Social Security Disability

Deciding to Apply

Often the decision to apply for Social Security disability benefits can be difficult.   Some factors to consider when deciding whether you should file an application:

1. You may be eligible for disability benefits if you are working less than full-time.  If you have had to cut your hours to less than forty (40) hours a week due to a mental or physical impairment and are earning less than $940 a month before taxes, you should consider filing an application especially if you anticipate having to cut your work activity even more in the future. 
2. On average, it takes approximately twenty-nine (29) months for a disability claim to resolve from the time you file an application through the administrative hearing level.
3. A delay in filing an application for Social Security disability benefits may result in the loss of monetary benefits. 
4. The cause of your disability is not important in a claim for Social Security disability benefits, unlike claims for Workers’ Compensation or Personal Injury.
5. There may not be an offset for VA benefits received, if you are 100% service-connected.
6. If you are able to return to work, you can withdraw your application.

Types of Disability

There are two main types of disability benefits, Social Security disability insurance benefits and Supplemental Security Income.

Disability Insurance Benefits:  You are only eligible for these benefits if you have paid a certain amount of Social Security tax over a period of time, making you insured.  To be insured, you must have worked and paid Social Security tax for about five of the last ten years before you became totally disabled. There is a different, easier rule for people whose disability began before age 30. In any event, you will be insured for a limited period of time after you stop working.  A claimant must prove that he or she was under a disability prior to the expiration of the disability insurance or they will not be entitled to benefits, no matter how serious the medical condition is now. The bottom line is that if you wait to file benefits, your insurance may expire leaving you ineligible for disability insurance benefits forcing you to rely on the Supplemental Security Income (“SSI”) program.  This program is based on financial need and, as a result, will make most ineligible.  

If your claim is approved, the monthly payment you will receive is set by your earnings (and Social Security tax payments) during your working career. There is no minimum rate, and the maximum a person can receive at this time is over $2,100 per month. There is a cost-of-living raise in the monthly payment at the start of most years. In many cases, your dependent children will also get benefits in addition to your own.  Another reason to file an application as soon as possible is to maximize your entitlement to retroactive benefits, or back pay, which is only payable a year back from the date an application for disability benefits was filed.  

Supplemental Security Income:  SSI can be paid whether or not a person has paid in enough Social Security tax to get disability insurance benefits. You must be disabled under the same rules as for disability insurance, or be blind, or be over 65. You must also have very little income or property, because this benefit is based on financial need. Social Security looks at all other income and property in the household you live in, not just your own, and also the value of any support (like free room and board) you may get from others, to determine whether you are financially eligible for SSI. Social Security does this in addition to deciding if you are disabled. Also, some children 18 or younger with a severe disability can get a monthly benefit if their family income is low enough.

The maximum SSI benefit amount is $637.00 a month.

Retroactive benefits, or back pay, for an application for Supplemental Security Income (“SSI”) are only payable from the first full month after you file an application.  There is no provision for retroactive benefits prior to the date your application was filed.

Other types of disability benefits include:

Disability Widow/Widower Benefits:  This is a special disability benefit for certain widows and widowers, based on the Social Security tax paid by his or her deceased spouse. In order to qualify, you must be between ages of 50 and 60, and have been married for at least 10 years to the person who was covered under Social Security at the time of his or her death. Also, you must have proof that your disability was severe enough to meet these rules within seven years of your spouse's death, with some exceptions for those already receiving other kinds of Social Security benefits. If you are awarded benefits, your monthly rate is determined by your spouse's income and Social Security tax payments. However, a surviving spouse's pension can usually be paid at the age of 60, regardless of any disability.

Disabled Adult Child Benefits:  In order to be eligible, you must be a child of a person already receiving Disability Insurance Benefits or Retirement Benefits, or who died while covered for Social Security. You must be at least 19 years old, and you must prove your total disability began before the month you turned age 22, and is continuing. The monthly benefit rate is based on a percentage of your parent's rate. Therefore, it is different in each particular case.

The Application Process

Once you have made the decision to apply, you should file an application as soon as possible to avoid losing any benefits to which you might have otherwise been entitled.

An application for Social Security disability benefits may be filed online, at www.ssa.gov, by telephone toll free, at (800) 772-1213, and in person at your local office.  The local office serving the greater Pensacola, Florida area is located at 411 West Garden Street, Pensacola, Florida.  To locate your local office outside the Pensacola area, click here.  Each local office has different processing times; however, it will usually take between 30 to 180 days to process an application.  Once the application is processed, you will receive a decision.  If the decision is unfavorable, you must file an appeal within sixty (60) days from the date on the denial. 

Since the appeals process varies from state to state, the state in which you will reside will determine the type of appeal that should be filed.  If you are a Florida resident, there are three levels of the application process, the initial application level, the reconsideration level and the administrative hearing level.  If you are an Alabama resident, there are only two levels, the initial application level and the administrative hearing level. 

Florida residents will submit a request for reconsideration to the reconsideration level.  Alabama residents will file a request for hearing; see the section below for a discussion on the hearing level.  In general, it will usually take between 30 to 180 days for an appeal to be processed at the reconsideration level.  Once the appeal is processed, you will again receive a written decision.  If the decision is unfavorable, a request for an administrative hearing must be filed within sixty (60) days from the date on the denial. 

Once an administrative hearing is requested, it will take approximately sixteen (16) months for an administrative hearing to be held.  This is where the claimant appears before an administrative law judge and presents evidence supporting the application for disability benefits.  At the hearing, the administration may ask either vocational or medical experts to be present and testify, or both.   After the hearing, a written decision will be issued in 30 to 90 days, sometimes longer. 

How Will Social Security Evaluate My Claim?

The SSA will evaluate your claim using the five-step sequential evaluation process listed below.

STEP 1: Are you working?

You may still be found disabled even if you are working as long as you are not working at a level determined to be substantial by the administration.  Earnings in excess of $940.00 a month and working 40 hours a week, regardless of your pay, will usually be determined to be substantial.

STEP 2: Is your condition severe?

Your condition must interfere with basic work-related activities for your claim to be considered.  If your condition does interfere with basic work-related activities, go to  "http://www.ssa.gov/dibplan/dqualify6.htm" Step 3.

STEP 3: Is your condition found in the list of disabling conditions?

For each of the major body systems, a  "http://www.ssa.gov/disability/professionals/bluebook/listing-impairments.htm" list of medical conditions that are so severe they automatically mean that you are disabled has been established by the administration. If your condition is not on the list, it must be determined if your condition is of equal severity to a medical condition that is on the list.  If it is, you are disabled. If it is not, go to Step 4.

STEP 4: Can you do the work you did previously?

If your condition is severe but not at the same or equal level of severity as a medical condition on the list, then we must determine if it interferes with your ability to do the work you did previously. If it does not, your claim will be denied. If it does, go to Step 5.

STEP 5: Can you do any other type of work?

If you cannot do the work you did in the past, the administration will evaluate your ability to adjust to other work.  Your medical conditions and your age, education, past work experience and any transferable skills will all be considered.  If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied.

Why Retain an Attorney?

Claimants with representation win their cases more often than those who are not represented.

There are no fees or costs unless we win your case.  Cases are generally handled on a contingency basis. That means the representative receives a fee only if you win your case. Normally the fee is 25% of your back benefits and must be approved by Social Security. If you do not win your case there is no fee.

Applying for Social Security disability benefits can be a long and complex process.  We are dedicated to making this process as stress-free as possible for you.  That is why we deal directly with the Social Security Administration on your behalf.  We will help you with the application and appeal process, including completing forms.  Another way that we make this process a little less stressful for you is to gather all of your medical records from your physicians.