SOCIAL SECURITY - PROGRAMS AND BENEFITS
The Social Security system provides two benefit programs for disabled
persons: Social Security Disability (Title II) and SSI (Supplemental
Social Security Disability (Title II) is for workers covered by Social
Security who have contributed to a Social Security account while working for
a specified period of time, usually 5 out of the last 10 years of work.
Disabled widows and widowers of Social Security wage earners may also
SSI (Supplemental Security Income) provides disability benefits for low
income persons not covered by Social Security. It can also be added to
Social Security benefits which are lower than a certain minimum level.
Social Security disability beneficiaries receive two primary benefits: a
monthly check and medical benefits. The amount of the monthly check is
determined by a formula which takes into account the amount paid into Social
Security and the length of time of employment.
SSI (Supplemental Security Income) does not require previous employment, and
monthly benefits are based upon "need", considering the individual's other
income and assets. Special rules apply for legal residents who are not
III. Medical Benefits
Social Security Disability recipients are entitled to Medicare benefits if
they have been disabled for two years after a five month waiting period. A
small "premium" (approx. $50.00) is deducted from the beneficiaries' Social
This entitles them to have certain medical expenses covered by Medicare.
SSI beneficiaries are entitled to Medicaid benefits. These are similar to
Medicare benefits, but may be more restrictive in terms of medical providers
and may cover items which are excluded from Medicare coverage. Medicaid
benefits are available from the first month the recipient is entitled to SSI
There is no waiting period.
Social Security recipients (Title II) receive Medicare. SSI recipients
receive Medicaid. Certain eligible recipients who receive both Social
Security Disability and Supplemental Security Income receive both Medicare
The health care benefits provided by Social Security are essential for
WHO IS DISABLED AND THE CLAIMS PROCESS
IV. Who is "Disabled"?
The standard of disability which must be shown is the same for both
programs. You must have physical or mental problems (or a combination of
problems) severe enough to keep you from working in any regular paying job
("substantial gainful activity") for at least 12 months. Disability due to
drug and alcohol addiction is not covered, but certain physical or mental
conditions as a result of a prior addiction may be covered.
In determining disability, the test is not whether you would be offered a
job, but whether there are jobs which you could perform.
For those over 55 years old, new regulations allow a more realistic look at
age, education, and experience in making this test.
V. The Claims Process
Application: For either Social Security or SSI, an application for
disability benefits may be filed at the local district Social Security
Office. Our office can assist you in filing a disability application in the
appropriate cases, particularly if you have been disabled for at least 12
months with documented significant disability.
Denial: You should not become discouraged if your claim is denied at first.
It is estimated that 80-90% of the applications are denied. This is an
appropriate time for you to seek legal representation. Our office can
discuss the circumstances of the case with you and give you an opinion of
the merits of your claim. The earlier we start working on the case, the
better chance we have of being successful.
Reconsideration: The next step in the process is the "Request for
Reconsideration" from Social Security. After approximately two to three
months, a decision will be reached on the Reconsideration request.
The case will either be granted benefits or denied. If the case is denied,
it is then time to request a hearing before an Administrative Law Judge.
Request for Hearing: At this stage in the process, it is critical to have
competent legal representation to give you the best chance of winning the
Preparing for the Appeal: An important service of this office is to make
sure that you have the right kind of medical and other evidence to give a
true picture of your condition. If appropriate, we may refer you to
specialists to examine you and may request reports from them. These doctors
will give an honest appraisal of your disability. (of course, we do not
guarantee that they will find you disabled).
We will attempt to obtain a comprehensive report from your own doctor.
Most doctors charge for preparing a report. If that is the case, we will
discuss the fee with you before obtaining the report or referring you.
We will write to the doctors who have examined you, including your own
treating doctor, to explain the Social Security regulations. Often times,
doctors feel they are writing the kind of report which you need, but they
may not understand what Social Security requires. It will be much more
helpful to you if the doctor writes his report with the regulations in mind.
THE HEARING AND DECISION
VI. The Hearing
The hearing is the most crucial stage of the appeal process, where the
attorney's representation is most helpful. An Administrative Law Judge will
preside and testimony will be taken under oath, but the hearing is generally
somewhat informal. It is private, usually held in a small room with only the
Judge and his assistant, you, your attorney, and possibly your spouse or a
The medical records will be admitted into evidence. You will be asked
questions, either by the Judge or by your attorney, which you must answer to
the best of your ability or recollection. The Administrative Law Judge may
call experts including "Vocational Experts" and "Medical Advisors," to
testify about the possibility of training for a new job and the severity of
the medical condition.
The attorney will prepare you thoroughly for the hearing, so there is no
need to be apprehensive. Its purpose is to seek the truth and to carry out
the purpose of the Social Security Act.
VII. The Decision
The Judge will not announce a decision at the hearing, though we can
sometimes tell from the general atmosphere of the hearing whether it appears
that the decision will be favorable. A written decision will be sent to your
lawyer and to you. It usually takes at least two to three months after the
hearing to receive the decision, if not longer. You should always contact
your lawyer after you have received a decision from the Administrative Law
If the decision is favorable, you should receive your first check
approximately 8-12 weeks after the decision.
VIII. Attorney Fees
Our office handles Social Security disability and SSI cases on a contingent
fee basis. In other words, we are paid only if we succeed in getting
benefits for you. A written copy of the retainer agreement will be given to
you. All fees or fee agreements must be approved by the Social Security
Administration. We generally request a fee of 25% of the retroactive
benefits, or a specified maximum fee.
In Social Security cases, the attorney's approved fee is withheld from the
lump sum payment. In SSI cases, the retainer fee which you pay the attorney
must be held in a trust account until the fee is approved. A retainer may be
requested prior to accepting an SSI case if you do not also have a Social
Security case. Under those circumstances, we will place those funds in a
trust account pending approval of our fee by the Judge at the conclusion of
Although we do not charge for our services unless we are successful, you are
responsible for paying costs as they occur, including payment of any fees
charged by doctors for their reports.
If you have any questions once you leave our office, feel free to telephone
us. You should advise us if you experience any change in your condition, if
you receive any notice from Social Security, or if you move or change your
Our office will work hand in hand with your worker's compensation or
personal injury case to ensure that the best possible outcome in your Social
Security disability matter.
If you are inquiring about a new case please contact us by clicking on the above Free Consultation Form above or calling the office.
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