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Social Security Disability and Supplemental Security Income Claims: An Overview

There are two similar, but distinct, social security programs through which individuals can be considered for disability benefits.

In order to be entitled to social security disability benefits, an individual must be disabled and "insured." In order to be entitled to supplemental security income benefits, an individual must be disabled and "poor."

Disability is generally defined as the inability to perform any jobs that exist in substantial number in the national economy.

An individual generally becomes insured by working and paying social security taxes. Each quarter of a year you work and pay taxes is a "covered" quarter. You must be "covered" for twenty out of the previous forty quarters before your onset date.

Even individuals with no work history can be eligible for Supplemental Security Income benefits if they are both disabled and "poor."

The Social Security Administration considers an individual's age, education, work history (sedentary, light, medium, or heavy; unskilled, semi-skilled, or skilled), and perhaps most significantly, an individual's residual functional capacity, i.e., what are your abilities in terms of sitting, standing, walking, lifting weight, etc.

People are disabled by symptoms. However, the law requires that before an individual's symptoms are considered, it must be established that the individual has a medically determinable impairment that can cause those symptoms. For example, if I am disabled as a result of headaches, but no cause for my headaches can be determined, I will probably not be found to be disabled.

Once it is established that an individual has a medically determinable impairment that can cause totally disabling symptoms, the next step is to obtain a medical opinion that in fact the impairment does cause totally disabling symptoms.

The application process normally includes filing an application, filing a request for reconsideration if the application is denied (in our area presently the reconsideration process has been eliminated on an experimental basis), and filing a request for a hearing before an Administrative Law Judge if the claim continues to be denied. The hearing before the Administrative Law Judge is an administrative proceeding, rather than a formal judicial proceeding, and thus the formal rules of evidence do not apply. The hearing normally lasts between thirty and sixty minutes.

The Administrative Law Judge evaluates the claim primarily based upon the medical evidence. It is crucial that the individual have an attending physician who will complete forms documenting both the medical impairment and the resulting functional limitations from that impairment. The Administrative Law Judge also considers the individual's testimony regarding the symptoms and the limitations they impose and also regarding the individual's activities of daily living. For example, if an individual states that he can not perform sedentary work, and yet he also testifies that he bowls three times a week and engages in other recreational activities, the Administrative Law Judge may find that the claimant's testimony about his limitations in terms of ability to work are not credible.

If an individual receives an unfavorable decision from the Administrative Law Judge, a further appeal can be made to the Appeals Council, and if the claim is still denied, an action can be brought in United States District Court. However, the Federal Court will not simply substitute its opinion for the opinion of the Administrative Law Judge. Rather, the Court will evaluate whether there is substantial evidence to sustain the determination of the Administrative Law Judge. If there is insufficient evidence to sustain the unfavorable determination, the claim may be paid, or more likely, it will be remanded for further proceedings.

We normally counsel individuals to consider filing an application without an attorney, with the hope that the claim will be processed favorably without legal expenses. However, if the claim is denied, we believe an individual should obtain the assistance of an attorney before filing the request for hearing before an Administrative Law Judge. Attorney's fees are generally on a contingent fee basis and are the lesser of 25% of the retroactive benefits or $5,300.00.

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