How do I apply for benefits?

Fill out the application here.

What is the difference between Social Security Disability (SSD or Title II) Benefits and Supplemental Security Income (SSI or Title XVI) Benefits?

Both programs are administered by the Social Security Administration. For most people, the medical requirements are the same and the person’s disability is determined by the same process. The major difference is that SSI disability program decisions are also made on the basis of financial need.

Social Security Disability Insurance (SSDI or DIB or Title II) is a program financed with Social Security taxes paid by workers, employers and self-employed persons. Disability benefits are payable to disabled workers, disabled widows, widowers or adults disabled since childhood who may otherwise be eligible. Auxiliary benefits may be payable to a worker’s dependents.

The monthly disability benefit payment is based on the Social Security earnings of the insured worker upon whose Social Security number the disability claim is filed. After you become entitled to SSDI benefits, you become entitled to Medicare benefits approximately twenty-nine (29) months later.

Supplemental Security Income (SSI or Title XVI) is a welfare type program financed through general tax revenues. SSI disability benefits are payable to adults or children who are disabled, meet the income, resource and living arrangement requirements and are otherwise eligible.

The monthly amount of SSI payments may vary from state to state and by the person’s income and resources. You may be eligible for SSI even if you have never worked or paid taxes. Generally, however, to be eligible for SSI payments you need to be a U.S. citizen or meet certain requirements for non-citizens. If you receive SSI, you are generally entitled to Medicaid.

How long will my benefits last?

Your Social Security Disability benefits (SSDI, DIB, or Title II) will last either:

  1. Until you return to substantial gainful activity for more than nine (9) months and are earning more than the amount set by Social Security, or; the government proves that your condition has significantly improved, or; you reach full retirement age. When you reach full retirement age, your benefits should continue by converting to Social Security Retirement Benefits.  You will not receive both Social Security Disability and Social Security Retirement Benefits after full retirement age.

Your Supplemental Security Benefits (SSI or Title XVI) will last either:

  1. Until you reach the age of eighteen (18) at which time you must reapply as an adult;
  2. You exceed the personal and/or household income requirements set by your state; you engage in substantial gainful activity and/or the government proves that your condition has significantly improved.

Do I need an attorney?

It is important to know that certain Administrative Law Judges will NOT hear your case if you do not have a representative.

When should I contact an attorney?

As soon as possible, some prefer to contact an Attorney before filing their initial application.  Others prefer waiting until receiving their initial denial. An Attorney may be able to assist you in determining if you are disabled, as defined by the Social Security Administration.

Attorneys in Social Security Disability cases do much more than sit in at a hearing and ask a few questions. Much pre-hearing preparation, analysis and evidence gathering go into adequate representation of your case. For these reasons you should not wait until a week or two before your hearing to contact an Attorney. The earlier an Attorney starts working on your case, the better your chances are of being successful at your hearing.

Please note that not all Attorneys practice before the Social Security Administration. You will do best to find an Attorney familiar with the complex Social Security Disability regulations and the somewhat unusual Social Security Disability procedures.

What can Grossman Law Firm do to help me in my claim for Social Security benefits?

Deborah Mitchell is a Registered Nurse and an Attorney at Grossman Law Firm working with a team with over forty (40) years of combined medical and legal experience familiar with the complex Social Security Regulations and Procedures working with you to help you get the benefits you deserve! Grossman Law Firm will be with you every step of the way. We can help you file your initial application, help develop your claim and represent you at your hearing. Click here to begin the application process.

How much does it cost to hire an attorney?

Attorneys’ fees in Social Security Disability claims are generally paid out of the claimant’s retroactive benefits.

Grossman Law Firm accepts the 25% that the government withholds as the attorney’s fee. At Grossman Law Firm, we will not charge you any fee for representation unless we are successful in obtaining benefits for you. However, you are responsible for reimbursing our firm for out of pocket expenses, such as medical record expenses and postage fees regardless of the outcome of your case.

Will my Worker’s Compensation or other disability payments affect my Social Security?

Ordinarily, disability payments from other sources do not affect your Social Security Disability benefits. However, if the disability payment that you receive is Worker’s Compensation or another public disability payment, such as civil service disability benefits, military disability benefits, Federal, State or Local government retirement benefits based on disability, your benefits may be affected. If this is the case, in general, your Social Security Disability benefit will be reduced so that the combined amount of the Social Security Disability benefit you and your family receives plus your Worker’s Compensation payment and/or public disability payment does not exceed eighty percent (80%) of your average current earnings.

What if I receive Social Security Disability benefits and my disabilities get worse and/or I am diagnosed with other health problems; will my benefits increase?

No, your benefit is based on the amount of your lifetime earnings prior to your disability and not the degree of your disability.

How much money will I receive if I qualify for Social Security Disability benefits?

Your benefits depend on your previous work record and how much you have paid into the system. Most workers receive a Benefit Estimate and Earnings Record annually in the third month before the month of their birthday.You can also get an estimate of your benefits by visiting the Social Security website at http://www.socialsecurity.gov/mystatement/.

If you have children under the age of 18 years, you may be eligible to receive additional monthly benefits for them. You may also receive Medicare Benefits beginning twenty-nine (29) months after the first month for which you receive a payment for disability.

What is the earliest age that a person can receive Social Security Disability benefits?

There is no minimum age. However, to qualify for Social Security Disability benefits, you must have worked long enough and recently enough under Social Security. You can earn up to a maximum of four (4) work credits per year. The amount of earnings required to earn one credit increases each year.

The number of work credits you need for Social Security Disability Benefits depends on your age when you became disabled. Generally, you need a total of forty (40) credits with twenty (20) credits having been earned in the last ten (10) years ending with the year you became disabled. However, some younger workers, depending on their age, may qualify with fewer credits.

What is the difference between the Social Security Administration and the Disability Determination Services?

You file your application paperwork with Social Security and it determines whether the non-medical requirements for SSD and SSI are met. However, the medical determination of disability is made by a state agency that contracts with Social Security called DDS. At the present time, there is no face to face decision-making by DDS on whether or not you are medically disabled.

I am approaching sixty-two (62) years of age, if I wait until I am sixty-two (62) and start receiving early retirement, may I then apply for disability?

NO! This is a common mistake people make and one that may be very costly. Once one has applied for early retirement, he or she has, unfortunately, lost the right to apply for disability benefits. Thus, I would strongly suggest if you are approaching sixty-two (62) and considering applying for disability that you do so before your 62nd birthday. Once the disability application has been processed, you may then begin receiving early retirement benefits while your appeal is being processed.

If I have a Medical Source Statement completed by my physician documenting my disability for a government service, i.e., the food stamp agency, should I provide a copy to the Social Security Administration?

YES!

What are the different types of Medicare?

Medicare has four parts. Part A is free. It is included with your Social Security retirement benefit when you are 66, and with your disability benefits starting with the third year of benefits. If you take your retirement benefit at a reduced level, before you are 66, you do not get Medicare right away.

Medicare starts at age 66. Part A is for hospital benefits, ambulance rides, and some other benefits. You should sign up for Medicare at age 66 even if you do not take your Social Security retirement benefit until you are at your full retirement age or even older, especially if you want the larger monthly amount.

Part B is for your doctor’s bills. You have to pay for Part B. There is a premium for Part B and the amount of the premium depends on your adjusted gross earnings for the second year before the current year. People who made more in earnings pay a higher premium. When you apply for Medicare, you are asked if you want Part B. Most people should say yes. If you get your primary care at the VA, you may not need this.

Medicare Part B has a deductible and a co-pay. Most people have a Medicare Supplemental insurance to pay for all or some of the deductible and co-pays. If you have a very low income and little to no resources, you may also get Medicaid, which pays the Medicare premium and all the other fees to health care providers.

Part C is what you should choose, along with Part B, if you want an HMO. The Part B premium pays for this. If you take Part C, the federal government pays the HMO a set amount of money every month for your care, whether you get any care or not. The amount of money paid depends on where you live and some other factors, but not on the amount of care you get. If you sign up for Part C, you usually have to go to the HMO doctors for care, although they may approve you seeing an outside doctor in special situations.

Part D is a prescription drug benefit. There are many insurance plans to consider for Part D, and you should consider the medicines you take before you pick the plan you want. There may be people at your nearby senior center who will explain the different plans and help you find the one that is best for you. Medicaid also pays for some medicines. You have to pay for Part D. Some Medicare supplemental insurance includes medicines.

The premium for Part B and the premium for Part D will be deducted from your Social Security benefit. If you do not receive a monthly Social Security benefit, you will have to pay these fees yourself.

I am having several problems, some worse than others, which ones should I tell Social Security about?

ALL of them! Many people who are dealing with chronic pain also experience depression and anxiety as they struggle with physical limitations and the inability to do all the things they used to do, such as working and providing for their families. If you are experiencing depression-like symptoms, talk with your doctors and make sure they are aware of your symptoms and that they address them appropriately. If necessary, seek additional help from a psychiatrist or psychologist. If your doctor is unable to treat your emotional problems, many county mental health departments offer this type of care for low or no costs.

Why is Social Security sending me to a consultative examination and should I go?

The primary reason a special consultative evaluation [CE] is set up at the government’s expense, is because the person assessing your claim for medical disability needs additional evidence to determine your eligibility. You should take advantage of that opportunity.  Go to the exam. Be very complete in describing your medical history and problems. In fact, if you do not go without a very good reason, your claim may be denied for failure to cooperate.

What do I do if I am denied benefits?

APPEAL in a timely manner. You have sixty (60) days from the date of your denial to file an appeal with the Social Security Administration.

OOPS! I missed my deadline, now what?

The denial letter will tell you that the Social Security Administration assumes you receive the letter within five (5) days of the date of the letter.  In order for you to request a hearing more than sixty (60) days after the date of your denial, you must have good cause.

The following situations may constitute good cause for missing the sixty (60) day deadline:

  1. You were seriously ill and this illness prevented you from contacting the SSA in person, in writing, through a friend, relative or other person;
  2. There was a death or serious illness in your immediate family;
  3. Important records were damaged by fire or other accidental cause;
  4. You did not receive the notice of determination or decision;
  5. Other dire and/or extenuating circumstances.

I was denied benefits for not being insured or exceeding the resource limit. What does this mean and can I appeal?

It means that the Social Security Administration is stating that you do not meet the non-medical or monetary requirements of the SSI or Title IXV program.  If you feel that SSA made a mistake in calculating your monthly income, you may appeal.  

How long will it take me to get a hearing before an Administrative Law Judge (ALJ)?

It generally takes 12 to 24 months to get a hearing.

What happens if the ALJ rules against me/denies my case?

If the ALJ issues an Unfavorable Decision you have sixty (60) days from the date of the decision to file an appeal to the Appeals Council. These appeals are complex but Grossman Law Firm has the experience and legal expertise to prepare a strong case to help you obtain your benefits.

How long does it take for the Appeals Council to review my case?

The average processing time for a request for review is at least eighteen (18) months from the date that the request is filed.

Dire Need

I’ve been waiting for over a year for my Social Security Disability hearing.  I can’t work.  My utilities are about to be turned off and I’m being evicted from my apartment.  What can be done about my case?

The Social Security Administration recognizes several situations which may allow your case to be expedited or processed faster.  One of the situations is referred to as Dire Need.  A Dire Need situation exists when a person has insufficient income, health or safety such as lack of food, clothing, shelter or medical care.

You must be able to show you have specific immediate circumstances such as 1) lack of food; 2) lack of medicine; 3) lack of care; 4) lack of shelter, such as a situation where the utilities are shut off and the home becomes uninhabitable, etc.  The threat of imminent eviction or foreclosure with no means to remedy the situation or obtain shelter would be an example.

Tips for a Successful Hearing:

    • Be honest;
    • Just answer the questions asked (use ‘yes’ or ‘no’ when possible);
    • Do not volunteer information or elaborate;
    • Bring your medications;
    • Bring your assistive devices (canes, walkers, braces, etc.);
    • Do not exaggerate your symptoms;
    • Do not under estimate your symptoms;
    • Describe your symptoms as accurately as you can;
    • DO NOT interrupt while the Judge, the Vocational and/or Medical Expert or your Attorney is talking;
    • REMEMBER:  It is not q question of whether or not you can do the work you ‘used to do’ ~ We must convince the Judge you are unable to do ‘any work’ that may be available in the national economy;
    • Describe your Past Work as you PERFORMED it.  For example, supervisors at fast food restaurants may hold the title of ‘Supervisor’ but are usually ‘Working Supervisors’ meaning they do not simply sit behind a desk and direct others but work along with their employees.  Also, most ‘Cashiers’ do not remain idle when they are not busy. Generally, they are expected to stock shelves, clean restrooms, etc. These details become very important when evaluating the exertional level of a job.

Foundations of a Successful Case:

  1. Your likelihood of success is much higher if your (a) physical or mental disability is severe, (b) your condition limits your activities of daily living, (c) your medical impairment(s) will last or has lasted longer than 12 months, and (d) your doctor agrees with this assessment.
  2. Understand that SSA has strict definitions of disability that ignores many real-life aspects of the job market. Difficulty finding a job, thinking that no one will hire you with your condition, believing you could not pass a job-required physical, or even knowing that the pay you would receive for the work you can do is too little to live on are important real-world considerations BUT they do not matter to the Social Security Administration (SSA) when evaluating your claim for benefits.
  3. Understand the importance of medical evidence. As is the case with most legal claims, what counts in disability evaluations is what you can prove. If no medical records exist to support your claim of disability, you are unlikely to be successful. SSA figures that if your medical condition is severe enough to keep you from working, then it should justify doctor visits, tests, diagnosis, and treatment.
  4. Keep good records. Conversely, if you do follow your doctor’s prescribed treatment, document your efforts. Without records, you are unlikely to remember the date of every doctor visit, lab test, medicine taken, and therapy received. Obtain the business cards of every doctor you see and file them. Save your pill bottles. Keep notes of your pain and other medical events.
  5. Realize the difference between Symptoms and Diagnosis. SSA does not expect you to be an expert on medical conditions. Even if you are, SSA would rather learn about your impairment from your doctor and your medical records. What SSA wants to receive from you are details about your symptoms. For example, how severe is your pain? Is it constant or intermittent? What aggravates your pain? What reduces it? Do you suffer from shortness of breath or fatigue? No one knows your symptoms better than you. Do your best to explain them in detail without exaggerating or minimizing. Do not omit or gloss over any lesser conditions just because you have one severe condition and several minor ones.
  6. Acknowledge your physical restrictions. What can’t you do? Sit for lengthy periods? Stand and walk? Lift and carry? Bend, twist, kneel, and stoop? Manipulate objects with your hands? Social Security disability is a functional program. SSA will focus on your limitations rather than your diagnosis.
  7. Understand the effect of your symptoms and subsequent restrictions. How does your medical condition affect your daily activities? Tell SSA about the impact on your personal care (hygiene, dressing, bathing), errands and housework (driving, shopping, cleaning), and social functioning (hobbies, sports, interaction with friends and family).
  8. Understand the importance of consistency, accuracy, and honesty. Contradictions, errors, memory lapses, and discrepancies all work to erode your credibility, and nothing will sink your claim faster than questions about your truthfulness.
Deb Grossman