About Social Security Administration

The Act does not offer anyone, either individually or collectively, an easy life--nor was it ever intended so to do. But it will furnish that minimum necessity to keep a foothold; and that is the kind of protection Americans want. - Franklin D. Roosevelt

Definition of "Disability"

The Social Security Administration (SSA) defines "disability" as the "inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to last for a continuous period of not less than 12 months or result in death". Short term disability or partial disability are not covered by SSA. Your disability must start before age 65.

About the Disability (DIB) and Supplemental Security Income (SSI) programs

SSA pays disability benefits through two programs, the Social Security Disability program (DIB) and the Supplemental Security Income (SSI) program. In general, to receive benefits under the Disability (DIB) program you must have worked five out of the last ten years. There are special earning tests for individuals under 31 years of age. If you do not meet the earnings tests, or have never worked, or are a disabled child under the age of 18, and you have limited financial resources, you may be eligible for disability benefits under the SSI program. The SSI program is for the poor and an individual is limited to no more than $2,000 in resources. A couple is limited to no more than $3,000. More information about the SSI program and "resources" is available at http://www.ssa.gov/pubs/11000.html

How SSA makes their decision

Under both programs, SSA uses a five-step process to decide if you are disabled:

Are you working? If you are working and your earnings average more than $1,000 each month, SSA will generally consider you not disabled. The amount changes each year. If you are not working, or your earnings average below $1,000 each month, SSA will then look at your medical condition.
Is your medical condition "severe"? To be "severe" your medical condition must significantly limit your ability to do basic work activities such as walking, standing, sitting, and remembering for at least one year. If you condition is determined to be "severe" SSA will go to the next step.
Is your condition on the List of Impairments? SSA has a List of Impairments that describes medical conditions that are so severe they automatically mean you are disabled. If your condition (or combination of conditions) is not on the list, SSA will look to see if your condition is as severe as a condition on the list. If the severity of your condition(s) meets, or equals, a listed impairment SSA will decide that you are disabled. If it is not, SSA will go to step four.
Can you do the work you did before? SSA will decide if your medical condition prevents you from doing the work you did before. If it does not, then you are not disabled. If it does, SSA will go to step five.
Can you do any other type of work? SSA evaluates your medical condition, your age, education, past work experience and any skills that you have that could be used to do other work. If you cannot do other work, SSA will find you disabled. If you can do other work, SSA will find you are not disabled.

The application and appeal process

SSA does not approve every claim at initial application. In fact, most are denied. If SSA denies your initial application, it does not mean you are not entitled to benefits. You must be persistent and follow through with the appeal process. Bohn & Associates can help you navigate the SSA appeal process and keep you from being discouraged.

You should apply for benefits as soon as you become disabled. For the initial application you will need to provide names, addresses, and telephone numbers for the doctors, clinics, hospitals, counselors, and caseworkers that took care of you. SSA will need a list of your medications and the dates you had medical tests done. Also, be prepared to give a summary of where you worked and what your jobs were for the past 15 years.

Once your initial application is filed, SSA may request additional medical records from your doctors. They may ask you to see one of their doctors. If SSA determines you are not eligible for benefits, they will send you a letter explaining their decision. If you do not agree with the decision, you have 60 days to file an appeal called Reconsideration.
SSA will review your case again, along with any new medical evidence that is added. It will take SSA approximately three to four months to make a decision. If your claim is denied, you will again have 60 days to file an appeal for a hearing before an administrative law judge.
It usually takes 18 to 24 months to be scheduled for a hearing before an administrative law judge (ALJ). At the hearing you will have an opportunity to present additional medical evidence and give testimony about your disability and how it affects your ability to work. The ALJ may request a vocational or medical expert be present at the hearing. The ALJ will review all of the evidence and issue a written decision approximately 2-4 months after the hearing is held. The majority of claims are approved at the hearing level but if the decision is unfavorable, you will have 60 days to file an appeal with the Appeals Council.
At the Appeals Council appeal, your representative will submit written arguments in support of your claim. The Appeals Council will review the arguments and take one of three actions: deny your request for review; order another hearing to be held; or decide in your favor. It may take 12 to 18 months to receive a decision from the Appeals Council. If the decision is unfavorable you have 60 days to file an appeal in Federal District Court.