Social Security Disability FAQ
What is a disability claim?
Many people suffer injuries and/or medical conditions which effectively prevent them from being able to maintain regular employment, and thus prevent them from supporting themselves and their families. Anyone can be disabled, even a newborn child, if their injury and/or condition equals or exceeds any limitation, or combination of impairments, as set forth by the Social Security Administration.
How are disability claims adjudicated?
Disability claims begin with an initial application for disability benefits. If the initial application is denied (and most are) the applicant must then file a Request For Reconsideration. The initial application and the Request for Reconsideration are both handled by the Department of Disability Services, which is a state agency operating out of Springfield. If an applicant is denied initially it is then proper and recommended to seek legal representation. The legal representative will file the Request for Reconsideration and, if denied again, will file a Request for Hearing. The Social Security Administration (SSA) will turn the file over to the Office of Hearings and Appeals (OHA). An Administrative Law Judge (ALJ) is assigned to the claim and a hearing is held. This is the one and only time during the process of applying for disability benefits that the claimant is able to personally testify directly to the person who will make the decision in his/her case at that time.
It is at the hearing stage that the claimant has the best chance of winning his or her claim for disability. If the claimant receives a favorable decision from the ALJ, the claimant will begin receiving disability benefits, including back benefits dating to the time the claimant first became eligible for disability benefits providing it is no more than one year before the date you applied. If the claimant is given an unfavorable decision by the ALJ, the claimant’s legal representative may the file an appeal to the Appeals Council in Falls Church, Virginia, just outside of Washington D.C. The Appeals Council may reverse the ALJ’s decision; remand the claim for a new hearing; or deny the appeal. If the appeal is denied by the Appeals Council, the claimant has effectively exhausted his or her claim at the Administrative Law level. Please note that a denial at the Appeals Council level may also be appealed to Federal Court, but this recommendation is only occasionally made under exceptional circumstances which must be specifically discussed with the attorneys and requires a new fee agreement.
In order to avoid the loss of back benefits forever, it is extremely important that you never give up the pursuit of your claim throughout the Administrative Law process. The process can be very discouraging (probably by design) and therefore many valid disability claims never receive an award simply because the claimant did not keep fighting. The Doyle Law Team will make sure all reasonable steps are taken to win your claim.
What types of awards can be received?
As to SSD, the Social Security Administration will determine the amount of monthly benefits available to each claimant based upon the amount of monies paid in to the system by the claimant and his/her employers prior to their onset of disability. A disabled person is eligible to begin receiving disability benefits 6 months after their onset date. If an award of disability is made more than 6 months after the onset date, the claimant is entitled to a lump sum award representing all back benefits due, as well as a monthly benefit from the time of award forward. Keep in mind that one cannot receive back benefits for more than one year prior to the date that they file their application for disability. Therefore, it is recommended you not wait more than one year from the date you last worked to file your application for disability benefits even if you are not absolutely certain at that time that you will not be able to return to gainful employment. You need only prove that you have been, or likely will be, continuously disabled from any kind of gainful work for at least 12 months. It is not necessary that you prove you will never again be able to work, and many people do return to gainful work activity eventually.
As to Supplemental Security Income (SSI), it should be noted that you cannot get an award of back benefits when you win your case back further than the actual date you first applied for disability on this appeal. Therefore, you should apply for benefits as soon as you are aware that you are unable to work gainfully on a full time basis. SSI is a needs based program providing funds to disabled minors and those adults who cannot work regardless of whether they worked in the past. Because it is needs based you must also demonstrate inadequate household income; no ownership of real property; and only a small amount of cash or savings. Call the local SSA for details.
How do you prove disability?
The Code of Federal Regulations (CFR) sets forth a comprehensive Listing of Impairments which analyzes most common ailments and the body systems affected by ailment to provide guidelines for determining whether the severity of a person’s condition qualifies them as disabled. Any person who “meets the listing” of impairments that applies to their condition, regardless of age, and is otherwise qualified, is entitled to a favorable decision. In many instances, the claimant will not meet the severity level for a specific listing, however, will suffer from several severe impairments and thus may be entitled to a favorable decision by virtue of having a combination of impairments which, taken together, are the equivalent of meeting a listing. As an example, a person suffering severe depression with agoraphobia (fear of leaving the house) as well as a herniated lumbar disc which causes severe pain in the sciatic nerve of the right leg, may not meet the listings as to the severity of either of those two areas but when put together they make the person unemployable on a regular continuing full time basis and therefore the person has a combination of impairments which are “equal to a (generic) listing”. The CFR also sets forth a “grid” that considers the age/education/vocational experience and ability to read, write, and comprehend the English language as a quick reference means of determining whether someone who has a severe impairment under the listings is disabled. The “grids” may require a finding of disabled. For instance, an individual 60 years old with a severe impairment to his back limiting him to light or sedentary work that has only a fifth grade education and can barely read and write will be found disabled under the “grid”. However, a 45 year old individual with the exact same injury and level of severity but who has a high school education and can read and write well is not “entitled” to a finding of disability under the “grid”. Whether he is disabled will very much depend upon the level of his pain and other factors and facts which will likely need to be developed before an Administrative Law Judge at a hearing.
Who is qualified to handle an SSD or SSI claim?
SSD and SSI claims are controlled by Federal Law and Regulations, rather than State Law. Therefore, an attorneys licensed in any state is qualified to handle such claims, provided they are otherwise familiar with the CFR and SSA procedures for Disability. In fact, the Social Security Administration allows non-attorneys to act as legal representatives for people with disability claims. However, it is rare that non-attorneys possesses the legal knowledge, medical knowledge and disability experience to provide a claimant with the best chance at winning his or her claim.
In addition to practicing law in many areas since I began practice in 1969, I pioneered the area of disability representation in East Central Illinois. For many years, our office was the only law office in this area representing claimants before the Social Security Administration, on any kind of regular basis. Representing those persons who are permanently prevented from working and thus providing for themselves and their families is an integral part of this firm’s practice. This office has always sought to help injured and disabled persons seek fair and full recoveries, and our disability practice is just as important to us as our practice in the areas of personal injury, product liability and medical negligence.
Over the years, our firm has represented thousands of Social Security Claimants. Richard J. Doyle will personally handle most of these cases at present. Of the decisions received over the years, we achieved a remarkable win rate. These claims all began with an initial denial by the SSA.
What are the fees?
At Doyle Law Team, p.c. we do not require any up front payment for representation. Our standard contingency fee for disability representation is 25% of the back benefits, not to exceed $6,000.00 (as of 2009) for representation from requesting reconsideration through a hearing before an Administrative Law Judge. If there is a viable appeal to the Appeals Council the fee remains a contingent 25% of the back benefits but the $6,000.00 ceiling is removed. All fees and fee contracts must be approved by the Social Security Administration. Fees are sent directly to the attorneys and the claimant’s back benefits (after the deduction of any fees) is sent directly to the claimant. It is important to note that our fees are only taken from the back benefits and all future monthly benefits are fully kept by the claimant. Simply put, it means the attorneys earns no money and does not get paid anything until or unless there is a recovery actually paid out and received on the claim. In our office, we present that to you with a written agreement that fully sets forth and limits our contingent fees and promises to take the claim on a strictly contingent fee basis if we accept the claim after speaking with you. An appointment to discuss your claim can usually be set up within a few days of making a telephone call to our office and answering some initial questions. We never charge for an initial consultation, whether you decide to hire us or not.
Are there time limits?
In all types of claims, there is a statute of limitations, statute of repose or both. In a disability case, once the initial application has been denied, the claimant has 60 days to file their Request For Reconsideration. If the reconsideration is denied, the claimant has 60 days to file a Request For Hearing. Once there has been a hearing and a decision has been made by the ALJ, the claimant has 60 days to appeal the ALJ’s decision. If the appeal is denied by the Appeals Council, once again, the claimant has 60 days to file an appeal in the U.S. District Court for the district in which the claimant resides. There are a variety of matters which may affect the statute of limitations in each of these situations and cannot be adequately discussed in this limited space. Any such variation of the statute of limitations should be determined and dealt with by the representing attorneys on a claim by claim basis.
Can I pursue a claim on my own?
As with most areas of law, a person may represent him or herself before the SSA and OHA. In fact, the claimant usually does represent him or her self up to the point of receiving their first denial. Any person who suffers from an injury or condition such that it prevents them from being gainfully employed for at least 12 months is in a very serious situation and should make sure their claim is given the serious consideration it deserves. Understanding the Code of Federal Regulations, Social Security Administration Guidelines and advocating claims before a judge all require a tremendous amount of legal knowledge, medical knowledge, expertise and savvy.
Many law firms concentrating in Social Security Disability now advertise nationally. Instead of being able to meet with the individual attorneys in order that he may learn the specifics about your case and how best to advise you to proceed in the future you only get forms in the mail. This may be okay up to a point but the best way in which to advise a Claimant is to know about the tests necessary to prove up his or her claim, the doctors available in the area who will treat the individual, low or “no cost” clinics available to those without any funds, and other areas of assistance to help them survive until the case can be resolved.
At Doyle Law Team, p.c., we meet with you personally and an attorney or paralegal will fully advise you at the initial consultation about the best way in which to pursue your claim and explore all of the possible avenues that should be pursued on your appeal. If the claim goes to a hearing before an Administrative Law Judge, we will be there personally with you and you will be well prepared for that hearing. Most out of state and many out of the area law firms either do not appear with you at your hearing or designate a young and inexperienced attorneys who may not be familiar with Social Security Laws or the way in which these hearings are conducted. He/she will certainly not be personally knowledgeable of you nor have the insight on how to handle your claim which only comes from personal meetings.
If you have time, please read Our Philosophy page, and if you have any questions about your potential SSD or SSI claim, please do not hesitate to call and make an appointment to meet with an attorneys. If you can, bring your medications, a list of your doctors, any medical reports and correspondence from the SSA that you have in your possession. This will help us give you the best possible answers and advice on how to proceed with your disability claim.