The following are the questions most frequently asked by our clients about Social Security Disability claims. The answers provided are brief and are obviously intended for general information only. If you have further questions on any of these topics, as they pertain to your case, we'll be happy to discuss them in greater detail with you.

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 sixty (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 hearing in front of a judge within sixty (60) days. Although some applications in cases of severe disability are granted at the initial or reconsideration stages, many claims require a claimant to 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 formal hearing?
The first two determinations are made by the Social Security Administration 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 Social Security Administration, 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.

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 a judge on that issue. Rather, the doctors' findings and opinions regarding physical restrictions are taken into account and applied to the law and regulations which 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", what does?
There is a 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 of this information is measured against a complicated "grid system" to determine whether you can be found "disabled". More information concerning the appeals process.

If I am found disabled, how long will I continue to receive Social Security benefits?
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 benefits?
Under certain circumstances, yes. To qualify for Social Security benefits, you must be unable to work for twelve (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 (5) years prior to the onset of your disability.

What is the difference between "SSDI" and "SSI"?
SSDI is essentially insurance benefits you earn based upon premiums you have paid into the system through your payroll taxes while employed. The amount of your monthly SSDI benefit is determined in part on your earnings record. For an estimate of that amount, contact Social Security and request an Annual Statement. SSDI 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 twenty (20) of the forty (40) calendar quarters prior to becoming disabled, or five (5) years of employment out of the prior ten (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 SSDI.

Please note that we do not handle SSI-only cases (those not associated with an SSDI claim). However, we would be happy to refer you to an attorney who specializes in this type of claim.

Please feel free to contact our office for more information.