We do our best to stay in good health. We try to exercise, eat right, and stay safe when driving or participating in outdoor activities. Unfortunately, our lives don’t always go according to plan and sometimes, we’re injured or fall ill with a debilitating disease. Such an injury or illness may be temporary, but it may also have lasting effects on the rest of your life. If one of these is that you are no longer able to work, you may be eligible for Social Security Disability Benefits.
Social Security is something we all contribute to. It comes out of our paychecks, so that when we reach an age or condition at which we can’t work anymore, there’s a pool of funds to assist those who have become disabled. If you’ve been seriously injured and can’t work, receiving these benefits can help you maintain at least some quality of living and help ease the stress of the injury or illness.
SSI vs. SSDI: Which Might I be Eligible for?
The Social Security Administration defines a disability as a physical or mental condition that prevents you from engaging in “gainful activity (read: employment).” Under the SSA, there are two different programs you may be eligible for in the event that you are disabled permanently or in the long-term: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
Social Security Disability Insurance (SSDI) is for individuals with disabilities who have already been in the workforce for a certain number of years. One of the main requirements for receiving SSDI is that you must have worked 5 of the last 10 years before you became disabled.
Supplemental Security Income (SSI) is a program run jointly by the SSA and the government of the state you live in. It’s designed to assist disabled or elderly individuals with low incomes and few assets. Rules vary based on where you live, so research your state’s laws to ensure a good understanding of any state-specific requirements.
There’s a big difference between SSDI and SSI. Not sure which you’re eligible for? Click here to learn more.
How to File for Social Security Benefits
The SSA website lists three options for beginning your disability benefits claim. You can:
- Apply online
- Apply over the phone by calling 1-800-772-1213, or, if you are hearing impaired, 1-800-325-0778
- Call or visit your local Social Security office to apply
Claims can take anywhere from 3-5 months to be decided upon. You can help expedite this process by gathering certain information, medical files, and documents in advance. Pull together as much of the following as you can:
- Your Social Security Number (SSN) and proof of age (birth certificate is the best option).
- Contact information (name, address, phone number) and dates of each visit for any and all doctors, caseworkers, or hospitals/clinics that have treated you.
- Prescription information (names of drugs, dosages, etc.).
- Medical Records from any doctor’s visits you’ve had.
- Lab or test results, if applicable
- A description and summary of your previous job and work experience
- The most recent W2 you have, or a copy of your tax return (if self employed).
If your spouse or another family member is also applying for benefits, you’ll need their social security numbers and proof of age, as well as the dates of any prior marriages, if applicable.
How Claims Are Decided
Unfortunately, not everyone who applies for Social Security Disability benefits receives them. Claims are decided based on meeting certain financial and medical requirements. On the medical side of things, the claimant’s condition must be severe and either:
- Meet the requirements of the Social Security impairment listing
- Prevent you from working a job you’ve held before
- Prevent you from doing any other job appropriate for your age, education level, and skill set
Financially, if you are seeking disability benefits and you are making a certain amount of money per month, you are considered gainfully employed and therefore ineligible for benefits. The SSA offers guidelines on what is considered to be “Substantial Gainful Activity.”
The SSA also uses a five step analysis system to determine if you’re eligible for benefits. This system ensures that every person applying for benefits gets the same consideration as anyone else, regardless of any potentially discriminating factors like age, gender, or race. The analysis asks five questions of applicants’ individual situations:
- Are you working?
- Is your condition severe?
- Is your disability on the list of disabling conditions?
- Can you do the work you did previously?
- Can you do any other type of work?
Being Denied Social Security Benefits
The rules and regulations regarding who can receive benefits are stringent and every year, a certain number of cases are denied for a myriad of reasons. On average, only about 30% of submitted claims are approved, leaving the majority of people in the position of appealing the decision or finding an alternative.
While some of the reasons for being denied may be ones that are out of your hands, there are 8 common reasons individuals are denied benefits. Being aware of these can help you either avoid a denial or be prepared with a plan B in the event you are denied. These reasons are:
- You earn too much money
- Your disability is viewed by the SSA as being temporary or insufficiently severe
- You’re unreachable or fail to keep in communication with the SSA
- You refuse to provide required documentation
- You are not completing therapy as prescribed
- Your disability is the result of drug or alcohol addiction
- You’ve been convicted of a crime
- Your application contains lies and/or is fraudulent in some way
Most of these reasons do have exceptions, but as a general rule these are the most likely reasons applicants are denied. The good news is that if your case is denied, you can appeal it and have the case submitted to an administrative law judge for reconsideration.
Appealing Your Case
The appeals process can be long and a little tricky. Having an experienced Denver Social Security Disability lawyer on the case can give you peace of mind knowing that your appeal is being handled quickly and efficiently.
There are four levels of appeals. The attorneys at the Frickey Law Firm will evaluate your case to help you determine which is right for your situation but for now, we’ll provide a brief overview of each kind of appeal.
- Reconsideration: This appeal involves the complete review of your claim by a member of medical personal who was not involved in the original decision to deny your case. Very few cases are won at this level, and some states do not provide the opportunity for reconsideration at all. If either of these are the case, you’ll need to move on to step two.
- Administrative Law Judge (ALJ): Many applicants find themselves in a hearing with an ALJ. These judges work for the SSA and most of their job involves reviewing and subsequently approving or denying existing claims. On average, more than 60% of cases that make it to an ALJ are approved.
- Appeals Council: If the ALJ has denied your case, you are then free to request that the appeals council review it. This route carries a low chance of success, partially because the cases for review are randomly selected, and partially because the appeals council can deny your case for a wide spectrum of reasons. Unfortunately, it’s a route that must be taken before you can take the SSA to court.
- Federal Court: If you’ve reached this stage of appeals, you will need the help of a Social Security Disability Lawyer. You, with the help of your attorney, will need to obtain a court summons, serve it to the SSA, and prepare a brief before a court date is ever set. While your chances of winning might be pretty good, less than 1% of cases ever make it to federal court.
When to Hire an Attorney
The short answer is that hiring an attorney as early in the claims process as possible only stands to help when and if things get tough. The last thing you should be worrying about after a serious injury or illness is dealing with the bureaucracy of the SSA. The Colorado Social Security Disability attorneys at the Frickey Law Firm have handled SSI and SSDI claims at every stage. We’ll represent you during your first administrative hearing in front of the judge all the way through the appeals process.
If you’ve become ill or have been seriously injured and are no longer able to work, you deserve to receive Social Security Disability benefits. We can also represent children who suffer from debilitating illnesses such as cerebral palsy or autism. Our consultations are free, we don’t charge any up-front fees, and we only get paid if the SSA accepts your claim. Now is when you need us most. Contact the Frickey Law Firm at (303) 59-LEGAL or (303) 595-3425 to set up a free consultation and review of your SSI or SSDI case.