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Social Security - Disability

Social Security Disability Claims

Social security is a program utilizing public funds, in order to provide a degree of economic security for the public as a whole once they have retired. In the United States, both employers and employees are required to pay social security taxes. The money raised from these taxes provide benefits for those who have reached retirement age, or are otherwise eligible to receive such funds. The system is intended to ensure that when everyone retires, they will have some type of money to keep the economy moving.

Social security can also refer to a government program which provides financial support for the disabled. Over the course of your working life, you pay a certain percentage of your income to the government in social security taxes. Once you retire or become disabled, the government sends you monthly payments based on how much you paid in social security taxes while working. This is known as work credits, and you are required to have a certain number of work credits to get certain benefits.

Generally speaking, such government assistance is referred to as Social Security Disability Insurance. These payments would be apart from any private disability payments provided by your employer. Only people with specific, “approved” disabilities are eligible to receive social security disability assistance. Eligibility is primarily determined by the severity of the disability or illness in relation to the person's career. An eligible person may begin collecting social security disability payments, even if they have not yet reached the age of retirement (usually 65 years of age).

How Is “Disability” Defined under Social Security Programs?

The Social Security Administration, or SSA, is responsible for defining what constitutes a disability. The SSA maintains a large list of requirements that define disability, as well as disability eligibility requirements. One of the main determining factors is whether the person's disability prevents them from both obtaining a job, AND maintaining that job for a set period of time. This period of time is, of course, determined by the SSA.

These eligibility requirements can be very complicated to understand, as they are especially nuanced. However, the SSA generally follows this three-step determination process:

  1. Determination of Disability Severity: There are some especially severe disabilities that will automatically qualify an applicant for social security assistance. The SSA maintains a comprehensive list of such conditions that result in automatic coverage; these automatic qualifiers vary based on whether the recipient is an adult, or a child. In general, this list includes heart disease, severe arthritis, kidney failure, brain damage, and various mental illnesses;
  2. Determination of Prevention: For disabilities that are not considered to be severe by the SSA, the SSA will determine whether the disability prevents the applicant from performing their current or former work. The SSA may administer a work test to make this determination; and
  3. Alternative Work Suggestion: If the case is not as simple as determining whether the disability is severe or not, the SSA will determine whether the disability prevents the applicant from finding other work available. When making this suggestion, the SSA is to take economic conditions into consideration, among other things.

Something else that the SSA will consider is whether the disability is total, or partial. Partial disability can be defined as any type of disability in which the employee is unable to perform at full physical capacity. Commonly, this is due to an on the job injury, or an illness. Alternatively, a total disability is one in which the employee is prevented from performing any work at all, directly because of the injury or condition. This is generally defined as the loss of the use of both:

  • Legs;
  • Arms;
  • Hands;
  • Eyes;
  • Any two such parts, like a leg and arm; and/or
  • Impairment due to a serious occupational disease.

When collecting disability payments, there can be considerable differences between total and partial disability. In order to receive social security disability benefits, the disability generally must be “permanent.” What this means is that the disability or injury is lasting and permanent, as opposed to being a temporary condition.

An example of this would be how the loss of use of a limb must be permanent in nature, and not a strain or sprain. Both total and partial disabilities can be permanent; meaning, a person can sustain either “permanent total disability,” or “permanent partial disability”.

Americans with Disabilities Act (“ADA”). What Does “Employment” Mean under the ADA?

When discussing disability and disability employment rights, it is important to understand the role of the ADA. In July of 1990, the federal government passed a law known as the Americans with Disabilities Act. The ADA is intended to fight against discriminating against people with disabilities. More specifically, the Act provides various civil rights protections to those who are disabled. Some of what the ADA guarantees to disabled people include the right to equal opportunity in employment, public accommodations, transportation, and housing.

The Act prohibits both public and private employers from discriminating against an employee or job applicant who has a disability. Specifically, Title I of the ADA has made it illegal for employers to discriminate against disabled employees or job candidates. This includes throughout the entire employment process, such as:

  • When a candidate is applying for a job;
  • During the interview process;
  • If the application involves discriminatory testing;
  • The job requires special training;
  • Being considered for a job offer;
  • An employer is assigning work projects or tasks;
  • During an employee evaluation or job performance review; and/or
  • Making decisions involving terminations or promotions.

This is relevant information because the SSA must adhere to the ADA's definition of employment when determining whether a disabled applicant should seek employment elsewhere, instead of being granted benefits.

What Questions Should I Expect at a Meeting with a Social Security Disability Lawyer?

It is extremely important for an individual to prepare for their first appointment with a Social Security disability lawyer. The lawyer will need accurate and detailed information in order to understand the individual's claim. Each lawyer's interview process will be different, but the most common questions that will come up during the meeting will be discussed below.

How To Qualify for Social Security Benefits

In order for an individual to receive Social Security Disability or SSI benefits, they must meet the Social Security Administration's (SSA) definition of disability. The SSA follows a five-step sequential disability analysis. It is helpful to be familiar with this analysis prior to filing for disability benefits.

The steps are as follows:

  1. Is the individual working?;
  2. Does the individual have a severe impairment?;
  3. Does the individual meet or equal a listing of impairment?;
  4. Can they perform past relevant work?; and
  5. Can they perform other work?

If an individual is performing substantial gainful activity (SGA), they cannot receive Social Security disability benefits. Each year, the SGA thresholds are set. If an individual's income meets or exceeds this threshold, they cannot receive Social Security disability benefits, even if they meet the SSA's medical criteria. It is important to note that not all work is considered SGA. An attorney will be able to further analyze an individual's work situation.

A severe medical impairment is a medical condition that significantly limits an individual's physical or mental ability to do basic work activities. It must have existed or is expected to exist at least one year. Medical evidence is required to support these types of conditions.

If an individual has a severe impairment, the SSA will determine whether it meets one of the Listings of Impairment, which describes specific conditions and symptoms and includes specific disability criteria. Many applicants will not meet or equal a listing, so they will continue to the last steps of the evaluation, which focuses on their ability to work.

Past relevant work (PRW) is any SGA-level work an individual performed within the past 15 years. Brief work attempts are usually not considered PRW. Past work will be categorized based on physical and mental difficulty. The SSA will assign the applicant a set of functional limitations, known as residual functional capacity (RFC). If an individual's past work can be performed within these restrictions, their claim will be denied.

If an individual cannot perform their PRW, the SSA will determine if they are capable of performing other full-time work. If an individual is capable of doing other work in the national economy, their claim will likely be denied. There are, however, different rules for workers over the age of 50, so it is important to seek the assistance of an attorney.

What Could Cause My Social Security Disability Claim to be Denied? What Happens If My Claim is Denied?

Social security disability claims are frequently denied, and for various reasons. Some of the most common examples for denial include:

  • The applicant is making too much or enough income, even if it is not as much they made prior to becoming disabled;
  • The applicant failed to submit substantial medical documentation of their disability, when required;
  • The SSA determined that the applicant can perform another type of job; and/or
  • The applicant does not have enough work credits with the SSA to receive the specific benefits they are applying for.

Those applying for social security disability may be entitled to an appeal of their denied claim. A denial letter will include a review of the applicant's disability, and information regarding the appeals process.

In most states, the first step would be to make a written request for reconsideration. The SSA will review the claim; however, the SSA officials who were responsible for denying the claim will not be reviewing. A medical consultant and an examiner are required to properly review a denied claim. At this stage in the appeals process, some claims may get overturned and the applicant will begin to receive benefits. However, most applicants will be denied once again. If denied at reconsideration, the applicant will receive another written notice of the denial, as well as next steps to appeal.

The next phase includes a hearing with an Administrative Law Judge, or ALJ. ALJs are specific attorneys who will hold a hearing, in which the applicant must appear in order to have their claim heard. The ALJ determines whether the denial should stand, or be overturned. The applicant can then begin receiving benefits if the denial is overturned. Roughly half of those who have an ALJ hearing will receive benefits.

The third phase is the SSA Appeals Council. If your claim was still denied after an ALJ hearing, you may appeal to the council. However, the council is under no obligation to hear your case; they may only choose to do so if the ALJ made some sort of mistake. Getting your case heard by the council can be difficult, and winning with the council is unlikely.

The last and final appeal option would be to file a lawsuit against the SSA in federal court. This option is only available after going through the first three, and is a time consuming and expensive process. However, it is important that those who feel they were wrongfully denied are heard and have their rights protected.

Do You Have Financial Resources or Income?

An individual's financial stability can impact their Social Security claim. If the individual is homeless, their lawyer may be able to expedite the appeal process. In some cases, the Social Security hearing office may agree to expedite an appeal if the individual has dire financial need.

In addition, if an individual has limited financial resources, they may be entitled to Supplemental Security Income (SSI) benefits. There are two types of Social Security disability benefits, including, Social Security Disability Insurance (SSDI), and SSI.

SSDI is an earned program that is based on an individual's work history and earnings. It is based on financial need. In some cases, an individual may be eligible for both SSI and Social Security disability.

Have You Applied for Social Security Disability in the Past?

In some cases, a previous denial of benefits may impact an individual's new application or appeal. This is especially true if the individual had a hearing before an administrative law judge (ALJ) in the past. If an individual's Social Security disability was denied following a hearing, it is important to bring that decision to the meeting with the individual's current attorney.

What Medical Conditions are Disabling?

Medical evidence is the foundation of any Social Security disability claim. An individual cannot receive Social Security disability benefits unless their medical conditions prevent them from working. 

Social Security relies heavily on an individual's medical records when evaluating their disability claim. When an individual meets with a lawyer, they should report all serious medical conditions. They should also provide a list of doctors or other medical providers, including:

  • Physical therapists;
  • Mental health counselors; and
  • Chiropractors.

When Did Your Medical Conditions Start to Impact Your Work?

A Social Security disability lawyer's goal will be to maximize their clients benefits. Generally, an individual cannot receive Social Security benefits while they are working full-time. In some cases, however, an individual's work may not be considered an income. 

For example, if an individual's work is significantly accommodated or reduced prior to when an individual stopped working, they may be entitled to claim an earlier disability onset date, and therefore, more benefits.

What Does Your Resume Look Like?

An individual's education and work experience are an important factor in a Social Security disability claim. An individual's eligibility is partly based on whether they are capable of doing work within their training or qualifications. 

Assessing whether an individual can work within their training or qualifications requires a detailed understanding of their education or work experience. Social Security employs vocational experts to evaluate an individual's work and education. An individual's attorney must have a detailed understanding of these parts of their client's case in order to cross examine experts and present accurate evidence on the issues.

Have You Struggled with Substance Abuse?

Even though addiction may be a legitimate medical condition, an individual cannot receive Social Security disability benefits if their only disabling condition is a substance abuse issue. 

It is important to note that Social Security does use substance abuse as a reason to deny a valid disability claim. While it may seem embarrassing, it is important to be honest and up front with an attorney regarding any history of substance abuse.

What Should I Bring to a Meeting with a Lawyer?

It is important to gather documents prior to a meeting with a lawyer regarding Social Security disability and bring them to the first appointment. This includes a Social Security denial letter and any other letters from Social Security. 

Generally, a lawyer cannot file an appeal, known as a Request for Hearing, without the date of denial letter from Social Security. In addition, a lawyer may want to review the following documents in order to evaluate and understand an individual's Social Security claim:

  • All available medical records;
  • Any and all work restriction slips;
  • Information about an individual's medications; and
  • Paperwork from any other disability claims, such as workers' compensation or short-term disability.

Where Can I Find the Right Lawyer?

It is essential to hire an experienced social security disability lawyer for any Social Security disability issue. In many cases, Social Security claims are too complex to handle on your own. A lawyer can review your case, advise you of your rights, and assist you with any aspect of your application. Whether you have already been denied or are just beginning your Social Security disability claim, having a lawyer on your side may be the difference between being denied and obtaining benefits.

Alternatively, if your current disability payments have stopped without a clear reason, the attorney can inform you of how to best proceed. Finally, an attorney will also be able to represent you in court, as needed, while fighting for your ADA rights.

Call our office today at 212-994-7777 or complete the convenient online contact form to set up a consultation.