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Social Security Disability Claims

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ELIGIBILITY

There are two types of disability programs available through the Social Security Administration: the Social Security Disability program and the Supplemental Security Income program.

Social Security Disability benefits are paid based upon work history. If you have contributed sufficient quarters of earnings, you are eligible for benefits under this program. Generally, someone who has worked an average of five of the last ten years qualifies for Social Security Disability benefits.

The Supplemental Security Income disability program is based on demonstrated financial need. To determine which disability programs you may be eligible for, contact the Social Security District Office closest to your home.

The medical requirements of disability are the same under both programs, and the process for determining disability is likewise the same. Further information on both programs is available for the asking at your local Social Security district office or by calling (800)772-1213. Ask for the following publications: Social Security Disability Benefits (SSA Publication No. 05-10029); Supplemental Security Income (SSA Publication No. 05-11000).


APPLYING FOR BENEFITS


If you have a disabling health problem that prevents you from working, you should apply at any Social Security office as soon as possible. If you wish to find out how to contact the district office serving your specific area, call the regional Social Security office at (800)772-1213.

You may apply in person or by phone. If you apply by phone, several questions will be asked at that time. Forms will then be sent to you that you are required to complete and return. Information about your work history, medical history, income, and assets prevail in the application process.

The medical information you provide will be used to obtain copies of your medical records, and someone will render a decision in your case within an average of three months. An agency of the state makes the determination on your disability claim using the Social Security regulations.

The requirements of disability under Social Security differ significantly from other private insurance disability programs, Workers Compensation programs, and Veterans Administration disability programs. You often must prove that you can no longer do any of your prior work performed within the last fifteen years nor any other work which exists in the national economy in significant numbers.


SPEEDING UP YOUR CLAIM


To make the process go more quickly, have the following items when you apply: the Social Security number and proof of age for each person applying for payments (including spouse and children, if they are applying); names, addresses and phone numbers of doctors, hospitals, clinics and institutions that treated you and dates of treatment; names of all medications you are taking; medical records from your doctors, therapists, hospitals, clinics and caseworkers; laboratory and test results; a summary of where you worked in the past 15 years and the kind of work you did; a copy of your W-2 Form (Wage and Tax Statement), or if you are self-employed, your federal tax return for the past year; and dates of prior marriages if your spouse is applying.

RULES OF THUMB

Each claim is different, and the information contained on this web site cannot completely prepare you to present your case, and an attorney cannot determine in advance how a judge will rule in a case. Following a few basic rules will, however, will go a long way to eliminating problems in the application and appeal process.

Always tell the truth in every aspect of your claim. Never exaggerate your medical problems, but never minimize them either. Provide all relevant details and specific examples that illustrate your condition and how your condition affects your activities. Continue medical treatment throughout your claim and afterwards.

Claims are periodically reviewed after benefits begin. The more likely your condition is to improve, the sooner your case will be reviewed to check for medical improvement. If finances and lack of insurance make obtaining health care difficult, county hospitals and clinics probably can assist you during these periods.


APPEALS


Most people who apply for Social Security Disability are denied initially. Appeals must be filed within 60 days of a denial at any stage in the process of determining disability.

In Texas there are four levels to determining a Social Security Disability claim. The four levels are the following:

Initial claim determination;

Reconsideration determinations;

Hearing before an Administrative Law Judge;

Appeals Council appeals.

After all levels of appeal have been exhausted, someone who is denied must file suit in federal court. Three levels of appeal exist in the federal court system. The three levels are the following:

Federal district court;

Federal circuit court of appeals; and

The Supreme Court.


ATTORNEY REPRESENTATION

At Kraft & Associates, we prefer to be called in on a Social Security Disability claim right at the beginning so that we can advise you and help to protect your rights throughout the application and appeal process.

We can assist you at both the initial application stage and at the reconsideration stage, as well as at your formal hearing with the Administrative Law Judge. We can assist you in obtaining the proper reports from your physicians and specialists, monitor the status of your case, assist you in preparing your case for a hearing before an Administrative Law Judge, attend the hearing with you and deliver an opening statement on your behalf and present your case in the most effective manner at your hearing, lay the foundation for a remand or reversal on appeal if the Administrative Law Judge decides against you, and verify that the monthly amount and beginning date of benefits are correct.

BENEFITS

Benefits you will receive depend on how much income you earned when you were working and, in some cases, upon the degree of your financial need. Any Workers Compensation benefits you received, or continue to receive, will be subtracted from your benefits.

There is a five-month "waiting period" for Social Security Disability benefits. The Administration will compute the number of months between the date that you were first determined to be disabled and the date that your claim was settled, and then subtract five months from that number. The resulting number of months multiplied by your monthly award adds up to be your total back benefits.

Medicare and Medicaid are additional benefits that come with Social Security Disability and Supplemental Security Income respectively which help with medical expenses.

Kraft & Associates

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