What are Social Security Disability Benefits?

When an employee receives wages, Social Security taxes are deducted from their wages (called FICA), with an additional contribution made by the employer.  Under the Social Security Act, eligible workers are entitled to a pre-determined retirement benefit.  For many years, workers could collect their full retirement benefit rate when they reached age 65.  This age limit still applies for people born before 1938.  For people born in 1938 or later, the full retirement age is slightly higher.  The current maximum age for full retirement is age 67, which is the age limit for people born after 1959.  (Determine your full retirement age).  A reduced retirement benefit can be received beginning at age 62.  However workers are entitled to their full retirement benefit amount or more at any age if they become totally disabled.

The Social Security Act defines total disability as the inability to perform any substantial gainful employment.  This means that you must not only be unable to perform your own occupation, but also any other type of employment.  Some people mistakenly believe that if their doctor informs them that they are no longer physically or mentally capable of performing their regular employment, they are entitled to Social Security disability benefits.  However the law requires that you prove you are unable to perform any job.  It is not enough to simply prove that you have applied for other jobs and have been unable to obtain them.  The question asked by the Social Security Administration is whether you are capable of performing another job within your limitations if those types of jobs are generally available.

To determine whether you are capable of performing any substantial gainful employment, the Social Security Administration considers your age, education, previous work experience, and physical and/or mental impairments.  In reviewing your medical impairments, the Social Security Administration determines what limits your medical condition places on your ability to perform employment.  For example, a back injury may affect your ability to lift, carry, sit, stand, walk or climb stairs.  A heart condition may affect your ability to handle stress, be exposed to dust, fumes or exhaust, or perform physically demanding labor.  The Social Security Administration will consider any physical and/or mental impairment.  Sometimes a person has a combination of impairments, none of which individually cause sufficient limitations to prevent them from performing employment, but the combination of which creates limitations severe enough to entitle them to Social Security disability benefits.

The Social Security Administration will consider any physical or mental impairment regardless of whether the condition was originally work related, accident related, congenital (from birth) or illness.  Social Security benefits may be awarded even if you are already receiving worker’s compensation, a disability pension, sickness and accident benefits, private disability insurance, or a settlement from an case.  However, in some cases, the receipt of Social Security disability benefits may reduce the level of benefits you are receiving from another source.  Even then, benefits are never reduced below that rate you would be entitled to receive if you had never applied for Social Security benefits.

To receive benefits, you must show that your disability will last for 12 consecutive months.  Once the benefits are awarded, they are payable until you are no longer disabled, or die.  At your full retirement age the benefits are converted to regular retirement benefits although the rate remains the same.  At that point your benefits would continue even if you were no longer disabled.

How Do I Apply for Social Security Disability Benefits?

The Social Security Administration suggests applying for benefits on-line (apply here).  Applications can also be completed at your local Social Security office (find my office).  There is no fee to apply.  The Social Security Administration will obtain information about your education, previous work experience and physical condition.  If the Social Security Administration determines that your medical records are not sufficient to make a decision, it may refer you for one or more independent medical consultations.  Occasionally, the Social Security Administration will request you to submit x-rays or other medical testing.  The evaluations and testing are paid for by the Social Security Administration.  Although the evaluations and testing may be helpful, you should always consult with your own doctor to report all conditions, symptoms and problems before you apply for Social Security disability benefits.  Your physician is usually more familiar with your condition and for that reason, in the best position to describe your condition to the Social Security Administration.  The independent consultants hired by the Social Security Administration frequently have heavy case loads and may not be able to spend adequate time with you to properly document and diagnose your condition.  It is best to not rely on the Social Security Administration’s evaluation to prove your condition.

After the Social Security Administration gathers all relevant medical evidence, it will issue a written notice to you with its decision.  If you are found to be disabled, you will receive an award certificate which will explain the benefits to which you are entitled, as well as your rights and responsibilities.  If the decision is not favorable, you will receive a formal letter of denial which will provide a notice of your right of review.

If your Security disability claim is denied, you may request a Reconsideration within 60 days of the date of denial.  You will lose your right to appeal if you do not request a Reconsideration within 60 days of your denial letter.  The Request for Reconsideration can be submitted on-line (appeal).  When you request a Reconsideration, the Social Security Administration will have your file re-examined to determine whether further evidence is necessary.  Such information may include a new independent medical consultation or employment records.  After the Reconsideration is completed, the Social Security Administration will render a new decision.  If the decision is not favorable, you will receive a new letter of denial.  Most people who receive a denial of their original application will also receive a denial of their Reconsideration.  However, the second denial is essential if you intend to appeal the decision further.

If your Request for Reconsideration is denied, you will have 60 days to request a hearing before an administrative law judge.  If a formal request for hearing is not filed within 60 days of the date of Reconsideration decision, your right to proceed further will be lost.  The application for hearing may be completed at your local Social Security office, or can be done on-line (appeal).  Your file will be transferred to the Social Security Administration’s Office of Disability, Adjudication and Review and assigned to an administrative law judge for a formal hearing.  You will be able to present further testimony and evidence to help establish your claim.  The hearing stage is the point at which you should consider retaining an attorney.  An attorney will contact your physician to request medical information addressing the specific legal issues set forth in the Social Security regulations.  Your attorney will be allowed to also cross-examine any witnesses called by the Social Security Administration to testify at your hearing.  An attorney may also request that a vocational consultant evaluate your claim and present evidence at your hearing.  The vocational consultant is an individual who has special training and experience in employment matters.  He or she is familiar with the physical, educational and skill requirements for the many various jobs in the national economy.  The vocational consultant can assess your previously developed skills and capabilities in determining whether you are capable of transferring those skills to a new vocation. 

Most attorneys will represent Social Security disability claimants on a contingent fee basis.  If the attorney is successful in your obtaining Social Security disability benefits, the attorney’s fees will be a percentage of the accrued benefit awarded (those benefits from the date you became disabled through the present).  If the attorney is not successful in obtaining your benefits, he or she will not charge for the services rendered.  The initial consultation and evaluation of your claim is usually provided at no charge.  Because of the complex nature of the issues involved in a hearing, it is advisable to consult with any attorney on any claim in which you have been denied at the initial two stages and intend to request a hearing before an administrative law judge.  Attorney Daniel E. Goldberg has successfully represented Social Security claimants since 1983.

If you are not successful on your claim at the administrative law judge level, you may request a further review by the Appeals Council in Virginia and if unsuccessful at that stage, file an appeal with the United States District Court. However, it is much more difficult to prevail at these stages.

Although the regulations defining and setting forth the requirements for Social Security disability benefits are voluminous and complicated, the initial application for benefits is simple and free.  If you are under age 65 and have any physical and/or mental impairment which prevents you from performing employment, you should consider applying for Social Security disability benefits.  You may obtain free legal consultation from attorney Daniel E. Goldberg.