Social Security Disability

In addition to normal retirement benefits, the Social Security system also provides for a monthly disability benefit if you are disabled and unable to be gainfully employed. Social Security Disability benefits are actually a form of disability insurance that you qualify for by paying into the system. In order to qualify for such benefits, you must have made sufficient payments into the system while you were working. If it is determined that you have made sufficient payments into the system, you will qualify for benefits if a medical or psychological condition prevents you from engaging in what is referred to as “substantial gainful activity” for a period of at least twelve months.

2. Do I need an attorney to apply for Social Security 
Disability benefits?

Generally, it is not necessary to be represented by an attorney to first apply for Social Security Disability benefits. Social Security Disability benefits may be applied for by making an appointment at your local Social Security office. You will be required to submit an application that details your educational background, work history, and medical treatment. You will be required to sign releases so that your medical records can be obtained and reviewed. You may also be requested to undergo an examination by a physician retained by the Social Security Administration to conduct an independent evaluation.

3. What do I do if my application for Social Security Disability benefits is denied? 

If your application for Social Security benefits is denied, you will receive notice of the denial in writing. Thereafter, you have a period of sixty days to file an appeal. Your appeal will be heard by the Social Security Administration Office of Hearings and Appeals which employs numerous Administrative Law Judges who will review the case and determine whether you are eligible for benefits. You will be given the opportunity to attend a hearing, to testify, and to present documentary evidence establishing disability.

4. Should I consult a lawyer to represent me in my appeal? 

You are not required to be represented by an attorney in a Social Security appeal, however engaging an experienced Social Security practitioner will in most instances greatly enhance your chance of prevailing on your appeal. An experienced attorney will gather all of your pertinent medical records and provide these to the Administrative Law Judge for review. The Attorney may also ask your physician to prepare reports or address questionnaires that directly address the question of whether or not you are disabled and whether or not you can return to any gainful employment. An experienced practitioner will also be familiar with the lengthy and sometimes complex regulations that govern when a claimant is eligible for Social Security Disability benefits. The attorney will also prepare you for the hearing and be prepared to have you testify in support of your appeal.

5. I cannot afford to hire an attorney to represent me. Does this mean that I must represent myself on my appeal? 

No. The vast majority of Social Security practitioners represent Social Security claimants under a contingent fee agreement that provides that the attorney will receive a fee only in the event that the appeal is successful. Under current Social Security regulations, an attorney is permitted to charge a twenty-five percent contingent fee with a cap of $5,300.00. Additionally, the fee is limited to the retroactive benefit to which the claimant may be entitled, that is the amount of benefit a claimant is entitled to retroactively from the date that disability commenced through the favorable decision of the Administrative Law Judge.

6. Once I became eligible for Social Security Disability benefits, how do I obtain medical benefits? 

A claimant who qualifies for Social Security Disability benefits is automatically entitled to benefits under Medicare. A claimant is automatically eligible for these benefits after a period of two years from the date that the claimant is initially found disabled.

7. What is the difference between S.S.I. benefits and 
S.S.D. benefits? 

As explained above, Social Security Disability benefits are actually a form of disability insurance that a claimant must qualify for by making payments into the system. S.S.I. or Social Security Income benefits are a different form of Social Security benefits that are available regardless of whether a claimant is qualified for Social Security Disability.

In order to qualify for S.S.I. benefits it must first be demonstrated that the claimant is medically disabled. Once this determination is made, either at the initial application stage or after a hearing, it is then determined whether the claimant qualifies on an income basis. In order to be qualified, it must be demonstrated that the claimant has only very limited income. Household income is taken into account, such that a potential claimant may be disqualified on the basis of the earnings of a spouse or other earnings of individuals residing in the household.

8. How long will it take me to obtain Social Security benefits? 

The initial application for Social Security benefits is generally reviewed and acted upon in a period of several months. If the application is denied, the appeal process will take somewhat longer. In Northeastern Pennsylvania, it takes approximately one year to obtain a hearing before an Administrative Law Judge after an appeal has been filed. After the hearing is held, a decision is issued by the Administrative Law Judge usually in thirty to sixty days.

9. Once I obtain benefits, can the benefits ever be taken away? 

The Social Security Administration may periodically review your entitlement to benefits. You may be asked to produce evidence from your physician that you continue to be disabled. Your benefits may not be terminated unless and until a hearing is held before an Administrative Law Judge who determines your continuing eligibility for benefits.

10. Is the amount of my S.S.D. benefit affected by other benefits I may be receiving? 

The only benefit that will reduce your Social Security Disability benefit is any wage benefit you may be receiving under Workers’ Compensation. Social Security will determine the amount of any “offset” of your benefit based upon the receipt of Workers’ Compensation.

11. Should I apply for disability benefits even though I am receiving Workers’ Compensation benefits? 

It is a good idea to apply for S.S.D. benefits even if you are receiving Workers’ Compensation benefits. This is especially true where you have a serious disability and are not likely to return to gainful employment. If your Workers’ Compensation case is settled, which generally involves a lump sum payment representing your future wage benefits, you will generally be eligible to receive an increased Social Security benefit. Additionally, you will be eligible for Medicare.