Social Security Disability

Social Security Disability Benefits

If you become unable to work because of your medical condition, you may be eligible to receive Social Security Disability benefits. Generally, your eligibility is tied to your prior employment history.

The SSA defines a disability as “an inability to perform substantial gainful activity by reason of a medically determinable physical or mental impairment, or combination of impairments, which has lasted or is expected to last at least 12 consecutive months, or end in death, taking into account the individual’s age, education, and work history.”

Generally, the SSA applies a five-step evaluation process to decide whether you are disabled.

1. Are you working? You only can receive benefits if you are not substantially employed, which means that you average less that $1,000 per month.

2. Do you have a severe medical condition? Your medical condition must be significant enough that it impairs your ability to perform basic work activities. Minor or temporary injuries do not provide a basis for a SSA disability determination.

3. Does the SSA list your condition as a disabling conditions? Some conditions are already listed by the SSA as disabling, which in most cases means that you automatically qualify as disabled.

4. If you have a severe medical condition that is not listed by the SSA as a disabling condition, can you still perform your prior work position? If you can still perform your position, then you cannot receive benefits. If you cannot perform your prior position then you proceed to the final step 5, which is where must cases are argued on appeal.

5. Can you do any other type of work? Most contested SSA Disability cases revolve around this question, whether based upon your medical condition, age, education and training, you are reasonably able to transfer your skill to less strenuous work.

SSI Benefits

Even if you do not have a regular work history to qualify for Social Security Disability Benefits you may be eligible for Social Security Income Benefits (SSI) if you are disabled and meet certain financial need requirements.  Eligibility for SSI is based on financial need. The amount of your benefit was be restricted by factors such as your assets and other household income.

Social Security Disability Application Procedures

SSA refers initial claims to a state disability determination service. It is important that you be able to identify each and every medical provider that has treated you for conditions relating to your impairment. They will request for medical records and in some cases refer you for a medical assessment examination. The purpose of the exam is to determine your residual functional capacity (“RFC”). However, the most important medical assessment comes from your treating physicians, who is your primary medical resource in any SSD application.

After you file your initial application, your claim is transferred to a state agency known as Disability Determination Services (“DDS”).  The role of DDS is to collect your medical records and to render a decision regarding your medical eligibility for benefits.  DDS also sends questionnaires to detail your daily activities.  If your basic medical information does not reveal a conclusive physical or mental status, DDS can send your records to a doctor for their opinion about your residual functional capacity (“RFC”), or DDS may send you directly to another doctor for a consultive examination.   Based on those RFC opinions and the opinions of your treating physicians, SSA will either find you to be disabled or not disabled.

Social Security Disability Denials and Appeal Procedures

Many people are denied in the initial application process.  Sometimes the denial results because of inadequte treatment or documentation.  In other instances, the denial may be based upon the duration of a relatively new diagnosis.   Qualified applications can continue to pursue their claim through SSA’s appeal process.  The first appeal stage is known as Reconsideration.  In Reconsideration, you send your file and any new medical documentation back to the SSA for review by another claims manager.  If Reconsideration is not successful, you have the right to present your case at a hearing before an Administrative Law Judge.

You get one chance before the administrative judge. The process for arguing Social Security Disability coverage is more complex than most persons realize. An attorney can assist you in collecting and organizing the medical and employment records necessary to evidence your disability. Most importantly, an attorney will present your case at the hearing before the Administrative Law Judge. In most cases, the attorney, in addition, to questioning you and your witnesses will have to cross-examining the Government’s vocational expert who provides testimony about your supposed work opportunities.  I stress the obvious benefit of retaining a local counsel, who will be able to meet directly with you to prepare your case.

In most cases, the SSA mandates that an attorney charge a contingency fee on your past due benefits, meaning that you do not have to pay an attorney fee unless you prevail.