Faq

Yes. In fact, we recommend that you do not wait until Worker’s Compensation benefits end before filing for SS disability, because individuals have been able to receive payments under both programs in many instances.

Yes. You can receive disability benefits so long as you have been disabled or expect to be disabled for at least 1 year, so you should file for SS disability benefits even if you hope to eventually return to work

Yes, so long as gross earnings are below a specified amount. If you experience medical improvement, unlimited earnings are allowed for up to 9 months while disability benefits will still continue under a Trial Work Period.

No, a claimant can represent himself through the entire process. However, legal representation is strongly recommended. The application and appeals process can be complicated and overwhelming, and often involves precise legal definitions and inquiries that must be responded to appropriately. Additionally, claimants with experienced counsel win much more often than unrepresented claimants.

Unfortunately yes. Most claims are denied on initial review, and around 90% of those denied claims are then denied again on Reconsideration (the second stage of review).

But don’t be deterred! Most appealed claims with legal representation at the Hearing (the third stage of review) are ultimately approved. Be persistent!

Generally after a claimant files a Social Security disability claim, there are five levels of review:

1. Initial Determination: Once a claimant files a Social Security disability claim, the Social Security Administration (SSA) sends the case to a disability examiner in the state where the claimant is located. The examiner consults with a doctor, evaluates the claim, and makes the initial decision on the claim. A large majority of claims are denied at the Initial Determination level, but there are more opportunities for reversing this denial and have the claim accepted later in the process, as explained below.

2. Reconsideration: If the claim is denied, the claimant can appeal for Reconsideration. The Claimant must make his or her request in writing within 60 days from the date of receipt of the denial. At this stage, the claim is sent to a different disability examiner who did not take part in the initial determination. The new disability examiner will look at all the evidence submitted for the claim when the original decision was made, in addition to any new evidence submitted for the reconsideration.

Most reconsiderations involve a review of the files on record without the need for the claimant to be present. However, when a claimant appeals a determination that he or she is no longer eligible for disability benefits because their medical condition has improved, that claimant can meet with a Social Security representative and explain why they believe they still have a disability. Only a small percentage of claims denied at the Initial Determination are reversed at the Reconsideration Phase.

3. Administrative Hearing: If a claim is denied at reconsideration, the claimant may then request a hearing. It can take quite a long time to get a hearing (more than one year in some states), which is conducted before an Administrative Law Judge who works for the Social Security Administration. The Administrative Law Judge makes an independent decision upon the claim at the hearing; this Judge had no part in the Initial Determination or Reconsideration. The hearing is usually held within 75 miles of where the claimant lives. It is very important for claimants to attend their hearings. Claimants unable to attend in person should make arrangements for appearance by video well in advance.

Unlike regular court cases, the administrative hearing is not truly an adversarial proceeding. In other words, there is not another attorney arguing against you. The procedures are less formal than a typical court proceeding and the rules of evidence are not as strict as they are in civil court.

Before the hearing, the judge may ask the claimant for more evidence or for clarification regarding the claim. At the hearing, the judge may ask claimant questions, and also ask questions to any witnesses that are in attendance, as well as other witnesses such as a Medical Expert (ME) or Vocational Expert (VE). MEs review the records from doctors you have seen in the past and evaluate them to determine if you meet the criteria for disability, and VEs evaluate what kinds of work you can do. Your attorney can also ask you questions, and may ask questions to the VE and ME too. Your attorney might also directly answer questions asked by the judge.

At the conclusion of the hearing, the judge will either issue a decision on the spot, or the claimant will be notified of the decision in the coming months.

4. Appeals Council Review: If the administrative law judge denies a claim, a claimant may request a review by the Social Security Administration’s Appeals Council. The Appeals Council reviews the record and will deny the request if it believes the hearing decision was correct. If the Appeals Council does decide to review a claim, it will either: (1) decide the case itself and reverse the administrative law judge’s denial; (2) modify the judge’s decision; or (3) return the case to an administrative law judge for further review (called a “remand”). If the Appeals Council returns a case to an administrative law judge, the SSA will send the claimant a letter explaining the decision, along with a copy of the order.

5. Appeals to the Federal District Court and Upward: A decision not to review, or a denial by the Appeals Council is still not the end of the road. After such a denial, a claimant has the ability to appeal this claim by filing a lawsuit in Federal District Court in the district where the claimant lives. The Federal District Court then can affirm, modify or reverse the decision of the SSA, including remanding the case for a rehearing.

If the Federal District Court affirms the ruling of the SSA, further appeals may be made to the United States Circuit Court of Appeals. A Circuit Court affirmation of the decision (in other words, the Circuit Court refuses to overturn the order) leaves only the remedy of fling a writ of certiorari with the United States Supreme Court, which asks the Supreme Court to review the case. Such a writ would be granted in very rare circumstances.

For Social Security purposes, “disability” is defined as the “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.” The determination must be based on medical evidence that describes the severity of the impairment. Sometimes the claimant’s work history is relevant evidence in a “disability” determination as well.

Attorneys Fees

No fee for legal services will be charged in connection with your application for SSI or disability insurance benefits unless your claim is approved.

If your claim is approved, United Disability Lawyers Group will seek a fee of 25% of your retroactive benefits either under the streamlined fee agreement process which limits our fee to $ 9,200 or through the longer process of filing a fee petition where there is no statutory maximum.

In cases where there are no (or a small amount) of retroactive Benefits, we may file a fee petition for a so-called minimum fee of $2000 to compensate us for the work performed on your claim.

The Social Security Administration will make direct payment to your attorney of the authorized fee directly from your retroactive benefits in most cases.

If for some reason the Social Security Administration fails to withhold our fee as required under the law, you will be responsible to pay us directly. In such a case we may also ask the Social Security Administration to pay us the attorney fees erroneously released to you.

Costs

Some of your medical providers may charge United Disability Lawyers Group for the cost of reproducing and forwarding your medical records. We will advance those costs on your behalf and bill you at the end of the case. Costs that are advanced must be repaid whether your claim is decided favorably or not. The amounts are usually incidental and if you need a payment arrangement we will be happy to comply.

You will be notified if there are any other advance costs associated with your claim, such as independent evaluations necessary to prove your disability. Those costs will also be your responsibility to repay whether or not your claim is approved. Again, we are happy to make payment arrangements if it is necessary.

If your case goes to federal court, we will also seek fees for our services before that court.

Yes. In determining an individual’s disability, Social Security is actually required to consider how the combination of health problems affects the individual’s performance. It is not uncommon for a disability claimant to have multiple health issues and still be able to receive benefits.

For Social Security Disability Insurance (SSDI), the amount you receive will be dependent on how much you have worked/earned in the past. Additionally, you will typically a receive a raise in monthly payments at the start of each new year due to increased cost-of-livings, and in most instances your children under 18 will get benefits separate from your own. On average, workers receive around $1,580/month.

If you are a disabled widow or widower, the amount you receive from SSDI will depend on how much your late spouse worked/earned.

If you are awarded Disabled Adult Child Benefits, the amount of monthly benefits is based on a percentage of your covered parent’s rate.

Depending on state, there is a base amount for all types of SSI benefits that an individual with no income will receive. If an individual has other sources of income, that income will reduce the amount of SSI benefits for that particular individual.

Once the social security judge awards you disability benefits, it can take anywhere from one to two months for you to start receiving payments for back benefits, sometimes as much as 3 months. Every state has different average waiting times and each judge operates differently. If it takes longer than 3 months, there may have been a mix-up in the payment, so you or your attorney should follow up with the Social Security Administration. When Supplemental Security Income (SSI) is involved it can take more time.  Keep in mind that sometimes a judge will issue a ruling at the conclusion of your social security hearing, but often times the judge will wait weeks or up to 3 months to actually issue the decision.

As your attorney, all we can do is make sure that your claim is processed correctly so that no additional unnecessary delays take place. Because of the slow process, it is important not to needlessly delay getting started.

State Aid Programs while you wait

The waiting time for receiving social security benefits places many Americans unable to work in an extremely difficult situation. Please check with your state to find out what kind of general assistance programs are available.

Local state agencies provide Interim Assistance to social security disability applicants. Through this program, you are basically advanced a modest amount of money by the state to help with your living expenses if it seems likely that you are going to receive social security benefits. The amount of any payments advanced through this program is then withheld when you are approved. In order to be eligible for such benefits, you have to apply for social security disability and meet all of the other public assistance criteria except for the receipt of SSI.

If you are awarded disability benefits or disabled widow/widower benefits, the cash benefit starts after a 5 month waiting period (i.e. on the 6^th month after the individual becomes disabled). It is also important to note that benefits can’t be paid more than 1 year before the date of the completed application.

If you are awarded childhood disability benefits, the cash benefit starts as of the onset date. However, benefits cannot be awarded for more than 6 months before the date of the completed application.

If you awarded SSI, benefits start at the beginning of the first month following the date of the completed application.

Absolutely not. The entire application process can be completed from your house (using the phone or internet) but we recommend you consult with us first .

How do I apply for Social Security Disability benefits?

One way you can apply for Social Security Disability benefits is to go to the Social Security District Office and file the claim in person. Alternatively, you can call Social Security at (800) 772-1213, where they will arrange a telephone interview with your local office and mail all necessary forms to you. Applications can also be filed partially online; just follow the straight-forward instructions on www.ssa.gov.

When can I file for benefits?

You can apply at any time. You can even file on the day you become disabled if you believe you’ll be unable to work for one or more years.

Do most claims get denied?

Unfortunately yes. Most claims are denied on initial review, and around 90% of those denied claims are then denied again on Reconsideration (the second stage of review).

But don’t be deterred! Most appealed claims with legal representation at the Hearing (the third stage of review) are ultimately approved. Be persistent!

Once again it is advisable to consult with us first before using any of the methods for filing the initial application.

Yes, Medicaid and Medicare are two distinct programs.

Not necessarily. Social Security makes its own independent decision regarding disability status; your doctor’s opinion will be part of the evidence and will be considered by Social Security, but is not conclusive.

A large number of claims are denied due to a lack of proof in individual medical records that shows the degree and consistency of the disabling medical conditions. It is important to remember that only your doctor’s medical charts and records, and not the doctor himself, will be present when Social Security makes its determination. As such, medical records must be extensive and detailed enough to overcome any medical inquiries conducted by Social Security.

Unfortunately, doctors are often not trained to routinely record such extensive information, so medical records frequently lack credible documentation or a showing of regular medical treatment.

Appeal immediately if Social Security is trying to end your disability benefits and you think you are still disabled! Sending an appeal within 10 days of being notified by Social Security will allow you to request that disability and medical benefits continue throughout the appeal process. It is also recommended that you speak with an attorney about representation.

In order to receive social security disability benefits, you must:

1. have earned at least 20 Quarters of Coverage (QC) during the last 10 years, and
2. be “fully insured.” See below for more details. Exceptions apply for those under 31 years old and in certain other instances.

You must be considered “fully insured” under the Social Security program before you can receive SSDI.  The SSA considers the number of quarters of coverage (now also called “credits”) you earned to determine if you are insured. A Quarter of Coverage (QC) is a block of 3 months, so you can earn up to 4 QCs in one year. You need to earn a minimum amount of money to earn a QC/credit.

To be considered “fully insured” for purposes of eligibility for social security disability benefits, you need at least one credit (QC) for each calendar year between the year you turned 21 and the year you become disabled, turn 62, or the year before you die. Regardless of age, you need at least 6 credits (QCs) to be determined to be “fully insured.” Any year (all or part of a year) that was included in a period of disability is not included in determining the number of QCs you need. The maximum number of credits is 40.

If you are fully insured and have earned the 40 quarters of coverage, you earn the “permanently insured” status. Being “permanently insured” means you will not lose your fully-insured status when you stop working. If you are not “fully insured,” you are not eligible to receive benefits, but just being fully insured does not guarantee that you will received benefits of course, because that determination is also based on your disability.

EXAMPLE: If you were born in 1949 and worked under covered employment from 1971-77, you would have earned a total of 28 QCs (7 years x 4 QCs a year). You had already attained age 21 in 1970 when you worked those years.

Under this scenario, you were “fully insured” after you earned 6 QCs. You continued to be fully insured through 1998 (you turned 21 in 1970 and you earned 28 QCs, so 1970 + 28 QCs = 1998). After 1998, you were no longer fully insured. Because you earned only 28 QCs, you were never “permanently insured”.

The Supplemental Security Income (SSI) program makes payments to people with low income who are age 65 or older, or who are blind or have a disability.  The basic SSI amount is the same nationwide. However, many states add money to the basic benefit. Whether you can get SSI depends on (1) your income, and (2) your resources.

1. Income

Income is money you receive such as wages, Social Security benefits and pensions. Income also includes such things as food and shelter you receive. For example, if you are getting free room and board from a friend, the value of that food and shelter could count toward income. The amount of income you can receive each month to still be eligible for SSI depends in part on where you live.

However, Social Security does not count all of your income when it decides whether you qualify for SSI. For example, the SSA does not count:

• The first $20 a month of most income you receive;
• The first $65 a month you earn from working and half the amount over $65;
• Food stamps;
• Shelter you get from private nonprofit organizations; and
• Most home energy assistance.

If you are married, the SSA will also include part of your spouse’s income and resources when deciding whether you qualify for SSI. If you are younger than age 18, the SSA will include part of your parents’ income and resources. If you are a student, some of the wages or scholarships you receive may not count. And, if you are a sponsored noncitizen, the SSA may include your sponsor’s income and resources.

If you are disabled but work, Social Security does not count wages you use to pay for items or services that help you to work. For example, if you need a wheelchair, the wages you use to pay for the wheelchair do not count as income when the SSA decides whether you qualify for SSI. Also, Social Security does not count any wages a blind person uses for work expenses. If you are disabled or blind, some of the income you use (or save) for training or to buy things you need to work also may not count.

2. Resources

Resources that the SSA counts in deciding whether you qualify for SSI include real estate, bank accounts, cash, stocks, and bonds. You may be able to get SSI if your resources are worth no more than $2,000. A couple may be able to get SSI if they have resources worth no more than $3,000. If you own property that you are trying to sell, you may be able to get SSI while trying to sell it.

Social Security does not count everything you own in deciding whether you have too many resources to qualify for SSI. For example, it does not count:

• The home you live in and the land it is on;
• Life insurance policies with a face value of $1,500 or less;
• Your car (usually);
• Burial plots for you and members of your immediate family; and
• Up to $1,500 in burial funds for you and up to $1,500 in burial funds for your spouse.

Other rules you must satisfy…

To get SSI, you must live in the U.S and be a U.S. citizen or national. In some cases, noncitizen residents can qualify for SSI.

You may receive SSI if you live in certain types of institutions, a publicly operated community residence that serves no more than 16 people, a public institution mainly to attend approved educational or job training to help you get a job, a public emergency shelter for the homeless, or a public or private institution and Medicaid is paying more than half the cost of your care. You usually cannot get SSI if you live in a city or county rest home, halfway house, or other public institution (but there are some exceptions).

There are several types of Social Security benefits for which an individual may be eligible. Individuals may be eligible for more than one type of disability benefit, and are not required to choose only one disability benefit. You must be “disabled” before you can qualify for any type of benefit, and there may also be additional non-medical requirements depending on the benefit.

It is recommended that you hire a legal representative as early as you can in the claim process, in order to help prepare for the initial filing/appeals and to ensure that all important information is correctly provided.

Depending on you or your family’s total income, SSDI benefits may be taxable. On the other hand, SSI benefits are never taxable.

Usually Social Security won’t require you to go to scheduled Government consultative exams. Consultative examinations are normally requested by Social Security only when your own treating physician fails to provide enough information regarding the impairment for which they are treating you.

Should Social Security request for you to attend a scheduled Government consultative exam, an attorney can best advise you on when you can appropriately decline to attend an examination request.

If you cannot work due to HIV or AIDS, you may be eligible for disability benefits. Like other disabilities, the evaluation will depend on whether your disability will last at least a year or end in death, and prevent you from engaging in substantial gainful work. Supplemental Security Income (SSI) is also available if your child has HIV or AIDS, depending on the same household income and resource limits for SSI claimants.

No, disability benefits will not be approved if the individual’s only disability is drug or alcohol addiction. However, if an individual has other independent impairments that render him/her disabled when combined with the drug or alcohol addiction, then benefits may be awarded for those medical conditions, although payees may be mandated.