Social Security Law FAQ

SOCIAL SECURITY LAW
FREQUENTLY ASKED QUESTIONS

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1. WHAT KINDS OF SOCIAL SECURITY ARE THERE?

THERE ARE SEVERAL KINDS OF DISABILITY BENEFITS THAT MOST PEOPLE ARE CONCERNED WITH. HOWEVER, MOST OFTEN PEOPLE ARE CONCERNED WITH CASH AND INSURANCE BENEFITS. THERE ARE TWO KINDS OF DISABILITY BENEFITS, SUPPLEMENTAL SECURITY INCOME (TITLE 16), AND DISABILITY INSURANCE BENEFITS (TITLE 2).

2. WHAT IS SUPPLEMENTAL SECURITY INCOME (SSI)?

I DESCRIBE SSI AS THE "POOR MAN'S DISABILITY." A PERSON DOES NOT HAVE TO EVER WORK TO GET SSI BENEFITS. THE QUALIFICATIONS ARE THAT A PERSON IS DISABLED AND VIRTUALLY WITHOUT ASSETS. IN OTHER WORDS, THE PERSON HAS TO MEET FINANCIAL CONSIDERATIONS, AS WELL AS PROVE THAT HE IS UNABLE TO PERFORM SUBSTANTIAL GAINFUL ACTIVITY.Ó BOTH PRE-REQUISITES MUST BE MET OR THE PERSON DOES NOT QUALIFY. THE PERSON COULD ACTUALLY RECEIVE NO BENEFITS IF HE HAS TOO MANY ASSETS, IS MARRIED TO SOMEONE WHO IS EMPLOYED OR DOESN'T MEET THE MEDICAL REQUIREMENTS. ALL SSI RECIPIENTS START OUT RECEIVING THE SAME CASH BENEFIT, BUT IT CAN BE REDUCED BY HAVING ASSETS COUNTED AGAINST HIM.

3. WHAT IS DISABILITY INSURANCE BENEFITS (DIB)?

DISABILITY INSURANCE BENEFITS IS WHAT MOST PEOPLE THINK OF WHEN THEY ARE REFERRING TO SOCIAL SECURITY. AN EMPLOYEE CONTRIBUTES MONEY TOWARD SOCIAL SECURITY ON EACH PAYCHECK THAT HE RECEIVES. THE CONTRIBUTIONS ESTABLISH QUARTERS OF COVERAGE.Ó THE KEY TO RECEIPT OF DIB BENEFITS RESTS WITH THE TERM QUARTERS OF COVERAGE. AN EMPLOYEE MUST REACH 20 OUT OF 40 QUARTERS TO HAVE AN INSURED STATUS. MOST ATTORNEYS EXPLAIN THE INSURED STATUS AS HAVING TO WORK FIVE OUT OF THE LAST TEN YEARS. BENEFITS ARE BASED UPON A PERSON'S PAST EARNINGS.

4. OTHER TYPES OF BENEFITS AVAILABLE.

OTHER MAJOR TYPES OF DISABILITY BENEFITS AVAILABLE. DISABLED WIDOWS/WIDOWERS BENEFITS ARE AVAILABLE TO PEOPLE WHO BECOME DISABLED WITHIN A SPECIFIED TIME AFTER A SPOUSE'S DEATH. THE KEY IS THAT THE INDIVIDUAL MUST ALSO BE DISABLED TO COLLECT. THERE ARE ALSO BENEFITS TO DISABLED ADULT CHILDREN WHO BECOME DISABLED BEFORE THE AGE OF TWENTY-TWO.

5. WHEN AND HOW DO YOU APPLY FOR BENEFITS?

IT IS MY OPINION THAT YOU SHOULD APPLY IMMEDIATELY UPON BELIEVING THAT YOU ARE DISABLED, OR EVEN ARE BECOMING DISABLED. FAILURE TO APPLY PROMPTLY COULD EFFECT YOUR ABILITY TO GET THE MAXIMUM BENEFITS AVAILABLE TO YOU. FOR EXAMPLE, YOU COULD LOSE YOUR INSURED STATUS FOR DIB BENEFITS THAT WOULD PAY YOU OVER $1,000 PER MONTH. THE SIMPLE DELAY IN FILING COULD EFFECT YOUR INSURED STATUS, AND YOU COULD END UP RECEIVING NOTHING. APPLY IMMEDIATELY! YOU MAY APPLY FOR BENEFITS OVER THE PHONE BY CALLING AN 800 NUMBER LISTED IN THE FEDERAL GOVERNMENT SECTION OF YOUR PHONE BOOK, OR BY APPLYING IN PERSON AT YOUR LOCAL SOCIAL SECURITY OFFICE.

6. WHAT IS THE DEFINITION OF DISABLED?

SOCIAL SECURITY DEFINES DISABILITY AS THE INABILITY TO PERFORM SUBSTANTIAL GAINFUL ACTIVITY THAT HAS EXCEEDED 12 MONTHS, OR IS EXPECTED TO EXCEED 12 MONTHS. SUBSTANTIAL GAINFUL ACTIVITY IS GENERALLY CONSIDERED THAT SOMEONE IS INCAPABLE OF EARNING MORE THAN $500 PER MONTH.

7. IS AGE TAKEN INTO CONSIDERATION?

YES. THE YOUNGER AN INDIVIDUAL IS, THE HARDER IT IS TO OBTAIN BENEFITS. PLEASE DO NOT LET THIS DISCOURAGE YOU FROM APPLYING. CHILDREN'S BENEFITS ARE A WHOLE AREA TO THEMSELVES. HOWEVER, SOCIAL SECURITY BASICALLY HAS CATEGORIES OF YOUNGER WORKERS (UNDER 50), APPROACHING ADVANCED AGE (50-54), ADVANCED AGE (5 5-AND OLDER) AND CLOSE TO RETIREMENT (60-64). THE OLDER YOU ARE, THE EASIER IT IS TO OBTAIN BENEFITS. THE ADMINISTRATIONS THEORY IS THAT OLDER PEOPLE ARE LESS ADAPTABLE TO NEW OCCUPATIONS.

8. ARE THERE WAYS TO AUTOMATICALLY QUALIFY?

YES. THERE ARE LISTINGS WITHIN SOCIAL SECURITY LISTINGS THAT ALLOW A CLAIMANT TO AUTOMATICALLY QUALIFY FOR BENEFITS. ADULT LISTINGS INCLUDE CONDITIONS UNDER THE MUSCULOSKELETAL SYSTEM, SPEECH AND SENSES, RESPIRATORY SYSTEM, CARDIOVASCULAR SYSTEM, DIGESTIVE SYSTEM, GENITO-URINARY SYSTEM, HEMIC AND LYMPHATIC SYSTEM, SKIN, ENDOCRINE SYSTEM AND OBESITY, NEUROLOGICAL, MENTAL DISORDERS, NEOPLASTIC DISEASES, MALIGNANT AND THE IMMUNE SYSTEM. SIMILAR LISTINGS ARE FOUND FOR CHILDREN.

9. WHAT ARE MY CHANCES OF SUCCEEDING?

THIS IS A DIFFICULT QUESTION TO ANSWER. MY EXPERIENCE SHOWS THAT INITIAL APPLICANTS ARE REJECTED NEARLY EVERY TIME. MY OWN FATHER WAS REJECTED AFTER A QUADRUPLE BYPASS SURGERY AND HARDENING OF THE ARTERIES THAT EVENTUALLY LEAD TO A LEG AMPUTATION. AT THAT POINT A PERSON HAS 60 DAYS TO FILE A REQUEST FOR RECONSIDERATION. THIS IS NO MORE THAN ANOTHER PERSON IN THE SAME OFFICE REVIEWING SOMEONE ELSE'S WORK. AGAIN I FIND THAT THIS IS USUALLY FRUITLESS, BUT YOU MUST DO IT. AT THAT POINT, YOU HAVE 60 MORE DAYS TO FILE A REQUEST FOR HEARING BEFORE AN ADMINISTRATIVE LAW JUDGE. THIS IS THE ONLY TIME THAT YOU SIT BEFORE A HUMAN BEING AND EXPLAIN YOUR PROBLEMS. IF YOU LOSE BEFORE THE JUDGE, YOU CAN FILE A REQUEST TO THE APPEALS COUNCIL. I HAVE HAD VERY LITTLE SUCCESS AT THIS LEVEL. YOU THEN HAVE THE OPPORTUNITY TO FILE IN YOUR LOCAL FEDERAL DISTRICT COURT FOR RELIEF.

10. HOW LONG DOES ALL OF THIS TAKE?

THIS IS VERY DIFFICULT TO ANSWER. I RECENTLY WAS CONTACTED BY A PERSON WHO HAD MOVED TO OKLAHOMA FROM PENNSYLVANIA. THE PERSON IN PENNSYLVANIA HAD BEEN TOLD THAT IT WOULD BE AT LEAST 18 MONTHS BEFORE HE WOULD SEE THE JUDGE AFTER HE HAD MADE HIS REQUEST FOR A HEARING. REMEMBER THAT REQUESTING A JUDGE TO HEAR YOUR CASE IS THE THIRD STEP IN THE PROCESS. OKLAHOMA WAS TAKING ABOUT 6-8 MONTHS BEFORE THE JUDGE WOULD HEAR THE CASE. MY ADVICE WAS TO REQUEST A TRANSFER OF THE FILE TO OKLAHOMA BECAUSE THE PERSON NOW RESIDES IN OKLAHOMA, AND IT WOULD BE A LOT QUICKER. MY ADVICE ENDED UP BEING CORRECT, AND THE PERSON RECEIVED A FAVORABLE DECISION WITHIN FOUR MONTHS OF THE TRANSFER. YOU MAY NOT SHOP WHERE YOU WISH TO HAVE YOUR CASE HEARD, BUT THE TRANSFER WAS APPROPRIATE IN THIS SITUATION. I TELL MY CLIENTS THAT THE FIRST THREE STAGES TAKE ABOUT SIX MONTHS EACH. THE APPEALS COUNCIL AND ALL APPEALS THEREAFTER, USUALLY TAKE MORE THAN A YEAR EACH.

11. WHAT IF YOU HAVE MORE THAN ONE DISABILITY?

I FIND THIS TO BE THE BEST SCENARIO FOR SUCCESSFUL CLAIMS. THE EVALUATOR, AT ANY STAGE IS LOOKING TO SEE IF YOU CAN DO YOUR PREVIOUS OCCUPATIONS, OR IF YOU ARE CAPABLE DOING ANY WORK IN THE NATIONAL ECONOMY. THIS IS A VERY DIFFICULT STANDARD TO PROVE IN THE NEGATIVE. MOST CLAIMANTS BY THE TIME THEY REACH ME, HAVE A SERIOUS MEDICAL CONDITION. MOST TIMES A PERSON HAS HAD A SURGERY INVOLVING THE NECK, BACK OR AN EXTREMITY. OFTEN TIMES, THIS PERSON WILL BE LIMITED IN HIS ABILITY TO SIT OR STAND. THE EVALUATOR THEN SAYS THAT THE PERSON CAN DO AN ALTERNATIVE OCCUPATION THAT WOULD ALLOW THE PERSON TO SIT OR STAND AT WILL. WHEN A PERSON HAS MULTIPLE IMPAIRMENTS INVOLVING, FOR EXAMPLE, AN OPERATED NECK AND CARPAL TUNNEL, THE EVALUATOR HAS A DIFFICULT TIME FINDING A SUITABLE OCCUPATION. IN OTHER WORDS THE PERSON COULD SIT OR STAND AT WILL, BUT REPETITIVE USE OF THE HANDS WOULD BE OUT OF THE QUESTION.

12. WHAT ABOUT MENTAL IMPAIRMENTS?

CURRENTLY, I FIND THAT THE JUDGES I HAVE BEEN BEFORE ARE MOST SYMPATHETIC TO MENTAL IMPAIRMENTS. DO NOT GET ME WRONG, YOU CAN'T JUST CLAIM TO BE CRAZY, YOU MUST HAVE SOME DOCUMENTED PROOF AND TREATMENT. TYPICALLY, MENTAL IMPAIRMENTS REQUIRE SOME SERIOUS MEDICATION AND OBSERVATION. PHYSICAL IMPAIRMENTS ARE CALLED EXERTIONAL LIMITATIONS AND MENTAL IMPAIRMENTS ARE CONSIDERED NON-EXERTIONAL LIMITATIONS. I FIND THAT THE COMBINATION OF EXERTIONAL AND NON-EXERTIONAL LIMITATIONS ARE THE MORE SUCCESSFUL CLAIMS.

13. WHAT IF MY DOCTOR SAYS THAT I AM DISABLED?

TREATING PHYSICIANS ARE GIVEN THE MOST WEIGHT IN EVALUATING YOUR CLAIM. ONE TIME EXAMINATIONS ARE LOOKED AT, BUT IT IS FELT THAT THE PHYSICIAN WITH THE LONGEST TREATMENT PERIOD WOULD KNOW YOUR CONDITION BEST. A SIMPLE STATEMENT THAT YOU ARE UNABLE TO WORK, OR THAT YOU ARE DISABLED, MEANS VERY LITTLE TO THE ADMINISTRATION. THE ADMINISTRATION LOOKS AT WHAT YOUR RESIDUAL FUNCTIONAL CAPACITY IS IN DETERMINING DISABILITY.

14. WHAT IS RESIDUAL FUNCTIONAL CAPACITY (RFC)?

THE TERM RFC REFERS TO A CLAIMANT'S ABILITY TO SIT, STAND WALK, LIFT, CARRY, USE ARMS, USE LEGS, PUSH, PULL, GRIP, FINGER, BEND, SQUAT, CRAWL, CLIMB, REACH AND OTHER PHYSICAL MOVEMENTS. THE ABILITY TO BE AROUND PEOPLE, TAKE INSTRUCTIONS, BE AROUND EXTREME TEMPERATURES, REMEMBER INSTRUCTIONS, CONCENTRATE AND BE AROUND PARTICLES IN THE AIR ARE ALSO TAKEN INTO CONSIDERATION. A PERSON'S IMPAIRMENT, SUCH AS VERTIGO OR SEIZURES, MIGHT LEAD TO WHAT ARE COINED AS SEIZURE PRECAUTIONS. THESE PRECAUTIONS INVOLVE RESTRICTIONS AROUND HEIGHTS, MOVING MACHINERY, OPEN FLAMES AND ANY OTHER POTENTIAL HARMFUL CONDITIONS.

15. WHAT ABOUT PAST AND FUTURE MEDICAL BILLS?

THE REAL QUESTION IS WHAT IS THE DIFFERENCES BETWEEN MEDICAID AND MEDICARE? MEDICAID IS USUALLY RECEIVED BY SSI RECIPIENTS, AND MEDICARE IS RECEIVED BY DIB RECIPIENTS. MEDICAID PAYS AT A LOWER RATE AND LESS PHYSICIANS ACCEPT IT. MEDICAID WILL PAY BILLS PRIOR TO THREE MONTHS OF THE INITIAL APPLICATION, IF YOU ARE EVENTUALLY APPROVED. MEDICARE IS RECEIVED AFTER THE ADMINISTRATION DETERMINES THAT A PERSON HAS BEEN DISABLED FOR TWENTY-FOUR MONTHS. IF IT TAKES YOU TWO YEARS TO GET APPROVED FOR DIB BENEFITS, THEN YOU HAVE ALREADY QUALIFIED. IF YOU ARE APPROVED IN SIX MONTHS, YOU MUST WAIT ANOTHER EIGHTEEN MONTHS TO RECEIVE MEDICARE. MEDICARE PAYS PHYSICIANS AT HIGHER RATES AND IT IS EASIER TO FIND A PHYSICIAN.

16. WHAT ARE THE REAL KEYS TO WINNING A CLAIM?

YOU WILL NEVER WIN IF YOU DO NOT APPLY. I FIND THAT THE BIGGEST OBSTACLE TO WINNING IS LACK OF MEDICAL DOCUMENTATION. JUDGES FIND IT HARD TO BELIEVE THAT YOUR EXCRUCIATING PAIN CAUSES YOU TO BE UNABLE TO WORK WHEN YOU HAVEN'T SEEN A DOCTOR IN TWO YEARS. MOST COMMUNITIES HAVE FACILITIES THAT TREAT PEOPLE WHO ARE FINANCIALLY UNABLE TO PAY FOR SERVICES. CHECK THE YELLOW PAGES FOR COMMUNITY SERVICES. MOST OFTEN YOU WILL FIND THAT STATE COLLEGES HAVE AFFILIATED MEDICAL SCHOOLS THAT TREAT FOR VERY LITTLE OR NOTHING AT ALL. IN ADDITION, CHECK FACILITIES THAT TREAT PARTICULAR INDIVIDUALS FOR FREE, SUCH AS THE VETERANS HOSPITALS AND INDIAN HOSPITALS FOR PEOPLE OF NATIVE AMERICAN HERITAGE. IF NONE OF THESE APPLY, REQUEST EARLY, AND OFTEN, THAT THE ADMINISTRATION PROVIDE YOU WITH A CONSULTATIVE EXAMINATION. SOMETIMES THIS IS A LAST RESORT, BUT I HAVE WON ON CONSULTATIVE EXAMINATIONS ALONE.

17. DO CLAIMANT'S NEED ATTORNEYS?

I AM AN ATTORNEY SO THE ANSWER IS OBVIOUSLY YES. OTHER THAN SELF INTEREST, THERE ARE OTHER REASONS. STATISTICS PROVE THAT REPRESENTED INDIVIDUALS ARE MUCH MORE LIKELY TO SUCCEED AT ANY GIVEN LEVEL, PARTICULARLY BEFORE THE ADMINISTRATIVE LAW JUDGE. MOST CLAIMANTS DON'T EVEN KNOW IF THEY ARE REQUESTING DIB BENEFITS OR SSI BENEFITS. THEY DON'T KNOW THE DATE THAT THEY WERE LAST INSURED. THEY DON'T KNOW THE FUNCTIONAL LIMITATIONS TO COVER. THERE MAY BE A VOCATIONAL OR MEDICAL EXPERT AT THE HEARING THAT REQUIRES CROSS-EXAMINATION. THEY ARE ALMOST CERTAINLY IGNORANT TO THE APPLICABLE LISTINGS AND CODE OF FEDERAL REGULATIONS THAT APPLY TO THEIR CLAIMS. FRANKLY, THESE ISSUES ARE GREEK TO INEXPERIENCED ATTORNEYS AS WELL. IF YOU ARE AN ATTORNEY THINKING OF TAKING ON A SOCIAL SECURITY CLIENT, PLEASE CHOOSE ONE OF THE FOLLOWING OPTIONS: (1) STUDY, STUDY, STUDY AND TALK TO EXPERIENCED COUNCIL, AND DECIDE THAT YOU WILL BE ENTERING THE SOCIAL SECURITY ARENA FOR GOOD. SOCIAL SECURITY IS REALLY NOT MEANT FOR THE ONE TIME EXPERIENCE; OR (2) REFER THE CASE TO EXPERIENCED COUNCIL, RECEIVE YOUR REFERRAL FEE UPON SUCCESSFUL COMPLETION, AND EXPLAIN YOUR AREA OF EXPERTISE SO THAT A RECIPROCAL REFERRAL MAY BE MADE.

18. WHAT DOES REPRESENTATION COST?

FEDERAL LAW STATES THAT AN ATTORNEY FEE IS CONTINGENT BASED UPON THE SUCCESSFUL COMPLETION OF THE CLAIM. THE FEE IS SET AT $4,000, OR 25% OF RETROACTIVE LUMP SUM BENEFITS WHICHEVER IS LESS. THIS FEE IS THE MAXIMUM OF THE CLAIMANT'S CASE AND ALL DERIVATIVE CLAIMS, SUCH AS DEPENDENT CHILDREN. IN OTHER WORDS, WHEN A CLAIMANT SUCCEEDS, HE WILL RECEIVE LUMP SUM BENEFITS FOR PAST DUE MOINES OWED, AND SO WOULD HIS MINOR CHILDREN. THE TOTAL FEE FOR ALL PARTIES MAY NOT EXCEED 25%, OR $4,000 WHICHEVER IS LESS.

19. HOW CAN I GET MORE ANSWERS?

YOU MAY E-MAIL ME AT stully@webzone.net OR YOU MAY CALL ME AT (918) 455-9569.