- About Social Security disability and SSI disability benefits Contact Social Security online (www.ssa.gov); or by phone (1-800-772-1213)
- What disability benefits are available? Title II (disability insurance – DIB) and SSI
- Who may be eligible? wage earners – Title II and SSI; non-wage earners – SSI; widow(er)s, surviving divorced spouses – Title II; children – SSI or adult disabled children’s disability benefits – Title II
How does Social Security determine eligibility for disability benefits?
First, the person must be financially eligible. For DIB benefits, this means that you have paid enough into the Social Security system and have worked recently enough. If you stopped working many years ago and only recently became disabled, you may not be “insured” and therefore not be financially eligible for DIB benefits. For SSI benefits, this means that you must have little or no income and less than $2,000.00 in cash or cash equivalent resources.
Second, the person must meet the disability definition.
Social Security’s disability definition. To meet Social Security’s disability definition, an individual must have one or more medical impairments that have lasted or are expected to last at least 12 consecutive months or result in death. If this is established, then a 5 Step sequential evaluation process is applied as follows:
1) Is the person currently working [earning more than $1,260.00 gross per month*]?
2) Does the person have a “severe” impairment?
3) Does a medical condition meet or equal one of the “listings” of impairments? If so, person is presumptively disabled.
4) Can the person still perform their past work? If so, they are not eligible.
5) Is there any other type of work the person can perform on a sustained competitive basis? If so, they may not be eligible, depending on age and past work experience.
* This is the figure for 2020. It rises annually.
BOTH REQUIREMENT MUST BE MET – FINANCIAL AND DISABILITY
Steps in the disability decision making process
Application filed with Social Security
State agency (initial) determination This usually takes 3 to 5 months and may involve a state agency medical exam or testing; 60 days to appeal an unfavorable decision for reconsideration
State agency reconsideration The second level of the disability process review; 60 days to appeal unfavorable decision for an administrative hearing
SSA Office of Hearings Operations Administrative hearing – wait can be 12 months or more
Appeals Council review – if denied at hearing level
Federal Court review – if denied by Appeals Council
What factors influence a favorable result in a disability case?
- claimant’s age, education and past work experience
- nature of the medical impairments
- consistent reporting of symptoms and treatment
- accurate description of symptoms and findings in medical records
- submission of all medical records to the Social Security Administration
- submission of doctor’s opinion concerning severity of impairment(s) on ability to work
- hearing testimony and how it is received by the administrative law judge
THINGS FOR INDIVIDUALS APPLYING FOR SOCIAL SECURITY DISABILITY BENEFITS TO REMEMBER
- Apply early – you can apply over the phone: 1-800-772-1213 or through Social Security’s website: www.ssa.gov
- Include all of your medical conditions in the application. If you have mental symptoms such as depression or anxiety, be sure to include them and obtain treatment for those symptoms
- Provide complete and detailed information on the SSA forms
- Your primary doctor and/or specialist must support your claim
- If denied, continue with appeals – don’t give up
- Continue in treatment and report all symptoms
- The process can take a year or more
- Keep your own copies of all forms and medical records
- Keep a record (diary) of symptoms and treatment
- Engage an attorney who specializes in Social Security disability law to improve your chances for success
THINGS FOR YOUR DOCTORS TO REMEMBER
- Doctors need to provide an accurate description of symptoms and findings in the medical records. This includes clinical and objective findings (restricted range of motion, spasms, swelling, discoloration, temperature, etc.) as well as subjective symptoms (pain, fatigue, depression).
- Doctors should indicate in the treatment records that they believe the symptoms reported and why (i.e. consistent with diagnosis and known symptoms of the disorder).
- The treatment records must be legible (typed is preferred).
- Provide a diagnosis.
- Obtain objective testing as appropriate.
- Refer to specialists as appropriate (i.e. mental health).
- Include in the treatment notes information about the patient’s daily activities (i.e. can’t cook, can’t drive, naps) and limitations in ability to perform daily activities (i.e. how many days a month are daily activities curtailed or impossible to perform?)
- THE ROLE OF A DISABILITY ATTORNEY
- Gather medical records – obtain assessment forms
- Seek an early favorable decision in appropriate cases
- Prepare client for the administrative hearing (how the hearing is conducted – what to expect)
- Present case – apply law – examine SSA vocational and medical experts
- Write legal briefs for the judge as required
- File appeals
- DISABILITY LAWYERS ARE ONLY PAID IF DISABILITY BENEFITS ARE AWARDED
Fees are normally limited to 25% of retroactive (back) benefits up to $6.000.00, whichever is less
- RESOURCES ON THE INTERNET
- disabilitylawpa.com – Homepage of the Disability and Injury Law Offices of David R. Machek, Esq.
- www.ssa.gov – Social Security’s website
Our law firm focuses exclusively on Social Security disability law. To learn more about the SSDI and SSI programs and how our disability lawyers can improve your chance for success, contact the Jenkintown and Philadelphia Social Security Disability attorneys of the Disability and Injury Law Offices of David R. Machek for a free consultation at: (215) 886-0398 or at: http://www.disabilitylawpa.com Email: [email protected]