Have thousands of people been unfairly denied disability benefits?
15 lawsuits allege a Kansas City company falsified medical test reports for Social Security, denying disability benefits to thousands of people.
Where to apply
The fastest way to file for Social Security disability insurance is online at https://www.ssa.gov/benefits/disability/. You can also apply by phone at 1-800-772-1213 (TYY 1-800-325-0778) or by making an appointment at a nearby Social Security office. Offices can be found by typing in a zip code at https://www.ssa.gov/locator/.
Who is eligible?
You must have been employed for a certain number of years and have paid social security contributions (FICA) to be eligible for SSDI, although there are exceptions. For example, if a person who worked and paid social security taxes dies, some of their family members, including their spouse, divorced spouse, and children, may also be eligible.
What if you’ve never worked?
People who have never worked for the most part are not eligible for Social Security disability benefits, although they may be eligible for another government program known as Supplemental Security Income, or SSI. SSI is a program for low-income people. It is given to people aged 65 and over, who are blind or disabled and have limited resources, whether they have worked or not.
To qualify for SSI, an individual or couple can own a home, car, and items like furniture, but otherwise have very low income and, in most states, cannot have assets greater than that. $2,000 as an individual or $3,000 as a couple. . In most states, the maximum SSI payment in 2022 was $841 per month for an individual and $1,261 for a couple.
How does the Social Security Administration determine if you are eligible for Social Security disability benefits?
The Social Security Administration looks at your age, salary, and employment history to see if you are “fully insured.” You become fully insured by working and paying social security contributions (FICA). When an individual works and pays social security contributions, they earn what are called social security “credits” – also known as “coverage districts” or QCs.
The amount an individual must earn in salary to earn a single Social Security credit is very small, although it has changed from year to year. In 1990, for example, workers had to earn $520 a year in wages (while paying Social Security taxes) to earn a single credit. In the year 2000, this amount was $780. Now, in 2022, it’s $1,510 per year. The number of credits one needs depends on the age at which one becomes disabled. A person aged 62 or over must accumulate 40 credits to qualify, either the maximum number or the equivalent of 10 years of work. The younger you are, the fewer credits you need, six being the minimum.
How much is the monthly benefit?
It depends on your work and salary history. The average in 2022 is $1,358, with most benefits ranging from $800 to $1,800 per month. The maximum monthly benefit is approximately $3,100. To find out exactly, create a My Social Security account at https://www.ssa.gov/myaccount/.
What information do I need to apply?
The Social Security Administration publishes a checklist. It includes basic information such as name, address, family members, your educational background, any professional training, and the types of jobs you have held in the past 15 years. At the center of the app are detailed medical records: names of doctors, hospitals, clinics, your patient ID numbers, dates of medical tests, exams, treatments, diagnoses, prescriptions, and the date your medical condition was started to affect your work.
What happens after my application?
Social Security Disability is a federal program, but it is administered by each state through a special office called DDS, for Disability Determination Services. The Social Security Administration reviews your claim to see if you have enough credits to receive benefits. If you do, your claim is forwarded to your state’s DDS office for an initial determination.
DDS workers consult your medical file and contact your doctors. They do not ask your doctors to determine if you are disabled. The DDS asks about your condition, when it started, what the tests show, the treatments you have received, the medications you are taking, and most importantly, how your condition may limit your abilities. Doctors and professional experts working for DDS review your records to help make an initial decision. If your medical documents are incomplete, the DDS may ask you to obtain more records or schedule an appointment for a consultative medical examination.
Getting approval at the initial level is difficult. Between 75% and 80% of initial claims are denied, often due to missing information or because the claimant’s medical condition does not meet Social Security’s definition of a disability or because the claimant did not have enough credits to receive benefits.
What is Social Security looking for?
The bar for receiving disability benefits is high. Unlike workers’ compensation or private insurance, social security disability does not pay benefits to partially disabled people. You have to be totally disabled, unable to do your past job as well as just about any other job in the US economy. Social Security disability has a strict definition of disability which reads, according to the Code of Federal Regulations:
“Disability is defined by law as the inability to engage in any substantial gainful occupation due to a medically ascertainable physical or mental impairment which may be expected to result in death or which has lasted or may expect it to last for a continuous period of at least 12 months. To meet this definition, you must have a severe impairment or impairments that prevent you from performing your relevant previous work or other substantial gainful work existing in the national economy. »
Can I appeal if I am refused and what are my chances?
You can absolutely appeal a decision and millions of people do. You can first appeal to the DDS for what is called a re-examination, in which an applicant sees their entire file again, sometimes with additional medical information. If you are denied again, you can request a hearing before an administrative law judge, or ALJ. This process can take months. The wait for a hearing ranges from six to 16 months, depending on where the hearing office is located, with the average being just under a year.
Nationally, the odds of getting your application approved at the ALJ level are about 52%, slightly better than half. But these numbers are misleading. It all depends on which judge you get, with some approving 70%-80% of cases, while others deny 70%-80%. If you fail the ALJ level, then you can appeal to the Falls Church, Va. Board of Appeals, which is considering whether the administrative law judge may have erred. The Appeals Board can approve a case outright, which rarely happens, or can send the case back to the ALJ for another hearing.
As you can see, this whole process can take years. If the Board of Appeals denies a claim, then claimants have the right to sue the Social Security Administration for benefits in federal court. Thousands of federal cases are filed each year, including 13,000 last year.
do i need a lawyer?
Ideally not, but trying to get a handicap can be a struggle. The practical reality is that an attorney who practices in the specialized area of social security law is often recommended to ensure that a claimant, from the outset, has the documents they need and follows all the correct steps. The attorney will also represent the client through what can be a years-long appeal process.
Most reputable Social Security disability attorneys work on an emergency basis, which means they don’t get paid upfront or charge deposits. They usually only get paid if they are able to secure benefits for their client and receive a percentage of those benefits in return.
Having trouble getting a Social Security disability?