SOCIAL SECURITY DISABILITY LAWYERS

WHAT IS THE DIFFERENCE BETWEEN SSD AND SSI?

Social Security Disability (SSD) benefit programs are "entitlement" programs. Workers, employers, and the self-employed pay for the benefits with their Social Security taxes. You qualify for these benefits based on your own work history (or the work history of your spouse or parent). The amount of your benefit is based on these earnings. Other names for SSD are SSDI (Social Security Disability Insurance) and RSDI (Retirement, Survivors, and Disability Insurance).

Supplemental Security Income (SSI) is a needs-based program for people with limited income and resources. Resources are assets or things that you own. The program is paid for by general tax revenues. The benefit amount is based on Federal and State laws which take into account where you live, who lives with you, and what income you receive.

Social Security Disability Benefits (SSD) are available to disabled workers who have enough earnings to meet Social Security Administration (SSA) requirements. SSA determines if you are eligible based on your work history during the years before you became disabled. As a general rule, you probably have enough SSA "work credits" to qualify for Social Security Disability if you worked for 5 out of the last 10 years.

 

THE FOLLOWING FACTORS DETERMINE YOUR ELIGIBILITY FOR SSD BENEFITS:

• Whether or not you have enough work credits to qualify for disability benefits
• Whether or not you have an impairment that has lasted, or is expected to last, for at least 12 months, or is expected to result in death
• The nature and extent of your impairment
• Your ability to engage in substantial gainful activity since your impairment began
• The date your disability began

 

The family members of a person approved for SSD benefits may also qualify for benefits based on the disabled wage earner’s SSA earnings. Furthermore, children and spouses of deceased individuals who accumulated enough SSA "work credits" prior to death may be eligible for Social Security Disability benefits.

 

SSD BASICS:

• Benefits based on earnings
• No income limit
• No resource limit
• Must have enough work credits
• Medicare
• Benefit Types:
  • Retirement (age 62 & older)
  • Survivor
  • Disability (includes blindness)
• Provides benefits to eligible family members
• Benefit amount based on average lifetime earnings
• Other income does NOT affect benefits (Except wages may affect benefits under full retirement age or disability)

 

Supplemental Security Income Benefits (SSI) are provided to low-income disabled children and adults. SSA considers other benefits, savings, certain assets, and income of household members, to determine whether a claimant’s income is low enough to qualify for SSI.

 

THE FOLLOWING FACTORS DETERMINE ELIGIBILITY FOR SSI:

• Whether or not your household income is within the SSI income limit
• Whether or not you have an impairment that has lasted, or is expected to last, for at least 12 consecutive months, or is expected to result in death
• The nature and extent of your impairment
• Your ability to engage in substantial gainful activity since your impairment began
• The date that your disability began

 

SSI BASICS:

• Benefits based on need
• Must have limited income
• Must have limited resources
• No work credits are required
• Medicaid
• Benefit Types:
  • Aged (age 65 and older)
  • Disability (any age, includes children)
  • Blindness (any age, includes children)
• No Family Benefits
• Benefit amount based on Federal and State laws
• Other income DOES affect benefits – report any income you receive
• Where you live or who lives with you MAY affect benefits – report all changes

 

DEFINITION OF "DISABILITY"

The Social Security Administration (SSA) defines whether a disability qualifies for Social Security Disability benefits (SSD).

The definition requires that the disability results in the following:

• The inability to…
• Engage in any substantial gainful activity…
• By reason of any medically determinable physical or mental impairment(s)…
• Which can be expected to result in death; or
• Which has lasted or is expected to last for a continuous period of 12 months or more;

AND

• The impairment must be of such severity that the claimant is unable to do previous work;
• After considering age, education, and past work experience the claimant is not able to engage in:
  • Any other kind of substantial gainful work
  • Which exists in the national economy
  • Regardless of whether such work exists in the immediate area where the claimant lives, whether a specific job vacancy exists for the claimant, or whether the claimant would be hired if he/she applied for work.

 

Essentially, you may be eligible for SSD Benefits if you can answer YES to one or more of the following questions:

• Do you have a severe physical or mental impairment that prevents you from participating in any type of gainful employment?
• Do you have a disability that prevents you from working at any job, rather than just your previous employment?
• Has your disability lasted, or is it expected to last, for at least one year?
• Is your disability life threatening?

 

If you or a loved one was denied Social Security Benefits or plans to apply for benefits we can help.

 

FIVE-STEP EVALUATION PROCESS

In order to be found "disabled" under Social Security Administration rules, the following five questions must be addressed:

1. Are monthly earnings under the "Substantial Gainful Activity" (SGA) threshold?
2. Is there a severe impairment?
3. Is the impairment already listed by SSA?
4. Can claimant perform their past relevant work?
5. Can claimant perform other work?

 

STEP 1: IS CLAIMANT EARNING LESS THAN "SUBSTANTIAL GAINFUL ACTIVITY" (SGA)?

SGA is determined by an amount of wages or self- employment earnings:

• In 2016: $1,130 per month of gross earned income
• This threshold amount generally increases yearly ($1,170 in 2017)
• $1,820 per month if the individual is blind ($1,950 in 2017)
• There are additional tests if claimant is self-employed

 

There are certain deductions that reduce the amount below the SGA threshold, including:

• Vacation and sick leave pay
• Impairment related work expenses (IRWE)
• Unsuccessful work attempt

 

Does claimant earn under the SGA threshold?

• If no, claimant is NOT DISABLED
• If yes, proceed to step 2

 

STEP 2: DOES THE CLAIMANT HAVE A SEVERE IMPAIRMENT?

The impairment must:

• Limit the physical ability to do work (ability to sit, stand, walk, lift, hear, see) and/or
• Limit the mental ability to do work (ability to follow instructions, handle stress or deal with co-workers)
• Be shown by medically accepted clinical and/or laboratory techniques
  • have a medical diagnosis by an acceptable medical source
  • be likely to last at least 12 months or end in death

 

Does claimant meet the severe impairment criteria?

• If not, claimant is NOT DISABLED
• If yes, proceed to step 3

 

STEP 3: DOES THE CLAIMANT IMPAIRMENT "MEET OR EQUAL" AN IMPAIRMENT LISTED IN THE SOCIAL SECURITY "LISTING OF IMPAIRMENTS?"

• "Meet" means having the exact criteria in a listed impairment
• "Equal" means at least equal in severity and duration to the criteria in any listed impairment
• Children and adults have separate listings
• The listing of impairments is divided into major body systems
• The listings describe impairments considered severe enough to prevent an individual from doing any gainful activity
• Multiple impairments must be considered to determine if the combined functional effects equals the severity set forth under one of the medical listings

 

Does claimant meet (or equal) a pre-approved impairment?

• If yes, claimant is approved and benefits are allowed
  • Claimant "skips" steps 4 & 5
• If not, proceed to step 4

 

STEP 4: IS THE CLAIMANT UNABLE TO PERFORM HIS/HER PAST RELEVANT WORK (PRW), CONSIDERING HIS/HER RESIDUAL FUNCTIONAL CAPACITY (RFC)?

What is Past Relevant Work (PRW)?

• Work performed within the past 15 years
• Work performed at or above the SGA income threshold
• Worked at occupation long enough to learn the job
• Work actually done by the claimant, as well as how the work is typically performed

 

What is Residual Functional Capacity (RFC)?

• Physical: maximum ability to stand, walk, sit, climb, crouch, kneel, lift, stoop, push, pull
• Mental: memory, social functioning, persistence, concentration, and pace

 

Physical RFC’s are characterized according to the amount of force an individual can exert:

• Sedentary- lifting 10 pounds occasionally, 5 pounds frequently, standing or walking no more than 2 hours out of an 8-hour day
• Light- lifting 20 pounds occasionally, 10 pounds frequently and standing/walking on and off for up to 6 hours
• Medium – lifting no more than 50 pounds, frequently lifting up to 25 pounds, crouching and stooping, and standing/walking on and off for up to 6 hours

 

Disability Determination Services (DDS) of the Health and Human Services Department determines a claimants Residual Functional Capacity (RFC)

Is claimant unable to perform past relevant work?

• If not, claimant is NOT DISABLED
• If claimant has not worked or if his/her past work does not meet the definition of PRW, go to step 5

 

STEP 5: OTHER WORK

"Other work" means work that is not the claimant’s "past relevant work".

Based on a claimant’s RFC, is claimant mentally able to perform other work in the national economy?

• Can claimant meet the basic mental demands of unskilled work?
  • understand, remember, and carry out simple instructions
  • make appropriate work-place decisions
  • respond appropriately to co-workers, supervisors, and the public
  • deal with changes in a routine work setting

 

Based on claimant’s RFC, is claimant physically able to perform other work in the national economy?

• Decision based on:
  • age
  • physical RFC based on amount of force an individual can exert
  • education
  • past relevant work

 

DDS uses the "Medical Vocational Guidelines" or "grids" to determine physical ability to perform work.

• These grids do not apply if the issue is the mental ability to do other work.
• Ability requirements are independent of:
  • if jobs are not available in claimant’s community
  • if claimant would actually be hired
  • An individual’s age can affect the process
    • Younger people are less likely to be found disabled under the grids
    • Older people are more likely to be found disabled under the grids
    • Ability to exert force is a significant factor

 

Is claimant unable to do substantial work in the national economy?

• If not, claimant is not disabled
• If yes, claimant is disabled and benefits will be allowed

 

This process can be very confusing and difficult. You can always call our firm with any questions about this process.

SOCIAL SECURITY APPEALS PROCESS

If the Social Security Administration (SSA) denies your application for Social Security Disability (SSD) Benefits, you only have 60 days (plus mailing time) to appeal and ask for a hearing to present your claim to an Administrative Law Judge (ALJ). This 60-day period starts from the date stamped on the SSA’s letter stating your claim was denied.

One of the biggest mistakes some people make is getting discouraged, delaying action, and missing the 60-day deadline. If you do not file an appeal before the deadline, and try later to get SSD benefits, the SSA will make you start at the very beginning. You will have to fill out the application over again and wait several more months for a decision. That's why it's important to contact an experienced Social Security Disability Lawyer. Our team get's to work on your case right away. Ensuring we meet all deadlines in a timely fashion. That's The Disability Express®!

 

IF I APPEAL, DO I HAVE A CHANCE TO WIN MY SOCIAL SECURITY DISABILITY CLAIM?

Yes.

The Social Security Administration often denies Social Security Disability applications at first, and then approves benefits on appeal.

There are many reasons why it may be necessary to appeal to win SSD benefits. Perhaps, an individual’s first application left out important medical information or did not list all the limitations caused by the disabling medical condition. Sometimes, a person is completely disabled, but has a serious illness that is difficult for most doctors to diagnose.

In these cases, an experienced attorney can carefully review your medical records and collect other important evidence, to convince the SSA to reconsider, and approve your benefits.

After you or a loved one has been denied SSD benefits, it is important to talk with an experienced lawyer as soon as possible. We want to help you through the appeal process and get you all the benefits you deserve.

THE SSD APPLICATION PROCESS IN MICHIGAN

Michigan’s path to apply for Social Security Disability (SSD) benefits is slightly different than some other states. Below, you can see how the process works.

 

INITIAL APPLICATION

There are 3 ways to apply for Social Security Disability benefits:

1. In person at a local Social Security Administration office,
2. Online at SSA.gov, or
3. By calling the Social Security Administration at 1-800-772-1213. (Deaf and hard of hearing individuals can reach the Social Security Administration on its TTY number at 1-800-325-0778.)

 

The application form for SSD Benefits requests a lot of information. Contact us now for help with the Social Security application process.

Many individuals are denied at this stage, even though they meet all the requirements for benefits.

Do not be intimidated by the application process. If you are disabled, you have the right to seek benefits.

 

RECONSIDERATION

In many states, the next step in the appeal process is called Reconsideration, but this step has been eliminated in Michigan. If you are denied, and live in the state of Michigan, you go straight into the Appeal stage.

 

APPEAL

If there is a denial on an Initial Application in Michigan, the next step is to request a hearing before an Administrative Law Judge (ALJ). A claimant has 60 days from the date of the denial to request a hearing before an Administrative Law Judge. Once the appeal and Request for Hearing have been filed, the average wait time for a hearing is typically between 12-18 months, although it can take longer.

An application for disability benefits can be denied for various reasons. The most common reasons are:

1. Your medical condition is not severe enough to keep you from working (medical denial);
2. You have not acquired sufficient quarters of coverage to remain insured for SSD benefits (technical denial);
3. You have too much income to qualify for SSI (technical denial); or
4. Your condition was not disabling at any time before your work credits expired (combined medical and technical denial).

 

There are 3 ways to appeal a denial for Social Security disability benefits:

1. In-person at a local Social Security Administration office,
2. Online at SSA.gov, or
3. By calling the Social Security Administration at 1-800-772-1213. (Deaf and hard of hearing individuals can reach the Social Security Administration on its TTY number at 1-800-325-0778.)

 

APPEALS COUNCIL

If there is a denial by an Administrative Law Judge, a claimant has 60 days to file an appeal with the Appeals Council, which will review the Administrative Law Judge’s decision.

If you or a loved one was denied Social Security Benefits or plans to apply for benefits we can help.

FAQ’S ABOUT SOCIAL SECURITY

 

I FILED FOR SOCIAL SECURITY BENEFITS IN MICHIGAN AND MY CLAIM WAS DENIED. WHAT DO I DO NOW?

It is not uncommon for SSA to deny an initial application for benefits. As soon as you receive a denial, you need to act immediately. You only have 60 days from the date stamped on the letter to appeal the denial and preserve your claim. That's why it's important to contact an experience Social Security Disability attorney as soon as possible. Our team get's to work on your case right away. Ensuring we meet all deadlines in a timely fashion. That's The Disability Express®!

 

IF I GET SOCIAL SECURITY DISABILITY INSURANCE BENEFITS, WHAT SHOULD I EXPECT TO RECEIVE?

Disability Insurance Benefits may include Medicare medical coverage, individual benefits, and family benefits. The amount of the benefits is based on a formula in the Social Security Act, as well as the amount that the Internal Revenue Service shows as your SSA earnings.

 

HOW DO I KNOW IF I AM DISABLED FOR PURPOSES OF RECEIVING SOCIAL SECURITY DISABILITY BENEFITS?

Under the Social Security Act, an eligible "disability" means the "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to last for a continuous period of not less than 12 months or result in death." If you are not certain if you qualify, you should speak with your family physician and contact our office regarding your qualifications for benefits.

 

I HAVE NOT WORKED IN RECENT YEARS. COULD I STILL QUALIFY FOR SOCIAL SECURITY DISABILITY INSURANCE BENEFITS?

SSA requires a specific amount of Social Security earnings (work credits) to qualify. As a general rule, if you worked for 5 out of the last 10 years, you probably acquired enough credits. You certainly should contact the SSA or consult with a lawyer to determine whether or not you qualify.

 

I HAVE A MENTAL OR PSYCHOLOGICAL CONDITION THAT PREVENTS ME FROM WORKING. CAN I STILL RECEIVE BENEFITS?

According to the Social Security Act, a "disability" can be physical or mental, or a combination of both. The key is that a doctor finds objective medical evidence that you are unable to work for a period of at least 12 consecutive months.

 

CAN I APPLY FOR SOCIAL SECURITY BENEFITS ON MY OWN?

Yes. You can file your own application for Social Security Disability Benefits or SSI, and represent yourself in seeking benefits. However, statistics indicate that claimants who have legal representation, especially on appeals, win their benefits much more often than those who represent themselves. If you retain our office, there is no fee if we are unsuccessful in obtaining benefits on your behalf. If we our law firm is successful, our fee is defined by the government and kept very reasonable.

 

I WAS DENIED SOCIAL SECURITY BENEFITS LAST YEAR, BUT MY CONDITION HAS GOTTEN WORSE. CAN I TRY FOR BENEFITS AGAIN?

Yes. There is no limit to the number of times you can apply for benefits. If you feel that you now qualify for benefits, you can reapply for consideration.

 

IF I RECEIVE SOCIAL SECURITY DISABILITY BENEFITS, HOW LONG WILL THE BENEFITS LAST?

You may receive benefits for as long as you remain disabled from gainful employment and meet all other SSA requirements. It is possible that the SSA will periodically review your condition by requesting a medical evaluation.

 

MY DISABLING CONDITION WAS BROUGHT ON BY ALCOHOLISM OR DRUG ADDICTION. CAN I STILL QUALIFY FOR BENEFITS?

To determine whether or not you may have a claim, you should consult with an attorney. If drug addiction and/or alcoholism is a contributing factor that is material to the determination that you are disabled, you may not qualify for benefits, according to the Social Security Act, sections 223(d)(2) and 1614(a)(3).

 

HOW LONG WILL IT TAKE TO GET MY BENEFITS?

For an initial application, it typically takes 4-6 months to get a decision. Once denied and an appeal has been filed, it typically takes between 12-18 months to get a hearing depending upon the ODAR. After the hearing, it will take an additional 2-3 months to get the decision, and an additional 1-2 months to receive your money if you win.

 

WHAT SHOULD I DO ABOUT (BILLS, RENT, ETC.) WHILE MY CASE IS PENDING & I CAN’T WORK?

Unfortunately, many people filing for SS disability benefits are also having financial difficulties. One option is to try and apply for benefits with DHS (food stamps, Medicaid, cash assistance). Another option is to contact local organizations (211-United Way, Salvation Army, etc) for assistance.

 

I HAVE NO INSURANCE. HOW AM I SUPPOSED TO GO TO THE DOCTOR?

Due to being off work, many Social Security claimants are in the unfortunate position of being without medical insurance. It is important to try to get medical care during this time, #1 and most importantly, to care for your health, and #2 because in order for an ALJ to decide your case favorably, there needs to be medical evidence in the record which substantiates your claim for disability. There are community programs in most counties to look into. Also, United way (211) may be able to help find a doctor/clinic that you can go to at little or no cost. Some claimants have to go to the emergency room for medical care at times.

 

WHAT CAN BE DONE TO SPEED UP THE CASE?

There is very little, if anything, that can be done to speed up the claim. There is a SSA backlog of individuals waiting to have their claims heard before Administrative Law Judges. There are circumstances when a hearing may be scheduled more quickly. For example, the SSA has defined certain terminal illnesses that will qualify a claimant to get a quicker hearing.

 

WHAT ARE MY CHANCES OF WINNING?

There is no way to know for certain how your case will be decided. The medical evidence in the file is needed to support your claims of disability, so the best way to help your claim get approved is by getting regular medical treatment and following prescribed courses of treatment.

 

CAN MY SPOUSE, CHILD OR FRIEND CAN ANSWER QUESTIONS FOR ME AT THE HEARING BECAUSE THEY ARE BETTER AT KNOWING DATES, DIAGNOSES, ETC?

Usually the only person that will testify at the hearing is the claimant. However, in certain circumstances (head injury, mental illness, etc), another person may be able to offer additional testimony that the claimant is not able to convey. In these instances, we will call additional witnesses to testify at the hearing.

 

I’M BEING EVICTED/HOUSE IS IN FORECLOSURE, WHAT SHOULD I DO?

If you are evicted or receive a judgment of foreclosure, your hearing may be scheduled more quickly due to dire economic need. This is totally within the discretion of the SSA and we cannot guarantee that requesting this will speed wait time up. Keep in mind that the vast majority of individuals waiting for their disability hearing have financial problems, and that the SSA will only look at the MOST DIRE circumstances when considering a dire need request.

 

IS THERE ANYTHING I CAN PUT ON MY APPLICATION THAT WOULD IMPROVE MY CHANCES OF WINNING?

You need to be specific about the disabilities that you suffer from and the functional limitations that those disabilities cause. You also need to list the doctors that you see regularly and medications/treatment they prescribe.

 

I’M NERVOUS ABOUT THE HEARING. WHAT WILL IT BE LIKE?

The hearing is relatively informal. You will be placed under oath before testifying, and so will any other witnesses. You will answer questions that the Judge and your representative ask (if you have one). Then the vocational and/or medical expert will testify in response to hypothetical questions posed by the Judge about what type of work you may be able to do considering your disability. The judge will most likely not make a decision on the day of the hearing, but will issue a written decision within 1-2 months. You will receive a copy of that decision by mail.

 

CAN I GO BACK TO WORK? IF I DO, HOW WILL THAT AFFECT MY CASE?

You are the only person that can make the determination about when/if you should go back to work. There are many variables involved and the answer really depends on your unique situation. If you are working and earning over $1040 per month (for 2013), then you are engaged in what the SSA calls "substantial gainful activity" and are therefore not disabled. However, if you attempt to go back to work but are unsuccessful due to your disability after a very short period of time, then the SSA may not hold that against you. If you are off work for over a year due to a disability and then are able to return to work, then you may be eligible for benefits for a "closed period".

If you or a loved one was denied Social Security Benefits or plans to apply for benefits we can help.