Don’t Get Denied: A Legal Guide To Applying for Social Security Disability

According to Social Security Administration (SSA), studies show that 1 in 4 20-year-olds will become disabled before their 67th birthday. That is a staggering statistic. For those who have sustained a debilitating injury or illness that has left them unable to work, fret not, there are options.

List of acronyms used by the social security administration

What is SSD & How it Compares to Other SSA Programs

For those looking for monetary assistance for a disability that has affected their ability to work, some Coloradans may be wondering what program to apply for and what the differences in eligibility there are between the two SSA disability programs: Supplemental Security Income (SSI) and Social Security Disability (SSD).

In short, the main difference between SSD and SSI is work history. SSD is for disabled persons who have collected enough work credits through employment that have paid into Social Security through payroll taxes. On the other hand, SSI is for low-wage income earners, has nothing to do with work history and is strictly needs based. To qualify, SSI requires that applicants have less than $2,000 in assets ($3,000 for couples) and have a limited income. A limited income is defined as $735 per month for individuals and $1,103 for couples.

So, if you haven’t paid your taxes or do not have enough work history, then you may try for SSI benefits.

Am I Eligible?

SSD benefits will not pay for partial or temporary disability. If you fall into either of these two categories and your disability is the result of a workplace injury or illness, you may be eligible to apply for state workers’ compensation benefits – read more here. Instead, your disability must be permanent (expected to last at least a year, or result in death). To show permanency, SSA looks at an applicant’s inability to continue doing the work they did before and their inability to adjust to other work due to medical conditions. These three factors are extremely important in the SSA’s decision on eligibility.

Those who wish to apply must follow these rules:

  • Have paid into Social Security through payroll deductions;
  • Be age 18 or older;
  • Are unable to work because of a medical condition that is expected to last
  • at least 12 months or result in death; and
  • Have not been denied disability benefits in the last 60 days.

How to Apply

If you wish to apply for SSD, you have 3 options.

  1. Apply online. You can apply through the SSA’s website. The application process takes one to two hours. Use their checklist to make sure that you have all the required information.
  2. Apply by phone. If you would rather, you can apply by phone by calling 1-800-772-1213 from 7 a.m. to 7 p.m., Monday through Friday. If you are deaf or hard of hearing, you can call 1-800-325-0778.
  3. Apply in person. You may also visit your local SSA office and apply in person. To find your office, use your zip code on their office locator website.
  4. Our lawyers can help.Our lawyers can help you navigate the application process and put you in the best position to win your benefits. To schedule a free consultation, click here.

Initial Claim Denied?

According to the nonprofit National Organization of Social Security Claimants’ Representatives, only about one-third of initial disability claims are approved. That means over 66 percent of applicants will be denied.

If your claim for SSD benefits was denied, you can appeal the decision through the SSA’s website. You must submit your appeal within 60 days of being denied. If your appeal is denied, then you may request a hearing. The hearing will take place within 75 miles of your home, which will be overseen by a judge that was not a part of the original decision. Further information may be requested from you before the hearing. The judge will inform you of the specific time and place. SSA now allows for video hearings, which can be scheduled faster than inperson hearings.

I’m Approved, Now What: Frequently Asked Questions

Q. When will I start receiving my benefits?

After you have been approved, SSA will let you know how much the payments will be and when they will start. By law, SSA cannot start paying you benefits until you’ve been disabled for five full months. The payment cycle usually begins on the sixth month.Do I have to pay taxes on my benefits?

Q. Do I have to pay taxes on my benefits?

About one-third of SSD recipients must pay taxes on their disability benefits. Only those who make more than $25,000 annually and are filing as an individual must pay taxes on their benefits. Those who file jointly and make more than $32,000 annually will also have to pay taxes on their benefits.Will my benefits go up with the cost of living?

Q. Will my benefits go up with the cost of living?

Depending on the year, most likely! Disability benefits increase in amount if the cost of living increases. Come the new year, SSA will notify recipients in January of the increase and the new amount.

Q. What about Medicare eligibility?

After you have received disability benefits for 24 months, you may become eligible to receive Medicare. SSA will send you information a few months before your eligibility begins. For those with Lou Gehrig’s disease or permanent kidney failure, Medicare eligibility begins immediately.

Q.What happens to my benefits when I hit retirement age?

If you are still receiving SSD benefits when you reach retirement age, then your disability benefits will automatically convert into retirement benefits. Don’t worry; the amount tends to stay the same.

Q.Do I need to update SSA when my circumstance changes?

In short, yes. If you have any change to your health you must report this to SSA, as this may affect your benefits. Additionally, any major life changes need to be reported, such as: having a child after entitlement (including adoption), if you start working, if you receive other disability benefits, if you move, if you change your name, if you get a work pension, if you get married or divorced, if you violate parole, are charged with a crime or have a warrant out for your arrest. It’s important to update SSA on the above changes, as they may increase or decrease benefits.

SSA Case Audits

The law requires SSA to randomly audit disability claims. Due to advances in medicine and rehabilitation, people are more likely to recover from their injury or illness. Therefore, the SSA audits claims to make sure a qualifying disability still exists. The frequency of audits is determined by a person’s ability to recover. If someone has a disability that has possible improvement, then the frequency will be more often (6-18 months initially, then every three years), than someone whose condition is not expected to improve (every seven years).

Before reviewing, SSA will send a notification to the disability recipient. As the SSA medical team reviews a file, they may ask for reports on recent medical treatments, or even request the benefit recipient to undergo a medical examination. SSA will pay for the exam, as well as some of the transportation costs. If the SSA team decides that a person is no longer eligible to receive disability benefits, then benefits will stop approximately three months after the decision. If a recipient disagrees with the team’s findings, then they have the right to appeal.

Appealing a SSA Denial

A taxpayer has three opportunities to appeal a SSA denial; first in a reconsideration, then a hearing, then finally at an Appeals Council Review. If a taxpayer is still unsuccessful at these three opportunities, they can always take their case to federal court.

While in trial, a previous benefit recipient can request that benefit payments be continued during the appeal process, so long as this request is made within 10 days of notice of termination. However, should the recipient lose their appeal case, they may be forced to pay back the benefits they received during the appeal.

If a case goes to the Appeals Council, it may take a year or more just to schedule the initial hearing. In 2014, the backlog was so bad, SSA was behind close to 1 million cases. Thus, it is so important to succeed in the first two appeal opportunities. Arguably, a disability attorney can greatly increase chances of success. According to NOLO, 85 percent of reconsideration cases fail to win their appeal. Of those who go to a hearing, chances get slightly better with about half of all cases won and those who retain a disability lawyer continue to increase their odds by 50 percent when compared to those who do not!

How a Disability Lawyer Can Help

Advice tailored to each case. A disability lawyer can advise you on weighing the benefits and risks regarding whether it is worth applying for continued benefits (in case you have to pay them back). They can help speed up the wait for a hearing by drafting and submitting a Dire Need Letter.

Help avoiding common mistakes. A disability attorney can advise you on what you should be doing, so you don’t fall victim to common mistakes that would hurt your case, such as: not taking medication, continuing to work or missing various appeal deadlines.

Evidence, evidence, evidence. Additionally, just because your doctor says you are disabled, does not mean SSA will approve your claim. A disability lawyer is trained and knows what kind of evidence SSA wants in order to approve a case. They can make sure that the right evidence is collected and presented in a way that will ensure the best possible outcome. Click here, if you’d like to read current updates concerning how SSA reviews medical evidence.

But how can I afford an attorney if I cannot work? A disability attorney typically charges what is called a “contingency fee.” According to the American Bar Association, this means you don’t pay any fees if your case is lost. If your case wins, then the fee (usually a fixed percentage) will be taken out of the money awarded to you.

If you have additional questions or would like a free consultation with an attorney, call 303-688-0944.