind of hearing.
If, after the "reconsideration" of your claim, the Social Security Administration again denies your claim, you may ask for a hearing. The hearing will be conducted by an administrative law judge. You will attend the hearing, and you may have an attorney present to represent you at the hearing. You and your attorney will have the opportunity to present evidence and explain to the judge why you believe that you are disabled and entitled to receive social security benefits. This is typically the first opportunity that you have to explain your case in person (or have your attorney explain it) to someone acting on behalf of the Social Security Administration. You and your attorney have a right to review all of the documents in your file that the Social Security Administration has created and provide new information and evidence at the hearing. You and any witnesses that you chose to bring to the hearing may testify. The judge will ask you and the other witnesses questions. You or your attorney will also have the opportunity to question the witnesses and to make arguments to the judge about how the evidence should be construed and why the judge should find that you are disabled and entitled to social security benefits.
If you disagree with the hearing decision, you may ask for a review by the Social Security Administration's Appeal's Council. If the Appeal's Council decides to review your case, it will either conduct the review itself or send your file to an administrative law judge for further review.
If you disagree with the decision of the Appeal's Council or if the Appeal's Council decides not to review your case, you may file suit in federal court.
Do you need a lawyer to represent you in order to obtain social security disability or SSI benefits?
Not always. Some people apply for and are awarded Title II social security disability or Title XVI SSI benefits on their own, without hiring a lawyer. However, an attorney who is experienced in handling Title II social security disability and SSI cases can often make a difference. Often, even though the Social Security Administration has denied your claim for social security disability or SSI benefits the first two times you applied, an attorney can look at your file and determine why your claim has been denied and what needs to be done to prove that you are, in fact, disabled, and entitled to the benefits for which you have applied. Many times, you need additional medical documentation from your doctors. An experienced attorney will be able to advise you as to whether you probably are, in fact, entitled to receive social security benefits; and if so, what additional documentation is needed in order to prove that to the Social Security Administration. In addition, the attorney will know how to go about obtaining the additional evidence that you need in order to prove that you are entitled to the social security benefits.
When should you hire an attorney?
Normally, you must go through the process of submitting your initial application for social security benefits, having your first application denied by the Social Security Administration, appealing that first denial, being denied again, and then, filing a request for a hearing. Generally, an attorney will not make a difference in whether the Social Security Administration denies your initial application for social security benefits or your first appeal. However, after your appeal has been denied and it is time for you to have a hearing in front of an administrative law judge at the Social Security Administration, at that stage, an attorney who is experienced in handling social security cases will be able to help you. An attorney will prepare the medical evidence that you need in the form of records and reports from your doctors; will be with you at the hearing and know the questions to ask you to bring out the facts that support your claim for social security benefits; may prepare and bring other witnesses to the hearing to testify about observations that they have made about you which support your claim that you are disabled; and, will cross-examine the doctors and other experts that the Social Security Administration has hired to give opinions as to whether you are disabled and on which the Social Security Administration has relied in denying your claim. In addition, an attorney will be familiar with the Social Security Administration regulations and will know the appropriate arguments to make to the judge about the specific reasons why you qualify to receive social security benefits under the specific sections of the Federal regulations.
How much will you pay an attorney to represent you in a Title II social security disability or SSI claim?
Almost all of our clients prefer a contingent fee arrangement -- which means that they pay us only if we win and obtain social security disability benefits for them. The normal contingent fee is 25% of the back benefits that are awarded to the disabled client -- up to a maximum fee of $5300.00. There is no fee charged out of the current benefits that are awarded. Our total fee never exceeds $5300.00 regardless of the amount of benefits that are awarded. In addition to our attorney fee, the client is responsible for paying the costs that are incurred to pay the doctors and other healthcare providers for copies of medical records, the doctor's charges for writing medical reports, et cetera.
