Here are the Social Security Disability basics: Generally speaking, Social Security is a fair system designed to fulfill an extremely important purpose: the payment of benefits to people who become disabled and can no longer support themselves by working. To qualify for benefits, a person must show that, due to injury or illness, he is unable to perform any job in the economy for which he is suited given his age, education and experience. A claimant does not have to establish a cause for the disability, and the incapacity does not have to be the result of work.
The Social Security Administration has developed extensive listings of impairments that qualify a person for benefits. However, complications do arise because there are many ailments and incapacities that do not fit neatly into the listings of impairments developed by the agency. For example, a person’s inability to continue working until retirement age may result from a combination of physical and emotional incapacities. It is common for a physical injury or illness to lead to severe depression or anxiety. It is relatively easy to see how unlikely it is for a person with these incapacities to work steadily or find new employment.
The application process begins with an initial application. A person who proactively develops his medical record to clearly document his disability, submitting letters and other evidence or testimony from medical professionals, may be awarded benefits right off the bat. At our firm, we have developed our own forms to submit to physicians in order to gather records that demonstrate the full extent a client’s disability. With a thorough collection of medical records, we create a comprehensive initial application and work to avoid an initial denial of claims.
Though your claim for Social Security disability (SSDI) benefits may be legitimate, it is likely that your initial application will be denied. The facts indicate that many adults with valid disabilities will have new claims denied or existing benefits discontinued. Fortunately, there is an SSDI appeals process available.
The next step in the process for claimants after an initial denial is a Request for Reconsideration. At this point a claimant must supplement his initial application with updated medical records and provide additional information about any progression of his illness or disability. This is often a time health care providers will be willing to provide additional information to support a claim.
If a claimant does not prevail during the Request for Reconsideration process, he can appeal that denial and request a hearing. A hearing is a formal court process where the claimant appears before an administrative law judge who will listen to the claimant’s testimony and perhaps the testimony of a vocational or medical expert, and then render a written opinion approving or denying the claim for benefits. Unlike a hearing or trial of the kind that we all have seen on television, there is no opposing lawyer or other person designated to argue that the claimant is not disabled. Nevertheless, a claimant would be well advised to prepare for the hearing. An experienced lawyer will prepare his client to answer the kinds of questions that the court will want to address, so that his testimony effectively shows the impact of his physical or emotional disabilities
If the administrative law judge denies a claim after a hearing, the claimant can pursue an appeal before the Appeals Council. At this juncture, the claimant must make a showing that the administrative law judge made some error of law in reaching the decision, and request that the Appeals Council remand the matter to the judge to make a decision addressing the problems in his or her analysis highlighted by the Council.
Up to this point, everything that the claimant has done has taken place within the Social Security Administration, an agency created by the U.S. Congress to administer social security benefits. At this point, however, a claimant has exhausted all of the steps available at the SSA. He still has a right, however, to appeal the decision of the SSA by filing an appeal in federal court. During such an appeal, a federal judge will review the decision of the SSA, and again the claimant must make a showing that the SSA made some error of law. If the judge finds an error of law, the judge will overturn the decision in a written opinion, and order that the administrative law judge rehear the matter following the direction set forth by the federal judge.
One further consideration is that most employer sponsored group disability plans require anyone who is submitting a claim to apply for SSDI benefits, because the group plan allows the payer to deduct SSDI benefits from any benefits payable under the group disability plan. Likewise, if a person became disabled as the result of a work-related injury and has qualified for workers’ compensation benefits, the workers’ compensation benefits will be reduced based on the amount paid in SSDI benefits.