The following are the 10 general questions most frequently asked by our clients about Social Security Disability (SSD) and Supplemental Security Income (SSI). The answers provided are brief and are obviously intended for general information only. If you have further questions regarding any of these topics, we'll be happy to discuss them with you in greater detail.
Why must I make so many applications for Social Security Disability?
Obtaining disability benefits can require up to three separate application processes. First is the Initial Application, a very high percentage of which are denied. Within 60 days of denial, you must file a Request for Reconsideration. Again, a high percentage of these applications are denied. If your claim remains rejected, you must request a formal hearing with 60 days. Although some applications in cases of severe disability are granted at the initial or reconsideration stages, most claims will require a claimant go through the formal hearing process in order to obtain benefits.
If I have already been denied twice, what is the use of going on to
The first two determinations are made by the Social Security Administration (SSA) itself, or by a contract agency of the State of Washington. The administrative processing of claims at the initial levels consistently results in a conservative interpretation of the medical evidence and the applicable law, partly because of the volume of claims to be handled. At the hearing level, your claim is reviewed by an Administrative Law Judge, who is not an employee of the SSA, and who can receive new evidence and apply the law in an independent fashion. Accordingly, the judge will often reverse decisions made at the administrative levels, after observing and listening to a claimant.
How does the hearing process work? What does a hearing involve? Is it a formal court proceeding, and does an attorney represent the Social Security Administration?
First, understand that well over a year may elapse from the time a hearing is requested to the date it is held. This scheduling delay results from the number of cases in the system and is not a matter your attorney can control. As the hearing date approaches, you may be involved in obtaining additional records for your case. The hearings themselves combine formality and informality. The testimony of all witnesses is taken under oath, but medical reports can be offered into evidence, instead of having a doctor testify, and both the claimant and attorney are allowed ample opportunity to provide all facts relevant to the disability in question and to express opinions. The Administration is not currently represented by an attorney in these hearings. However, the Administrative Law Judge who hears the case may subject you to lengthy and detailed questioning. Additionally, the judge may call a medical or vocational expert to help interpret the evidence in the case. An administrative assistant records the proceedings so that an official record is made.
After the hearing, how long will it be until I receive a decision and, if the decision is favorable, when will I begin to receive benefits?
Judges widely vary in their decision-making timetable, in part because of differing caseloads. A rough estimate for a decision is one to two months from the hearing date at the earliest, and sometimes up to six months, particularly if additional evidence is submitted. You will receive the decision directly, and we will get a copy. A favorable decision is sent on to one of the Administration's processing centers for the computation of your benefits and you should not expect to receive any benefits until a separate Certificate of Award is issued, usually two to three months after the favorable decision. You will generally receive any retroactive benefits shortly after the award certificate issues, and current benefits, if appropriate, will begin at about the same time. Regrettably, there is virtually nothing we can do to speed up the payment process.
My doctors have all sent in reports saying I am disabled. Why doesn't
that decide the issue?
Difficult as it may be to understand, doctors' opinions regarding whether a person is or is not disabled do not control the decision of the Administration or the judge on that issue. Rather, the doctors' findings and opinions regarding physical restrictions are taken into account and applied to the law and regulations that control all cases. The purported reason for this is to eliminate the subjective aspects of your doctors' opinions – in other words, based upon the same findings, one doctor may feel a patient is "disabled" while another would not. Thus, it is important that we obtain your physician's opinions regarding physical restrictions and difficulties as they impact your ability to carry out daily functions.
If my doctors' opinions don't determine whether I am found "disabled",
There is formal process, called "sequential analysis", which the Administration and the judge will use in determining whether your conditions qualify for a finding of "disabled" under the law. First, a determination is made as to whether your conditions meet or exceed certain standards set forth in a listing of impairments which, regardless of your age, education or prior work experience, would justify a finding of "disabled". If disability cannot be found on that basis, further inquiry is made as to your remaining physical and mental capacity to perform any work at all. Your "residual functional capacity", as it is called, is combined with other factors, such as your age, education, and the physical and skill requirements of your prior employment, and all this information is measured against a complicated "grid system" to determine whether you can be found "disabled".
If I am found disabled, how long will I continue to receive Social
From time to time, Social Security may review your case. This is particularly
the case with younger individuals whose disabilities might be expected to improve
over time. If your condition is reviewed – which usually involves an independent
medical evaluation – the Administration must demonstrate that your condition
has improved in order to terminate benefits. If that occurs, you will have further
appeal rights. In the case of older workers with chronic conditions, reviews
and terminations are less likely.
Can I receive both Social Security benefits and Workers' Compensation
Under certain circumstances, yes. To qualify for Social Security benefits, you must be unable to work for 12 continuous calendar months before benefits are payable. Also, the standards of proof for Social Security disability are different from workers' compensation, which does not have time limits for being off work, but requires that your disability be solely the result of your on-the-job injury or condition. Thus, you may qualify for one and not the other. And, if you otherwise qualify for both types of benefits, there is a maximum amount you can receive in total combined benefits. That limitation is 80% of your highest average monthly wage in the five years prior to the onset of your disability.
What is the difference between "SSD" and "SSI"?
SSD is essentially insurance benefits you earn based upon premiums you have paid into the system while employed. Your monthly SSD benefit will largely depend upon the amount of premiums you have paid over the years. Thus, such coverage requires that you have been employed for certain periods prior to the onset of your disability. The law currently requires that you demonstrate earnings in 20 of the 40 calendar quarters prior to becoming disabled, or 5 years of employment out of the prior 10 years. Without such earnings, you do not have "insured status". SSI, by contrast, pays a lesser benefit in a standard amount to individuals who otherwise qualify as disabled but do not have "insured status" for SSD.
How can an attorney help me with my Social Security disability case?
Social Security Disability has evolved into a very complicated area of the law. There are literally hundreds of laws and regulations, and thousands of cases construing them that will determine whether the facts of your particular case will result in a finding of "disabled". Court cases, legislative changes and administrative revisions occur on a frequent basis, and these may impact your eligibility for benefits. An attorney knowledgeable about these laws and regulations, and the system in general, can help to increase your chances of obtaining benefits.
How are attorneys' fees handled in these cases?
All attorneys represent Social Security Disability claimants on a contingent fee basis. If there is no recovery, there is no charge for legal services, and you will only be responsible for the costs your attorney incurred in preparing and presenting your case. The SSA caps attorneys' fees at 25% of the value of the retroactive recovery, or a maximum of $6,000, whichever is less. There is no fee taken from your ongoing SSD benefits. In most cases the amount approved for attorneys' fees is deducted from your retroactive benefits and sent directly to your attorney.
Personnel at Casuey Law Firm have handled many hundreds of Social Security Disability cases over the years. We belong to the National Organization of Social Security Claimants' Representatives, which issues monthly updates on developments in the law on administrative processes, and lobbies Congress on behalf of claimants. Additionally, we limit our practice to medical-legal matters in other words, injury and disability claims. We are therefore very familiar with the interplay between Social Security Disability and, for example, workers' compensation and insurance coverage for personal injury claims. We make every effort to ensure that all claims are coordinated so as to maximize the extent of recovery from all systems.