SOCIAL SECURITY DISABILITY:  FREQUENTLY ASKED QUESTIONS

 

How can I tell if I am disabled enough to apply for Social Security Disability benefits?

You don’t have to be bedridden in order to be found disabled. Basically, if you cannot do your past jobs and you cannot work full-time at any regular job, however menial and sedentary that job may be, that may be enough for you to qualify for Social Security Disability Insurance benefits (SSDI) or Supplemental Security Income (SSI).

There are two critical factors to consider in deciding whether to apply for disability benefits or not: age and doctor support.  The Social Security Administration (SSA) regulations make it easier to be found disabled as you get older. It becomes easier for a few people at age 45, for more people at age 50, even more people at age 55, and even more people at age 60. If you are over age 55 and you cannot do any job you have done in the past 15 years, you should definitely apply. If you are over age 50 and have a severe impairment that keeps you from doing all but the easiest jobs, you ought to apply.

In our experience, it is extremely difficult to win a case if a client does not have a treating doctor “in their corner.”  The process awards special weight to the opinion of a claimant’s treating physician or specialist.  It’s important to talk to your doctor before applying for benefits to see if they respond positively to the idea; if your own doctor has urged you to apply for disability benefits, even better.  This is why it is so critical to seek medical care before and during the process of applying for disability benefits – if you do not have any health insurance, our office may be able to refer you to some free clinics or help you apply state medical insurance through the Commonwealth’s COMPASS program.

If you really cannot work, apply for disability benefits. If you are denied benefits after your initial application, APPEAL so that you have a hearing before an administrative law judge. Many cases – though not all, of course – are won on appeal.

 

What’s the difference between Social Security Disability Insurance (SSDI) & Supplemental Security Income (SSI)?

 The simple answer to the difference between SSDI and SSI is your work history.  In general, if you have worked 5 of the last 10 years (for more than 20 hours a week), you have probably achieved “insured status” and thus would qualify for SSDI.  The 5 years need not be consecutive.  SSI is for individuals with no work history at all or who do not meet the “insured status” requirement for SSDI (perhaps you have worked, but it was a long time ago or it was far less than 20 hours per week).  Most people who qualify for SSDI also apply for SSI since it is basically the same application (it depends on your “assets” – see below).  If you do not qualify for SSDI, you can only apply for SSI.

Importantly, if you only qualify for SSI there are certain asset limitations as well.  For example, if you have more than $2,000 in the bank or elsewhere (retirement funds, pension, general savings or investments, etc.), you will not qualify for SSI.  To qualify for SSI, you can own a home and a car, but that’s about it. Our office can help you determine whether you qualify for SSDI and SSI or SSI only, and also discuss with you the asset limitations for each.  (There are no asset limitations when applying for SSDI basically).

 How do I apply for Social Security Disability or SSI benefits?

 

SSA offers three ways for you to apply for Social Security Disability benefits: by telephone, in person at a local Social Security office or via the Internet. If you want to use the Internet to apply, go to http://ssa.gov and click on “Benefits” tab at the top of the page.  That tab will bring you a menu where you will see a tab (to the far left) for “Disability” – click that, then click the “Apply for Disability” button.  However, if you are applying for SSI, you must apply either in person at your local social security office or by coordinating an appointment with your local office to have your application filed over the telephone.  Only individuals who qualify for SSDI have the additional choice to apply online.

If you want to complete an application for SSI or SSDI by telephone or in person, telephone SSA at 1-800-772-1213. If you choose to go to a Social Security office to apply, the person at the 800 number above will schedule an appointment for you, give you directions to a local Social Security office, and tell you what papers to bring along. If you want to apply by phone, you will be given a date and an approximate time at which to expect a phone call from someone at the Social Security office who will take your application over the phone. The application will then be mailed to you for your signature.  For individuals who qualify for SSDI, our office can assist by helping client’s apply online from home or in our office.

What happens if I am denied benefits?

 If you are denied benefits, you have 60 days to file an appeal.  If you wait longer than 60 days, you will have to file new application. It is extremely important to appeal all denials within 60 days, as Social Security rarely makes any exceptions to this rule. It’s best if you appeal right away – the quicker you file an appeal, the quicker you can get to the hearing stage, which is generally a year-long wait (sometimes less, sometimes more).

 How do I appeal?

 Your denial letter will tell you about appealing. As with the application process, you can appeal by telephone, in person or online with the assistance of a social security disability specialist or attorney – or not.

 

When is the best time for a lawyer to get involved in my case?

 Many people wait until it is time to request a hearing (i.e., once a person is denied benefits after the initial application is filed) before contacting a lawyer to represent them. Although everyone agrees that a lawyer’s help is essential at the hearing stage, how necessary it is to have the help of a lawyer at the early stages is an individual decision.

About one-quarter of people who apply for disability benefits will be found disabled after filing the initial application – with or without a lawyer’s help. If you are comfortable applying for benefits on your own, you don’t have to pay an attorney if you win benefits outright. It is hard to predict which cases may benefit from a lawyer’s help early on.

The Law Office of Shawn N. Wright assists clients at every stage in the process, from helping clients file an application to representing clients during the appeals process. We generally recommend that if you are able to file an application on your own, to get the process started, wait until/if you receive a denial letter before getting a specialist/lawyer.  But once you receive that denial letter, call immediately. Even if you do not choose to have our office represent you, we highly recommend obtaining a lawyer who does disability work to help you with your appeal.

 What are the biggest mistakes people make when trying to get disability benefits?

 Failing to appeal. More than half of the people whose applications are denied fail to appeal.   Another mistake, although less common, is made by people who fail to obtain appropriate medical care. Some people with long-term chronic medical problems feel that they have not been helped much by doctors. Thus, for the most part, they stop going for treatment. This is a mistake for both medical and legal reasons. First, no one needs good medical care more than those with chronic medical problems. Second, medical treatment records provide the most important evidence of disability in a Social Security case.  If you are un- or under-insured, but need medical treatment for physical or mental illness, The Law Office of Shawn N. Wright may be able to help you find a free or reduced-fee clinic near you.

 Finally, one mistake people make when they file for benefits on their own is failing to provide all the necessary documentation that is required after the initial application is filed.  In some ways, filing for disability and appealing an unfavorable decision are easy – it’s the paperwork that follows that can become confusing.  Unfortunately, we see too many clients come to our office because they were denied based on a technical issue, that is, failing to provide a required report or form with one’s signature in time.  Filing for disability is very deadline-driven, so if you are not sure what needs to be submitted when, you should call our office to lessen the risk of being denied initially or on appeal due to a technicality.

 

Since medical evidence is so important, should I have my doctor write a letter to the Social Security Administration and should I gather medical records and send them to SSA?

 

SSA will gather the medical records, presuming you fill out their documentation thoroughly based on all doctor visits and hospitalizations. That said, our office always requests records too in order to be certain all evidence in your favor is submitted and fully considered.  Obtaining medical reports may be something best left for a law office to do.  Some doctors’ offices don’t release certain forms without a lawyer’s request. We have specific forms we send to each client’s doctor(s) to capture information that is most relevant to a judge or other SSA administrator deciding your case.

How much do you charge?

For all of our Social Security Disability clients, a fee is only paid if you win your case. The fee is 25% (one quarter) of back benefits up to a maximum amount set by SSA, currently $6,000.00. That is, the fee is one-fourth of those benefits that build up by the time you are found disabled and benefits are paid. No fees come out of future monthly benefits, after winning your case.