Do I have to be disabled permanently to receive Social Security Disability (SSD)?
No you do not. A claimant needs to be disabled for at least 12 months or have a medical condition that is terminal or expected to lead to death. Sometimes a claimant is not disabled permanently but has a certain time frame in which they are disabled from working. For example, a claimant may get into a car accident, need to have multiple surgeries and is out of work for at least one year. That claimant can receive benefits for the period before he or she returned back to work.
Can I get Social Security Disability (SSD) if I have not gone to the doctor?
It is possible but rare. In a SSD case, medical records are your evidence and that is the proof you have to show the SSA and an social security judge that you do have a severe medical condition that keeps you from working. If you do not have recent medical records, it is much harder to win a case. There is a possibility, though not common, that your case might be approved simply by going to a consultative exam that SSA sends you to, where a doctor gives you a physical or mental examination. One benefit of working with our office is that we will look carefully at your case and if you do not have enough or current medical records, we can often give you information about low-income or indigent health services where you can go and get medical treatment for free or greatly reduced cost.
How can I afford a Social Security attorney if I’m not working?
Our law firm, the Law Office of Gerard Lynch, only charges our clients if we win their SSD or Supplemental Security Income (SSI) benefits. We charge on a contingency basis, 25% of the backpay, a cap of up to $6000, awarded to a claimant when we win the case. The fees are regulated by the Social Security Administration (SSA). If we do not win their case, we do not charge anything no matter how much work we have done. Once a client wins and their monthly checks begin, they will keep 100% of their checks.
What is the difference between Social Security Disability (SSD) and Supplemental Security Income (SSI)?
Social Security Disability (SSD) comes from FICA taxes that are deducted from paychecks during the work history of a person. Every month that a person works and reports income to the government, taxes are deducted which are paid into social security. When FICA taxes are taken out of paychecks, most of it goes into the social security retirement fund. However, a smaller portion goes into the social security disability fund. People who become disabled over their lifetime and are not yet eligible to get their full age retirement benefits can get benefits from the disability fund. One difference between Social Security Disability (SSD) and Supplemental Security Income (SSI) is that Social Security Disability (SSD) is like social security retirement – it does not matter how much money a person has or how many assets they have. Supplemental Security Income (SSI) is a different program for disabled people and it is like a form of welfare. Like food stamps, if you have too much money, assets or property, then you will be ineligible for Supplemental Security Income (SSI) even if you are clearly disabled. Supplemental Security Income (SSI) is for people who are either too young to have paid enough into the system or have not worked recently enough to receive Social Security Disability (SSD). The benefits given to Supplemental Security Income (SSI) claimants come from the general US government fund. To receive Supplemental Security Income (SSI), a claimant has to be equally disabled to a person who receives Social Security Disability (SSD) – the standard for determining disability are the same. The only difference in deciding which claimant receives Social Security Disability (SSD) or Supplemental Security Income (SSI) comes from the amount of money paid into the social security system over one’s lifetime.
What are the typical steps taken in a Social Security Disability (SSD) or Supplemental Security Income (SSI) claim?
The steps are identical for both claims.
- The first step is the initial application which can be done in several different ways. A claimant can fill out an application online, in person with a SSA representative, on the phone with a SSA representative, or by working with an attorney. In our office, we ask claimant’s to fill out a brief information form and then our staff files it online with the SSA. The reason for the extra step is to ensure that everything written in the application is correct, written in the most favorable light for a claimant’s case and also to ensure that the right application has been filled out. Once the initial application is received by SSA using one of the filing methods listed above, the date of that application is the protected filing date for that claimant. The SSA then requests medical records from the doctors, hospitals, and clinics the claimant listed in the application. The SSA may also send out additional paperwork that must be filled out by the claimant to give a more accurate and complete picture of the claimant’s disabilities and limitations in functioning. Then the application is sent to the Disability Determination Services located in Austin, Texas. The SSA case workers then review the file with all attached medical records and make an initial determination on the case. If your application is approved, you will be mailed out an award letter. Most cases are denied at the initial level and must be appealed. If your case is denied at the initial level, that does not mean you will not be able to win. This appeal is the second step of the case.
- The second step of the case is called a reconsideration. At this level, you may receive additional paperwork to fill out and update any new medical treatment that you may have had since the initial application was filed. The records are sent for and all additional paperwork is attached and routed back to the DDS in Austin. Another caseworker examines the file and makes a second determination as to whether the claim should be approved or if this case should be heard by and ALJ. Statistically, the fewest claims are approved at the reconsideration level. If the reconsideration is denied, which most are, the claim must be appealed a second time and a request for a hearing with an ALJ is made.
- The third step is a hearing with an ALJ. The claimant has a right to a face-to-face hearing with a judge to present their testimony, any witnesses to support their claim, have an attorney present and present their case fully. Many times, the SSA will have a medical doctor and a vocational expert, someone who is an expert on all the jobs that exist in the local and national economy, how unskilled or skilled those jobs are, what the exertional demands of the jobs are, present at the hearing. The hearings typically last an hour or so and are much more thorough and careful than the decisions made at the initial and reconsideration levels. The hearing is the step with the highest approval rate. Typically, a claimant does not know at the hearing whether their case has been approved or not. The ALJ will write a written decision that is mailed out to the claimant within 4-6 weeks with the decision.
- The fourth step is an appeal to the Appeals Council if a claimant does not win their case at the hearing. It generally takes 6 months to 1 year to receive an answer back from the Appeals Council. If the Appeals Council decides that there was an error made at the hearing, they can remand the case to be heard by an ALJ, can grant the case, or turn the appeal down. Winning at the Appeals Council is infrequent but can happen.
- There are additional appeals that can be made after the hearing with an ALJ. Claimants can appeal to the Appeals Council, to federal court, and even to the US Supreme Court. However, the chances of winning a case the higher up one goes become slimmer. If a claimant does not win at the hearing at times, the best thing to do is to simply file a new initial application.
Do I receive any medical benefits if I win?
Yes. Once a claimant wins a Social Security Disability (SSD) case, he or she gets Medicare just like a person on retirement gets. After the Social Security Disability (SSD) claim is approved, the claimant gets Medicare after 29 months of being disabled. If a claimant wins a Supplemental Security Income (SSI) case, he or she gets Medicaid immediately as there is no waiting period for Medicaid. It should be noted that if your Social Security Disability (SSD) check is quite low, in some cases, a claimant can receive disability and Supplemental Security Income (SSI) both, which will allow them to receive Medicaid and Medicare. This is a complicated process and an attorney can explain how this works for people who qualify for both.
What happens if I recover from my disability and return to work?
SS encourages people to try to return to work if they are able. They will continue your disability benefits for up to 9 months after you have returned to work. The reason for this 9 month is to allow a person time to try to work and see if they are physically or mentally able to do the job. Some people try to return to work and after a few months realize that they are not able to go back full time. If you make a work attempt and it is not successful, you will not be taken off disability for 9 months. In addition, if you have been on disability long enough to receive Medicare (29 months), you can continue to receive Medicare benefits for 7 years.
What kind of medical problems are severe enough to receive disability benefits?
There is no magic list of medical conditions that can get disability. Technically, any condition that is severe enough and interferes with a person’s ability to work can be disabling. For example, cancer or HIV/AIDS or any other life threatening conditions are not automatically disabling conditions. Nor are common conditions like high blood pressure and diabetes automatic losers. Nearly any condition, if severe enough can be found to be disabling. What is important is how the medical condition affects your ability to work a 40 hour full time job.
Can children receive Social Security Disability (SSD) or Supplemental Security Income (SSI)?
Disabled children are eligible only for Supplemental Security Income (SSI). For a child to receive Supplemental Security Income (SSI), the parents of a disabled child must have less income in their household than the SSA guidelines allow. If the income is too high, then the child will not receive Supplemental Security Income (SSI) even if they are clearly disabled. As mentioned above, Supplemental Security Income (SSI) is a welfare program and has strict income guidelines. Those income rules change annually and are based on how many other minors live in the household. An attorney can help you understand the rules and how they will affect your child’s case. Young adults may also receive Social Security Disability (SSD) or Supplemental Security Income (SSI) depending on which program they are eligible for based on how long they have worked and paid into the system. It is harder to win a younger individuals case because a claimant has to show that they are not able to do any sort of work. This does not mean that a younger individual cannot win their cases – but for those people, it is almost necessary to have an attorney to help you prepare for your case.
Do I have to quit working?
No. If you are reduced to earning less than $1000 per month (gross, before taxes) because of your disabling medical condition, you can keep working while you are applying. If you are working and making more than a $1000 per month then this is considered “working” by the Social Security Administration and you are ineligible for benefits.