Common Disability Questions
1. How can I tell if I am disabled enough to apply for Social Security disability benefits?
Social Security regulations make it easier to be found disabled as you get older. It becomes easier for a few people at age 45 (those unable to read English), for more people at age 50, for most people at age 55, and even more people at age 60. If you’re over age 55 and you cannot do any job you have done in the past 15 years, you should definitely apply. If you’re over age 50 and have a severe impairment that keeps you from doing all but the easiest jobs, you ought to apply.
But even if you’re a younger person, you don’t have to be bedridden in order to be found disabled. If you’re under age 45 or 50 and you cannot do your past jobs and you cannot work full time at any regular job, that ought to be enough.
Nevertheless, being unable to work and being found “disabled” by the Social Security Administration (SSA) are two different things. It is often difficult to convince SSA that someone is “disabled” even when he or she genuinely cannot work. But it is not impossible.
If you really cannot work, apply for disability benefits from SSA. And keep appealing denials at least through the hearing before an administrative law judge. If you lose at a hearing, sometimes a lawyer with experience handling disability cases can figure out a way to win your case by pursuing the next appeal – to the Appeals Council.
2. How do I apply for Social Security disability or SSI benefits?
The Social Security Administration (SSA) offers three ways for you to apply for Social Security disability benefits:
- By telephone.
- In person at a local Social Security office.
- By the Internet.
If you want to complete an application for SSI or Social Security disability by telephone or in person, you must first telephone SSA at 1-800-772-1213. If you choose to go a Social Security office to complete the application, the person at the 800 number will schedule an appointment for you, give you directions to the Social Security office, and tell you what papers you need to bring along. If you want to apply by phone, you will be given a date and an approximate time to expect a phone call from someone at the Social Security office who will take your application over the phone. The application will then be mailed to you for your signature.
If you want to use the Internet to apply, go to www.socialsecurity.gov/applyfordisability/adult.htm. If you want to apply for SSA’s other disability program — Supplemental Security Income (SSI) –you cannot complete an SSI application online but you can complete one of the necessary supporting documents, the Adult Disability and Work History Report, on the Internet.
3. Do you have any advice about applying for disability benefits?
Yes. Give SSA all the information it asks for in a straightforward way. Be truthful. Do not exaggerate or minimize your disability.
When you complete the Disability Report, a form that SSA requests completed at the time the application is submitted, explain how your medical impairment keeps you from working. If you’re under age 50, your explanation must show why you cannot do any job you have done in the past 15 years and why you cannot do an easy full-time job.
4. What happens if I am denied benefits and I do not appeal within 60 days?
You’ll have to start over with a new application — and it may mean that you’ll lose some back benefits. So, it’s important to appeal all denials within 60 days. It’s better if you appeal right away so that you get through the bureaucratic denial system faster. The quicker you can get to the hearing stage the better.
5. How do I appeal?
Your denial letter will tell you about appealing. The first appeal is called a “reconsideration.” You must request reconsideration and then, after the reconsideration is denied, you must request a hearing within the 60-day time limit.
You can appeal in one of three ways:
(1) Telephone the Social Security Administration and make arrangements for your appeal to be handled by phone and mail.
(2) Go to the Social Security office to submit your appeal. If you go to the Social Security office, be sure to take along a copy of your denial letter. And be sure that the Social Security representative gives you a signed copy of your appeal paper showing that you appealed on time.
(3) Appeal online at https://secure.ssa.gov/apps6z/iAppeals/ap001.jsp. Be sure to print and retain the receipt for your appeal so that you can prove you appealed on time.
6. What are the two biggest mistakes people make when trying to get disability benefits?
Failing to appeal. More than half of the people whose applications are denied fail to appeal. Many people who are denied on reconsideration fail to request a hearing.
Another mistake, although much less common, is made by people who fail to obtain appropriate medical care. Some people with long-term chronic medical problems feel that they have not been helped much by doctors. Thus, for the most part, they stop going for treatment. This is a mistake for both medical and legal reasons. First, no one needs good medical care more than those with chronic medical problems. Second, medical treatment records provide the most important evidence of disability in a Social Security case.
7. Since medical evidence is so important, should I have my doctor write a letter to the Social Security Administration and should I gather medical records and send them to SSA?
SSA will gather the medical records, so you don’t have to do that. Whether you should ask your doctor to write a letter is a hard question. A few people win their cases by having their doctors write letters. You can try this if you want to. The problem is that the medical-legal issues are so complicated in most disability cases that a doctor may inadvertently give the wrong impression. Thus, obtaining medical reports may be something best left for a lawyer to do.
8. When is the best time for a lawyer to get involved in my case?
Many people wait until it is time to request a hearing before contacting us to represent them. Although everyone agrees that lawyer’s help is essential at the hearing and the great majority of people who have lawyers win their cases at a hearing, how necessary it is to have the help of a lawyer at the early stages is a subject with arguments on both sides.
More than one-third of those people who apply will be found disabled after filing the initial application without a lawyer’s help. About 15% of those who request reconsideration are found disabled at the reconsideration stage, mostly without a lawyer’s help. If you are successful in handling the case yourself at the initial or reconsideration steps, you will save having to pay attorney’s fees. It is hard to predict which cases may benefit from a lawyer’s help early on.
We never get involved when someone is just filing an application. SSA makes it difficult for a lawyer to do much at this point. As a rule, we won’t get involved in a case until after an initial denial is issued and a legal controversy exists. About once or twice per year, though, a claimant points out to us an obvious (and quite unusual) legal problem with a case. We do consider getting involved in such cases before the initial determination is issued.
If a claimant asks us to get involved at the reconsideration stage, we will evaluate the case even though cases are harder to evaluate at this stage than they are at the hearing stage. Sometimes it is even hard to tell if a claimant will be disabled for twelve months, which is required by the Social Security Act. And it is harder to get access to a file at SSA if we have questions. If you want us to consider representing you at the reconsideration stage, we may ask you to do more work gathering records so that we have enough information to evaluate your case.
If you want us to consider becoming involved in your case at the initial or reconsideration steps, please telephone us to discuss your situation. Otherwise, the best time to call us is as soon as you get the reconsideration denial.
9. How much do lawyers usually charge?
Most clients prefer … and most lawyers offer … a “contingent fee,” a fee paid only if they win. The usual fee is 25% (one-quarter) of back benefits up to a maximum amount set by SSA, which is currently $6,000. The fee comes from those benefits that build up by the time you are found disabled and benefits are paid. No fee comes out of current monthly benefits.
Although the usual fee will not normally exceed the maximum fee of $6,000, if your lawyer has to appeal after the first administrative law judge hearing, your contract might allow for a fee greater than $6,000. Even in this circumstance, though, your fee is likely to not be greater than 25% of back benefits.
In addition to the fee, many attorneys expect you to pay the expense of gathering medical records, obtaining medical opinion letters, etc.