There are lots of different types of lawyers in the world, and if you’re a disability attorney, awesome! You probably already know everything there is to know about Social Security Disability benefits. But if disability isn’t your specialty, maybe you’re wondering what’s involved in this particular niche of law.
And lucky for you, I’m about to run you through the disability law basics that every lawyer out there should know, especially if you ever encounter a client looking to apply for Social Security Disability. Here goes nothing:
The Two Types of Disability Claims
All disability claims are overseen by the Social Security Administration (SSA) and have the same medical eligibility requirements, but there are still two main camps of that these claims fall into:
Social Security Disability (SSD or SSDI)—Disability insurance is a program available to people with a work history. If they’ve worked for at least five out of the last ten years and contributed to the Social Security fund, this is where their disability benefits will be coming from. This program’s beneficiaries usually receive Medicare coverage along with their benefits.
Supplemental Security Income (SSI)—This type of claim is based on financial need rather than work history. Essentially a government assistance program, SSI is for people with disabilities who have less than $2,000 of assets (or $3,000 for a couple) and a very limited monthly income. SSI beneficiaries usually receive Medicaid with their benefits and often qualify for additional benefits like food stamps.
If a claimant fits into one of the two financial buckets above, next they need to pass the SSA’s medical and vocational qualifications for disability. To qualify for SSDI or SSI, a person must be totally disabled and unable to be gainfully employed. This is an all or nothing program, but a claimant doesn’t have to be permanently disabled to qualify. Generally the SSA will grant benefits to anyone who is going to be disabled for a minimum of 12 months. Once a claimant passes the medical and vocational qualifications, they have to pass all five steps of the disability determination process.
The Five-Step Disability Determination Process
Step 1: Is the person engaging in substantial gainful activity? According to the SSA, a person who’s working and earning at least $1,090 a month is engaged in gainful activity. This person is not eligible for benefits.
Step 2: Does the claimant have a severe impairment? A severe impairment is one that will prevent a claimant from working either physically or mentally for at least 12 months or result in their death.
Step 3: Does the claimant have an impairment or combination of impairments that meets or medically equals a listed impairment? This stage is where a disability attorney’s skills come into play the most since there is a very exact formula of severity and symptoms needed to convince an administrative law judge that a claimant should be granted benefits. You can view the SSA’s complete list of medical conditions and symptoms that qualify for disability benefits on their website.
Step 4: Can the claimant perform his or her past relevant work? This question is usually answered based on evidence from the claimant’s treating doctor, a medical expert hired by the SSA, and the claimant’s personal testimony.
Step 5: Is there any other work in the national economy, given the claimant’s age, education, past relevant work, and residual functional capacity, that the claimant could perform? The SSA will often bring a vocational expert to the hearing to present evidence on this point. It’s the disability attorney’s job to rebut this evidence.
The Procedural Stages
A claimant can be declared lawfully disabled and granted disability benefits at any point in the application process, but the complete five-step process of a disability case includes:
1. Initial Application
3. ALJ Hearing
4. Appeals Council
5. Federal Court
If a claim gets denied in any of these stages, a claimant has a 60-day time limit to appeal and move on to the next stage. Every lawyer should realize that time is of the essence in a disability case, so it’s important not to delay one of these cases. If a claimant’s deadline passes, they have to start the entire process over again and will lose their original filing date, which decides how much disability back pay they receive. So if someone comes to you saying they’ve been denied for disability, be sure to answer their questions in a timely fashion.
Good Questions to Ask if You’re Planning to Refer a Disability Claimant
- What’s your full name as listed on your Social Security Administration paperwork?
- Are you married? Do you have any dependents under 18?
- What’s your level of education? Have you worked five of the last 10 years?
- What is your Date Last Insured (DLI) when you are eligible to start receiving benefits?
- Have you applied for disability benefits before? When were you last denied? Do you have a copy of your last letter of denial?
- Have you attempted to return to work since your disability began? (Get dates worked and amounts earned)
- What is your current monthly income? Are you receiving any form of government assistance such as food stamps or unemployment?
- Who is your treating doctor? Has he or she restricted your work or the amount you can lift in any way?
- Can you afford ongoing medical treatment?
- Are you receiving long-term or short-term disability benefits from private insurance?
- Are there any third parties such as friends or neighbors who can corroborate your restrictions on daily activities?
- Are you an honorably discharged veteran with a potential service-connected disability?
For even more information about Social Security Disability, check out the SSA’s official website at ssa.gov. And if you’re interested in more blog posts like this one, check our post on the top 10 reasons to work with a disability attorney.