Answering the Most Frequently Asked Questions Is a Good Start, But We Decided to Answer The Most Important Questions Too. Learn What You Need to Know About Your Injury and Disability Claim.
Answering the Most Frequently Asked Questions Is Good, Answering The Questions You Should Be Asking Is Even Better
We have been answering questions about Oregon and Washington personal injury and auto injury claims, Oregon Workers' Compensation claims, and Social Security Disability claims for more than a little while. People have a lot of the same concerns, so they ask the same questions. That's good. However, our job is not just to answer the most frequently asked questions, but also the ones you should be asking. That's better.
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Why does Social Security want to know about prior work experience?
When Social Security determines if someone is disabled, one of the first issues is when the applicant no longer participated in "substantial gainful activity." In other words, when did you stop working on a regular basis? Social Security will usually figure this out by looking at your official earnings records, which is included as an exhibit in your file at hearing. Sometimes, your records may show earnings after the date that you stopped working because of payment of sick benefits or other severance payments. It is important to look at your file to compare the date you left work with Social Security's earnings records.
Work history is also important in terms of the quality of work you performed. If Social Security determines that you have a "severe impairment," it then must determine how much the impairment limits your ability to perform work activity. This is known as "residual functional capacity." Once the Social Security Administration determines your residual functional abilities, it will determine whether you can do any of your past work. This is why it is important to provide an accurate description of the physical and mental requirements of your prior jobs.
We have seen cases decided on the description of our client's past work. When a Judge decides whether our client can perform any of her past work, the Judge will ask a vocational expert for a list of the physical and mental requirements of the job. Sometimes, our client performed the job at a more strenuous level them what the job normally required. This could mean the difference between obtaining benefits or not.
If you have a denied Social Security disability claim, we will review your claims file to see whether not your prior work was properly considered in determining whether you're eligible for benefits. Call us at 503-325-8600. We can review your file, and let you know where you stand with your claim.
How do I pay a lawyer to help with a Social Security Disability appeal?
Social Security Disability benefits are provided under the Social Security statute. The statute tells us what you need to prove in order to obtain benefits. It also regulates how attorneys can be paid for their work representing disability claimants.
The most important thing you should know is that an attorney representing a disability claimant cannot charge a fee unless the attorney is successful in obtaining benefits. If the attorney does not get a favorable decision for the client, there is no attorney fee. If the attorney is successful, then the fee comes out of retroactive benefits. "Retroactive benefits" are those benefits that have built up from the date your disability started up until the date of the favorable decision. The attorney is entitled to no more than 25% of the retroactive benefits, but to no case, can the fee exceed $6000.00. In other words, the fee is the lesser amount of 25% of retroactive benefits, or $6000.00.
For example, if your retroactive benefits total $4000.00, then the attorney fee would be 25% of that amount, which equals $1000.00. However, if your retroactive benefits were $40,000.00, then the attorney fee would be $6000.00.
The $6000.00 limit on attorney fees applies to cases at the initial appeal, known as "reconsideration," and at the hearings level. The hearings office is known as the Office of Adjudication and Disability Review, or "ODAR." Some attorneys handle cases at Federal Court, and a different statute may govern how attorneys are paid for their fees. Nonetheless, the fees will still come out of retroactive benefits.
The statute also allows attorneys to charge an hourly rate, based on their time involved in the case. Again, this fee is subject to the 25% or $6000.00 rule.
When a Social Security Disability claimant hires us, we review the written fee agreement with our client, and then submit that fee agreement to Social Security. When we win a case, the Administrative Law Judge approves the fee agreement.
If you are curious about whether an attorney can help you on your Social Security Disability claim, call us at 503-325-8600. We have over two decades of experience working with disability claimants, and can let you know where you stand with your case.
Should I appeal my Social Security Disability denial?
The Short Answer: When in Doubt, Appeal
You only have sixty days from the date of the denial letter to file your appeal.
The Long Answer:
Many of the people coming to us for help with Social Security Disability have applied in the past, but when their claim was denied, they chose not to appeal the denial. This can create problems for the claim. Some can be solved, but sometimes they cannot. If you are not sure whether it makes sense to appeal your denial, please consider the following:
First, going through the appeals process with Social Security disability can be a long-term proposition. Many folks will wait several months for the initial decision. If the initial claim application is denied, a request for reconsideration may only take a month, but could drag out to for five or six months.
The next appeal after a reconsideration is denied is a request for hearing, and depending upon the hearings office that schedules your case, you can be looking at well over a year before you get in front of an Administrative Law Judge. Sometimes a medical condition will improve after all these months, but other times, it will progress, and worsen.
The point is that you may not know where you will be with your health by the time a hearing is scheduled, and for that reason, it makes sense to appeal the claim and move forward. You can always withdraw your claim if your condition improves, and return to the work force.
Second, another problem not appealing a denial is that it may prevent a new application down the road. Depending upon the facts of your case, if you file an application for disability benefits, and that claim is denied, it may prevent you from filing a new application in the future. In many cases, Social Security will claim that it already decided that you are not disabled, and unless you are able to come up with new evidence that was not in your claims file the first time around, your claim will be denied. Making sure you appeal your denials will give you your best shot at having the case heard and decided with all of the required information.
If you have questions about whether to appeal a claim denial, call us at 503-325-8600. We can review your case, and let you know the consequences of appealing the denial, or not.
Questions? Give Us A Call
We have handled literally hundreds of Social Security Disability cases, both at hearing, and on appeal. Social Security regulates how we earn our fee. We are entitled to a fee only if we win the case. If we do, the fee is a percentage of retroative benefits (the benefits you should have received from the date your disability began). There is a cap, or limit on these fees, and no fees come out of ongoing benefits.
If you have a denial, contact us. We can help you file the appeal, review your claims file to see what's missing, and build a case to give you the best possible chance of getting your claim approved.
Do I need an attorney for my Social Security Disability claim?
There is no law or rule that requires you to hire an attorney to represent you on your Social Security Disability claim. Disability claimants can file their request for reconsideration or request for hearing without the help of an attorney, and can even appear at hearing in front of a judge. However, here are some things to think about when deciding whether you need an attorney to help with your Social Security Disability claim.
First, under the Social Security statute, an attorney cannot charge a fee unless your claim is approved. The fee is based on the attorney’s time working on the case, or a percentage of the retroactive benefits. All fee agreements must be approved by the Social Security Administration. If your attorney is unsuccessful in obtaining benefits, there is no attorney fee. This minimizes the risk of hiring an attorney.
Second, Social Security is a complicated area of the law. There are many potential issues you may face going into a hearing. For example, if you performed some kind of work after the date you claim your disability began, is that “significant gainful activity?” Is your medical condition “severe” in that it interferes with work activity? Other possible issues include whether you meet an impairment listing, your residual functional capacity, and whether you can perform any work that exists in significant numbers in the national economy. Often times, a well-meaning physician will write a letter supporting your claim, but may not address the critical questions Social Security needs to make the right decision on your claim.
Finally, we see many cases where medical records critical to the case have not made it into the claims file, or where the Social Security Administration simply does not have an accurate understanding of your past work and your current medical condition.
Overall, it makes sense to have someone helping you with the case.
That raises another question of how to go about selecting an attorney.
Social Security Disability is a federal benefit system, and as a result, any attorney or approved non-attorney representative can represent a disability claimant, regardless of location. We have seen situations where non-attorney representatives clear across the country in the Northeast will represent a claimant in Oregon or Washington. Although some of these national firms may do a good job for their clients, we have heard some sad stories regarding the quality of representation. It is not unusual for a disability claimant to meet their attorney or representative for the first time just a few minutes before the hearing in the hearing office waiting room.
If you are considering retaining a representative or lawyer that handles cases on a national level, make sure you understand how the firm will work with you, and handle your case. Will there be one representative assigned to your case? Will the representative assigned to your case also go to hearing with you? Will there be a pre-hearing appointment other than a brief meeting in the waiting room before you go in and see the Judge? Find out how your firm or attorney will handle the case before making a decision, and do not be shy about talking to a few different firms or attorneys.
If you have a denied Social Security disability claim, call us at 503-325-8600. We will meet with you in person, and explain the appeals process, what you must prove, and how we work with clients. Then, we leave it up to you to decide whether you would like us to help with the case, and encourage you to check around with other attorneys or representatives before making your final decision.
Why does Social Security want to know about my past work?
When you apply for Social Security Disability benefits, a state agency will evaluate your claim. In Oregon and Washington, the agency is known as Disability Determination Services, or DDS. DDS will send you a form asking about your past work. Why?
When Social Security decides whether not you are “disabled” as defined in the statute, it goes through a five-step sequence of questions. If Social Security determines that you have a severe medical problem or a combination of problems that is severe, it then decides your “residual functional capacity.” In other words, Social Security is determining what you can and cannot do in a competitive work setting.
Once Social Security determines what it thinks you can and cannot do, it then looks back at the jobs you worked for 15 years prior to the date you are claiming that your disability began to see if you can still perform those jobs with the limitations Social Security has placed upon you.
There are two important points here. First, it is important that you described in great detail the physical requirements of your job. For example, you may be a retail store manager, with lots of responsibilities that involve sitting at a desk in working on a computer. However, you may also work side-by-side with your workers, lifting boxes and stocking shelves. This is important, because if you are no longer able to do this kind of work, it puts you one step closer to getting your claim accepted.
The second point is that Social Security will decide what you can and cannot do both physically and mentally. Often, this is the most disputed issue when we go to hearing with our clients. If Social Security denies your claim because it thinks you can do some of your prior work, you need to sit down and review the claims file to see where Social Security is incorrect.
We help people seeking disability benefits all the time, so if you have a question, call us at 503-325-8600. Under the Social Security statute, we do not get paid unless we prevail on your appeal.
Will Social Security consider my doctor's note that I am disabled in order to prove Social Security Disability?
A simple note from your doctor that you are disabled is not enough to prove Social Security Disability. This has a lot to do with how the statute is written.
Social Security applies a five-step process to determine whether somebody meets the definition of a "disability." I put the term "disability" in quotes for a reason. It is a statutory definition, and only the Social Security Administration can decide whether somebody is "disabled" under the statute.
When a doctor writes a short note in their chart or on a prescription pad that the patient is disabled from work, Social Security will reject that note, explaining that whether someone is disabled is for Social Security to decide, not the doctor. However, your physician can be helpful in a lot of other ways.
In most cases, the key issue in determining whether you are disabled is determining your "residual functional capacity." This term simply refers to what you can still do in a work setting, day in and day out, despite your physical or mental limitations. Some people have serious medical problems that limit them from many kinds of work, but not all work.
For example, if you were working as a logger, fishermen, or construction worker, and you suffered a serious knee injury that disabled you from this kind of work, you may still have the physical ability to do other kinds of work. Depending upon your age and your work experience, you would probably not be found disabled. For younger workers, it doesn't matter whether the other work you can perform only pays a fraction of your prior earnings. The real question is whether or not you retain some physical and/or mental ability to perform work activity.This is where your treating physician can be helpful. Your treating physician can provide an estimate on your ability to do work activities like sitting, standing, and walking. If somebody suffers from a mental impairment, your mental health provider can provide estimates on your ability to concentrate, follow instructions, and get to work on time. Social Security will generally defer to your treating physician's opinion because your physician knows more about your condition than Social Security doctors who never see you, but only review medical records.
If you are in the middle of a Social Security disability claim, and wonder what medical opinions may help your case, call us at 503-325-8600. We work with physicians every day to help our clients establish their claim.
What is "residual functional capacity?"
Proving Disability: An Overview
To explain residual functional capacity, we should first talk about where it fits in when Social Security evaluates a claim for Social Security Disability benefits. Social Security goes through a five step process to determine whether someone is has a "disability" under the statute. First, Social Security determines whether the Claimant has engaged in "substantial gainful activity." This means working and earning money. If the Claimant is not working and earning money, Social Security looks at the medical evidence to see if a medical condition causes some interference with work ability. If there is, then Social Security looks to see if the Claimant meets an impairment listing. An impairment listing is like a checklist. The Social Security Administration looks at the medical records to see if someone "meets a listing." If the Claimant does not meet a listing, then Social Security determines the Claimant's residual functional capacity.
Residual Functional Capacity
Residual Functional Capacity is what a person can physically and mentally do in a work setting on a sustained basis. Often, a disability claimant's significant medical problems prevent them from returning to their prior work. However, that is only one half of the equation. Social Security must determine whether the claimant, depending on their age, can perform other work that exists in the national economy. To do this, the Social Security Administration reviews the evidence in the claim file to determine a claimant’s residual functional capacity.
For example, a construction worker may have suffered a back injury that prevents him from returning to his prior work. However, that construction worker may still work “light duty” job that does not require climbing, balancing, or heavy lifting.
Why It’s Important
If our construction worker can perform light duty work, then Social Security will determine whether jobs exist in the national economy that this construction worker can physically perform. For example, if Social Security feels the construction worker can still work as a cashier or a security guard, then that claimant will not be found disabled.
How Social Security Determines Residual Functional Capacity
When we review a denied claim, the claims file includes a physician’s evaluation of the medical records. The physician reviews the medical records and other evidence in the file and provides an opinion on the claimant’s residual functional capacity. We often argue that these opinions are speculative and based on limited information. These physicians did not examine the claimant and may not consider what the claimant’s every day activities.
At a hearing, the Administrative Law Judge considers the medical evidence, including other medical opinions, but also the claimant’s testimony, and statements from friends and family. The Judge is not bound by any prior opinions or findings that justified the denial. There also may be new evidence for the Judge to consider.
If you have a denied Social Security Disability Insurance claim, and want to know what extent, contact us. We have nearly thirty years of experience helping disability claimants.
What is an "impairment listing" under Social Security Disability?
Social Security Disability involves a five-step process to determine whether you are "disabled" as defined in the Social Security Disability statute. First, Social Security will ask whether not you have done any significant work since the date you claim you became disabled. If you have not done any work, the second question is whether not your condition is "severe." If the condition or a combination of your medical conditions is deemed "severe,", then the next question is whether you meet an impairment listing.
The impairment listings are not actually in the roles, but they are an appendix to the rules. We tell our clients that the impairment listings are like a catalogue of disabilities. There are twelve chapters, and each chapter covers a certain category of medical problems. For example, orthopedic conditions appear in one chapter, neurological conditions appear and another, and psychological conditions, also known as "mental impairments," appear in yet another chapter.
Essentially, the listings are a screening tool to weed out those obvious cases. A typical impairment listing will provide a list of findings or opinions that must appear in the medical records in order to meet a listing. The thinking behind the impairment listings is that if a person's medical records have the required combination of medical findings, then it is obvious from looking at the medical records alone that this individual is not able to hold any kind of job on a regular basis. When a Social Security Disability claimant meets an impairment listing, there found "disabled," and provided benefits.
Many of our clients do not meet a listing, and yet we have been successful on many occasions prevailing on the disability appeal. This is because Social Security is required to take a harder look, even if a person does not meet an impairment listing to see if they could still work on a regular basis.
If you have questions about whether not you have enough evidence to prove your disability, or what you can do to gather the required evidence, call us at 503-325-8600. We can walk you through the process, and explain where you stand with your claim.
What does it mean to have a "severe impairment" under Social Security Disability?
The Social Security Disability evaluation process boils down to five questions. After Social Security determines that you have not worked since the date you alleged your disability began, it then determines whether not you have a "severe medical impairment." To make this determination, Social Security will look at not just one medical condition, but all the medical conditions and their combined effect on the ability to work. If the condition or combination of medical conditions significantly limits your ability to perform basic work, then your condition is severe.
In our experience, a significant impact on the ability to do basic work activities is the same as "more than a minimal impact" on the ability to do basic work activity. This is a relatively low hurdle to jump on your way to proving Social Security Disability. However, it is still crucial.
If you are concerned about whether you can establish that your medical conditions are severe, give us a call at 503-325-8600. We can explain how this works, and answer any other questions you have with your Social Security Disability claim.
What is the Alleged Onset date?
The "alleged onset date" is the date that you tell Social Security when your disability began when filing the initial applicatoin for benefits. For many people, this may be the last date that they worked full time. However, other people may have stopped working for other reasons than a disability, and they will have to rely upon medical records and other information to determine when they were no longer able to work.
There are other issues that can arise around the alleged onset date. For example, if somebody is filing a Social Security Disability Insurance claim, they must show that their disability began prior to the date they were last insured for benefits. This is called the "date last insured." In order to qualify for disability insurance benefits, the claimant must prove that the disability began prior to the date last insured. Thus, deciding on the alleged onset date is even more important, because it must be a date prior to the date last insured.
In our experience, the Social Security Administration staff at the local branch offices often recommend the earliest alleged onset date possible to ensure that the alleged onset date of disability precedes any date that the claimant was last insured for benefits. It is always easier to amend an application to allege a later onset date than it is to allege an earlier onset date.
In many cases, we will go to a hearing, and agree with the Administrative Law Judge to amend the date that more accurately reflects what are client was no longer able to work on a sustained basis.
If you are in the middle of an application for Social Security Disability benefits, and have questions about the alleged onset date and your insured status, give us a call at 503-325-8600. We can review your claims file, and let you know where you stand with your claim. If you decide to hire us, we are not paid unless we are able to obtain benefits for you.
What happens if I lose my Social Security Disability hearing?
Social Security Disability allows for several appeals. An initial denial can be appealed with a request for reconsideration. A request for reconsideration denial can be appealed with the request for hearing. When you go to hearing, it is usually the first time you get to actually meet the person who is making the decision on your case. If you are unsuccessful at hearing, you will receive an Unfavorable Decision. That can be appealed.
Unfavorable Decisions are appealed to the Appeals Council. The Appeals Council is a group of judges located in Falls Church, Virginia. Certain judges are assigned to hear appeals from certain parts of the country. The Appeals Council will allow you to submit new evidence if it pertains to the issues that the judge reviewed at hearing, and will also allow written arguments.
If you are successful at the Appeals Council, the case will be sent back to the original Administrative Law Judge for another hearing. if you are in the middle of an application for Social Security Disability, and have questions, call us at 503-325-8600. We have represented hundreds of people over the last two decades, and know our way around the system.
Can I appeal an Unfavorable Decision on my Social Security Claim?
Yes you can.
You must file a request for review with the Appeals Council within sixty days of the date on the Unfavorable Decision.
The Office of Disability and Adjudication and Review's Appeals Council, located in Falls Church, Virginia, reviews all appeals of Unfavorable Decisions.
The Appeals Council will review the Administrative Law Judge’s Decision for legal errors and factual errors. The Appeals Council can do one of three things. It can deny your request review. If the request for review is denied, you can then file another appeal with the US District Court where you reside. Oregon has one District Court, Washington has two District Courts. Where to file depends upon where you live.
The Appeals Council may also approve your disability claim. This does not happen very often, but it is a possible result.
Most often, if the Appeals Council finds a problem with the Unfavorable Decision, it will send the case back to the Administrative Law Judge that originally heard your case with instructions on how to properly evaluate the evidence. This is known as a “remand.” The Administrative Law Judge may still deny your claim at the remand hearing. Social Security will not have the same Judge hear a case that has been remanded back to the hearings office more than one time.
If you have a case at the Appeals Council, or have a case that has been remanded back to the hearings level, call us with your questions at 503-325-8600. We can let you know where you stand with your appeal.
What is "Substantial Gainful Activity"?
The Social Security And ministration employs a five-step sequential process in determining whether somebody meets the definition of "disability." This is a series of questions Social Security Administration decision makers ask in determining every disability claim. With some exceptions, the Claimant must meet all the criteria in the five-step process.
The first question is whether somebody has engaged in "substantial gainful activity" this term, often referred to as SGA. SGA simply means regular work for earnings. Generally, Social Security will determine whether somebody is engaged in substantial gainful activity by looking at their monthly earnings. If a person's earning monthly income beyond the maximum earning level set by Social Security, there engaged in substantial gainful activity, and their claim will be denied without any further consideration. The amount of earnings considered "SGA" is set year by year. Of course, there are many exceptions to this general rule.
First, a person may not be engaged in substantial gainful activity if they worked for a short period of time, and were forced abandon the work due to their disabling condition. This is considered an unsuccessful attempt at a return to work, and will not be considered substantial gainful activity.
There are other situations where a friend or family member will accommodate the Claimant. For example, the employer may tolerate several absences for month, or may allow the Claimant to take several breaks during the day. In essence, the employer is subsidizing the claimant's work activity, and the Social Security Administration will determine the amount of subsidy the employer is providing. If the subsidy puts the Claimant below the earnings levels for significant gainful activity, then the work will not be considered significant and gainful, and the Claimant can proceed with attempting to prove the other required elements of a disability claim.
If you have a denied Social Security Disability claim in Oregon or Washington, and there is an issue regarding your work activity, call us at 503-325-8600. We have handled issues involving significant gainful activity in the past, and can answer your questions.
What is the "date last insured," and why is it so important for Social Security Disability Insurance claims?
Social Security Disability Insurance is Just That: Disability Insurance
Social Security Disability Insurance is nothing more than a disability insurance policy. The only difference is that the federal government is the insurer, not some private insurance company.
When a person earns income, whether as an employee or business owner, contributions out of gross income are made to the Social Security program. This is like a premium that a person pays to an insurance company. So, what does it take to be insured?
Under the Social Security Disability program, a worker is insured if they make the required amount of contributions from wage withholdings over the required amount of time. Social Security looks at earnings made each quarter of a year. If you earn enough in a quarter of a year, than that quarter counts as a quarter of coverage.
Generally, to be insured for disability benefits, a worker must have at least twenty quarters of coverage in the last forty quarters. Stated another way, you must have at least five years of insurance paid in over the last ten years. There are exceptions for workers under the age of 31.
The Date Last Insured
If someone works for ten years and earns enough quarters, then they have forty quarters of coverage. But if they stop working on January 1st, they start losing quarters of coverage. After one year of no work, the worker will have 36 quarters of coverage. Each additional year of no work is four quarters of coverage lost. This worker will remain insured for five years after they stopped working. The day after the fifth year has passed that person is no longer insured for benefits.
How does this affect a disability claim?
The Alleged Onset Date and Continuous Disability
Even if the worker is no longer insured for disability benefits, she may be able to make a successful claim for benefits if she can prove that her disability began prior to the date she was last insured for benefits, and that the disability has been continuous. So if a person applies for benefits in 2018, and was last insured on December 31, 2015, they must prove that their disability began prior to the end of 2015, and has continued to the present.
The common challenges in proving this kind of a claim include finding supporting medical evidence, and showing that the disability has been continuous. Many times, hospitals and medical clinics purge their medical records after so many years, and medical records are critical to prove disability. Other times, the worker attempted to go back to work, and if they worked long enough, it breaks the chain of continuous disability.
We have reviewed many cases involving a remote date last insured. Sometimes, we can dig and find supporting evidence. If you have a question about Social Security Disability claims involving a date last insured, contact us to find out where you stand.
What medical conditions will Social Security consider for disability benefits?
Social Security recognizes several medical conditions that can cause disability. The most common in our experience are orthopedic and spinal conditions. However, many of our client struggle with mental impairments to keep them from being able to work as well.
Other disabling conditions we have helped client on include cardiovascular conditions, respiratory illnesses, neurological disorders, immune system disorders, digestive tract problems, cancer, and kidney disease.
For many medical problems, the Social Security Administration has developed "impairment listings." The impairment listings are an appendix to the rules, and set out the medical findings necessary to determine whether somebody, based on the medical records alone, is entitled to disability benefits. Even if you do not "meet a listing," you still may be found disabled if your residual abilities are so reduced that you cannot engage in any competitive employment.
There are some conditions, like fibromyalgia, that do not have a specific listing. However, Social Security does maintain policies on how to review and consider claims for disability arising from fibromyalgia.
To learn more about the Social Security Disability application process, order our free book, or call us at 503-325-8600. We have extensive experience representing Claimants in front of the Social Security Administration, and can answer your questions.
Can I receive Supplemental Security Income and Social Security Disability Insurance together?
Yes you can, but everything has to line up correctly.
First, you will only receive both benefits when your Social Security Disability Insurance is less than your Supplemental Security Income. Learn the difference between each here.
Supplemental Security Income, or SSI, will pay $721.00 per month currently. If you are entitled to Social Security Disability Insurance, or SSDI, and your SSDI monthly benefit is more than $721.00, then you do not receive SSI because you have too much income. But, if your SSDI is less than $721.00, then you will receive your SSDI, and the SSI will "supplement" that benefit up to the $721.00.
What are the advantages? Well, if you are eligible for SSI, you will receive Medicaid right away. But, if you are also eligible for SSDI, you will eventually be eligible for Medicare. (Medicare does not kick in until 24 months after you have been eligible for SSDI benefits). However, more doctors accept Medicaid, so you have that advantage, eventually.
If you are in the middle of an application for Social Security Disability, and have questions, call us at 503-325-8600. We help people seeking benefits every day.
What is the difference between SSI and SSDI?
SSI is also known as "Supplemental Security Income," or Title XVI benefits. SSDI is known as "Social Security Disability Insurance," or Title II benefits. Both of these programs require proof of "disability," but the source of payment distinguishes the two programs.
Social Security Disability Insurance is a disability insurance program. If you meet the definition of a "disability," then you are entitled to insurance benefits. The benefit amount is based upon your past earnings, and whether you're "insured" at the time your disability began.
Supplemental Security Income benefits are a federal welfare benefit, and in addition to proving you are disabled, you must show that you meet the income and resource limitations set out in the statute, rules and policies. Generally, any "income" that you receive, whether or not it is earned, read results in a dollar per dollar reduction in your monthly benefit. Also, if you are "resources" exceed two thousand dollars for an individual, then you are not eligible for SSI benefits. The determination of whether you meet the "non-disability" requirements for SSI is made at the local branch level.
Do you have questions about your disability application and SSI or SSDI? Call us at 503-325-8600. We answer these questions every day.
What is a Consultative Examination?
A "consultative examination" typically occurs early in a Social Security disability claim. Depending upon the nature of your medical condition, the State agency that initially reviews your application may ask you to see a doctor or other health care provider for an examination.
It would be nice to say that these physicians are truly objective, and have no "agenda" driving their opinions. Unfortunately, that is not always the case. However, many doctors who perform these examinations are truly fair and objective. Here are some things to think about when attending the examination.
First, you have to realize that if the physician has an agenda, or some bias, there's not much you can do about convincing the doctor that you have a disability. In fact, the harder you try to explain your condition, the more harm you may do!
However, you can minimize the damage done by giving good voluntary effort at the examination, and being polite and cooperative. I have had clients tell me that the examining physician actually laughed at them when reporting their symptoms. This is where you simply have to ignore the response, continue to give your best effort, and respond politely to all questions.
Often times, the examining physician will not have all of the facts, and we can point this out to the Administrative Law Judge at the time of the hearing. Also keep in mind that the rules and policies that direct the Administrative Law Judge's evaluation of medical opinions can be used to discount the consultative examiner's opinions. Generally, a treating physician with a well reasoned opinion will trump the opinion of the one time consultative examination.
If you are working her way through a Social Security disability application, and have questions, call us at 503-325-8600. You can also download our free eBook, which answers the most commonly asked questions, and advises you on the most commonly made mistakes.
How do I appeal a Social Security Disabilty denial?
The first step is to file a request for reconsideration, which is the first appeal on a denied claim for Social Security Disability benefits. This can be done via the mail, or online, which ever you prefer. We help many disability applicants with this at the first appointment. Along with the appeal, you have to file a Disability Report, which is a form seeking updated information on your medical conditions and treatment.
When this appeal is filed, the same office that originally decided your denial reviews the appeal. It is not the same exact person, but is it in the same agency. This is called the Disability Determination Services (DDS) office in Oregon. DDS should update any medical records, and may decide to send you to a doctor for an examination.
The fact is, however, that most reconsideration requests are denied. There was even some talk of scrapping this whole level of appeal, but it is still around. If the the reconsideration request is denied, then you have 60 days to file a request for hearing, which is a very similar process.
If you have a denied claim, and you have questions, give us a call at 503-325-8600. We appeal cases for people all the time, and can help you perfect your appeal, even if you decide you do not need an attorney.
How do you prepare a client's Social Security case?
This a good question, because most of the work on a Social Security case happens well prior to hearing. There are a few stages of work that we perform.
First, we perfect the appeal, which includes filing the actual request for review, and completing the Disability Appeal Report. We then request your claims file, and review it. In the early stages, we are making sure that Social Security has updated medical records.
When we review the file, we are looking for any evidence that will help, or even hurt, your claim. We are also interested in finding out if a doctor or other health care provider is willing to comment on your condition and provide a report or respond to questions. We will meet with these folks, and help them with reports, or statements to help prove your case.
We then continue to monitor the file, depending on which stage of the appeal you are facing. If a request for reconsideration is denied, we file the appeal for our client, and request the hearing. Prior to hearing, we are regularly in touch with our client to make sure that medical records are up to date, and that we have all the evidence we can find to prove the case.
We meet with our clients prior to hearing after summarizing and reviewing their file, and explain the hearing process from the time you walk into the door, until the time you leave the hearings room. We also talk about what kind of questions will be asked, and what to expect from the particular Judge hearing the case.
After we receive a Decision, we contact our client, and discuss when benefits will be paid, or in some cases, whether to file an appeal.
For us, the goal is to get the proof early, keep things up to date, and keep our client informed. If you are facing a denied claim, call us at 503-325-8600. Even if you do not need our help, we can answer your questions.