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What is SSDI & SSI
Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits are administered by the Social Security Administration (SSA). They are meant to provide a safety net to disabled Americans and their families when working is no longer possible. Unfortunately, many claims are initially denied for medical and non-medical reasons. If you are dealing with the SSDI or SSI appeals process, a Social Security lawyer may be your best chance to prove your disability claim to the SSA or Office of Hearings Operations (OHO).
SSDI is a program designed for people who have worked and paid taxes into the Social Security system, thereby earning work credits. If an individual is determined to be disabled, the individual will receive SSDI benefits regardless of the individual’s income or assets. SSDI benefits begin 5 months after the onset date of your disability. SSDI benefits can be paid retroactively for up to 12 months prior to your initial application depending on your date of disability but subject to the 5 month waiting period.
SSI is a “needs-based” program designed to pay benefits to disabled people who need help with basic living costs, even if they haven’t worked or paid taxes into the Social Security system. To qualify for SSI payments, a claimant cannot have family assets or income over a certain limit. SSI benefits begin the month of your disability onset date. However, no benefits will be paid for any time prior to the month you file your initial application.
The Application and Appeals Process for Social Security Disability Claims
The Initial Application
When you decide to pursue Social Security Disability or SSI benefits you first need to fill out the initial application. You must acquire medical records and fill out an application in person, by phone, or online. Many applicants choose to take this step alone since it seems so straight forward, but unfortunately many initial applications are also denied. A social security disability lawyer can help develop your claim based upon your age, education, impairments, work history, and how you reached the point of being unable to work. The finished application is then submitted to SSA who sends it to Disability Determination Services (DDS) where your initial claim will be reviewed. The determination process is slow and normally takes 3 to 6 months to receive a determination letter from the SSA.
If your application is denied, you have just 60 days to file a request for reconsideration with the SSA. Hiring an attorney at this step is very important. He will be able to review your initial application and determine if any information needs to be reiterated differently or if any additional evidence needs to be presented. Your attorney will handle the request for you and help gather any additional evidence to support your request. The request will then be reviewed by DDS again. Unfortunately, only a small percentage of claims are approved at this stage. Fortunately, they will usually make their determination in a shorter time frame.
Administrative Law Judge Hearing
If your claim is again denied, you have another 60 days to request a hearing. If you still do not have a social security disability lawyer at this point, we strongly recommend that you retain us for this hearing as your chances of winning at an administrative hearing are much higher with representation.
The hearing will be held before the Office of Hearings Operations (OHO) (formerly Office of Disability Adjudication and Review, or ODAR) where an Administrative Law Judge (ALJ) will decide whether or not you will be awarded benefits. A disability lawyer will prepare your case and prep you before the hearing where the ALJ will ask you a number of questions. Your lawyer will also be able to take your testimony so that you can highlight the strengths of your case, and he will be able to rebut any adverse vocational evidence. Your attorney will also keep the record updated with your most recent medical records, and he will obtain supporting written opinions from your healthcare providers.
If your claim is denied by the ALJ, you have 60 days to request that the Appeals Council review your case. The purpose of the Appeals Council is to determine whether an error was made by the ALJ. The Appeals Council has discretion to dismiss your case, overturn the decision and grant benefits, or remand it to back to the ALJ for another hearing. Only a small percentage of cases are overturned. Rather, it is much more likely that the case will be dismissed or remanded.
You have 60 days following a denial by the Appeals Council to file a petition against the SSA in U.S. District Court. Federal judges are supposed to review the case only for legal errors, but in reality many judges also rule on factual questions. Reasons for a reversal often include the SSA not giving sufficient weight to a treating doctor’s opinion, not considering pain and other symptoms, or not asking for assessments of abilities from treating doctors.
As you can see, the process can be long and highly technical. The best advice is to seek representation from a disability lawyer at the start of the process.
5 Step Analysis in SSDI & SSI Claims
Disability is the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment or combination of impairments that can be expected to result in death or that has lasted or can be expected to last for at least 12 consecutive months. This standard can be broken down as follows:
Step 1: Substantial Gainful Activity
Generally, SSA wants to know if a person is still working. SSA determines whether a person is doing something that involves significant physical or mental activities and whether it is the type of activity normally done for pay or profit. If someone is working and earning a certain amount each month (SGA level), SSA will consider them to not be disabled, regardless of any actual disability. A person who might otherwise be disabled will not be able to receive benefits while they are currently engaging in substantial work. 20 C.F.R. 404.1520 (b).
Step 2: “Severe” Medically Determinable Impairment
SSA determines whether a person has a “severe” impairment or combination of impairments. Impairments are “severe” if they significantly limit a person’s ability to perform basic work activities. Generally, an impairment is “severe” if it imposes more than a minor limitation in someone’s ability to do work or life functions. SSA considers all impairments, including symptoms like pain or fatigue, in determining whether a condition is “severe.” 20 C.F.R. 404.1520 (c).
SSA also figures out whether an impairment meets the durational requirements at step 2. The impairment must have lasted or is expected to last for more than 12 months, or is expected to result in death. 20 C.F.R. 404.1521.
Step 3: Listings
SSA determines whether a claimant meets any of the “Listings.” The Listings are descriptions of certain conditions and the impairments they cause. Generally, a condition that meets a Listing is considered so severe that the claimant is automatically considered disabled. If the condition does not rise to “Listing level” SSA then goes on to Step 4. The Listings are codified at 20 C.F.R. Part 404, Subpart P, Appendix 1.
Step 4: Past Relevant Work
Most social security cases, at whatever level, are won or lost at steps four and five of the process. Step four is where SSA first determines a claimant’s “residual functional capacity” which is their ability to do work. SSA then determines whether someone can do their “past relevant work.” If a person is no longer able to do the work they used to do, the process proceeds to step five. However, if SSA finds that the claimant is still able to do their old work, they will find that the person is not disabled. 20 C.F.R. 404.1520 (f).
Step 5: Any Other Work
Finally, SSA must determine whether the claimant can do any other work in the national economy, considering that person’s age, educational background, work experience, and residual functional capacity. To make this determination, SSA uses a set of “Grid Rules” and ALJ’s often consult with vocational experts. If it is found that that they are not able to engage in other work as a result of their impairments, that person is entitled to benefits, possibly including back benefits depending on the onset date of the disability. 20 C.F.R. 404.1520 (g).
It also possible for a judge to find a claimant is not capable of any other work outside of the Grid Rules if there are additional limitations that erode the claimant’s residual functional capacity to the point that no work would be available or able to be maintained long term.
Need assistance with your social security disability (SSDI) or supplemental security income (SSI) claim? Contact an experienced social security attorney today.
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