My doctor tells me I’m disabled, so why is SSA not giving me my benefits?

While your doctors’ opinions are important, SSA has its own definition for disability – that is you must have a physical or mental health problem or a combination of problems severe enough to keep you from working any job that exists in the national economy in significant numbers for 12 months or more. SSA looks at your age, education, work experience, medical problems, and daily activities when making its decision.

What is the difference between Social Security Disability and Supplemental Security Income (SSI)?

Assuming you meet the other requirement, Social Security Disability pays benefits to you and certain family members if you worked long enough and paid Social Security taxes. Supplemental Security Income (SSI) pays benefits to disabled adults and children who have limited income and resources.

When should I apply for Social Security Disability?

You should apply for Social Security Disability as soon as you and your doctors agree that your disability is going to last a full year. You are not eligible for Social Security Disability if your condition doesn’t last a full year so many people have to wait for a while to see what happens with their medical conditions. Others, who have been struggling to work in spite of their disability and know the condition is not going away, should apply as soon as they stop working.

When should I apply for SSI?

You should apply for Supplemental Security Income (SSI) benefits as soon as you become disabled. Unlike Social Security Disability, there is no retroactivity prior to your application so the sooner you file the safer you are.

Do I have a good case?

I don’t know. Every case is different and must be carefully evaluated on its own facts and circumstances. I have years of experience and expertise in evaluating cases. My office will obtain some information over the telephone, and then schedule a free initial consultation in the office to meet with you and your family. Even then, it may be hard to conclusively tell you whether you have a “good” case. However, you can be sure that we will be honest and forthright with you about your situation.

How long will my case take?

That depends. It usually takes about 12 to 16 months from when the appeal is filed before you have your hearing before the Administrative Law Judge. On occasion, cases will take longer than 16 months. In certain cases, if dire circumstances exist, cases may be expedited. However, you can be assured that Attorney Elizabeth A. Smith will vigorously pursue your claim within the bounds of excellence and professionalism.

What is the process?

Stage One – Initial Application
In order to receive Social Security benefits, you must first apply. Begin by calling the Social Security Administration (SSA) at 1-800-772-1213 or by applying online at http://www.ssa.gov/applyfordisability/. Once you contact Social Security, you have established a protective filing date for your application for benefits. You will then be scheduled for an interview with a claims representative at a local Social Security office. If you are unable to go to your local Social Security office, you can have a telephone interview. When you apply for benefits, you should advise Social Security about every health problem that is preventing you from working. You should also tell Social Security about every doctor, therapist, clinic and hospital you have been to for treatment. Make certain that you ask for copies of your disability report, vocational report and any other forms completed by Social Security at the time of your application for benefits. A claims examiner at Social Security will make an initial determination as to whether or not you qualify for benefits and the State Disability Determination Section will make a medical decision on your case. You will be sent a written decision in approximately 90 to 120 days following your application. If you do not hear from Social Security within this time frame it is a good idea to call and check on the status of your claim.

Stage Two – Hearing
If you receive a notice of denial of your request for benefits, you must file a request for a hearing within 60 days or the Law Office of Attorney Smith can assist you with filing the request for a hearing. Since your hearing is your best opportunity to win benefits, and because you will be appearing before a judge, it is wise to have Attorney Elizabeth A. Smith working on your case. Social Security’s own statistics show that claimants who have lawyers win more often than claimants who go to hearings alone. In certain jurisdictions, a request for reconsideration must be filed before a request for hearing is filed.

Stage Three – Appeals Council
If you lost at the hearing level, you can appeal to the “Appeals Council” and ultimately to Federal Court. The Appeals Council accepts written arguments in support of an appeal. You must file your request for review within 60 days of your receipt of the hearing denial notice. The Appeals Council will only reverse or remand a hearing decision for a limited number of reasons. An experienced attorney will know how to argue on your behalf before the Appeals Council.

Stage Four – Federal Court
Even if you lose all of your administrative appeals, an attorney can still represent you in an appeal to the federal district court. Again, this appeal must be filed within 60 days of your receipt of the Appeals Council denial notice. Unlike the previous stages of appeal, an appeal to the Federal District Court is an adversarial proceeding and a United States Attorney will defend the Social Security Administration and their decision in court. Like the Appeals Council, a District Court Judge will only reverse or remand a hearing decision for a limited number of reasons. An experienced attorney will know how to argue a case in District Court, but very few cases are reversed or remanded at this level of appeal.

You can also file a new application for benefits. However, filing a new application is not the same thing as appealing a denial, and you could lose benefits by not appealing a denial. In some instances, failure to appeal a denial can even result in your becoming ineligible to receive further benefits.

How much does Attorney Smith charge?

Attorney Smith accepts Social Security Disability cases on a contingency fee basis and may advance costs and expenses to help you and your family in your time of need. A “contingency fee” means that you do not pay unless you receive benefits. In cases where you win, she limits her fees to 25% of the total back benefit award or $6,000.00, whichever is less. There is no fee if there is an unfavorable decision. The fee must be approved by SSA. SSA will withhold the approved fee from the past-due benefits payable to you and your family.

In cases where you receive benefits, you will be asked to reimburse Attorney Smith’s office for the expenses she incurred to support your claim, primarily medical records, reports, charges by doctors to complete questionnaires, and so forth.

Will I be eligible for health insurance?

If you win Social Security Disability, you get Medicare twenty-nine months after your onset date or two years after the first date you were eligible for cash benefits, whichever is later. If you get Supplemental Security Income, you receive Medicaid effective the day you applied for Supplemental Security Income (SSI). People with amyotrophic lateral sclerosis (Lou Gehrig’s disease) or those with end-stage renal disease are eligible for Medicare without the normal waiting period.

What information will Attorney Smith need for an office consultation?

You will need to bring with you all your social security papers – denial notices, appeal forms, and your recent social security statement (https://secure.ssa.gov/apps6z/isss/main.html). You will also need to bring with you a list of your doctors & hospitals with the addresses and phone numbers. It is helpful if you also bring with you a list of your current medications or a medication print out from your pharmacy which lists the medications you have been on for the past year. Or

What should I expect at an office consultation?

Attorney Smith will meet with you and your family to explain the Social Security Disability appeal process, obtain information from you to evaluate your claim. Once the hearing has been scheduled, Attorney Smith will meet with you and your family in order to review the hearing procedure, to explain the legal standards, to review with you and your family the evidence obtained in order to support your claim, and to go over the types of questions that will be asked.

What happens between the time of the office consultation and the hearing before the Administrative Law Judge?

You will be asked to keep a simple calendar or journal containing different kinds of details depending on the type of disability you have. You will be asked to mark down all of your doctor’s appointments, Emergency Room visits, hospital stays, chiropractic appointments, physical therapy appointments, counseling sessions, therapy sessions, and medication changes.

From time to time a representative from Attorney Elizabeth A. Smith’s office will contact you by telephone or e-mail to ask how you are doing, ask if you have worked at all since the last contact, obtain information about any changes in your condition, ask about any new medications, ask about any doctor’s appointments, and ask about your medications.

Do I need an attorney for my SSD, SSI or SSDI claim?

Strictly speaking, you do not need an attorney. The procedures followed in Social Security Disability hearings and the general issues in these cases are not impossible to understand. As recently as 1980, attorneys were involved in only 20 to 30 percent of the hearings.

However, beginning in the early 1980s there were a number of changes in the law that added to its complexity, and those changes (in the form of changes to the Social Security Act, Regulations and Social Security Rulings) continue to this day. Claimants who are not represented at their hearing before the administrative law judge (ALJ) are denied twice as often as those who are represented.

So, the decision about whether you “need” an attorney is up to you. But allow us to tell you some of the things we can do to put your case in its best light and increase your changes of succeeding in your claim:

  • Gather medical evidence and other evidence
  • Contact your doctor(s) to obtain a report of your medical condition that is geared directly to Social Security Disability requirements
  • Request that Social Security schedule a medical or psychological examination
  • Review your Social Security file
  • Review decisions made by the Social Security Administration
  • Ask for reopening of prior applications
  • Prepare you to testify at your hearing
  • Question any witnesses at your hearing
  • Present opening and closing statements at your hearing and/or argue that your claim may be favorably decided without a hearing
  • If you are successful, make sure the Social Security Administration correctly calculates your benefits