1. WHAT IS DISABILITY?
The Social Security Administration uses complex regulations to determine if you
are eligible for disability insurance benefits (SSDI) or
supplemental security income benefits (SSI). These cash benefits are paid to
people not yet retired who have physical or mental health
limitations which prevent any work in the national economy when disability is
expected to last for 12 months or more. The Social Security
regulations take into consideration such additional factors as your age,
education, past work, and potential for obtaining a job. Disability means
that you have a medical condition which prevents you from performing any
full-time competitive employment in the economy (not just jobs you
have held in the past).
2. WHAT IS THE DIFFERENCE BETWEEN SSDI AND SSI BENEFITS?
SSDI benefits requires proof of disability, as defined above, as well as
“coverage” in the SSDI system. “Coverage” is obtained by
paying taxes into the system over the course of your working career. Successful
SSDI applicants receive Medicare benefits.
SSI benefits are available to those who have not paid enough into the system to
have “coverage” under the SSDI program. SSI benefits require proof of
disability, as defined above, as well as proof of having few financial assets.
Successful SSI applicants receive Medicaid benefits.
3. HOW DO I APPLY FOR SOCIAL SECURITY BENEFITS?
Go to your Social Security Administration's (SSA) local office and apply for
benefits immediately if you believe you are disabled and will be so
for 12 continuous months. After your medical records are reviewed, the local SSA
office will send you a letter giving you a decision.
4. SHOULD I APPEAL MY INITIAL DENIAL?
Yes! Most people who apply are denied benefits at the first two stages of
review. Unfortunately, many people simply give up after an initial denial. The
next stage of appeal is called "Reconsideration." You must request
Reconsideration within 60 days after initial denial. You should hire an
experienced Social Security attorney after initial denial. Most people who apply
for Reconsideration are also denied again.
5. SHOULD I APPEAL MY RECONSIDERATION DENIAL?
Yes! You must appeal within 60 days by requesting a hearing before an
Administrative Law Judge (ALJ). The ALJ is independent from the
Social Security Administration. ALJs review all cases to ensure the Social
Security regulations are applied fairly.
6. HOW LONG WILL A DECISION TAKE?
The first two levels of review take approximately five months each, during which
you will receive two written decisions. If your case requires a
hearing before an Administrative Law Judge, you may have to wait 18-20
additional months for a hearing.
7. WHEN SHOULD I SEE AN ATTORNEY?
Immediately! Preparation takes time. The best time to hire an attorney is the
earliest stage of denial.
8. WHAT DOES IT COST TO HIRE AN ATTORNEY?
An attorney cannot charge a fee for representing a Social Security claimant
unless approved by the SSA or an ALJ. Fees are generally limited
to 25% of past due benefits by SSA regulations. Most attorneys also charge
actual office expenses (such as doctor charges for medical
records) even if the case is lost. The SSA withholds 25% of past due benefits
for the attorney in disability and SSI cases. After winning benefits,
the attorney is not entitled to further fees for future benefits.
9. CAN MY CHILDREN RECEIVE BENEFITS ON MY CLAIM?
Yes. Any dependent child under the date of your disability should receive
benefits through the date of their 18th birthday. There is a total
family maximum that can be paid in any one claim.
10. IS THERE A CAP ON HOW MUCH MY MEDICAL PROVIDERS CAN CHARGE FOR MEDICAL
RECORDS?
Yes. Under N.C. Gen. Stat. § 90-411: “A health care provider may charge a
reasonable fee to cover the cost incurred in searching,
handling, copying and mailing medical records to the patient or the patient’s
designated representative. The maximum fee for each
request shall be seventy-five cents (.75) per page for the first 25 pages, fifty
cents (.50) per page for pages 26 through 100, and twenty-five cents (.25) for each page in excess of 100 pages, provided that the health
care provider may impose a minimum fee of up to ten
dollars ($10.00), inclusive of copying costs.
11. WILL THERE BE ANY OTHER WITNESSES AT HEARING?
In addition to yourself, and any close friends and /or family members you may
wish to testify, the Administrative Law Judge may have a
medical expert and/or vocational expert testify at your hearing.
12. WHAT IF I LOSE AT THE ADMINISTRATIVE LAW JUDGE HEARING?
Unfavorable decisions from the Administrative Law Judge can be appealed to the
Appeals Council in Falls Church, Virginia.
Unfortunately, these appeals take years, and often lead to an affirmation of the
Administrative Law Judge’s decision. A further appeal
can be taken from the Appeals Council to U.S. District Court, where your case
can be heard by a United States District Court Judge or
U.S. Magistrate Judge. In the event of an additional loss, your case can then be
appealed to the United States Fourth Circuit Court of
Appeals in Richmond, or even the United States Supreme Court.
13. WHAT ABOUT MENTAL HEALTH CONDITIONS?
Individuals with serious mental health conditions can win disability claims
without suffering from any physical medical conditions.
If you would like for us to contact you about your case,
click here.
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