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Social Security Disability Benefits – Part II

How does the claimant apply for benefits?  Is there any way to apply other than going to a local SSA office and waiting for hours?  What proof will I need in order to apply?

West Virginia social security disability lawyer talks about social security disability benefits (Part 2)A claimant can choose how he/she applies for Social Security Disability.  We’ve highlighted the claimant choices in the following paragraphs.  Most people are aware of the historical way to make application for anything involving a government office.  That, of course would be to locate and drive to the closest office, try to find parking in the same zip code, stand in line for hours only to learn that you have been in the wrong line.  You then stand in another line, at the front of which is a government representative that views you as the garbage truck that is going to dump a load of dirty work on them.  It can be frustrating, to say the least, especially if your condition makes it difficult for you to be at the SSA office for long periods.  Representation by a Social Security lawyer or non-attorney claims representative eliminates much of the hassle.

Most Social Security employees seem to be very polite.  They are, however, overwhelmed with more applications than ever before.  In 1998, applications for SSDI averaged 86,780 per month.  Compare that with 212,378 applicants a decade later in February 2008.  February 2010 applications were up almost an additional 10%, with the disability applications numbers coming in at 232,555.  If a Social Security Disability applicant has an attorney, SSA representatives are far less likely to “shelf” the claim in order to work on others.  If a claim is submitted with out the proper information, SSA personnel may set that claim aside and work on the next 3 or 4 that have the proper information in order to meet productivity standards.  If a Social Security Lawyer submits your claim, it is not set aside because it is date stamped throughout the process to show where the claim has been and for how long.

The Social Security Administration has opened several call centers at various places in the US in order help handle high telephone call volumes. The toll free number is 1-800-772-1213.   Someone, typically 1 to 3 people, is assigned to telephone duty in each local office each day as well.  You can file an application by telephone if you are unable to come to the office and do not have access to the internet.  Generally, an appointment is made for the claims rep to call you, so you don’t have to wait on hold.  Before the appointment, SSA should send you an envelope with a list of the items you need to provide as proofs for your claim (drivers license, birth certificate, military DD-214, marriage certificates, children’s birth certificates, etc).  Although this option is intended to provide convenience to the claimant, wait times are generally very long and original documents must be mailed in.  Most people are not comfortable mailing their original driver’s license, passports, or state issued ID’s.  As a matter of policy, the Social Security Administration must see original documents for proofs submitted.

It typically takes about 1½ hours to complete a disability application in person or by phone, provided the claimant has all the information needed with them.

The claimant may also apply online.  The claimant may wish to contact an advocate, social security attorney or lawyer, a trusted friend or non-attorney representative, or a relative to help them apply.  It really depends upon the condition and abilities of the claimant as well as the access to the internet.  Some attorneys will help with filing the original claim for disability and some will not.  There are valid reasons either way.  Many times it comes down to how busy the firm is and the staffing.

We will mention fees again below, but many social security lawyers choose not to get involved in original claim applications.  The fee guidelines for a social security attorney are clearly stated by the SSA.  The fees that are paid to attorneys and non-attorney representatives are calculated by multiplying the amount of back pay by 0.25 or (25%).  The maximum that an attorney can recover is $6000.  Once again, this is only a percentage of back pay that is due the claimant.  If the attorney completes and submits the forms and the claim is approved within the first 5 months, there are no fees.

If the claimants benefit amount is $2000 per month and it takes a year to get the approval, fees would be as follows:  Time that has elapsed from the date of injury to present is 12 months.  12 months minus the 5 month waiting period = 7 months of benefits due.

7 months x $2000 per month = $14,000.  $14,000 x .25 = $3,500 to the representative.

If the attorney is involved from the beginning and the claim is approved within the first 5 months, then ther is no back pay.  If there is n0 backpay, no fees are paid to the attorney.  If the case goes on over a long period and more than $24,000 of backpay is due the claimant, the attorney still only receive $6,000.

At West Law Offices, we like to be involved in our cases from the beginning.  We can help you with any part of your claim and submit documents accurately and in a timely manner.  As long as we are able to provide this service to our clients, we will.  If the cases are not approved quickly, we already know what information has been submitted and the accuracy of the submissions.  This makes filing for a reconsideration or request for hearing much less stressful for you, the client, and for us, your social security advocates.

Information to Compile

Bank information, such as a checkbook or deposit slip will be helpful in setting up direct deposit for benefits, if the claimant has a bank account.  Social Security will stop issuing paper checks in the near future.  Persons receiving benefits must have the funds electronically deposited into an account at a bank or credit union.  The Social Security Administration does not issue debit cards, but can help you apply for a Direct Express debit card.  Comerica Bank usually issues the cards.  After signing up on Direct Express, funds are directly deposited to the account and any questions regarding deposits would be directed to that bank.

The claimant should have W2’s or tax returns for the past five years and be able to explain the type of work performed at the positions held during that period of time.  The Social Security Administration has wage information which is provided by the IRS each year when persons file income tax returns.  Sometimes these records are not complete; especially if there have been multiple employers.  W2’s and tax returns allow them to add any missing wages in order to accurately figure the amount of the benefits.

If the claimant served in the military, their DD-214 would provide the necessary information to add military service if that information is not already in the claimant’s record.  Adding the military service may not change the benefit amount at all, but the record should be as complete and accurate as possible.

The claimant should also be able to provide the names, addresses, and telephone numbers of all the doctors, clinics, or hospitals that have provided medical advice or treatment.  Even if the claimant doesn’t feel that the treatment is directly related to the condition which they believe has cause the disability, bring all the information on hand.  Any test results are helpful but not mandatory.  They can be obtained directly from the service provider.

Last, but not least, the claimant should have a list of all the medications (prescriptions, supplements, vitamins, etc) taken.  The list should contain the name of the medication, the doctor or organization prescribing or recommending the medication or supplement, the dosage amount and frequency.)  The claimant should also include what the medication is for.

EXAMPLE:

Medication   Doctor                        Condition                  Dosage                       Frequency

Lexapro          Dr. Smith        Anxiety                       10mg                          1 time daily

Ibuprophen   Dr. Allen         Inflammation             800mg                     1 time daily

Providing the proofs seems more difficult than it is.  Most people keep a list of medications, that list may just need to be modified.  If tests and test results aren’t readily available, do not worry about getting them before filing.  The filing process, and the reason for compiling the information, consists of completing an application, completing a disability report, and signing releases that allow doctors to submit tests and results to be considered for disability.

The disability report takes the longest to complete and can often take more than an hour, depending upon the nature of the disability, the length of the explanation (how does this effect your work?), and the number of healthcare providers and medications.  This report should be completed fully and accurately.

Once the application is completed, what takes so long?  Who makes the decision?

The Social Security Administration will review the application and check to see that basic requirements are met.  For example, to be disabled you must not be able to participate in SGA (substantial gainful activity – i.e. to work and earn $1000 or more per month).  If the claimant is still working and earning more than $1000 per month, and there has been no substantial change in the workplace routing, the claimant could not be considered disabled.

If basic requirements are met, the application is then sent to a state agency called Disability Determination Services, or DDS.  This a state agency that receives funding from the federal government.

A DDS agency will typically have staff physicians and other medical professionals as well as disability examiners.  DDS will use the medical release forms signed by the client to request medical records from the doctors, hospitals, clinics, etc., that have given medical advice or treatment to the claimant.  Once the medical records have been requested, many times requested more that once, there may be a substantial period of time before the records are received.

Once the DDS has received and reviewed the medical history, they will make a decision about the case.  Often times, DDS will even contact the claimant directly if a clarification about a particular issue is needed.

A good example may be a construction worker that has worked for the same company for many years.  Let’s assume that he arthritis and has been unable to do his job.  Let’s also assume that his employer has compassion on him and allows him to come to work but not participate in his usual activities so that he can keep his medical coverage.  In that case, even though still employed, it is possible that the construction worker could be found disabled since the employer had to provide special conditions to allow him to continue.

Do I need an attorney?  How much does a Social Security Attorney charge?  What if I can’t afford to hire an attorney?

The Social Security Administration will not tell a claimant to hire an attorney.  That decision is completely up to the claimant.  An attorney can be very helpful when filing for benefits.  West Law Offices will fight your social security battles and let you concentrate on minimizing your disability.

Social Security claims representatives go through months and months of intense training.  The regulations and guidelines are modified and changed on a seemingly continual basis.  The number of guidelines and the amount of regulations, the scope of policy, and continual changes are too much for the average person to keep up with.  Claims representatives routinely make mistakes that need to be corrected, and they deal with these cases day in and day out.

The tremendous workload on SSA workers adds to possibility of errors on the application or disability report.  If an SSA worker only makes one mistake on one case each month, that would be considered very accurate work to everyone except the person on whose account the mistake was made.  For this reason alone, it may be beneficial for an individual to consult with someone knowledgeable in Social Security regulations that can be an advocate for them.  West Law Offices can provide this service.

Fees Revisited

Attorneys cannot negotiate fee agreements with their clients when it comes to Social Security.  The fee guidelines are set by the SSA.  Since June 2009, an attorney will be paid the LESSER OF 25% of the back pay due the claimant or $6000.  If, when a claimant is determined to be disabled, the claimant is due $30,000 in back pay, the attorney can still only collect $6000 because $6000 is less than 25% of the back pay, which amounts to $7,500.

The Social Security Administration has specific forms for client/attorney fee agreements, so the claimant need not be overly concerned about the wording of the agreement.  It will be exactly the same for all attorneys.  The claimant should, however, choose someone in whom they have confidence and with whom they can communicate.

When a favorable ruling has been made, the Social Security Administration distributes payment to the attorney out of the total proceeds, and also pays the claimant.  This insures the claimant and the attorney that the fees will be paid accurately and provides incentives for all parties to provide information quickly.

 

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