Navigating the Disability System

Questions and Answers

about Social Security Disability benefits

Ted Walkenhorst, Esq.

Disability Benefits Law Center

1.         I'm still working, but I'm having difficulty continuing.  When should I apply for disability benefits?

            Because the application process is often lengthy and the amount of benefits is not large, the best advice is usually to work as long as possible.  When applying for disability benefits, it's actually better to be asked to leave a job than to quit the job.  Being asked to leave is evidence that you can no longer work.  If you do decide to quit, see if your doctor is willing to advise you to do so and write that advice and the reasons for it in your treatment records.

2.         What benefits are available for the disabled from Social Security?

            There are two benefit programs, disability insurance and SSI.  The first program is for persons with a sufficient earnings history recorded by SSA.  The second program, SSI, is a federal welfare program for those who have never worked or not worked enough to qualify for disability insurance benefits.  The better benefit is disability insurance.   In some cases, widow(er)s and divorced spouses can qualify on the earnings record of the former spouse.

3.         What are the eligibility requirements for Social Security Disability?

            First is the financial determination.  Has the person worked enough or recently enough to qualify for insurance benefits?  Is the person indigent to qualify for SSI?  If the person is not eligible financially, then they will not qualify for benefits even if disabled.

            Second, the person must have been disabled for at least 12 months or be expected to be disabled for that long.  Total disability for less than 12 months will result in no benefits.

            Third, in most cases the person must establish that their medical condition is severe enough that it prevents then from performing not only their past work, but all other types of work.

4.         What is the application process like?  How long will it take?

            There are several steps to the process:

                        Initial application and review by the state disability determination agency.  Expect this to take 4-5 months.  Make your application detailed and tell your doctors to cooperate with the state agency's request for records and assessments.

                        Reconsideration by the same agency (if you live in a state other than Pennsylvania).  Expect this to take another 4-5 months.  In Pennsylvania there is no Reconsideration step and the appeal from the initial denial is for an administrative hearing.

                        Administrative hearing conducted by an administrative law judge of the Social Security Administration.  Expect the wait for a hearing to be 6 to 12 months in Pennsylvania.

5.         What if I've had my disability application denied?  What can I do then?  Should I appeal, reapply or just give up?

            Always talk with an attorney as soon as you are denied.  You should always appeal and in some cases can appeal and reapply at the same time.  Do not give up without consulting with an attorney.

6.         Do I really need an attorney to represent me in this process?  If so, what will it cost?

            These are important benefits that are not easy to qualify for.  You do need an attorney if you must appeal for an administrative hearing and one is helpful earlier in the process as well.

            Social Security regulates all attorney fees.  There is almost never a fee unless you are awarded benefits and the fee is limited to 25% of your retroactive benefits or $5,300.00, whichever is less. 

Some Do's and Don'ts for individuals seeking disability benefits

DO                                                                           DON'T

Apply as soon as you know you'll                              Wait to apply or get advice

be out of work for a year.                                          about benefits you may be

The process is often lengthy.                                      eligible for.

Seek advice early in the process.                                Assume that the information

                                                                                 SSA provides is reliable.

Keep a record of all of the doctors                             Assume that SSA will obtain

and hospitals who have treated you.                           all of your treatment records.

Tell your doctors that you are                                     Assume that your doctors will

applying for disability benefits                                     support your disability application.

and ask if they will support you.

DO                                                                           DON'T

Report all of your symptoms on each                          Assume that your doctor

and every medical visit.                                              knows how you feel or is

Report fatigue, and Rx side effects                             recording your symptoms

as well as pain symptoms.                                          in your treatment records.

Tell your doctor about functional                                Let your doctor assume you

limitations (cook, clean, drive) and                             can do things that you really

ask that they be included in your                                 can't.  Tell him or her about

treatment records.                                                      your functional limitations.

Report and get treatment for                                      Assume that depression is

symptoms of depression or anxiety.                            "normal" and doesn't need

Treatment for these symptoms                                    treatment.  Get treatment.

will strengthen your case.

Keep a journal of your symptoms                               Assume that you'll remember

on your worst days.  Record how                              your worst days later.  You may

you feel and what you couldn't do.                             not and your doctor needs to

Take your journal to each                                          know and record those problems

doctors visit.                                                              in your treatment records.

Ask your doctors to keep good                                 Assume that they will.  Your

records of your symptoms and                                   doctor¿s treatment records are

functional limitations.                                                  the most important part of any

                                                                                 disability case.

Follow through with any testing                                  Refuse testing, as it may mean

recommended by your doctor.                                   evidence to support your claim

                                                                                 is not available.

DO                                                                           DON'T

Report any side effects of                                           Refuse to take medication without

medications to your doctor.                                        a good reason.  SSA will likely

                                                                                 hold this against you.

See other specialists you are                                      Avoid other specialists you are

referred to by your doctor.                                         referred to.  SSA expects you to

                                                                                 comply with these referrals.

Contact an attorney if your are                                   Give up if your claim is denied.

denied at any stage of the process.                             Do file a timely appeal.

      If you or someone you know has any questions about disability benefits, call the Disability Benefits Law Center for a free consultation at: 215-886-0660 or email us at:  info@disability-benefits-law-center.com  The Disability Benefits Law Center maintains offices in Center City Philadelphia and Jenkintown.  The Disability Benefits Law Center focuses its practice exclusively on Social Security and private disability matters.