Social Security Disability
1. How do I
qualify for Social Security Disability benefits?
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.
Do I need an attorney to apply for Social
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
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
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
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
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
7. What is the difference between S.S.I. 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
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
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’
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.