Social Security Disability

Why should I consult with an attorney?

Facing a debilitating injury or disease is an incredibly stressful experience. In addition to concern over your physical and mental health, you may be worried about your financial security and wonder if you will ever be able to return to work.

Falsani, Balmer, Peterson & Balmer helps disabled individuals recover any and all benefits to which they are entitled, including Social Security disability benefits. We will examine your circumstances and if you qualify we can:

  • We can help you apply for Social Security disability benefits.
  • We protect your best interests.
  • We can serve as your trusted advisors throughout this overwhelming process.
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Social Security Disability Claim FAQs

What are Social Security Disability benefits?

There are two main types of Social Security disability benefits. Social Security disability benefits (also known as RSDI, SSDI, or DIB) and Supplemental Security Income (also known as SSI) benefits are both federally-administered disability benefits payable pursuant to the Social Security Act. Both benefits require the claimant to be disabled, and both programs analyze disability the same way.

Sometimes (though not often), a person can be eligible for both RSDI/SSDI and SSI benefits. You can find out more about the two types of Social Security disability benefits online.

RSDI/SSDI Benefits

RSDI/SSDI benefits are based upon payroll deductions from work activity or as a result of contributions made by self-employed workers. This benefit program functions much like an insurance program with the employee earning “credits” through their payments into the program. Employees who have been paying into the program are still subject to a “date last insured,” which means that at some point, after a person has stopped getting paid for work, that person’s “insured” status will lapse. In other words, workers who have been paying into the Social Security program generally need to prove disability within so many years of when they stop working. These dates vary between people and depend on each person’s work history and pay. If too much time passes between the date that someone stops working and the beginning of that person’s disability, then that person may not receive RSDI/SSDI benefits.

Generally, if you have been working continuously for the last five (5) years or so, your insured status will probably last for another five (5) years if you stop working right now. People who have been off work already for a while or who have had sporadic income may have a harder time determining their date last insured.

You can usually find out your “date last insured” from your local Social Security field office. If you became disabled on or before that date, then you should file an application for RSDI/SSDI benefits. If you became disabled after that date, then you may not qualify for RSDI/SSDI benefits.

Disabled adults whose disability started before their 22nd birthday as well as spouses and children of disabled workers can also receive RSDI/SSDI benefits.

SSI Benefits

SSI benefits are similar to RSDI/SSDI benefits in that they are paid to disabled individuals, but are available to people who have not worked at all (and so have not paid into the program) such as children. Disabled individuals can receive SSI benefits as long as they are disabled and their household (including spouses) have limited resources.

SSI recipients must follow the rules regarding resources or they risk being cut off and/or held responsible for an overpayment.

SSI benefits are also available to disabled people who haven’t been able to work enough or recently enough to qualify for RSDI/SSDI.

How do I qualify for Social Security Disability Benefits?

In addition to the “insured” and/or resource rules referenced above, a person must also meet the SSA’s definition of “disabled” in order to qualify for Social Security disability benefits.

The SSA’s definition of “disabled” is an inability to sustain full-time competitive employment for 12 months or longer due because of a severe medical condition.

The disabling medical condition(s) do not need to be permanent; many people receive Social Security disability benefits for a period of time before returning to full-time work.

The five (5) steps to qualifying for Social Security disability are:

1).You must be earning less than “substantial gainful activity” through work activity. (In 2021, this amount is $1310.00.) This means that you cannot qualify for Social Security disability benefits if you are still working and earning more than the SGA limit (net) per month. That can pose a financial stress for employees who need to stop working soon due to medical conditions, but cannot afford to wait for their Social Security disability claim to be approved. There are, however, some steps you can take to maximize the odds of your Social Security disability claim being approved sooner rather than later.

The SSA will not even consider your medical conditions if you are earning more than SGA. If you are earning more than SGA, then you are automatically not disabled as far as they are concerned.

2). You must have at least one “severe medical impairment.” This essentially means that you have at least one medical condition that causes you so many problems that you cannot work.

3). If you meet or “equal” a listed impairment, then you automatically qualify. The “listed impairments,” or “listings,” are detailed rules about certain medical conditions. There are separate listings for adults and children. If there is enough of a certain type of medical evidence to prove that you qualify under a listing, then your claim should be granted right away. If you do not meet or equal a listing, or it’s unclear, then we go on to the next step.

4). You must be unable to perform your “past relevant work” because of your severe medical impairments. The SSA will determine what your “residual functional capacity” (or “RFC”) is based upon your medical evidence and other information. The RFC is one of the most important parts of a disability claim. If the SSA decides that you can do more than what you feel you can do, then that may be a basis for denial. This is where you can help your claim by talking to your medical providers about what you can/cannot do.

Once the SSA determines your RFC, they will then look at your work history (from the 15 years before you became disabled) to see if you can still do any of those jobs. If you cannot, then we go on to the next step.

5). You must be unable to perform any full time work because of your severe medical impairments.

PLEASE NOTE: You cannot qualify for Social Security disability benefits if you can do any full time job (no matter what the job is or how little it pays). The SSA does not care how much you were making before you became disabled. If you can still work full time, then you won’t qualify.

How do I apply for Social Security Disability Benefits?

You can apply online for RSDI/SSDI benefits here: https://www.ssa.gov/applyfordisability/

This site also provides information regarding the process, what information you will need to provide, and timelines.

If you are not able to apply online, you should contact your local Social Security office. You can find your local Social Security office here: https://www.ssa.gov/locator/

Generally, you should apply for both RSDI/SSDI and SSI if you are disabled.

You cannot apply for SSI online, but you should complete the RSDI application and be sure to check “yes, I intend to apply for SSI as well” in that application. The SSA will then contact you to complete the SSI application over the telephone.

What if the SSA rejects my claim?

Many disability claims are denied. This does not mean you are not disabled. You may wish to appeal, or you can file a new claim. If you file a new claim, you may lose the period of back pay from the prior claim.

PLEASE NOTE: if your “date last insured” has come and gone, you may not want to file a new claim but should instead appeal so that you don’t lose access to your RSDI/SSDI insured status.

Generally, you have 60 days to appeal a rejected claim. Do not let the 60 days lapse.

If you do appeal, you should appeal right away. You can do it on your own or you can hire an attorney to handle it for you.

What information and/or documentation will I need to provide to the SSA?

You want to tell the SSA about ALL of your medical conditions, physical and mental, disabling and otherwise. For many people, this is simply one condition (for example, a back injury). Others may have multiple medical conditions which, when considered together, prevent an individual from working full time.

The SSA will want to know about all of the medical facilities where you have undergone treatment (doctors, hospitals, chiropractors, therapists, counselors, etc.), as well as a list of your prescription medications and any side effects. You will be asked to sign a release so that the SSA can obtain your medical records.

You may also have to provide the SSA with wage records/paystubs, tax information, marriage/death/birth certificates, and other types of documentation.

The SSA may send you to one or more “consultative examinations” (CE). It is very important that you attend those evaluations and participate as best you can. You will not be responsible for bringing any medical records or other evidence to that evaluation.

Social Security will also want a list of the jobs you have had over the past 15 years as well as the dates of your employment, wage info, and task descriptions. You can fill out a Work History Report to prepare this information.

The SSA will also want to know how your medical conditions affect your ability to function. You can fill out a Function Report to get this information organized.

How much money can I anticipate recovering?

For RSDI/SSDI claims, you have what’s called a “primary insurance amount” (PIA) which is the monthly benefit you would receive at your full Social Security retirement age. This is the same amount as your RSDI/SSDI benefit amount. You can find your PIA amount in your MySocialSecurity.gov account.

The monthly amount of RSDI/SSDI benefits depends upon how much money you paid to the Social Security system through Social Security taxes coming out of your paycheck. The more money you made, the more money you paid in, and the higher your monthly benefit will be. You can get an estimate of your monthly RSDI/SSDI benefit by opening an account with www.mysocialsecurity.gov.

PLEASE NOTE: RSDI/SSDI claims do not pay benefits for the first five (5) months of disability. So, if you were found disabled on January 1, 2020, then you would not start receiving RSDI/SSDI benefits until June 2021.

RSDI/SSDI claims only pay up to a year prior to the date on which you applied, regardless of how far back your disability onset date is. In other words, if you were found disabled on January 1, 2010, but you didn’t apply until January 1, 2013, then even though you are considered disabled as of January 1, 2010, your back pay will only go to January 1, 2012.

SSI disability claims will only start with the month in which you applied. So, even if you allege disability going back several years, benefits will only be paid beginning the month of your SSI application.

The monthly amount of SSI benefits is the same amount for all people no matter what. For 2021, it is $794 per person. Each year there is a cost of living increase for SSI.

How much does it cost to hire an attorney representative?

Social Security law allows attorney representatives to be paid 25 percent of all past due Social Security disability benefits up to $6000.00. Beginning with the first month of your claim (regardless of whether it’s the first time you’ve applied for benefits or you are trying to get reinstated on/continue benefits), every month that goes by is a month of “past due benefits” that will continue to add up until the claim is granted. Then the meter stops and the attorney representative can be paid 25% of the past due benefits (or “back pay”).

Attorney fees have to be approved by the SSA.

You can find more information on paying an attorney representative in a Social Security claim by clicking here.

How long does a SSD claim take? 

There is no set timeline for Social Security disability claims. It can take anywhere from a few weeks to several years. There are many moving parts to a claim and the process involves a lot of information, paperwork, and patience. The SSA has to follow many rules in processing disability claims. It can be very frustrating to fill out what seems like the same paperwork over and over. You can help speed up the resolution of your claim by answering questions as thoroughly and accurately as possible whenever asked and by taking careful notes regarding the details of your claim (who you speak with, when, about what, etc.).

Why is my claim being denied when I know someone who is receiving benefits even though theyre not disabled?!

This is a very common complaint. But, be careful; these types of statements are the very reason it can be so difficult for even a good claim to be granted. This is because the government does not like hearing that people are receiving benefits when they shouldn’t and the response can be to make it even harder to qualify.

Additionally, it is impossible to know someone’s reality simply by looking at them. Medical conditions can be invisible or temporarily in remission. Many disabled people have good days and bad days.

People cannot qualify for disability benefits based on addiction alone. If you know someone who receives Social Security disability benefits who also struggles with substances, you can assume that they have disabling medical conditions in addition to chemical dependency.

So, not only is it inaccurate to say that someone doesn’t “deserve” disability benefits, but it might actually hurt your own valid claim or that of a loved one by making it that much more difficult to qualify. Think twice before you make that statement.

What can I do to strengthen my Social Security Disability claim?

The most frequent cause of a denied Social Security disability claim is missing, poor, or inaccurate medical evidence. There are several steps you can take to minimize the odds of your claim being denied on those grounds:

1). Review your medical records for accuracy. You can request your medical records from your medical providers for free. Look at what your providers have been writing down about your symptoms and problems. Many providers write down “no problems” when in fact you WERE having problems. This may seem nitpicky, but Social Security judges frequently rely upon those details.

2). Do not ask your medical providers for a note saying you cannot work. Such a note is not helpful. Instead, the SSA wants to know how your medical conditions and symptoms affect your ability to function: how long can you sit, stand, walk; how much can you lift; do you need breaks during the day, and if so, for how long; and so on. Talk to your medical providers about your limitations. If your provider is willing to write something up regarding your specific limitations, that’s ideal.

Contact us for qualified legal representation.

If you have suffered a serious personal injury, deserve workers’ compensation benefits, need assistance with short- or long-term disability claims, or require help with the Social Security Disability claims process, Falsani, Balmer, Peterson & Balmer can serve as your trusted legal counsel. Schedule a free initial consultation with our qualified legal team and we will carefully evaluate your case and give you honest and expert legal advice.

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