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Social Security Disability Claims
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.
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