Social Security Disability Benefits for Adults
What is the benefit and am I candidate?
The benefit is a monthly check designed to help you get by during the period of your long term disability (12 months or more). Once you put in an application, Social Security will do a preliminary screening to determine whether you are a candidate for the benefit. In general, you will be considered a candidate for Social Security Disability benefits (SSDI and/or SSI) programs if you fit into any one or more of the following groups:
You worked and paid taxes on your earnings for a good portion of the 10 years before you became disabled, fewer years if you are under 30;
You have been disabled since before you turned 22 and one or both of your parents worked and has passed away or is receiving disability and/or retirement benefits from Social Security;
You are extremely poor and, if married, household income is very low. (If single – fewer than $2,000 in non-exempt assets; if married, fewer than $3,000 in non-exempt assets); or
You are the surviving spouse of a deceased wage earner and you are claiming disability within seven years of your spouse’s passing and/or within seven years of your minor aged children reaching majority, and you are at least 50 years old but not yet 60.
What do I need to prove to get the benefit?
You will need to demonstrate that you have a medically determined impairment (MDI) or combination of MDIs that cause such severe impairment to work-related activities that you cannot do substantial gainful activity (SGA) for a period of at least 12 months.
Ex. Joshua, age 22, is in a car accident. He had held a job as a plumber's assistant for 3 years. He had to leave that job because of his injuries. He'd like to try another line of work, but, in his current condition he cannot lift or bend or even tolerate sitting for more than a few minutes at a time before he must use one or the other hand to brace his weight. The objective evidence should show that Joshua has a MDI and may help explain that this MDI causes severe impairments to work-related activities. How he responds to questions about his activities of daily living (SSA form 3373) and other forms, if answered accurately, will further demonstrate that his MDI (or combination of MDIs) cause such severe impairment to work-related activities that he cannot do substantial gainful activity (SGA) for a period of at least 12 months.
How do I get started?
The easy answer is that you get started by putting in an application. You can do the application online (https://ssa.gov), on paper (form SSA-16-BK, https://www.ssa.gov/forms/ssa-16-bk.pdf)
or call Social Security and make an appointment to do the application on phone or in person (800-772-1213).
Do I need an attorney?
No. You can put in the application and do everything on your own, or with the help of a trusted advisor.
If you don’t NEED an attorney, how do I stay in business? While you don’t necessarily need an attorney, having the counsel of an involved attorney is a good thing. There are many bureaucratic steps to getting Social Security Disability Benefits. If you have the tenacity to go it alone, you may well not be so disabled as to be deserving of disability benefits. Any attorney who has worked in this area of practice for more than a couple of years will have met a fair share of people who started disability applications just to abandon them because they became overwhelmed by the process. In truth, if your case goes to the hearing level, and most do, your judge will likely tell you to get representation. Why? Because when a claimant is represented, the process is deemed fairer. Afterall, you are representing that you are disabled, are you really capable of representing yourself? Further, it is easier for the judge. The Judge and the claimant's attorney/representative speak the same language, and we both know what is necessary to prove your case. Personally, in that I get paid the same whether I take a case early or late, I prefer taking it on early. Why? In general, if I take the case on early, it will be in better shape than if I have been brought in late. It’s like preventative medicine. Better that I come in at the beginning of the disease process than if I am brought in when the disease has progressed too far. The potential result is brighter if I come in early.
How do attorneys get paid for Social Security Disability Cases?
Attorneys' fees are regulated by the Social Security Act. For cases that are decided during the early stages of review – at initial, reconsideration or by the Administrative Law Judge, the attorney may charge no more than 25% of the retroactive benefit with a cap of $6,000. If cases are decided very early on, prior to there being a retroactive benefit, attorneys may submit a fee petition.
Ex: Ted is awarded benefits. Ted had a substantial work history. In determining his benefits, SSA finds that he has retroactive benefits of $72,000. Because he used an attorney, he will receive $66,000 in retroactive benefits and his attorney will be sent a check for $6,000 (minus a handling fee). In this case, Ted’s attorney receives less than 25% because of the $6,000 cap. Note, whether Ted hired his attorney on day one or on day 555, the attorney’s gets the same fee.
Is there any expense to applying?
No. There is no expense in applying. However, you do bear the burden of proving your case. Social Security will pay for your medical records when your case is initially reviewed and at reconsideration. But, if your case has to go to hearing, you will be responsible for the cost of the medical records needed to update your medical evidence.
Does applying and/or receiving this benefit mean that I can't work at all?
No. Even while you are claiming disability, you may do some limited amount of work. We have successfully represented individuals who can continue to manage some work, but just cannot manage substantial gainful activity (SGA).
Ex: Alice has been working as Janice’s receptionist for 14 years when her Lupus becomes symptomatic. Because of this, she can no longer manage to work more than 4 hours at a time, and no more than 3 days a week. Also, she is no longer dependable. There are days when she just cannot predict what will happen. On average, she is absent 3 or more days a month. Janice keeps her on because they have been together for so many years, and when Alice is there, she does good work. Janice pays Alice $12 an hour. Based on this work and income, is Alice barred from receiving Social Security Disability benefits? I don't believe she would be barred. She works 12 or less hours a week, and her income is never more than $480. Currently, the amount Alice earns is far less than the presumed SGA amount of $1,130/month. Given these facts, it is extremely doubtful that Alice's work would preclude an award of disability benefits.
If I get disability benefits, does that mean that I labeled for life?
No. It means that you have proven that due to medically determined impairments (MDI) you have been and/or will be disabled from SGA for a period of 12 months or more.
What are barriers to receiving benefits?
In general, if your disability is substantially contributed to by ongoing abuse of “street drugs” and/or alcohol, Social Security will deny benefits. Also, if you are non-compliant with medical treatment, Social Security will not look kindly on that; at times, there are legitimate excuses for being “non-compliant”. If that is the situation, you will have the burden of proving that your non-compliance is justified.
If I apply for Disability Benefits, aren't I abusing the system?
ABSOLUTELY NOT!!!!! Too often people postpone applying for benefits because they are embarrassed and/or they feel guilty about it. If you have worked and paid taxes and you apply for disability benefits, you are simply collecting on a promise the government made to you akin to the promise an insurance company makes when it sells you a policy of fire insurance. If your house burnt down, would you feel it was an abuse of "the system" to apply for the benefits of your fire insurance? Of course not. And, while disability benefits will not magically get you back to working condition with the wave of a magic check, these deserved benefits will help you to improve your condition, and give you a better chance of returning to improved health and possibly to work.