Social Security Disability(“SSD”) pays disability wage loss benefits and medical bills under Medicare. These are federal benefits and each check you receive from your employer deducts funds to pay for these benefits when you need them.
In order to qualify for benefits, assuming you have worked for a sufficient period of time in the past, you must be totally disabled from employment due to a severe impairment (s) and such disability must be expected to last longer than 12 months or you must meet the Social Security Administration’s definition of a listed impairment. Generally your doctor will have to advise whether you meet a listing. Age plays a major role in the award of benefits. Generally the older you are the better, however young people can still qualify. If you do not have a sufficient number of quarters to qualify for SSD benefits, you can still apply for needs based Supplemental Security Income benefits. Your assets and whom you live with will play a role in establishing need. SSI benefits pay less the SSD benefits per month.
The process requires you to file a petition for benefits with the Social Security Administration located in New Castle County or the nearest Social Security office. There are three phases of review: The Initial Application, Request for Reconsideration, and a Hearing before an Administrative Law Judge. A favorable application decision at any level generally results in benefits starting on a monthly basis retroactive to the date disability started subtracting out the first five months. Applications for disability can be retroactive for one year from the date of filing assuming the evidence of disability extends back that far. However, as noted the first five months of disability are subtracted from any award. This is essentially like a deductible under an auto or health insurance policy. Two years from the date of your disability start date, you will be eligible for Medicare.
Our office will help you prepare forms to file your application, although we generally recommend you apply the first time on you own just in case benefits are awarded so you can avoid an attorney’s fee. It is unlikely you will be approved on your first application, but it will save you my fee if you are approved. If you are denied, you will be advised in writing you have 60 days to file a Request for Reconsideration.
At this point you should contact my office immediately so the Appeal can be filed in a timely manner. I will analyze the claim and supply certain forms we will need to have completed by your doctor(s) regarding your disability. The Social Security Administration may also have you examined by one of its doctors and additional SSA forms will have to be completed to update the record. We will assist you with that.
If you are denied at the Reconsideration phase, we will file an appeal so the case may be heard by an Administrative Law Judge. Again any denial will be in writing with a 60-day appeal period. You will have the right to appear at the hearing with me and offer new evidence by way of testimony, additional medical records and argument as to why the previous denials should be overruled. You can also have persons close to you testify to corroborate your injuries and the impact on your life. It is at this stage that most claims with merit will be approved. However, if you lose here you still have appellate rights to the SSA’s Appeals Council and/ or the U.S. District Court based on the record created below, although new written evidence may be presented to the Appeals Council.
In representing you I will be given the opportunity to review your file at the SSA’s local office to determine the specific reasons for your denial. I will also request copies of records from your physicians or have the Administration subpoena any medical or employment records that will support your Appeal. Of course we will also meet to discuss your testimony and the questions you can expect from the ALJ and to assist you in filling out certain appeal forms. The hearing for New Castle County residents is conducted by video conference with the Judge located in Dover. I will also probably recommend you apply to the State of Delaware’s vocational rehabilitation assistance program. It is likely they will either deny you services given the severity of your disability or conclude that you are economically disabled given any restrictions you have and the need for retraining to return to the work force.
My fee is contingent on recovery of back benefits due up to the date of the award and by law cannot exceed 25% and/or $5,300.00 of such back benefits, whichever is less. Appellate fees are also contingent on recovery, but that subject is beyond the scope of this brief description of the process
Ongoing disability benefits are paid directly to you and the amount you receive each month depends on how much you have earned at your previous jobs. You are responsible for any medical records and report fees. However, I try to limit those costs by copying records from the SSD file when I review it and by having your present disability forms to your doctor directly. Usually doctors will fill these forms out for free for their patients. The forms are then returned to me for filing with the SSD.
I have represented countless employees before the Social Security Administration, its Administrative Law Judges, and the Appeals Council and the United States District Court. I have more than 16 years experience in successfully representing disabled employees in this regard.
Representative cases include disability based on all forms of illness and injury from cancer to back injuries, to amputations, et. Cetera. You need experienced counsel on your side, both as to the medical and disability regulation issues to cut through the bureaucracy.