Social Security Disability
- How can I tell if I am disabled enough to apply for social security disability benefits?
- How do I apply for Social Security Disability or SSI benefits?
- What Is The SSD Determination Process Like?
- How do I appeal?
- What is the biggest mistake people make when trying to get disability benefits?
- Since medical evidence is so important, should I have my doctor write a letter to the Social Security Administration and should I gather medical records and send them to SSA?
Hiring Professional Counsel
- Should I contact a lawyer to help me apply for Social Security Disability or SSI benefits?
- How Does An Attorney Make A Difference?
- Should I hire an attorney or a non-attorney?
- When I hire an attorney, what should I know about the attorney?
Hiring An Attorney
Roylance & William's Rules on Dealing With SSA
Social Security Disability
How can I tell if I am disabled enough to apply for social security disability benefits?
SSA makes it easier to be found disabled as you get older. It becomes easier for a few people at age 45, for more people at age 50, for most people at age 55, and even more people at age 60. If you're over age 55 and you cannot do any job you have done in the past 15 years, you should definitely apply. If you're over age 50 and have a severe impairment that keeps you from doing all but the easiest jobs, you ought to apply.
But you don't have to be bedridden, even if you're a younger person. If you're under age 45 or 50 and you cannot do your past jobs and you cannot work full time at any regular job, that ought to be enough.
Nevertheless, being unable to work and being found "disabled" by the Social Security Administration (SSA) are two different things. It is often difficult to convince SSA that someone is "disabled" even when they genuinely cannot work. But it is not impossible.
If you really cannot work, apply for social security disability benefits. And keep appealing denials at least through the hearing before an administrative law judge.
How do I apply for Social Security Disability or SSI benefits?
Telephone the Social Security Administration at 1-800-772-1213. When you call, you will be given the option of 1) going to the social security office to apply for benefits or 2) having your application taken over the telephone. If you choose to go the social security office, the person at the 800 number will schedule an appointment for you and give you directions to the social security office. If you want to apply by phone, you will be given a date and an approximate time to expect a phone call from someone at the social security office who will take your application over the phone.
What Is The SSD Determination Process Like?
The SSD determination process can be divided into five basic stages:
- Initial Application (1-2 days to complete);
- Initial Decision (95 days);
- Request for Reconsideration (63 days);
- Appeal for Hearing (391 days); and
- Other Appeals (about 18 months).
At each stage you may provide, or the SSA may request, detailed information regarding your condition and how it prevents you from doing any type of work. Again, always be honest with yourself, your attorney, and the SSA. In addition to medical records establishing your disabling condition, you will need to provide evidence of your identity, as well as your earnings and employment history for the last 15 years, and contact information for all individuals and/or institutions involved in your treatment or diagnosis. Among the most beneficial information you can personally provide is a complete and detailed list of functions and activities, both at work and at home, that you can no longer perform because of your disabling condition. It is important to stay in regular contact with your doctor(s), and notify your attorney immediately if you experience difficulty with your medical insurance. Due to the lengthy nature of the process and the very high rate of initial denials, it is also very important not to become impatient or discouraged.
How do I appeal?
You can appeal in one of two ways. 1) Telephone the Social Security Administration and make arrangements for your appeal to be handled by phone and mail. Or 2) go to the social security office to submit your appeal. If you go to the social security office, be sure to take along a copy of your denial letter.
Your denial letter will tell you about appealing. The first appeal is usually a "reconsideration." But SSA is experimenting in Wisconsin with procedures allowing some people to skip the reconsideration step. If you're involved in one of these experiments, your denial letter will tell you that you can appeal by requesting a hearing. Otherwise, you must request reconsideration and then, after the reconsideration is denied, you must request a hearing within 60 days.
What is the biggest mistake people make when trying to get disability benefits?
Failing to appeal. More than half of the people whose applications are denied fail to appeal. Many people who are denied on reconsideration fail to request a hearing.
Another mistake, although much less common, is made by people who fail to obtain appropriate medical care. Some people with long-term chronic medical problems feel that they have not been helped much by doctors. Thus, for the most part, they stop going for treatment. This is a mistake for both medical and legal reasons. First, no one needs good medical care more than those with chronic medical problems. Second, medical treatment records provide the most important evidence of disability in a social security case.
Since medical evidence is so important, should I have my doctor write a letter to the Social Security Administration and should I gather medical records and send them to SSA?
SSA will gather the medical records, so you don't have to do that. Whether you should ask your doctor to write a letter is a hard question. A few people win their cases by having their doctors write letters. You can try this if you want to. The problem is that the medical-legal issues are so complicated in most disability cases that a doctor may inadvertently give the wrong impression. Thus, obtaining medical reports may be something best left for a lawyer to do.
Hiring Professional Counsel
Should I contact a lawyer to help me apply for Social Security Disability or SSI benefits?
As a rule, a person does not need a lawyer's help to file the application. SSA makes this part very easy and, in fact, it usually will not let a lawyer (or anyone else) sign the application for you. After the application is filed, however, a lawyer's help may make the difference between winning and losing even at this stage.
How Does An Attorney Make A Difference?
Some important differences to note among attorneys or other representatives include: their experience level with social security disability cases at all stages of the process - including Federal Court; their success rate with social security disability cases; their concentration (or lack of concentration) on social security disability cases; and perhaps most importantly, their genuine interest in your situation and willingness to communicate openly and help you when you need it. Tragically, many clients who don't know to expect more, never meet or even speak with their attorney, and others only meet their attorney just prior to actually appearing before the judge. Some applicants even choose (sometimes unknowingly) "non-attorney" representation! This is alarming because the Social Security Administration sets the fees that can be charged for representation, and has decided that they are to be exactly the same, regardless of the type [or quality] of representation. In other words an educated, experienced, successful, trained attorney generally costs no more than a "non-attorney" who cannot even represent disability applicants in Federal Court. Because your careful selection of the right attorney can have a tremendous impact on your quality of life for many years to come, you deserve an experienced, successful, open, and sincere attorney who cares about you.
Should I hire an attorney or a non-attorney?
The Social Security Administration allows attorneys and non-attorneys to represent claimants in proceedings before the agency. Why would a claimant hire an attorney instead of a non-attorney or vice versa? Consider the following:
Attorneys and non-attorneys charge the same fee. The Social Security Administration tightly regulates the amount of fee that representatives can charge claimants, and the regulated amount is the same for representation by an attorney or a non-attorney.
While there is no education requirement for an individual to represent a claimant, the Social Security Administration does require basic levels of competency. However, in many cases, a basic level of competency is not sufficient to get a case approved. Social Security does not do much to enforce competency because the Social Security Administration has an interest in deciding a case in the way it would like. A representative not doing much frees Social Security to do as it pleases. In fact, if your representative does nothing to develop your medical evidence, accompanies you to a Social Security hearing and says nothing, Social Security will not object. Therefore, the Social Security Administration's competency requirements are not an adequate protection to claimants.
Attorneys are required to attend at least three years of intensive legal schooling (after obtaining a four year bachelor's degree) and must pass a state bar exam to be licensed as an attorney. An attorney must attend a number of continuing legal education courses every year to improve his/her skills and knowledge of the law. Attorneys who specialize in Social Security Disability law usually attend many courses on Social Security law each year to become a better representative of Social Security claimants. If the attorney does not attend such courses, the bar association will revoke the attorney's license. Furthermore, the bar association monitors the general conduct of an attorney and can revoke an attorney's license if the attorney is not competently representing his/her clients. Attorneys are required to have been trained in methods of cross examination, development of arguments and evidence that will support a case, persuasive writing, and a full understanding of the law in the area in which they practice, including the interaction of court decisions, federal laws and agency regulations. The bar association oversight and training requirements for an attorney are an important protection to Social Security claimants.
There is no guarantee that non-attorneys have received any of the above training or have an adequate knowledge of the law. There is no association that can force them to stop representing individuals if they are not doing a good job. There is no one a claimant can go to with a complaint if the non-attorney mishandles their claim.
National statistics, published by the Social Security Administration, indicate that attorneys consistently obtain a higher percentage of favorable results for their clients than non-attorneys. In fact, locally, the top Social Security attorneys are seeing results of approximately 80-90% of cases decided favorably. Nationally for the year 2000, the Social Security Administration published figures that indicated when non-attorneys were added to the mix of total represented claimants, only 62% of claims were approved, which was only about 20% better than claimants who represented themselves. Contrast that to the results of local top attorneys, who may be improving the chance of a claimant getting approved by around 50%.
Finally, attorneys can appeal your case into federal court. Non-attorneys cannot. This is extremely important. A significant percentage of denied claims are overturned by the federal judges. Furthermore, when an attorney appeals cases into the federal courts and wins, the administrative law judges of the Social Security Administration are more careful when that attorney appears before them. Furthermore, handling cases in federal court significantly helps attorneys become cognizant of what will work and won't work in their arguments before the Social Security Administration. No amount of study and research can replace the valuable lessons learned from appealing cases into federal court.
It is the opinion of this author that there is absolutely no justifiable reason for a claimant to hire a non-attorney over an attorney. Non-attorneys charge the same fee. There is virtually no oversight of a non-attorney's representation and no bar association for protection. The vast majority of claimants who hire a representative recognize these facts and do hire an attorney to help them. I am always very disappointed when I have a claimant come to my office after their claim has been denied and their non-attorney representative has given up. I review their file and can usually identify many errors that were made in their case. However, in many cases, the damage is done and there is very little I can do to correct it. Even when I can correct the mistakes, it usually takes a substantial amount of time to do so.
When I hire an attorney, what should I know about the attorney?
Probably one of the most important decisions you can make with respect to your disability claim is who to hire as an attorney if your claim is denied. As mentioned in the previous section, top local attorneys are seeing results of approximately 80-90% of cases decided favorably. Here are some issues to consider:
Do not rely solely on a good recommendation. Remember that even claimants who do not have representation win at the hearing level 40% of the time. Just because a claimant received a favorable decision and they liked their representative, does not necessarily mean that the representative did a good job and is deserving of a recommendation. Ask the person who makes the recommendation on what basis the recommendation is made.
Hiring An Attorney
When should I contact you about representing me?
In the past, we encouraged people to wait until it was time to request a hearing before contacting us. But things have changed. The Social Security Administration has put new emphasis on making the right decision at the earlier stages. It is also applying the same legal rules at the earlier stages that used to be applied only at the hearing stage. This means that a lawyer's help at the early stages may make a difference.
We recognize that about one-third of those people who apply will be found disabled even without a lawyer's help. We understand that some people may want to go through the earlier stages by themselves. On the one hand, if you are successful in handling it yourself, you will save having to pay attorney's fees. On the other hand, your case might be one in which an attorney's help would make the difference. It is up to you whether to contact us when you first apply or to wait until you are denied; but the general rule is that it is better to contact us earlier rather than later.
How much do you charge?
Almost all of our clients prefer a "contingent fee," a fee paid only if they win. The usual fee is 25% (one-quarter) of back benefits up to $4,000.00. That is, the fee is one-fourth of those benefits that build up by the time you are found disabled and benefits are paid. Although the usual fee will not normally exceed $4,000.00, if we have to appeal after the first ALJ hearing, our contract drops the $4,000.00 limit. But under no circumstances do fees come out of current monthly benefits.
Sometimes at the request of a client, we charge a non-contingent hourly or per case fee. There are a few cases where the contingent fee arrangement or the $4,000.00 limit on fees is insufficient to allow for an adequate fee. In those cases, we use a different method of calculating the fee.
In addition to the fee, you will be expected to pay the expense of gathering medical records, obtaining medical opinion letters, etc.
Roylance & William's Rules on Dealing With SSA
Most people who deal with the Social Security Administration (SSA) first talk to an SSA representative at SSA's toll-free telephone number, 1-800-772-1213 (which SSA likes to write as 1-800-SSA-1213). Because so many people have had problems dealing with SSA at the 800 number, we have devised a set of rules to use this number effectively. Here they are:
Rule 1: Call the 800 number only during the second half of the month and then only on Wednesdays, Thursdays and Fridays before 10:00 a.m. or after 3:00 p.m.
We know this sounds silly, but this recommendation, which comes out of an official SSA brochure, will help you avoid the times when the 800 number is most heavily used. Whether you adopt this rule depends on two things: 1) whether you really have to call SSA at some other time, and 2) how much you hate busy signals and recordings. The teleservice center is busiest during the first half of the month when people are calling about missing checks, on Mondays and Tuesdays, apparently because people use the weekend to dream up questions for SSA, and between 10:00 a.m. and 3:00 p.m. daily.
You can call and talk to a real person from 7:00 a.m. to 7:00 p.m. Monday through Friday. If you call before 8:00 a.m. or after 4:15 p.m. your call will be routed to a teleservice center in another time zone. If you call from Wisconsin during regular business hours, your call will probably be handled by a teleservice center located in the Central Time zone. If you call between 7:00 p.m. and 7:00 a.m. or anytime on weekends or federal holidays, you will get to talk to a machine and leave a recorded message.
Rule 2: Do not rely on the teleservice center for answers to important questions.
Answers from the teleservice centers that affect entitlement to Supplemental Security Income (SSI) or social security disability benefits are not to be trusted. The SSI program, a federal welfare program for disabled and elderly people, is the most complicated program operated by SSA. One study done shortly after the beginning of the toll-free telephone system found wrong answers to nearly one quarter of the SSI questions. About ten percent of the answers to questions about social security retirement, survivors and disability benefits were wrong. So it makes good sense not to rely on the answers of a teleservice representative to questions that might affect SSI or social security disability benefits. You can usually, but not always, rely on answers given you by a claims representative at a local social security office. If you are not put in touch with a claims representative, call back to the 800 number to see if you get the same answer twice.
Rule 3: Remember, with SSA, the right hand does not always know what the left hand is doing.
The people at the local social security office don't necessarily know what the people at the teleservice center told you. If you have questions about both social security disability and SSI, the people at the local office who deal with one program don't always know the answers about the other program. The office in Baltimore doesn't necessarily know what is going on at the social security office in Wisconsin and vice versa. A little skepticism about things you are told is healthy, even when you are told these things by someone from the local office.
Rule 4: If you're applying for disability benefits and you really cannot work, don't let SSA discourage you.
Many people with valid disability claims give up after they receive a denial letter or after they talk with an SSA representative. This is unfortunate because many of these people would be found disabled if they pursued their claims. You shouldn't necessarily believe them when they tell you you're not disabled. They are wrong in many cases.
For more information about applying for social security disability benefits, see the two brochures published by this office titled, "Social Security Disability and SSI claims - Your Need for Representation" and "Preparing for Your Social Security Disability or SSI Hearing." Also see this office's Memorandum No. 1.
Rule 5: If you have a claim pending, start a collection of secret telephone numbers of claims representatives at the local social security office.
All of the social security offices in Milwaukee and many in the rest of Wisconsin have unlisted telephone numbers. You cannot get these numbers from the phone company and you may not be able to get them from the teleservice center. Only the 800-number is listed in the telephone directory.
Once you get past the teleservice center, and actually talk to a claims representative at a local social security office, always ask for a telephone number. Save the number while your claim is pending so that you can contact the claims representative if necessary. If you lose it, you'll have trouble getting the number again. But be prepared for this: Once you have treasured a secret number for months, SSA will change the number. It does this just to prevent you from being able to call with questions!
Rule 6: Keep notes of conversations and copies of everything you send to SSA.
Write notes of your questions and SSA's answers. Be sure to write down names and locations of everyone you talk to at SSA and the date of each contact. And always save a copy of everything that you mail to SSA. If you complete forms at the social security office, ask to be provided with copies for your records. If you are told something that affects your eligibility for benefits, ask for it in writing. You won't always get it, but there's no harm in asking.
Rule 7: Follow-up.
Following up is the best thing you can do. If an SSA representative promises to get back to you within three days and does not call, phone the SSA representative again on the fourth day.
Rule 8: When there is a problem, go to the social security office.
You can make an appointment or not, as you choose. If you make an appointment, you probably won't have to wait as long. Sometimes, it is best to make an appointment and insist on meeting face-to-face with the person at the local office with whom you have been dealing over the telephone. Whatever you do, take along all your papers.
Rule 9: Don't be afraid to ask for a supervisor if you cannot work out a problem at the local office.
If you cannot work out a problem in a meeting with a claims representative, ask to meet with a supervisor. Don't be afraid of hurting anyone's feelings or that you should not take up the supervisor's time. Often supervisors are in the best position to solve problems at the local office.
Rule 10: As a last resort, call your Congressman.
If nothing else works, one of the best resources for straightening out SSA's bureaucratic foul-ups is your Congressman's office. All Congressional members have at least one employee who specializes in dealing with social security questions. They are best at straightening out true bureaucratic SNAFUs such as long delays, lost files, and inability to get a straight answer to a question. But it won't help to call your Congressman simply because you've been denied disability benefits. Denying disability benefits is, after all, normal SSA behavior. A Congressional office is most helpful in dealing with abnormal SSA behavior.
Rule 11: Try to keep your sense of humor.
Let's face it, dealing with SSA can be very frustrating. Try not to let it get you down.
