How do I know if I qualify?
In order to receive benefits under the social security disability and SSI programs, you must have experienced physical or mental health problems severe enough to have prevented you from working in any regular paying job for at least one year.
The test is whether you are capable of doing jobs that exist in the economy in significant numbers, not whether you can go back to your old job or get any job.
Using complex regulations, the Social Security Administration (SSA) considers the following criteria in making determinations regarding your case:
- medical condition
- your remaining ability to work
- your age
- education
- training
- work experience
At age 50 (in most cases), and again at age 55 and 60, SSA regulations make it easier to be found disabled.
What do I do if I've been denied benefits?
Nationwide, about 60 percent of all applicants are initially denied benefits, but many of these ultimately receive benefits after requesting reconsideration.
If you are disabled, and have been denied benefits, you should contact your local social security office and file for a reconsideration hearing within 60 days of the day you receive your denial notice.
What is a hearing?
The hearing is a crucial step in the appeal process. More than half of all hearings result in the claimant being awarded benefits. Although the hearing is informal, it is conducted by an administrative law judge, who takes testimony under oath.
Strict rules of evidence do not apply, and medical records will be accepted as evidence in the hearing. The judge or your attorney will ask you about your medical condition, medical history, abilities, education, work experience, training, and limitations caused by your disability.
You may present witnesses in your behalf, and have the right to examine or cross-examine medical or vocational experts who may be called by the judge to testify.
You or your attorney may make a closing argument summarizing that you are entitled to benefits under applicable regulations.
Do I need an attorney?
Because of the informal atmosphere of the hearing, it is possible for a claimant to represent himself or herself. Statistics show, however, that claimants who are represented by attorneys have been successful more often than persons without attorney representation.
It is completely your decision whether you hire an attorney, but you should consider the benefits of professional representation, and understand what services an attorney would provide in your behalf.
What would an attorney do to represent me?
Since every case is different, your attorney's role depends on the specific aspects of your situation. In general, though, your attorney might do some or all of the following:
- Gather medical and other items of evidence
- Analyze the specifics of your case relative to SSA regulations
- Discuss the specifics of your case with your physician, explain regulations and acquire a report consistent with SSA regulations
- Refer you to additional specialists, as required, to answer questions and issues addressed by SSA regulations
- Send you to an approved vocational specialist for an evaluation of your ability to work
- Recommend that the SSA refer you to a physician for a consultative examination and evaluation
- Obtain documents from SSA and review actions taken by SSA
- Request that prior application for benefits be reopened
- Request waivers of time limitations
- Request subpoenas to ensure critical witnesses or documents for your hearing
- Advise and assist you in preparation for your hearing
- Protect your rights during the hearing by objecting to improper evidence or procedures
- Cross-examine adverse testimony during your hearing
- Present a closing argument at your hearing arguing your entitlement to benefits under existing SSA regulations
- Submit written summary of evidence and arguments to the administrative law judge
- Review, amend or make legal objections to written post-hearing questions which are sometimes sent to doctors by an administrative law judge
- If you win, ensure that the SSA properly and accurately calculates your benefits
- If you lose, request a review of the hearing decision from the Appeals Council
- If necessary, represent you in a federal court review of the circumstances of your case
When should I contact an attorney?
Since SSA is now applying the same legal rules at the earlier stages of the claim process that used to be applied only at the hearing and Appeals Court levels, some attorneys are now representing claimants early in the process, while others prefer to wait until a case is closer to the hearing.
Generally, it is felt that the hearing stage is where representation makes the biggest difference in the outcome of your case, so you should arrange for representation early enough to allow for proper and complete hearing preparation.
Since much pre-hearing preparation, analysis and evidence-gathering go into good representation, you should allow as much time as possible. Your chances of winning improve significantly when your representative has adequate time to prepare.
In cases involving termination of benefits for current recipients, the type of hearing conducted at the reconsideration stage is somewhat different. If you are going to have a reconsideration hearing, you should contact an attorney as soon as you receive the termination notice.
What if I've already lost a hearing?
It may not be too late if you're still within 60 days of having received a hearing decision denying benefits or a denial from the Social Security Appeals Council. You should contact an attorney immediately. While it's best to have representation at the initial hearing, an experienced attorney may still find a way to win your case at the Appeals Council or in federal court.