At the Law Office of Mike Winer, we assist with both: Social Security Disability Insurance and Supplemental Security Income Benefits.
There are two disability programs operated by the Social Security Administration (SSA):
- Social Security Disability Insurance (SSDI and/or Title II benefits)
- Supplemental Security Income (SSI and/or Title XVI benefits)
You first must determine if you are eligible to apply for SSDI and/or SSI benefits. This determination is based on the qualification criteria and definition of disability under the SSA guidelines.
- Step 1: Is the individual engaging in “substantial gainful activity” (SGA)? This is an evaluation as to whether the claimant is actually working by earning wages or performing self-employment and whether these wages exceed a certain threshold set by the SSA on an annual basis. For 2014 the threshold for SGA is $1,070 for non-blind individuals and $1,800 for blind individuals.
- Step 2: Does the claimant have a severe impairment? This is an inquiry into whether the individual has a medically determinable impairment or combination of impairments that is “severe” in that it significantly limits an individual’s ability to perform basic work activities. Has the impairment lasted or is expected to last for 12 months or more?
- Step 3: Does the claimant have an impairment that meets or medically equals the “listing of impairments”? The listing of impairments is a list of diseases and medical conditions and criteria of severity for each. If the individual’s medial condition meets the criterion, then the person is found disabled without further inquiry and Steps 4 and 5 are not considered.
- Step 4: Considering the claimant’s “residual functional capacity” or RFC (what the person can do despite their medical impairments) are they capable of performing any of their past relevant work. Past relevant work is work that they performed in the last fifteen years.
- Step 5: Is the claimant capable of performing other work (that exists in the national economy) that is within the claimant’s RFC given their age, education and transferable work skills. Here the Social Security Regulations make it easier to qualify for benefits if the individual is older, has less education and hasn’t worked in skilled employment in the past.
The second step is to formally request a reconsideration of you claim within sixty (60) days of your initial application denial letter. The reconsideration can also be requested at your local SSA office or online at www.ssa.gov. You will need to have your initial application denial letter in order to complete the reconsideration request. The reconsideration process takes two to three (2-3) additional months and again, the disability determination is made by the state Disability Determination Service (DDS). During the reconsideration process, the DDS may also request additional information or require you to see a physician in order to make their decision. Once the DDS makes a decision on your reconsideration, you will receive a letter stating you have been accepted (favorable) or denied. If you have been accepted, you will receive a Notice of Award detailing the SSDI and/or SSI benefits you have been awarded and the amount of your monthly payments. If you have been denied, you will have sixty (60) days to file the second appeal in the process called a “Request for Hearing by Administrative Law Judge”.
When the Request for Hearing is filed, the file gets transferred to the Office of Disability Adjudication and Review (ODAR) which is within the Social Security Administration. It can take anywhere from 6 month to 24 months before a hearing will be held before an Administrative Law Judge depending upon what area of the country you are in. When should an individual seek the assistance of an attorney? An individual seeking disability benefits can hire an attorney at any stage of the process including the initial application. The decision of when to involve an attorney in the claim depends upon the needs and strengths of the individual applying. Although many individuals will be able to handle the lengthy application and forms associated with the initial claim, when the case reaches the reconsideration and hearing level, it is important that the proper evidence is obtained and evaluated early to maximize a favorable outcome. Certainly at the hearing level, it is imperative you seek the advice of a qualified attorney to assist with the case. During this process, you and your attorney will be working together preparing your claim for the hearing.