Social Security Disability

The Social Security Administration has complex regulations to determine if you are eligible for disability insurance benefits (SSDI) or supplemental security income (SSI). These benefits may be paid to people who are not yet retired, but yet who have physical or mental health limitations which prevent any work in the national economy. In these cases, the disability must last for 12 months or more. The Social Security regulations consider such additional factors as your age, education, past work, and potential for obtaining a job. Disability means that you have a functional disability that prevents you from performing any full-time gainful employment in the national economy. Social Security Disability programs consider functioning ability rather than a specific medical condition or mental condition. That means that they are looking to see how a person’s medical or mental state prevents them from performing activities that affect their ability to work. Routine activities of daily living include performing household chores, driving, shopping, socializing, visiting family and friends, the ability to handle money, to perform personal grooming and hygiene, to pay bills, etc. These activities are the subject of the review and assessment when applying for Social Security benefits.

How do I apply for Social Security benefits?

Visit your Social Security Administration’s (SSA) local office or its website ssa.gov and apply for benefits immediately if you believe you are disabled and will be so for 12 continuous months. Regardless of the format chosen, the claims representative will ask questions about your disabling conditions, medical treatment, and work history. Providing medical history information must include medical treatment sources, and you must make sure that information is complete and detailed. When it comes to the work history information, you should give the claims representative information about the various kinds of work you performed before becoming disabled.  Don’t ever use the word “manager” in describing your past work unless you absolutely must. Social Security considers all work activities performed in the fifteen years before filing for disability. When examining the disabling conditions, Social Security will go through objective medical evidence from an acceptable medical source (a licensed physician, psychologist, psychiatrist, etc.). It is worth mentioning that Social Security is more concerned about how your disabling condition, or a combination of conditions, affects your ability to perform substantial work than the conditions themselves. After reviewing your medical records, the local SSA office will send you a letter giving you a decision. Most people applying for benefits at this initial stage will experience a denial.

How long will a decision take?

The Social Security definition of disability mandates that you must have a medically determinable mental or physical impairment and that the impairment has prevented you from performing work activity. After initiating each claim and conducting a disability interview, claims representatives at Social Security offices gather the medical and work information for your disability claim and then send it to a state disability agency (DDS, or disability determination services) for a medical determination. Once the state disability agency receives your file, they assign it to a disability examiner, who then sends for your medical records. Sometimes they will gather your medical files within a couple of weeks. However, in most cases, it can take months if the medical provider is slow and inactive in responding to the medical record requests.  Many times the entirety of the medical record is never considered. Furthermore, if your claim requires a hearing before an Administrative Law Judge, you may ultimately have to wait 26 months or more for a favorable decision.

Should I appeal my initial denial?

Yes! Unfortunately, many people give up after an initial denial. The next stage of appeal is called “Reconsideration.” You must request Reconsideration within 60 days after the initial denial. Once the local Social Security office has your reconsideration appeal, it is sending it electronically to a state disability agency responsible for making disability determinations for the Social Security Administration. At DDS (Disability Determination Services), the process used to decide on your application for disability is similar to the procedure of rendering a determination on your initial application. That means that your medical evidence will be reviewed, along with information regarding your work history. In any case, you should hire an experienced Social Security attorney after initial denial. Most people who apply for Reconsideration experience denial again.

Should I appeal my Reconsideration denial?

Yes! You must appeal within 60 days by requesting a hearing before an Administrative Law Judge (ALJ). The ALJ is independent of the Social Security Administration. Once your disability hearing request is submitted, it could be months before you get a schedule for an administrative law judge hearing. Eventually, you will receive a letter informing you of the date of your disability hearing, along with the location and the name of the administrative law judge who will be hearing your case. Administrative Law Judges review all cases to ensure the Social Security Regulations (SSR) are applied fairly. Even if the Administrative Law Judge denies your disability hearing request, you can file an appeal to an Appeals Council responsible for reviewing their decisions.

When should I see an attorney?

Immediately! Preparation takes time. The best time to hire an attorney is the earliest stage of denial. Representation may win you disability benefits sooner due to eliminating the need to go through an additional appeal step. Additionally, hiring an attorney removes the possibility of repeating the process, given that the attorney will follow the SSA deadlines. Finally, an attorney will ensure that you fully comply with the requirements of an examiner at the first two levels of the claim system and an Administrative Law Judge at the hearing level.

What does it cost to hire an attorney?

An attorney cannot charge a fee for representing a Social Security claimant unless approved by the SSA or ALJ. They are limited to 25% of past-due benefits by SSA regulations, and the amount of the fee is capped by the United States Congress. Most attorneys also charge actual expenses, such as doctor charges for medical records (sometimes even if the case is lost). The SSA withholds 25% of past-due benefits for the attorney in both types of disability cases.