Federal Social Security Law Overview

If you are reading this, it is most likely that you applied for and believe you were wrongfully denied Social Security Disability Insurance Benefits (SSDI) or Supplemental Security Income (SSI) benefits.

The Social Security system is designed, as the title suggests, to provide security to the elderly, blind and disabled. The basis of your disability under Social Security depends on your inability to work. You will be considered disabled if you cannot do the work that you did before, and if you cannot adjust to any other type work because of your physical and/or mental condition(s). According to the Social Security Administration, you must be “completely disabled from performing substantial gainful activity” to be eligible. Your disability must last or be expected to last at least 12 continuous months or result in death. The medical and vocational requirements are the same for both SSDI and SSI benefits. However, each program has different financial requirements.

How do I apply for Social Security benefits?

The best way to apply for SSDI and SSI benefits is to call Social Security and arrange for an application appointment. You may do this by logging on to SSA.gov or calling SSA’s main number at 1-800-772-1213 to schedule a telephone appointment. If you wish to appliy online visit: http://www.socialsecurity.gov/applyfordisability/. You can always set an appointment at your local SSA office.

Keep in mind that the benefit amounts for both SSDI and SSI benefits are tied to the application date. Do not delay in contacting Social Security. Keep a record of any contact you have with Social Security and copies of all applications and forms you submit. Remember to obtain the names of staff persons you speak with and the date(s) of your contact as well.

Do I need an attorney?

Some people are able to obtain their benefits without a lawyer. However, it is often difficult for disabled people to navigate the process of obtaining such benefits from the federal government. This is because of the often confusing requirements and amount of paperwork that is involved throughout the process. The process of getting benefits is a legal process that requires evidence of disability. That is why many applicants for benefits choose to hire an attorney who has special expertise in the area of Social Security to help them.

Because Social Security’s rules are so strict, many disabled people are mistakenly discouraged from filing claims. If you are not sure about your situation, it is important to consult with an attorney. 

How much will it cost? Do I have to pay up front?

Fees for Social Security/SSI disability appeals are contingent fees. This means that we do not get a fee unless we win your case. Our fee process is set by Federal Regulations and the amount of each fee is first approved by the Social Security Administration. The fee is based on the amount of the retroactive/back benefits that are awarded to you. Current fees are 25% of your back benefits, or $6000, whichever amount is LESS. You are responsible for reimbursing us for all costs advanced in your case. This includes the cost of such items as obtaining your medical records. However, there is no charge for our initial consultation.

When should I contact an attorney?

We assist people at all levels of their appeals. If you wish to consult with and hire an attorney, you should contact us immediately after you have been denied at any stage of the process: Initial level, Reconsideration level, the Administrative Law Judge hearing level, or the SSA Appeals Council.

We generally do not take cases until after the initial denial. However, if you have already received a denial at any level of the process it is important to check the date on your denial letter from Social Security. Don't miss any deadlines for your appeal, or other rights discussed in the notice.

What geographic areas does your office serve?

We are located in Northern California and have clients throughout the San Francisco Bay Area. This includes San Francisco as well as Marin, Napa and Sonoma counties to the north, Alameda and Contra Costa counties in the East Bay and San Mateo counties on the Peninsula. We may also be available for representation outside of these areas if needed. Please contact us to discuss this.

What records does Social Security need?

Medical records, medical records, medical records! The determination of disability is a legal process that requires written documentation of what is wrong with you. If you have not received ongoing medical treatment for the condition that is the basis for your disability claim, you will need to discuss this further with us.

Social Security may send residual functional capacity questionnaires to your physicians. They may send forms for you to complete regarding your daily activities to see if you are able to function despite your medical condition. If you are already our client, we can assist you in filling out these forms.

Do I have to wait until I am disabled for 12 months before I can file a claim?

You may be eligible for benefits with a condition that is expected to last at least 12 continuous months or result in death.  

How long might I have to wait to obtain benefits?

This is not a fast process. Though there are occasions when people are awarded quickly, you should be prepared to go through the appeal process before being awarded benefits.

This can be a long and frustrating process. But if you do believe that you are disabled, it is important to obtain help and to fight through the appeal process. Too often people get frustrated and give up, only to apply again at a later date and start over at the beginning, where the denial rates are the highest.

While each area is different, you can expect the initial level to take between 3 and 6 months. The Reconsideration level also takes approximately 3 months. If your case goes to the hearing level, it can take approximately 12 months from the date you request the hearing to have your hearing. Again, all of these times are approximate. The times can be faster but can also be significantly slower. 

SSA does look to expedite certain cases based on dire financial or medical or financial need, but this requires meeting very specific criteria. 

Is CA SDI part of Social Security?

CA State Disability Insurance (SDI) is NOT a Social Security disability program.

California State Disability Insurance (SDI) is a partial wage-replacement insurance plan for workers in California. The SDI program is funded through employee payroll deductions. It is handled through the CA State Employment Development Department (EDD) office. This is the same office that handles CA State unemployment insurance benefits.

The CA SDI criteria for establishing disability are not as strict as Social Security’s criteria. Also, even though CA SDI benefits are limited to 6 to 12 months, they are often approved and released much faster than SSA benefits and can be of much help as you go through the lengthy SSA process.

If you are not working due to your illness or injury, you might be eligible for CA SDI. You should contact CA EDD/State Disability insurance office right away.

The following links will provide information for CA EDD/State Disability Insurance benefits:
Should I file for Social Security even if I am still receiving my State Disability Insurance (SDI) or Workers’ Compensation payments?

Yes. You may file your SSDI claim while still receiving SDI or Workers’ Comp payments. We generally urge people to file for Social Security sooner rather than later as SDI coverage lasts for only 12 months at the most and because it can take significantly longer to be approved for Social Security Disability.

What if my doctor thinks that my condition is not severe enough for Social Security benefits?

SSA’s SSDI/SSI disability programs are stricter than most other disability programs. It is also true that many people are denied at the early stages of the process. It is, however, also a very complex program and physicians and other practitioners cannot be expected to know the different rules for establishing disability under SSA’s programs. 

Your doctor may think that you can do some kind of work, but Social Security is generally looking for whether you are able to work on a full-time basis. There are also other factors that SSA considers such as age and education that your physician may not be considering. The important thing is that you at least seek legal consultation if you believe that your condition is preventing you from working.  

What types of medical and/or mental health problems do you have experience with?

It’s a very long list. Our clients have included people with the following impairments (as well as others not listed below):
  • Lumbar or cervical disc problems
  • Failed back surgery
  • Other spinal disorders
  • Bilateral repetitive stress injury / carpal tunnel syndrome
  • Severe hearing loss
  • Vertigo
  • Chronic obstructive pulmonary disease (COPD)
  • Chronic heart failure or ischemic disease
  • Chronic liver disease including cirrhosis, Hepatitis C
  • Crohn’s Disease
  • Diabetes with diabetic neuropathy and/or retinopathy
  • Fibromyalgia/Chronic Fatigue Syndrome
  • Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy (CRPS/RSD)
  • Ehler’s Danlos Syndrome
  • Multiple Sclerosis
  • Peripheral Neuropathies
  • Epilepsy uncontrolled by medication
  • Grand Mal and petit mal seizures
  • Traumatic brain injury/cerebral trauma
  • Incapacitating migraine headaches
  • Cancers and residual treatment-related impairments
  • Lymphedema
  • Severe cognitive impairment
Severe mental illness including:
  • Depression
  • Bipolar Disorders
  • Anxiety disorder/agoraphobia
  • Schizophrenia and other psychotic disorders
  • Organic mental disorders
  • Dually diagnosed psychiatric / substance abuse disorders
  • Obsessive Compulsive Disorders/OCD
  • Personality disorders/anti-social personality disorders
Where can I find a list of the medical and psychiatric conditions that Social Security will evaluate for disability?

You can check their Listing of Impairments online at: www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

How do I know if I am financially eligible for Social Security and/or SSI benefits?

Social Security Disability Insurance (SSDI) pays benefits to you and certain members of your family if you are "insured," meaning that you worked long enough and paid Social Security taxes. Your eligibility depends on whether you have consistently contributed money from your earnings into Social Security and whether you have accumulated enough “quarters” of coverage. The more money that you have contributed over the years, the higher your disability payments will be. You must also be found to be disabled during the period that you are “insured” for disability.
Persons receiving SSDI benefits may also receive payments for their minor children, even if the children are not living with them. 

Supplemental Security Income pays benefits based on financial need and there are very strict requirements about how much money or resources you can have in your possession – or have access to - in order to be eligible for SSI benefits. SSI may also be available in combination with SSDI benefits for those people whose SSDI rate is less than the full SSI rate. This may occur if one has worked enough quarters to be insured for SSDI, but did so at lower wages.  
Further SSI eligibility information can be found at: http://www.socialsecurity.gov/ssi/text-eligibility-ussi.htm

Again, if you believe that you are disabled and unable to work but are not sure if you are eligible, it is important that you obtain more
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