Transcript A Basic Guide to Social Security Disability Benefits

Understanding
Social Security & SSI
Presented by
Matthew D. Lane, Jr.
www.zieglerlane.com
Definition of Disability
• As defined under the Social Security Act
– Unable to consistently perform full-time work
– Due to medically-determinable physical or
mental impairments
– Or a combination of impairments
– That will last one year or result in death
Two Types of Disability Benefits
• The purpose of Disability Insurance Benefits (DIB; Title II
of the Act) “is to provide the measure of economic
security for program beneficiaries.”
• The purpose of Supplemental Security Income (SSI; Title
XVI of the Act) “is to assure a minimum level of income
for supplemental security income recipients who
otherwise do not have sufficient income and resources to
maintain a standard of living at the established Federal
minimum income level.”
•
See HALLEX I-1-2-57(A)(1) (available online at
http://www.ssa.gov/OP_Home/hallex/)
Disability Insurance Benefits
• Must be disabled and have insured status
• Insured status obtained by payment of
payroll taxes for enough quarters
• Insured status expires
Advantages of DIB
• Retroactive benefits available (1 year)
• Eligible for Medicare after 24 months of
receiving benefits
• Auxiliary benefits available for spouse and
children
Supplemental Security Income
• Must be disabled and have limited income
and resources
• SSI benefits available only from date of
application
• Concurrent Medicaid eligibility
SSI Resource Guidelines
• Very detailed requirements
• Generally speaking, $2,000 for an
individual and $3,000 for a couple
• Excluded assets: home and one car
• Income from spouse deemed to claimant
Disability Evaluation Process
1. Are you performing substantial gainful
activity (making over $1,000 per month)?
2. Do you have one or more severe
impairments?
3. Do you meet or equal a listed
impairment?
4. Can you return to your past work?
5. Can you perform any other work?
Most applicants do not meet Listings
Most cases are decided at Step 5 of the
evaluation process.
Once you have proven you cannot return to
your past work, the issue becomes whether
you can perform any other work.
The Appeal Process
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Initial Denial by State Agency
Reconsideration (where applicable)
SSA Administrative Law Judge hearing
SSA Appeals Council review
Federal District Court
*60 day appeal deadline at each step
Deciding to Apply
• Work and self-identity
– DIB is funded by your payroll taxes (6.2%
FICA tax out of every paycheck)
• Many claimants experience severe
financial hardship during the disability
application process and less than half are
approved even after appealing
Proving Disability
• Symptoms alone cannot prove disability
• Medical conditions must be documented with
treatment records
• Letter from last employer about why you could
not do your job duties because of your medical
problems
How Your Doctor Can Help
• The treating source rule – well supported
opinions are given more weight
– A letter stating “my patient is disabled” is not
enough
– “My patient is disabled because. . .” is more
helpful
– What comes after the word “because” is what
counts.
– Medical opinions that you cannot perform job
duties must be properly considered by SSA
How Your Doctor Can Help
• SSA is concerned with functional
limitations (e.g., patient can stand no more
than 30 minutes at one time).
• Doctor can validate and explain episodic
problems and symptoms of your
impairment or disease
Mental Health
• SSA must consider the combined effect of
all impairments, including physical and
mental health problems (e.g., depression)
• Importance of seeking help for depression
from a mental health provider
Returning to Work
• Substantial Earnings
– Impairment Related Work Expenses (IRWE)
• SSA’s Ticket to Work program
– SSA’s Trial Work Period
– Extended Payment Eligibility
• Different rules apply for SSI
Selecting a Representative
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When to hire (well before ALJ hearing)
Benefits of local attorney vs. national firm
Advantages of experience vs. a generalist
Seek a referral from National Organization of
Social Security Claimants’ Representatives
(NOSSCR; www.nosscr.org)
• Ask how the term “expenses” is defined.
Attorneys’ Fees in DIB/SSI cases
• Attorneys’ fees are regulated by the Act
• Fees are contingent; thus, if you are not awarded
benefits, there is no fee.
• Typically, at the administrative level (through the ALJ
hearing), fees are limited to 25% of your past-due
benefits (back pay) with the maximum fee being $6,000.
• For example, if your back pay is $12,000 ($1,000 per
month for 12 months), then the attorney fee would be
$3,000.
• The $6,000 cap can be removed if extended appeals
become necessary.
Your Social Security Statement
• Enables you to confirm your earnings are
properly reported, which is how insured status is
determined
• Obtain a copy of your Social Security Statement
online at www.ssa.gov
• Look for SSA seal and the words “Official Social
Security Website”
Matthew D. Lane, Jr.
Ziegler & Lane, LLC
Disability Law is all we do.
1-800-451-0300
www.ZieglerLane.com
[email protected]