Social Security Disability FAQ
What are Social Security Disability Insurance (SSDI) benefits?
Through the Social Security Administration, the federal government provides monetary benefits to disable individuals. While you are working, taxes that are withheld for FICA pay into the Social Security trust fund. If you have paid enough to Social Security and you have done so recently enough, you could be eligible for benefits. If you are found eligible, the amount of money you receive each month will be determined by how much you have paid throughout your working life.
Are your children eligible for benefits?
If you are disabled and you have paid a sufficient amount to qualify for SSDI benefits, your children might also be entitled to benefits. Minor children may be eligible to draw a separate check from their parent’s account so long as the parent receives disability benefits.
What are Supplemental Security Income (SSI) benefits?
For individuals who do not qualify for SSDI benefits, the government also offers a needs-based program called Supplemental Security Income (SSI). Unlike Social Security Disability Insurance benefits, it is possible to qualify without having paid into FICA. However, benefits are set at a maximum rate of $698 a year. Further, like other needs-based programs, the more income or support a recipient gets, the more his or her benefits will be reduced. The Administration makes these determinations on a month-by-month basis, so recipients often have checks that vary greatly.
Why are so many claims denied initially?
The majority of people who apply for disability benefits are initially denied. It has been our experience that the reasons for denying meritorious claims vary greatly. At the first two stages of the process, a state agency called the Disability Determination Service (DDS) decides whether or not the claimant is disabled. At DDS, a panel (typically consisting of a non-examining doctor, a vocational consultant and a claims examiner) determines whether or not you meet the requirements for disability based on the evidence submitted.
How many cases a DDS allows varies significantly from one state to another. Additionally, the staff at DDS frequently has a different interpretation of the law than the Administrative Law Judges (who consider these cases later on in the process). This often creates a situation where cases that an Administrative Law Judge would pay will be denied by DDS. This is particularly true with certain conditions that DDS conclude will improve within a year. Unfortunately, the Administration has adopted this approach to numerous life-threatening conditions, including various types of cancer.
In other instances, the claimant is at least in part to blame for the denial. Because the early stages of the evaluation are conducted solely by reviewing the medical records and documents submitted by the claimant, it is critically important that the claimant cooperate. Because the people making the decision at DDS never actually lay eyes on the claimant, they need numerous forms completed. Similarly, where there is not enough detail in a claimant’s medical records, the Administration may send the claimant to an evaluation with a consulting doctor. When a claimant fails to cooperate with these requests, a denial is almost always the result.
Unfortunately, the single biggest (and most frustrating) reason that most claims are initially denied is lack of evidence. Specifically, claimants frequently do not have the medical treatment records to establish the severity of their conditions. This is usually made worse by the fact that people typically lose their health insurance coverage at the same time they lose their jobs for health-related reasons. Therefore, they are put in the difficult position of needing to show evidence of their medical problems just as it is hardest to get in to see a doctor. At Donati Law, PLLC, we put an emphasis on helping our clients get into medical care so they can obtain the proof they need to win.
I am being sent to a doctor by Social Security. What should I do?
Because Disability Determination Services (DDS) often doesn’t have enough information from medical records, they will send claimants out for testing with consulting doctors. One of the leading causes for denial is a failure to cooperate with the government-consulting doctors. We encourage our clients to be honest and courteous when dealing with doctors. Claimants should also be aware that government doctors often look for signs of a claimant exaggerating. They may do things like watch the claimant enter and leave the building. They may also ask simple questions that people only miss when they are not being cooperative.
Do I need an attorney to file for Social Security benefits?
You don’t need an attorney to file your claim initially. However, if you are denied, an attorney can be very helpful in fighting your appeal. An attorney can help you with:
- Gathering evidence, both medical and work-related
- Reviewing evidence Social Security has collected and determining how to use it to help your case
- Working with your doctors to develop opinion evidence to support a finding of disability
- Reviewing Vocational Expert opinions and questioning any experts Social Security may have at your hearing
- Preparing legal briefs for the Judge advocating for your case
How does Donati Law, PLLC get paid for representing Social Security claimants?
In claims for Social Security disability benefits, we represent our clients on a contingency fee basis. If we do not win a case, the client does not owe us anything. If the client's case is successful, we receive 25% of the past due benefits the client receives, up to a maximum amount set by the Social Security Administration. Additionally, if there are any expenses incurred (from medical records, fees from doctors, etc.), the client will be responsible for these when the case is won. Typically, the Social Security Administration pays the fee (25%) directly to our office. However, expenses are paid directly by the client at the end of the case.