What is disability?
To be considered under Social Security you need to have a medical condition that will last for 12 months or longer and prevent you from working in any capacity. Social Security Disability is considered long term disability and does not provide benefits for short term disability. Additionally, Social Security does not award partial disability like the Veteran’s Administration; under Social Security you are either 100% disabled or you are not.
In addition to the medical requirements for Social Security Disability you need to have worked in jobs that pay the taxes for a minimum of 5 of the last 10 years prior to the onset of your disability to be insured under Social Security. Even if you are not currently insured for Social Security Disability you may still qualify if you meet the insured status requirements prior to when you became disabled. For younger workers Social Security does make some adjustments to the 5/10 rule.
What type of Disability Benefits are there?
One way to check if you are currently insured for Social Security Disability is to look at your Social Security Statement. On page two of the statement it will tell you if you have enough credits earned on your work record to qualify for Social Security Disability, and gives an estimate of your benefit amount. Again, Social Security makes some exceptions for younger workers. Because a disabled younger worker has less potential to earn credits under Social Security they typically receive a higher amount for the work that they do have.
Assuming that your doctor has told you that you will be out of work for 12 months or longer (or you have a terminal condition) and you meet the work requirements for Social Security Disability, you need to file an application. There are several ways to file. If you are already familiar with Supplemental Security Income (SSI) program and know that you do not qualify based on your household income or money you have in the bank, the simplest way to file is online at Social Security’s website. (http://www.socialsecurity.gov/applyfordisability/)
If you are familiar with the SSI program or would like a determination for SSI, you need to call Social Security’s national number 1-800-772-1213 and speak to a representative. Before you call you’ll need to gather some information. The representative will need to know the date that you first became disabled, what the nature of your disability is, and when you stopped working. They will also need to know if workman’s compensation is involved through your State. Additionally, for the SSI screening, they will need to know how much income your household has per month, and how much money you have in the bank. They also need to know about any investment accounts you have including IRAs, 401k plans, stocks, mutual funds, and CDs. They will need to know how many vehicles you and your spouse own, what kinds of property you own, and how many children you have.
This information is important because SSI is a “need based program” and if you qualify the money you receive is paid from the Federal Tax Revenues, not from the Social Security Trust fund. Once you have scheduled your appointment or applied online you will need to provide proof of citizenship or resident alien status. This is done by providing your original birth certificate, passport, or Resident Alien card to the Social Security office processing your claim. This office will provide you an application for signature and a medical release form where you will be required to list all the doctors, clinics, and hospitals where you have been seen.
After you records are complete in the Social Security office, you case is transferred to your State’s Disability Determination Service (DDS). It is important to know that Social Security does not evaluate your disability or approve you initial claim. The determination that you meet the medical requirements is made by an agency of your State’s government. Once this decision is made, and it typically takes the State 120 days to evaluate you, you will receive a decision letter in the mail.
If you are approved, your case is sent back to Social Security where your folder goes to one of the many regional payment centers that will start your payments. Once you have an approval letter from the state it will take Social Security 30-60 days to process your record for payment. At that time you will receive an award letter from Social Security telling you how much you will receive and when.
If your claim is denied by the State agency you will need to file an appeal. This appeal will be reconsideration with the State or a hearing before an Administrative Law Judge depending on the State you live in.
It is important to have experienced legal counsel to increase your probability of success in getting your Social Security benefits.
A person is entitled to receive Social Security Disability (SSD) benefits when they are no longer able to perform substantial gainful activity, as the result of a physical or mental impairment that is expected to last at least 12 months, or possibly result in death.
How do I meet the definition of disability?
To satisfy the definition of disability used by Social Security, a person’s disability or impairment must meet or equal the level of severity described in the Social Security listing book. This is essentially the manual that describes dozens of conditions, ranging from arthritis and high blood pressure to asthma, heart failure, and depression. Satisfying the criteria quoted in the listing book will guarantee a disability approval.
However, it is very difficult to win a disability approval based on meeting the disability criteria in the listing book. Most individuals will qualify for social security benefits another way – basically where their disabling condition is severe enough that they are unable to perform their past work while earning at least a substantial monetary amount each month. Currently the SGA amount is $1,000.00 before taxes. Additionally, in this process, it must be concluded that the individual is not capable of doing certain “other work”.
What exactly is other work? Other work that a claimant might possibly do must be related, according to social security regulations, to several factors: a person’s age, level of education, and the type of work they did in the past.
For example, a person with a 9th grade education who cannot do their past work will never be expected to perform other work that goes beyond their education limits. And individuals with mental or affective impairments (low IQ or depression or anxiety) will not be expected to perform other work that requires detailed attention and concentration. Also, as a third example, individuals who are physically incapable of doing more than sedentary work will never be expected to perform work that requires medium (lifting 50 lbs on an occasional basis) or even light (lifting 25 lbs on an occasional basis) exertion.
How do I qualify for Social Security monthly benefits & past due benefits?
To qualify for disability benefits, an individual must have paid Social Security payroll taxes over a certain length of time. An individual who has done this will be considered insured. The time frame for paying into the system varies by age. And if an individual stops working and paying Social Security taxes, they must be able to show that their disability began before their insured status ran out.
What can I do to help get benefits?
Specific criteria for disability approvals are included in the Social Security Listing of Impairments. It is important to note that a claimant’s doctor should be familiar with these criteria when submitting statements on a claimant’s behalf. Therefore, it is sometimes useful for a claimant to explain to a doctor just how their condition limits their daily activities.
Also, it is important to provide a full listing of all impairments, conditions, and symptoms on the application for Disability, as well as a list of all the doctors, hospitals, and clinics involved in a claimant’s treatment (along with addresses and phone numbers).
Are denials common?
It is not uncommon for a claim for SSD to be denied. In fact, it is the norm and appeals are generally required for disability benefits to be established.
Many claims, however, are denied because the patient’s medical records lack adequate documentation that fully establishes the severity of the disability. Therefore, it is essential that all information regarding continuing medical treatment be reported to Social Security Disability.
Gaps in information to prove disability can be overcome by your lawyer’s review of your medical records. Weaknesses can be overcome by sending requests to your healthcare providers to supplement your file with residual functional capacity reports and other reports calculated to clear up or complete your medical claim.
Appealing Disability Denials
If the application for SSD is denied, do not reapply. This is a common mistake made by applicants for disability benefits. You should never reapply because new applications will simply be denied again. Instead, file an appeal. Or better yet, seek the services of a qualified Social Security lawyer who can guide your case through the disability appeals process.
It is simply a fact that attorney represented cases have a much higher chance of winning than those that are not represented by legal counsel.
How can I tell if I am disabled enough to apply for Social Security disability benefits?
Social Security regulations make it easier to be found disabled as you get older. It becomes easier for a few people at age 45 (those unable to read English), for more people at age 50, for most people at age 55, and even more people at age 60. If you’re over age 55 and you cannot do any job you have done in the past 15 years, you should definitely apply. If you’re over age 50 and have a sever impairment that keeps you from doing all but the easiest jobs, you ought to apply.
But even if you’re a younger person, you don’t have to be bedridden in order to be found disabled. If you’re under age 45 or 50, and you cannot do you past jobs and you cannot work full time at any regular job, than that ought to be enough.
Nevertheless, being unable to work and being found “disabled” by the Social Security Administration (SSA) are two different things. It is often difficult to convince SSA that someone is “disabled” even when he or she genuinely cannot work. But it is not impossible.
If you really cannot work, apply for disability benefits from SSA. Do not become discouraged if you are denied benefits on your first attempt, we can help. After you have been denied benefits, you have to ask yourself do I continue to apply for benefits on your own, or should I seek the help of an attorney. Most people are better served with the assistance of legal counsel because their chance of a favorable decision is greatly increased.
How do I apply for Social Security Disability and/or SSI benefits?
The Social Security Administration (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 www.socialsecurity.gov/applyfordisability/adult.htm. If you want to apply for SSA’s other disability program – Supplemental Security Income (SSI) – you cannot complete an SSI application online, but you can complete one of the necessary supporting documents, the Adult Disability and Work History Report, on the Internet.
If you want to complete an application for SSI or Social Security disability by telephone or in person, you must first telephone SSA at 1-800-772-1213. If you choose to go to a Social Security office to complete the application, the person at the 800 number above will schedule an appointment for you, give you directions to the Social Security office, and tell you what papers you need to bring along. If you want to apply by phone, you will be given a date and an approximate time 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.
Do you have any advice about applying for disability benefits?
Yes. Give SSA all the information it asks for in a straightforward way. Be truthful. Do not exaggerate or minimize your disability. Furthermore, do not enhance your education or work record or job responsibilities. If you exaggerate your job responsibility and SSA determines you are a supervisor, it is more difficult to receive benefits.
Should I contact a lawyer to help me apply for Social Security Disability and/or SSI benefits?
As a rule, a person does not need a lawyer’s help to file the application. SSA makes this part very easy. If you cannot handle the stress of the application process or cannot complete this task, we will help you fill out the application.
What happens if I am denied benefits and I do not appeal within 60 days?
You’ll have to start over with a new application – and it may mean that you’ll lose some back benefits. So it’s important to appeal all denials within 60 days. It’s better if you appeal right away so that you get through the bureaucratic denial system faster. The quicker you can get to the hearing stage the better. At this stage, it is when a lawyer’s assistance is very helpful and greatly improves your chances of getting benefits.
What will an Attorney do for me?
Each case is different, but provided below are just some of the ways an attorney or advocate can help you through the Social Security process:
- Aid you in filling out all forms
- File your initial claim completely and quickly
- File any appeals, if necessary, completely and quickly
- Evaluation your case and answer any questions
- Help strengthen your case by referring you to additional doctors
- Monitor and notify you of your case’s progress at the Social Security Administration
- Supplement your claim with updated records and reports
- Gather evidence from persons such as your doctor to strengthen your claim
- Handle all aspects of the hearing
- Prepare you for the questions and topics that will come up at your hearing, and address any issues you are concerned about
- Ask the Administrative Law Judge to subpoena any witnesses necessary to proving your claim
- Fully argue your case at the hearing by giving an opening and closing statement, cross-examining the vocational expert and any other adverse witnesses, asking the Administrative Law Judge to review and reassess any prior claims, and preserving the hearing’s evidentiary record through proper and timely objections
- Ensure the Social Security Administration calculates your benefits correctly
How do I appeal?
Your denial letter will tell you about appealing. At this stage hiring a lawyer is wise. Your chances of winning are substantially greater. The first appeal is called “reconsideration”. You must request reconsideration and then, after the reconsideration is denied, you must request a hearing within the 60-day time limit.
You can appeal in one of three ways. (1) Telephone the Social Security Administration and make arrangements for your appeal to be handled by phone and mail. (2) Go to the Social Security office to submit your appeal. If you go to the Social Security office, be sure to take along a copy of your denial letter. And be sure that the Social Security representative gives you a signed copy of your appeal paper showing that you appealed on time. Or (3) appeal online athttps://secure.ssa.gov/apps6z/iAppeals/ap001.jsp. Be sure to print and retain the receipt for your appeal so that you can prove you appealed on time.
What are the biggest mistakes that people make when trying to get disability benefits?
Failing to appeal. More than half of the people whose applications are denied fail to appeal. Many people who are denied on reconsideration fail to request a hearing.
Another mistake, although much 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.
Since medical evidence is so important, should I have my doctor write a letter to Social Security Administration and should I gather medical records and send them to SSA?
SSA will gather the medical records, so you don’t have to do that. Whether you should ask your doctor to write a letter is a hard question. A few people win their cases by having their doctors write letters. You can try this if you want to. The problem is that the medical-legal issues are so complicated in most disability cases that a doctor my inadvertently give the wrong impression. Thus, obtaining medical reports is best left for a lawyer to do.
Also, a lawyer, after review of your case can submit questionnaires for your healthcare provider to complete. There are many types of questionnaires and it is vital that the right questionnaire gets to the right healthcare provider.
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 before contacting us to represent them. Although everyone agrees that a lawyer’s help is essential at the hearing and the great majority of people who have lawyers win their cases at a hearing. The help of a lawyer at the early stages of application is not as critical.
About twenty percent (20%) of the people who apply for benefits will be found disabled after filing the initial application without a lawyer’s help. About 15% of those who request reconsideration are found disabled at the reconsideration stage, mostly without a lawyer’s help. If you are successful in handling the case yourself at the initial or reconsideration steps, you will save having to pay attorney’s fees. It is hard to predict which cases may benefit from a lawyer’s help early on. However, our office gets disability awards for over 90% of our clients on our initial application.
Because the percentage of claimants who receive Social Security benefits is rather low and the time lag between review hearings is about two (2) years, most Social Security applicants are without benefits for twenty (20) to twenty seven (27) months that would otherwise been successful with the assistance of legal counsel.
We seldom get involved when someone is filing their initial application. As a rule, we won’t get involved in a case until after an initial denial is issued and a legal controversy exists. On occasion, though, a claimant points out to us an obvious (and quite unusual) legal problem with a case. We do consider getting involved in such cases before the initial determination is issued. Some claimants have mental deficiencies that make early attorney involvement advantageous.
If a claimant asks us to get involved at the reconsideration stage, we will evaluate the case even though cases are harder to evaluate at this stage than they are at the hearing stage. Sometimes it is even hard to tell if a claimant will be disabled for 12 month, which is required by the Social Security Act.
If you want us to consider becoming involved in your case at the initial or reconsideration steps, please contact us to discuss your situation. Otherwise, the best time to call us is as soon as you have been denied benefits.
Filing for Social Security Disability benefits is too important to be unfamiliar with the laws and facts. The process can be confusing and overwhelming. Errors on the application or in documentation can cost you time and money, and can get you denied needlessly. Let Mortimer Law Firm, PLC assist you in your case and avoid being without your benefits for years due to not having legal counsel to help you through the minefield in your quest for benefits.
If you have applied for disability benefits though the Social Security Administration and having been denied, contact Mortimer Law Firm, PLC. We will help you get the benefits you deserve.
How much does Mortimer Law Firm, PLC charge?
We charge legal fees only after we win. Almost all of our clients prefer a “contingent fee,” a percentage fee paid only if they win. The usual 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 fee comes out of prospective monthly benefits.
Although the usual fee will not normally exceed $6,000.00, if we have to appeal after the first administrative law judge hearing, our contract drops the $6,000.00 limit on fees. Even in this circumstance, through, our fee will not be greater than 25% of back benefits.
Sometimes at the request of a client, we charge a non-contingent hourly or per case fee. There is also the rare case where a contingent 25% fee arrangement is insufficient to allow for an adequate fee. In such a case, we use a different method of calculating the fee.
In addition to the fee, you will be expected to pay the expense of gathering medical records, obtaining medical opinion letters, etc.
Why hire Mortimer Law Firm, PLC over other Social Security representatives?
We will be with you throughout the process. You will be interviewed by your lawyer from your first visit and he/she will be with you at your disability hearing. Most out of town firms or disability advocates only talk to you over the phone and rarely appear at your hearing.
If I have other questions, will you answer them by telephone?
Yes. If this memorandum doesn’t answer your questions, please telephone us. We have a knowledgeable and experienced staff, interested in you and your case. We take pride in our ability to solve your problems.