Social Security

Obtaining disability benefits can require up to three separate application processes. First is the initial application, a very high percentage of which are denied. Within sixty (60) days of denial, you must file a Request for Reconsideration. Again, a high percentage of these applications are denied. If your claim remains rejected, you must request a hearing in front of a judge within sixty (60) days. Although some applications in cases of severe disability are granted at the initial or reconsideration stages, many claims require a claimant to go through the formal hearing process in order to obtain benefits.

The first two determinations are made by the Social Security Administration itself, or by a contract agency of the State of Washington. The administrative processing of claims at the initial levels consistently results in a conservative interpretation of the medical evidence and the applicable law, partly because of the volume of claims to be handled.

At the hearing level, your claim is reviewed by an Administrative Law Judge, who is not an employee of the Social Security Administration, and who can receive new evidence and apply the law in an independent fashion. Accordingly, the judge will often reverse decisions made at the administrative levels, after observing and listening to a claimant.

Unfortunately, doctors' opinions regarding whether a person is or is not disabled do not control the decision of the Administration or a judge on that issue. Rather, the doctors' findings and opinions regarding physical restrictions are taken into account and applied to the law and regulations which control all cases. The purported reason for this is to eliminate the subjective aspects of your doctors' opinions -- in other words, based upon the same findings, one doctor may feel a patient is "disabled" while another would not.

There is a formal process, called "sequential analysis", which the Administration and the judge will use in determining whether your conditions qualify for a finding of "disabled" under the law. First, a determination is made as to whether your conditions meet or exceed certain standards set forth in a listing of impairments which, regardless of your age, education or prior work experience, would justify a finding of "disabled". If disability cannot be found on that basis, further inquiry is made as to your remaining physical and mental capacity to perform any work at all. Your "residual functional capacity", as it is called, is combined with other factors, such as your age, education, and the physical and skill requirements of your prior employment, and all of this information is measured against a complicated "grid system" to determine whether you can be found "disabled".

From time to time, Social Security may review your case. This is particularly the case with younger individuals whose disabilities might be expected to improve over time. If your condition is reviewed -- which usually involves an independent medical evaluation -- the Administration must demonstrate that your condition has improved in order to terminate benefits. If that occurs, you will have further appeal rights. In the case of older workers with chronic conditions, reviews and terminations are less likely.

Maybe. To qualify for Social Security benefits, you must be unable to work for twelve (12) continuous calendar months before benefits are payable. Also, the standards of proof for Social Security disability are different from workers' compensation, which does not have time limits for being off work, but requires that your disability be solely the result of your on-the-job injury or condition. Thus, you may qualify for one and not the other. And, if you otherwise qualify for both types of benefits, there is a maximum amount you can receive in total combined benefits. That limitation is 80% of your highest average monthly wage in the five (5) years prior to the onset of your disability.

Social Security Disability has evolved into a very complicated area of the law. There are literally hundreds of laws and regulations, and thousands of cases construing them, which will determine whether the facts of your particular case will result in a finding of "disabled". Court cases, legislative changes and administrative revisions occur on a frequent basis, and these may impact your eligibility for benefits. An attorney knowledgeable about these laws and regulations, and the system in general, can help to increase your chances of obtaining benefits.

What does a hearing involve? Is it a formal court proceeding, and is the Social Security Administration represented by an attorney?

These hearings combine formality and informality. The testimony of all witnesses is taken under oath, but medical reports can be offered into evidence, instead of having a doctor testify, and both the claimant and attorney are allowed ample opportunity to provide all facts relevant to the disability in question and to express opinions. The Administration is not currently represented by an attorney in these hearings. However, the Administrative Law Judge who hears the case may subject you to lengthy and detailed questioning. Additionally, the judge may call a medical or vocational expert to help interpret the evidence in the case. The proceedings are recorded by an administrative assistant so that an official record is made.

Judges widely vary in their decision-making timetable, in part because of differing caseloads. A rough estimate for a decision is one to two months from the hearing date at the earliest, and sometimes up to six months, particularly if additional evidence is submitted. You will receive the decision, as will your attorney. A favorable decision is sent on to one of the Administration's processing centers for the computation of your benefits and you should not expect to receive any benefits until a separate Certificate of Award is issued, usually two to three months after the favorable decision. You will generally receive any retroactive benefits shortly after the award certificate issues, and current benefits, if appropriate, will begin at about the same time. Regrettably, there is virtually nothing we can do to speed up the payment process.

The Social Security Administration has set limits to the fee structure attorneys can use in their contracts of employment. With this, the fee charged by all attorneys is fairly standardized. Social Security will withhold 25% of the retroactive benefits and will forward that fee, less a handling fee, directly to the attorney. This payment is for the attorney's fee only, and does not include the reimbursement of costs incurred. This remains a matter between you and your attorney. In any case, regardless of the size of the retroactive benefits awarded, the fee may not exceed $6,000.