If You Have Been Denied SSI or SSDI,
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Social Security Insurance
Social Security Disability
What can a lawyer do for me?
Statistics show that people who have been denied Social Security Disability benefits are much more likely to succeed on appeal if they are represented by a lawyer. That’s because the laws governing SSI and SSDI are complex. Not surprisingly, an experienced SSI attorney can gather the medical evidence and make the persuasive arguments under the law that you most likely cannot. You should consider engaging an attorney for appeal if:
Social Security is a safety net created by the Federal Government to provide for those who are sick and unable to work by virtue of their mental or physical health problems. The benefits provided under Social Security are paid under two programs: SSI and SSDI.
Social Security Disability Insurance (SSDI) provides disability benefits for those who cannot work due to a health problem, and who have paid into the Federal Social Security program through the FICA taxes withheld from their paychecks. To be eligible for SSDI, you must have worked at least 5 of the last 10 years, or if less than 5 years, enough to “earn the sufficient number of credits” required to be eligible. This is a Long Term Disability insurance program that you have paid into as a taxpayer if you have worked in recent history.
Social Security Insurance (SSI) provides similar monthly benefits to those who cannot work by virtue of a physical or mental health impairment, and who also meet certain financial requirements relating to the amount of resources in their household. For example, if you are married and your spouse earns too much, you will not be eligible for SSI even if you can’t work because of your health problems. But you may still be eligible for SSDI if you have a sufficient work history.
SSI and SSDI both require that you suffer from your alleged health problem for a period of 12 months, before you can be eligible for benefits. You must prove that you suffer from a “Severe” impairment and the first step to showing that is to prove that it lasted for “12 months or longer, or is likely to result in death.”
No matter how serious your health problems are, if you are working and earning over a certain amount each month, you will not be eligible for SSI or SSDI benefits. Even if you are working on a part time basis, the Social Security Administration may consider this evidence that you are able to work full time. If you have an “on and off” work history, you may need a lawyer to help you show why this is relevant to your health problem and should not be counted against you. If you are earning over a certain amount each month, but are granted special accommodations at work, even if they seem minimal, you may need a lawyer to show that this should not make you ineligible for benefits.
The SSA often views a medical record with references to even small amounts of drug or alcohol use as an automatic reason for denial of benefits. However, the laws surrounding the intersection of disability with drug and alcohol use are complicated, and in some cases an attorney can convince the judge that this should not be a limiting factor.
The Social Security Administration (SSA) is an enormous federal bureaucracy that employs thousands of people across the county to evaluate disability claims. Given the complexity of the Social Security laws, and the numbers of people interpreting the applications and making the decisions, it is not surprising that their decisions sometimes seem inconsistent. Often a person who is denied knows someone who is receiving benefits that is “not as bad off,” or who “doesn’t deserve it.” This is another reason why you should give yourself the best chance of success with an appeal by having an attorney assist you in navigating the bureaucracy.
SSA applies different rules to younger applicants than they apply to applicants who are older. The reasoning for this is a general agreement that older individuals are less capable of occupational retraining and less likely to recover from illness. Younger applicants, on the other hand, are presumed to be more capable of retraining, and more likely to recover. If you are a younger applicant, but your circumstances make retraining and/or recovering highly unlikely, and attorney can help you show the judge that you should not be treated as “a younger individual.”
At its most basic level, a hearing is your Constitutional due process right to have your entitlement to government benefits adjudicated. If it sounds technical, that’s because it is. It is quite literally your opportunity to be heard and to have the government consider your case and judge whether your health problems render you disabled under the law. In many respects, it is like a trial. Your lawyer will make an opening statement, ask you questions about your life, especially about your work and health, and will also cross examine expert witnesses that may be called by the government at your hearing. Without an attorney present you will most likely miss important details in your file that the Judge will consider. Without an attorney to prepare you for the hearing, you will not know what types of questions will be asked of you and you certainly will not know what types of questions to ask the expert witnesses presented by SSA. Do not go to hearing without representation.
While it is important to have a lawyer representing you during a Social Security appeal, you do not have a Constitutional right to a lawyer, as you do in certain criminal cases. On the other hand, the Congress has recognized that people who are prevented from working by virtue of a health problem are unlikely to be able to afford an attorney. Therefore, the law provides for attorneys to be paid on a contingent basis. This means that they don’t collect a fee for their time on your case unless they win. SSA must approve a fee agreement between a lawyer and client before the lawyer is paid. In most cases a lawyer will be entitled to 25% of the back benefits that he or she proves you are entitled to, or $5300.00, whichever amount is less. Most often, lawyers are paid directly by the U.S. Treasury and your back benefits are adjusted to reflect this direct payment. Read any fee agreement you sign carefully and make sure that you understand what your obligations are to pay for the costs associated with your case. The U.S. Treasury will not pay these expenses and your lawyer may bill you for those directly. Although typically not a lot of money, you should be clear on what your responsibility is when it comes to paying for these expenses.
SSI – Supplemental Security Income is a program of the Social Security Administration which provides a monthly benefit to those who are disabled under the law, have not earned enough “credits” based on their earnings, and meet certain low income guidelines for their household. This program is governed by Title XVI of the
SSDI – Social Security Disability Insurance is a program of the Social Security Administration which provides a monthly benefit to qualified individuals who are disabled under the law. Individuals who have paid sufficiently into the program through their employment tax withholdings are covered under this program, provided that they are medically disabled under the law. This program is governed by Title II of the
Decision – The Judge who decides your case will issue a written decision of his or her rationale. The decision will either be designated as “Fully Favorable,” “Partially Favorable,” or “Unfavorable.” A Fully Favorable decision is one in which the Judge grants your application for disability benefits and awards benefits back to your Alleged Onset Date (the day you claim you became disabled). A Partially Favorable decision is most commonly one in which the Judge awards benefits but for some reason did not go back as far as you requested in awarding benefits. It also includes situations where the Judge awards benefits for a closed period of time, where you get benefits going back to a certain date, but not past another certain point in time. An Unfavorable decision is one in which the Judge denies your appeal.
Appeal – When an applicant receives an unfavorable decision from the Social Security Administration, the applicant should file an appeal of that determination. The Appeal process has two phases consisting of a “Reconsideration” and “Hearing.” Many people often fail to appeal unfavorable initial determinations and instead file a new application. They do so at their own peril and may be giving up important rights by not filing an appeal. Generally speaking, the appeal period at each stage of the process is 60 days.
Work History – This refers to the various details of your employment prior to becoming disabled. Your employment history over the preceding 15 years is generally what the SSA is interested in and regards as relevant. Because the central issue in a Social Security claim is whether or not you can perform any work, the details of your work history are an important part of the process.
Accommodations – Accommodations are special rules or exceptions to rules that your employer applies to you so that you can perform a job despite your health impairment. The existence of special job accommodations may be important to a Judge’s finding as to whether or not you meet the technical requirements for “Substantial Gainful Activity.” If work you are performing qualifies as Substantial Gainful Activity, you will not be deemed disabled.
Fee Arrangements - something that describes the legally prescribed percentage agreement on back benefits used to pay attorney fees.
Most people are denied SSI or SSDI the first time they apply. To maximize your chances of a first-time approval or for help with the more likely appeal, consult an experienced attorney.
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Social Security Insurance and Disability Appeals
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