Social Security Disability

Under the Social Security Act disability is defined as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.

The first thing to be recognized is that the definition of disability contains an economic component (substantial gainful activity) and a medical component. Substantial gainful activity is currently defined as the ability to earn $1,000.00 or more per month. If an individual is earning at, or more than $1,000.00 per month, then that individual will not qualify for disability, because their earnings are too high. This is regardless of what their physical or mental problems may be. Even an individual with terminal cancer, for example, who is working and earning more than $1,000.00 per month, will not qualify for disability.

The medical component requires that an individual have physical or mental problems (or both) which have lasted or can be expected to last at least 12 months. The determination of disability from a medical standpoint is based on a review of an individual's medical records. There must be objective medical evidence to support a finding of disability. No finding of disability can be made merely based on an individual's complaints. Many people are not insured and have no access to health care. They may have visited emergency rooms for care, but their medical record is quite sparse. In such instances the Social Security Administration may send the claimant for a consultative examination to determine the individual's condition. This examination would be conducted by a doctor hired by the Social Security Administration. The exam, however, would be only a one-time examination by a doctor who does not know you. Further, the doctor is limited in any testing he or she can order. The examination may or may not confirm your medical problems.

Claims are evaluated not only from a medical standpoint, but a vocational standpoint as well. The vocational aspect consists of an evaluation of your age, education and work experience. The Social Security Administration has established 3 age categories. A younger individual is defined as below the age of 50. From the age of 50-55 an individual is categorized as approaching advanced aged. From 55-60 an individual is of advance age. Individuals aged 60-62 are closely approaching retirement age. Once an individual reaches the age of 50 the vocational rules (or "Grids") begin to relax and less is expected of an individual to be able to adapt to other work.

FILING FOR DISABILITY

There are 3 ways to file an application for Social Security Disability benefits. You can file online by going to the Social Security website at www.ssa.gov and in the middle top of the home page is a spot where you can click to apply for disability benefits. The application process is somewhat lengthy. However, should you need to stop for some reason you will be assigned a re-entry number that will allow you to return to the spot where you were without having to start all over again.

You can also apply for disability benefits by calling Social Security at 1-800-772-1213. When you do this you will be asked a few questions and then an appointment will be made for your local Social Security office to call you to conduct a more detailed interview or you can tell the representative you are talking to that you would like to appear for the conference at your local Social Security office. It is always best to have an appointment if you are going to go to your local Social Security office.

Finally, you can apply for disability benefits by going to your local Social Security office. Again, this is not the preferred method since you will not have made an appointment and you may face a lengthy wait.

THE DISABILITY EVALUATION PROCESS

When your claim is initially filed it will go to the state office hired by the federal government to handle the first two stages of the disability evaluation process. This agency is known as DARS (Department of Assistive and Rehabilitation Services). In Texas this office is located in Austin. There they will collect your medical records and they will be evaluated by a doctor, or possibly more than one doctor, as well as vocational experts, who will make a recommendation as to whether you are disabled and whether you meet or equal a Listing (see below). It can take 3-5 months for a decision to be made at this stage. It is not uncommon for your claim to be denied at this particular level of the process.

If your claim is denied you will receive a Notice of Decision which will contain an explanation as to why your claim was denied. We encourage applicants for Social Security Disability to call the Law Offices of Michael Sloan at this stage so that we can begin to assist you in developing the record so that you can obtain a favorable decision.

If you are found disabled Social Security will issue you a notice stating that you have been found to meet the medical requirements for disability. Your case will then go to a payment center for processing and both your monthly and past-due benefits will be calculated.

If your claim for disability benefits is denied at the first stage you have the right to file a Request for Reconsideration. At this point you will be asked to update your information, such as any other doctor's visits of hospitalizations you may have undergone since originally filing for disability. This request will also be handled by the state agency, but another doctor or doctors will be assigned to do the review. It can take another 90-120 days for a decision to be made at this stage.

If you are denied at the Reconsideration stage you have the right to request a hearing before an Administrative Law Judge. It is at this point that your case would come under the direct jurisdiction of the Social Security Administration and your claim would be considered by an Administrative Law Judge at a hearing that would be conducted at a hearings office. The number and location of hearing offices varies throughout the country. In Dallas there are two hearings offices. In Fort Worth there is one hearing office. Hearing Offices vary on how long you have to wait for a hearing. The processing time at some hearing offices takes longer than others. This is due to how many appeals the office receives, as well as its staffing level.

If you go to a hearing and lose, you then have the right to appeal the decision of the Administrative Law Judge to the Appeals Council and request review. In fact, all decisions, whether favorable or unfavorable, can be reviewed by the Appeals Council for a period of 60 days following the decision. Should the Appeals Council decide that the Administrative Law Judge who heard your case made an error it does have the power to enter a decision in your favor, but the more likely action is that it will send your case back to the Administrative Law Judge (a process called "remand") for a second hearing. Administrative Law Judges are usually given two chances to hear a case. If they hear a case twice and are reversed twice the case will be sent back to be heard by another Administrative Law Judge.

If the Appeals Council should deny your request for review you then, finally, have the right to file a lawsuit in federal court. Such cases are difficult to win. The issue is whether the decision of the Administrative Law Judge is supported by substantial evidence. This is a difficult standard to satisfy. Sometimes, however, you have no choice but to fight.

HIRING AN ATTORNEY

The Law Offices of Michael Sloan encourages that you hire an attorney early in the disability application process. Attorney's fees in a Social Security disability case are governed by federal law and almost all contracts contain the following elements:

  1. There is no fee unless your claim is successful;
  2. Fees are limited to 25% of past due benefits or $6,000.00, whichever is less;
  3. The fee must be approved by the Social Security Administration prior to payment.

HOW MUCH WILL I BE PAID?

It is impossible for us to determine what you would be paid on a monthly basis if you are found disabled and how much you would be owed in past-due benefits. However, every year you receive a Personal Earnings Statement from the Social Security Administration. Page 2 provides an estimate of what you would receive in disability benefits. If you do not have your earnings statement you can order one through the Social Security website, www.ssa.gov.

For more information on Social Security Disability, please click HERE.

Handicapped accessible. Located directly east of Highway 75 near the historical district. Weekend appointments available.

Texas lawyer Michael Sloan represents clients in McKinney, Plano, Frisco, and throughout the Dallas-Fort Worth Metroplex, in communities such as Allen, Richardson, Prosper, Wylie, Murphy, Sachse, Sherman, Denison, Bonham, Anna, Van Alstyne, Greenville, and Celina, and in Dallas County, Grayson County, Hunt County, Fannin County, Collin County and Denton County.