|
If you are unable to work because of
illness or injury, you may qualify for Social Security Disability (DIB) or
Supplemental Security Income (SSI) benefits. If you have been wrongfully
denied benefits by the Social Security Administration, we can represent you
in obtaining the benefits to which you are entitled. There is no fee for
your initial office consultation with an attorney, and we will normally
charge a fee only if we are successful in recovering benefits for you. The
fee must be approved by the Social Security Administration and is usually in
the amount of 25% of your back benefits.
The purpose of this information is to help
answer some of your questions about Social Security disability claims. This
information is not meant to cover every situation. This information is a
general statement of Social Security law and procedures and is not to be
used as a substitute for specific legal advice from an attorney. Please
remember that the law is always changing through actions of the Congress,
the Social Security Administration and the courts.
This
information is about:
•
How to apply for benefits from the Social Security Disability (DIB) and
Supplemental Security Income (SSI) Programs.
•
How to prepare for a hearing to get DIB or SSI if the Social Security
Administration denies you benefits.
Nearly all of
the information applies to the process as it occurs throughout the United
States, but some information, notably about the hearing process, is specific
to the Portland and Eugene, Oregon, Social Security Hearings offices.
Topics covered:
Applying for Social
Security
Disability and SSI
 Disability
Hearings
Overpayments
APPLYING
FOR SOCIAL SECURITY
DISABILITY AND SSI
Who can get
Social Security Disability Insurance benefits (DIB)?
Social Security
Disability Insurance benefits, also called DIB, SSD, or Title 2 benefits, are for any disabled person who can no longer work, but who has the
required history of working. The disabled person’s spouse, dependent
children and parents, and even a divorced spouse might also be able to get
DIB. This program is an insurance program while a person works he or she
pays money into the Social Security system and is eligible to get benefits
if he or she becomes disabled and can no longer work.
Who can get
Supplemental Security Income (SSI)?
SSI, also
called Title 16, benefits are for any person who is blind, disabled or
elderly (65 or over) and who meets certain income and resource rules. You do
not need to have a work history. The income rules depend on your living
arrangements and whether you apply as a single person or couple. Resources
include cash, savings, investments and valuables. But they do not include a
needed car, your home, ordinary belongings, or some life insurance policies.
How can I
get SSI if I’m aged or blind?
If you are
applying for SSI as aged, you must show that you are 65 or over. If you are
applying for SSI as blind, you must give evidence that you have corrected
vision of 20/200 or worse in your better eye.
How can I
get benefits for a disability?
To get benefits
from the DIB or SSI disability programs you must show you are “disabled.”
“Disabled” means that a physical and/or mental impairment or impairments
keep you from working any regular, paying job. Your disability must have
lasted or be expected to last for at least 12 months, or be expected to
result in death. It is normally not enough to show that you cannot do your
old job. You must show that you cannot do any kind of full-time work, taking
into consideration your age, education and experience. Different rules apply
if you are over 50 years of age. You cannot get benefits if you are able to
work, even if no one will hire you.
When should
I apply for the DIB and SSI programs?
Apply as soon
as possible after disability occurs. You do not need to wait 12 months to
apply.
An application
for DIB may also be filed after the death of a disabled worker. You must
apply within three months of the worker’s death. If the claim is approved,
back payments may be made for some months before the worker died.
Where do I
apply for Social Security programs?
You must make
an appointment to apply. You can make this appointment at your local Social
Security office or by calling 1-800-772-1213.
What evidence should I include with my
application?
To get SSI or
DIB, you must have medical evidence that shows you have some physical or
mental impairment(s) that makes you unable to work. Medical evidence
includes doctor or hospital reports, chart notes, test results, and letters.
The more medical evidence you have the better chance you will have of
winning benefits. List all the medical evidence that you have when you
apply.
Are
there special rules if my disability is based on alcoholism or drug
addiction?
Beginning in
April, 1996, people who are disabled because of the current use of alcohol
or another drug are not eligible to receive benefits. If you have a
drug addiction or alcohol problem your disability must be caused by another
medical problem that makes you unable to work in order to be eligible for
benefits. The basic test is: would you still be disabled if you stopped
using drugs or alcohol? If so, then you are eligible for benefits.
What happens
after I apply?
The SSA will
contact your doctors and request records. They also may send you to a doctor
for an evaluation. Whenever possible you should try to take copies of your
medical records to the doctor because the doctor will usually have no
records of your medical history.
Can I get
other help while waiting for Social Security benefits?
While you are
waiting for a decision by SSA you may be able to get General Assistance from
the State of Oregon if you are single or have a disabled spouse, and have
very little in the way of financial resources. You must have medical
evidence showing that you will be disabled at least one year. You will also
be asked to sign a statement saying you will pay back welfare for your
General Assistance if you get SSI benefits. If you do not get those benefits
you do not have to repay welfare.
What happens
if I’m found to be eligible for benefits?
If you are
found eligible for DIB, you will
get benefits beginning 5 full months after you became disabled, but only for
a maximum of 12 months before you applied for benefits.
If you are
eligible for SSI, you will get
benefits back the first day of the month after the month in which you
applied, or later if Social Security believes your disability began after
you applied. If you were getting General Assistance you may have to pay back
the state out of your retroactive benefit check.
IF YOU ARE DENIED BENEFITS
What can I do if I am denied benefits?
Many people do
not get benefits when they first apply, but don’t be discouraged. You can
many times get benefits by appealing and having a Social Security hearing.
Most people are
denied benefits because the SSA thinks:
• The
evidence does not show a serious medical problem; or
• The
disability won’t last 12 months; or
• The
person can do some type of work even if it is not their regular work.
If you think
Social Security was wrong in denying you DIB or SSI benefits you can fight
the decision by: asking for a reconsideration and (if you still
don’t get benefits) (2) then asking for a hearing.
(You have to go
through a reconsideration before you can ask for a hearing.)
How do I ask
for a reconsideration?
To get the SSA
to reconsider your claim you must write the local Social Security Office
within 60 days of the denial of benefits. You must also sign and give
SSA a form entitled “Request for Reconsideration.” Your case will be
reviewed again and you will be notified by mail of the decision. Most of
the time you will again be turned down.
Do not be
discouraged if your claim is denied at first or on reconsideration. Many
people win their cases at hearings.
How do I ask
for a hearing?
If your request
for reconsideration is denied, you can appeal the decision by asking for a
hearing. The hearing is your chance to explain your situation face-to-face
to someone who can grant you benefits. You can have a lawyer represent you
at the hearing. (See below.) Many people win benefits after the hearing, so
it is worth trying. If you don’t appeal your case you can apply again later,
but you might no longer be eligible for benefits or you might get a smaller
amount of retroactive benefits. You must ask for a hearing in writing
within 60 days of the date of denial of reconsideration. Forms for
appeal are available from any Social Security office. On the form for
requesting a hearing, be sure to mark the box by saying that you want to
"appear" at your hearing.
DISABILITY HEARINGS
When and where will the hearing be?
After you
request a hearing it usually (but not always) takes approximately one
year for the Social Security hearings offices in Oregon to set a hearing
date.
Social Security
will tell you the date and place at least 20 days in advance. The hearing
will usually be held within 75 miles of your home. If the hearing will be
held more than 75 miles from your home you and your witnesses will be paid
back for reasonable travel expenses.
What happens at the hearing?
An
administrative law judge will run the hearing. The judge’s job is to make an
independent decision based on the evidence in your case. This evidence
includes medical records, other documents, and testimony you and others give
at the hearing.
The judge will
question you about your disability. The hearing is private and is held in a
small conference room. The only people at the hearing will be the judge, the
judge’s assistant, you, your representative, and any witnesses. The judge
will usually also ask a “vocational expert” to testify and sometimes also
ask a “medical advisor” to testify. The hearing will be tape-recorded.
Can
I be represented at the hearing?
You can go to
the hearing with a lawyer. You do not have to have a lawyer, but if you can
get a lawyer to represent you, you have a better chance of winning. It is
important to obtain an attorney with experience in representing Social
Security disability claimants. You should ask the attorney you talk to how
many years of experience he or she has with Social Security representation
and how many hearings he or she has handled.
An attorney can
help you with:
• Gathering medical
and other evidence.
• Analyzing your case
under Social Security Regulations.
• Contacting your
doctor and explaining Social Security Regulations to obtain
a report consistent with the regulations.
• Referring you to
specialists for further medical reports to answer questions raised by Social
Security Regulations.
• Sending you to a
vocational expert for a report on your ability to work.
• Suggesting that SSA
send you to a doctor for a consultative
examination.
• Obtaining documents
from your Social Security file.
• Reviewing actions
taken by SSA.
•
Asking that a prior application for benefits be reopened to obtain more
retroactive benefits for you.
• Seeking waiver of a
time limit.
• Requesting
subpoenas to assure the appearance of crucial witnesses at your
hearing.
• Advising you on how
to best prepare yourself for your hearing.
• Protecting your
right to a fair hearing by objecting to improper evidence and procedures.
• Cross-examining
adverse witnesses at your hearing.
• Presenting a
closing argument at your hearing.
• If you win, making
sure that SSA is paying you the appropriate amount of benefits.
• If you lose,
requesting an appeal of your case to the Appeals Council.
• If necessary,
representing you in a federal court review of your case.
An attorney
will usually expect a fee for representing you, and normally you will be
charged a fee only if you win your case. The fee must be approved by the
Social Security Administration and is usually in the amount of 25% of your
back benefits. Talk to the lawyer about the fees when you first contact the
attorney. Make sure you understand and agree to any fee agreement you sign.
You will also
be responsible for what are called "out of pocket" costs of your case
whether you win or lose. These costs usually involve charges by medical
providers for copying costs or letters, and in a typical case are less than
$100.00.
Preparing for a Disability Hearing
Should I prepare for the hearing?
It is usually
very important to prepare for a Social Security hearing. Your chances of
winning the hearing are much better if you take time long before the hearing
to:
• Get
the medical evidence you need, whether it is obtaining existing records or
asking
your doctors their opinions;
•
Think about the testimony you’ll give;
• Get
witnesses who can give information about your disability.
It is part of
an attorney's job to take care of these things.
Evidence at the hearing
What evidence do I present at the hearing?
You need to
prove that you have a serious medical problem that has lasted or that will
last for at least 12 months, or will result in death, and that keeps you
from working. You do this with:
• Medical
evidence
• Your
testimony
• Testimony
of witnesses
What kind of medical evidence do I need?
SSA helps you
gather medical information for your case, but sometimes they do not have all
the medical information that is available. It is important that your SSA
file has all of the medical information in your case (from your treating
doctor, medical specialists who have seen you, any hospital records, etc.).
If you think there is anything else the judge should see before making a
decision in your case, you can ask the judge if you can add that information
after the hearing.
Your Testimony
What will I testify about at the hearing?
1. Medical Condition
The judge will
ask how your medical condition makes you feel. You should tell the judge
about the symptoms you experience such as pain, dizziness, numbness, nausea
or paralysis as well as you can.
For example, if
your case involves pain, you might be asked:
• Is
the pain burning, stabbing, crushing, sharp, throbbing, radiating or
aching?
• Do
your activities affect the pain?
•
What do you do to relieve pain?
•
What medicine do you take for pain?
• How
well does the medication work?
• Are there any side effects from the pain medication?
Before the
hearing, you should make notes to yourself about what conditions you have
and how they affect you. Don’t leave anything out.
2. Medical History
The judge may
ask you how often you see your doctor, what sort of treatment your doctor
provides, what medication you are presently taking, how often you take each
medication and whether there are any side effects. You may also be asked to
describe the symptoms and treatment of your medical condition since it
began. You may be asked what your doctor has told you about your problem,
but the judge won’t ask you medical questions about your disability.
3.
Physical Abilities
If you have a
physical disability, the judge will ask you a lot of questions about what
you are able to do. For example:
• How far
you can walk before resting;
• How long
you can sit and stand at one time during an eight-hour day;
• How much
you can lift.
4.
Mental Abilities
The judge will
ask about your ability to understand, carry out and remember instructions,
to use good judgment, to respond appropriately to supervision, co-workers,
usual work situations, and changes in your work setting.
5. Education and Training
The judge will
ask you how far you went in school, if you have had any training in the
military, if you can read and write, and if you have had any job training.
6. Work
Experience
The judge will
ask you about the jobs you have had during the past 15 years. If your
condition caused you to miss a lot of work or caused you to stop working,
you should explain this.
7. Daily Activities
The judge will
ask you a lot of questions to find out how your disability affects you. For
example:
• How
do you spend your time during the whole day;
• How well you usually sleep;
• If you take naps during the day;
• What things you do around the house, such as cooking, housework,
or gardening;
• If you go shopping;
• If you drive a car;
• What hobbies and activities you have now.
You may also be
asked how your daily routine has changed since you became disabled. For
example, what kinds of activities did you do before you became disabled that
you can’t do now?
Witnesses
Can I have witnesses at the hearing?
You can bring
relatives, friends or others to the hearing as witnesses. Good witnesses are
persons who see you regularly and see how your medical condition affects
you. The best witnesses are usually not friends or relatives, but someone
else who knows you, such as a neighbor or former boss. Witnesses should talk
about the activities that you are not able to do.
What is a “Vocational Expert”?
Usually the
judge will ask a vocational expert to testify at the hearing, at SSA's
expense. A “vocational expert” will testify whether or not your disabilities
make a job too hard for you to do, and which jobs you might be able to
perform in spite of your disabilities.
What is a “Medical Advisor”?
Sometimes the
judge will ask a doctor or psychologist to testify at your hearing. The
medical advisor is paid by SSA to help the judge decide if you have a
serious medical problem that keeps you from being able to work.
AFTER THE
HEARING
When will I
get the results of the hearing?
It often takes
a few months to receive a decision from the judge. It is very unusual for a
judge to announce a decision at the hearing.
What happens
if I win the hearing?
If you win
benefits, you will get DIB benefits retroactively depending on the date that
you applied and on the date the judge says you became disabled. For SSI, you
can only get benefits as far back as the first day of the next month after
your application.The judge may also request that you have a "representative
payee" if you have trouble handling money. This is a person who gets your
checks on your behalf. If a representative payee is recommended you should
think about who would be willing to help you in this way. SSA will ask for
your suggestions.
What happens if I lose the hearing?
If you lose
your hearing you can ask that your case be reviewed by the Social Security
Appeals Council. You must make this request within 60 days of your
unfavorable hearing decision. Your attorney will normally do this for
you.If the Appeals Council refuses to review your case or decides against
you, you have another 60 days to appeal to the U.S. District Court in your
area. You will need a lawyer to appeal your case to the federal court.
Once I’m on DIB or SSI, what can I do if
Social Security tries to stop or reduce my benefits?
If you are
getting SSI or DIB, Social Security may review your case at some time to see
if your medical condition has improved and, as a result, if you are now able
to work.
If SSA reviews
your case, and if you are still disabled, try to get medical evidence from
your doctor that shows that your condition has stayed the same or is now
worse. It is also very important to get a lawyer to represent you if you
can.
If Social
Security decides to terminate your benefits, you can appeal the decision.
You will have 60 days to make a written request for an appeal. But,
if you make a request within 10 days, your benefits will stay the same until
you have a hearing and the Administrative Law Judge has made a decision on
your case. If you receive an unfavorable notice, appeal immediately! If you
lose the appeal you may be asked to pay back the benefits as an overpayment.
OVERPAYMENTS
What should I do if I get a notice of
overpayment?
You will get a
notice of overpayment if the SSA thinks they paid you more money than you
should have received. If this happens, you can:
1) File for
reconsideration if you think the amount of the overpayment is wrong or
there was no overpayment.
2) File for
a waiver of repayment if you think the overpayment was not your fault
and you cannot repay the money. A request for a waiver asks SSA to free you
from having to pay back the overpayment.
If you do not
want your checks reduced while you are contesting the overpayment, SSA
should stop trying to collect the overpayment if you
a) ask for reconsideration or waiver within 30 days of the date of
the overpayment notice
or
b) ask for waiver at a later time. (If your request is more than 30
days after the date of the overpayment notice, SSA probably will have
started to try to collect the overpayment. But they should stop when you
make your request.)
If the
overpayment is not successfully contested, and SSA does not waive the
overpayment, and you are continuing to receive benefits SSA will recover
the overpayment from the money you are being paid. If you are not receiving
benefits it is very unlikely that SSA will take action against you to
collect the moneys. Normally SSA will simply wait until you are again
entitled to benefits and recover the overpayment at that time, without
interest.
|
