Pittsburgh, PA 15222
Overview of Social Security Disability
Social Security disability benefits are often overlooked as a source of funds for the injured or ill workers or members of their families. Whenever a person cannot work because of illness or injury, whether work related or not, that person may be eligible for Social Security disability benefits. It is possible to collect both Workers' Compensation and Social Security (the two benefits together cannot exceed eighty percent (80%) of the worker's average monthly wage.) In order to be disabled for Social Security purposes, the claimant must be unable (or expect to be unable), to perform any job that exists in significant numbers in the national economy for a period of at least 12 consecutive months. Thus, the standard of disability here is stricter than the standard for Workers' Compensation. However, it is by no means impossible. Cases can be won if there is sufficient evidence presented by the claimant that she/he is totally disabled.
Social Security Disability (DIB) benefits are available to people who have worked and paid into the SS system through FICA. In order to be insured for purposes of entitlement to DIB benefits, the claimant must have earned wages and paid into the system for 20 out of the last 40 quarters prior to the start of the disability. If the claimant is found disabled, s/he gets these benefits without regard to any other resources s/he may have. The DIB benefits are not need-based. Benefits are also available to dependents. Once the claimant has been receiving DIB for two years, s/he becomes eligible for Medicare.
Disability benefits for people who have never worked or who do not have enough quarters of coverage are called Supplemental Security Income (SSI) benefits. These benefits are not the same as DIB in that these benefits are need-based. If the claimant has more resources than allowed, these benefits will not be paid, even if the claimant is otherwise disabled. No family benefits are available in SSI. The claimant can receive Medicaid coverage.
Requirements To Prove Disability
The requirements for disability are: (1) must be off work or expect to be off work for 12 consecutive months; and (2) must be unable to perform any work which exists in significant numbers in the national economy. In order to make this determination, Social Security takes into account the claimant’s age, education and past work experience, if any.
The Initial Claim
When the claimant has been off work or expects to be off work for twelve consecutive months, she/he should file a claim for Social Security disability and/or SSI as appropriate. There is no cost to file the claim. The claim can be filed in person at a local district office, over the telephone or online. (See our link to the SS website). The initial application is referred to the Bureau of Disability Determination (BDD) in Greensburg, PA for initial processing and decision. The BDD will ask you for information about your age and education. They will also ask you to provide information regarding your past work. The BDD will write to your medical providers to get your medical records. Then, an initial determination will be made.
Social Security routinely denies a very large percentage of the claims that are filed. The initial decision-makers at the BDD are bound by a strict set of regulations and guidelines. If your case does not fit exactly within those regulations, your claim will be denied. However, the claimant should not give up.
The Hearing Level
Initial denials should be appealed to the hearing level. The appeal is taken by filing a Request for Hearing at the local SS district office. Please note that the claimant must appeal each denial within sixty (60) days of its issuance, or that decision will become final. Social Security has strict time limits which must be followed in order to allow the claim to proceed. Once the appeal is filed, your case will be sent to a Social Security hearing office called the Office of Disability Adjudication & Review (ODAR). The Social Security Administrative Law Judges (ALJs) work from the ODAR offices.
Once your case gets to the ODAR, it will be assigned to an ALJ and there will be a hearing. At the hearing, the claimant will appear and will have the opportunity to testify and to present medical evidence in support of disability. It is vital to success to have the right kind of medical evidence from your doctors, which explains in detail the effects your impairments have on your ability to work. The report should take into account the requirements of Social Security’s rules and regulations for proving disability. You will also need to testify at the hearing. Your testimony is very important. You should know how to testify so that the most important information is presented to the Judge in a clear and concise manner. Most hearings also involve testimony from a Vocational Expert who will testify regarding the vocational issues in your case. After the hearing, the Judge will make a decision. The decision will be in writing and a copy is sent to both you and your attorney.
Why Get An Attorney?
At the hearing, the claimant should be represented by an attorney who is well versed in Social Security law. Social Security statistics show that people who are represented at the hearing win more often than people who are un-represented. As your attorneys, we are familiar with the Social Security law and regulations about your specific illness or injury. We will try to get the best medical evidence we can in support of your disability. We are also familiar with the ways Social Security evaluates your age, education and past work experience. These are vital areas in proving disability and must be properly presented. The Vocational Expert will testify about your past work experience and about potential jobs you could perform even with your impairments. It is vital to properly question the VE in order to get the best testimony on the vocational aspects of your case.
What About Attorney Fees?
Claimants often do not hire attorneys for Social Security disability hearings because they are afraid of the cost. Social Security attorney's fees are contingent. No fees are payable unless the case is won. If the attorney is successful in winning the case for the claimant, twenty-five percent (25%) of the claimant's past-due benefits will be withheld toward the attorney's fee.
Appeal From The ALJ’S Decision
If the case is lost before the ALJ, it can be appealed to the Appeals Council of Social Security. The Appeals Council is based in Falls Church, VA. There is not another hearing. The appeal is all done in writing. As your attorneys, we will prepare and file a Brief in support of your disability. The Brief explains why we believe the ALJ was wrong to deny your benefits. If the Appeals Council denies the appeal, the next step is to take the case to the United States District Court for the district where you live. This appeal is also done in writing by filing a legal Brief.