SOCIAL SECURITY DISABILITY APPEALS

 WHAT IS SSA’S DEFINITION OF DISABILITY?

Under the Social Security Act, disability is the “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.”

Other agencies’ decision about disability such as VA, Worker’s Comp, State Social Service departments and private insurance companies are not binding on SSA.  Social Security will consider their evidence in making its decision, however.

WHAT KIND OF SSA DISABILITY BENEFITS ARE THERE?

1.  Disability Insurance Benefits (DIB):  You may be eligible for this benefit if you had worked and paid Social Security taxes in 5 of the 10 years prior to the start of your disability.  Dependent children may also receive benefits under this type of benefit.

2.  Supplemental Security Income (SSI):  You may be eligible if you have never worked or have not worked enough to meet the requirement for DIB.  SSI is a needs-based benefit.  You must have little or no income and assets to qualify.  Children under age 18 with a severe disability may also get SSI benefits if their family income & assets are low enough.

3.  Disabled Widow/Widowers Benefits (DWB):   You may be eligible for this benefit if you are between age 50-60, were married to a worker for at least 10 years and were disabled within 7 years of the worker’s death. 

4.  Disabled Adult Child (DAC):   You may be eligible for this benefits if you are an adult child of a worker who is deceased or already receiving SSA retirement or disability (DIB) benefits.  Your disability must have begun before age 22.

HOW DO I PROVE THAT I AM DISABLED?

You must have hard medical evidence of some condition either physical or mental or a combination of both, which prevents you from working.  It is VERY important to be under and compliant with current medical care.    Under the law, SSA  must depend on medical information from doctors, hospitals and clinics’ notes, tests and procedures to determine how severe your condition is.  It doesn’t matter how sick or hurt you say you are, SSA is not allowed to pay you benefits without a clear medical explanation based on evidence of why you are disabled.

WHAT SHOULD I DO IF MY INITIAL CLAIM IS DENIED?

You have 60 days from the date on your denial letter to ask to appeal the decision.   Your denial letter will have information about appealing the decision.  If this office represents you on the appeal, we will normally take care of filing the necessary paperwork.

ARE THERE OTHER FACTORS THAT SSA CONSIDERS BESIDES MY MEDICAL CONDITION IN MAKING ITS DISABILITY DECISION?

By law, SSA must also consider your age, education and all work skills you have developed from your last fifteen years of work.   Some people believe that SSA will find them disabled if they can’t do their old job.  This isn’t necessarily true.  SSA will review the skills you’ve developed at  your old jobs to determine if you could  use them in other, less demanding kinds of work.  SSA will then determine if you can do that kind of work.  SSA’s rules assume that the younger and more educated you are, the easier it would be for you to adjust or learn new skills  for a different job that you can do based on the restrictions they say you have.   

HOW DO I APPLY FOR ANY TYPE OF SOCIAL SECURITY DISABILITY BENEFITS?

There are three ways to apply for benefits:

1.     ONLINE:  Apply online at www.socialsecurity.gov                        

2.     IN PERSON:  Call SSA at 1-800-772-1213 to make an appointment to file your claim at your local Social Security office.

3.     BY PHONE:   Call SSA at 1-800-772-1213 to take your claim over the phone either immediately or by appointment.

WHAT CAN I DO TO INCREASE MY CHANCES OF WINNING MY SSA DISABILITY CLAIM?

Give SSA all the information it requests in a straightforward way.  Be complete and truthful. Do not exaggerate or minimize your disability.   Many claimants won’t mention any psychiatric problems or learning disabilities, even though these conditions may be very important in getting their claims approved.

DO I NEED A LAWYER TO REPRESENT ME IN MY SOCIAL SECURITY DISABILITY CLAIM?

As a rule, a person does not need a lawyer’s help to file an application for benefits.  SSA make this part of the process very easy.  A person can go through all levels of the appeals process on their own.  SSA’s own statistics show that people who have a lawyer are much more likely to win their appeals.  Our office does handle initial claims for some people, though we generally prefer to become involved at the hearing stage.

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