In the United States, we have a system to protect people who due to illness or injury become unable to work. We call this system “Social Security”, and benefits can be paid out so long as the condition will last at least one year or result in death. Benefits come from our tax system, whereby FICA taxes that were deducted from yours and my paychecks while we were working are used to pay disability benefits when we are no longer able to work.
There are two benefit programs available to people. The first program is called Social Security Disability Insurance or Disability Insurance Benefits (“SSDI” or “DIB”). You must be “insured” for benefits under this program in order to get benefits, which usually means that you must have worked and paid FICA taxes for 5 out of the last 10 years ending when you become disabled. The second program is called Supplemental Security Income (“SSI”), which is a needs-based program. In addition to being disabled, you must also meet the financial requirements of the SSI law, meaning that you must be “poor” enough to qualify for this benefit. In certain rare circumstances, an individual can receive both SSDI and SSI benefits at least initially when their case is won. In only a small handful of circumstances will a person get both benefits on an ongoing basis.
Most people are very surprised when they become disabled through injury or illness. An injury is usually a traumatic event that was unexpected, like a car accident or a work accident. The illness may come about initially from a doctor’s diagnosis, which a person might receive many years before he or she can work no longer. And because most people are taken by surprise when they become disabled, they are not mentally, emotionally, or financially prepared to be off from work. This is why people continue to work until they absolutely are unable to work any longer. We call this point the “Disability Onset Date.” While this date is not always obvious, it usually means the date you can no longer work and earn wages.
The Claims Process
While a person may file an application for SSDI by filing online as well as by mail or telephone, an application for SSI must be filed in person at the local office of the Social Security Administration to be considered effective. The government has gone to great efforts in trying to make the application forms simple and easy to understand and complete. Nevertheless, you will be required to fill in many blanks; to provide a great deal of specific information, such as dates of employment, contact information for your doctors, and hospitalizations you have had. If you have any questions about any of the questions you must respond to, feel free to give us a call to discuss the matter. We will provide you this advice free of charge, as we only get paid a fee when we accept your case for representation and win your claim for you.
The initial application stage usually lasts only 3 to 5 months. Once the local Social Security office verifies your eligibility information, it usually sends your file to the nearest location of the Division of Disability Services (“DDS”), a state agency whose job it is to develop the medical evidence and issue an initial decision on whether you meet the medical requirements to be considered disabled. DDS might call you, or your doctors and other health care providers. They may collect some of your medical records and reports. They might even set up an examination for you to attend, either for diagnostic testing or an actual hands-on medical or psychological exam. Your file will then be sent back with a “Medical Advisor’s” (MA) finding that you are or are not disabled. More than 80% of the time, this results in our clients receiving in the mail a “Notice of Disapproved Claim”, giving them 60 days (plus 5 days mailing time) to appeal.
The appeal of this initial denial is called a “Request for Reconsideration.” We are often called upon to help our clients to file their initial applications. Many occasions, however, it is at this initial denial and request for reconsideration point that disabled persons decide to retain our services and we are glad to get involved as early as possible in their claims. The reconsideration process is almost identical to the initial claim process, with the file again being sent to DDS for a medical review. This time, however, DDS usually employs a medical doctor to review the claim instead of a medical advisor who might not be a medical doctor. However, more than 70% of all reconsideration requests result in persons receiving a document from the SSA entitled a “Notice of Reconsideration” informing them that their claim is once again denied. The individual is then given another 60 days to appeal, by filing a “Request for Hearing by Administrative Law Judge” or an “ALJ.”
Once we file a request for an ALJ hearing, the big wait begins. In the 31 years since Mr. Soloway began representing disability claimants in Florida and Alabama, the wait time for the ALJ hearing to occur ranges from 12 to 16 months from the date it is requested from the Mobile, Alabama Office of Disability Adjudication and Review (“ODAR”) that covers our area. While we are waiting for a hearing to be scheduled, we send periodic medical updates to the ODAR office and prepare your case from both a factual and legal standpoint, completing all research necessary to build and win your case.
The hearing may include testimony by the claimant and usually a vocational or job expert, although sometimes a medical doctor may give consultive testimony. It usually lasts about an hour and is recorded. The hearing may take place in Pensacola (by video conference) or in a live setting in Mobile, Alabama. After the hearing, the ALJ will make a written decision and send a copy to the claimant and the attorney. A favorable decision will result in the file being returned to the Social Security Administration for processing. An unfavorable decision may be appealed to the Appeals Council in Falls Church, Virginia. Any appeals made beyond this last administrative review by the Council would have to occur in the Federal Court System.