The Social Security Administration (SSA) administers three programs. The first is the SSA retirement program. This program is available to workers beginning at 62 years of age, however, full benefits will not begin until 65 years of age. The other two programs are disability programs: Social Security Disability Insurance and Supplemental Security Income.
Social Security Disability Insurance
Social Security Disability Insurance (SSDI) benefits are available to people who have paid into the program and they have become unable to work because they have a medical condition that is expected to last at least one year or result in death.
To qualify for disability benefits, a person must have worked enough quarters of coverage to be considered “fully insured” by the SSA. A person must have had employment where Social Security taxes were taken out of his or her paychecks. There are two different earnings tests to meet the fully insured requirement: the “recent work” test and the “duration of work” test. Recent work is based on age at the time of becoming disabled and duration of work is based on the length of time employed.
A person must also be considered totally disabled under the SSA’s rule. Total disability means a person cannot perform substantial gainful activity based on age, education, and prior work experience.
The SSA uses a 5 step process to determine whether a person is totally disabled:
1. Is the person working? If a person is working and earnings average more than a certain amount each month, that person will not be considered disabled.
2. Is a person’s condition “severe”? This means the medical condition significantly limits a person’s ability to do basic work activities such as walking, sitting, lifting, pushing, pulling, etc.
3. Is a person’s medical condition on the List of Impairments? Some medical conditions are considered so severe that a person will automatically be considered totally disabled.
4. Can a person do the work her or she did before?
5. Can a person do any other type of work?
Social Security Disability Appeals
If the SSA denies or “disapproves” a person’s claim, he or she has a right to appeal the decision and has a right to be represented by an attorney.
How a Social Security Appeals Attorney Can Help
Often, claims are disapproved because the information provided is not complete or properly presented. It takes an attorney who is familiar not only with the intricacies of the Social Security disability insurance system, but also the complex medical issues that arise during treatment and how those issues affect a person’s capacity to work. There are also issues that cross over into the state workers’ compensation that can benefit from having an attorney with knowledge and experience in both areas of law.
Once a social security appeals lawyer is appointed, they will:
1. Obtain information from Social Security
2. Obtain medical records or information to help support a claim
3. Represent in any interview, conference or hearing with the SSA
4. Request a reconsideration, hearing or Appeals Council review
5. Prepare a claimant for a hearing and question witnesses
What a Social Security Appeals Attorney can charge for services
An attorney cannot charge or collect a fee without the SSA’s authorization. To charge a fee for services, a written fee agreement must be filed with the SSA. Generally, if there are past-due benefits owed, and the fee agreed on is no more than 25% of the past due benefits, to a maximum of $6,000, whichever is less, the SSA will approve the fee agreement.
The attorney may also file a fee petition after completing work. This is a written request that describes in detail the amount of time spent on each service. The amount of the fee the attorney may charge is determined by the SSA. However, out-of-pocket expenses, such as cost to obtain medical reports do not require prior approval.
Generally, the SSA will withhold 25% of past due benefits and pay the attorney directly.
Sometimes a person must pay his or her attorney directly if:
1. The approved fee is more than the amount withheld and paid to the attorney by the SSA
2. The attorney is not eligible for direct payment
3. The SSA did not withhold 25% from past-due benefits; or
4. The attorney made a timely request for a fee and the money that should have been withheld was sent to the claimant.
Call us today for a complimentary consultation to either appeal a denial or to apply for you on your behalf.