SOCIAL SECURITY DISABILITY

SSA administers two programs that provide benefits based on disability

 

  • Social Security Disability Insurance Program – DIB – (Title II)Pays disability benefits for insured workers, their disabled surviving spouses and children of disabled, retired or deceased workers. Provides for payment of disability benefits to individuals who are “insured” by virtue of contributions to the Social Security Trust Fund through the social security tax on their earnings, as well as to certain disabled dependents in insured individuals, e.g., widow or spouse.
  • Supplemental Security Income – SSI – (Title XVI) Provides payments to individuals (can include children under age 18) who have little or no income or resources. Comparable to welfare; house & a car.

Definition of Disability

Both types of disability require proof that the claimant is incapable of substantial gainful activity:

  1. Unable to earn a minimal amount (set by the SSA) per month because of a medical condition(s).
  2. Medical condition must have lasted, or be expected to last, at least 12 months. A claimant must meet the social security definition of disability: the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for at least 12 months. Can’t earn over $8140.00 per month. A medically determinable impairment, whether physical or mental, must be established by medical evidence and not just the individual’s (claimant’s) statement of symptoms.

TO WHOM IT MAY CONCERN LETTER FROM DOCTOR

Medical Evidence in the form of treatment, tests, procedures, etc., must substantiate doctor’s assertions.

The Application Process

SSA is a federal program; however, there is a network of both local social security field offices (Bradford Drive) and state agencies (Disability Determination services) that initially process the disability claims.

File an application: mail, telephone or in person with field office. Verifies information and sends to DDS for decision

  1. Description of impairment
  2. Names/addresses for treating physicians
  3. Other pertinent information

Requirements

Non Medical Eligibility Requirements (quarters, marital status, income from other sources, etc.)

  1. Medical Requirements – (incapable of SGA)

The Initial Decision:

Three possibilities

Favorable:
  • DDS sends back to field office to compute benefits and begin payment. 25%
Partially Favorable:
  • DDS sends back to field office to compute benefits and begin payment in the event claimant does not appeal. Rare, e.g., closed period of disability.
Not Favorable:
  • Can appeal with 2nd DDS team and then file for a Hearing with an ALJ Office of Hearings and Appeals (located in Florence) but come to Huntsville for hearings. Equipment has been purchased to handle via video.

The Hearing:

Stage
Players
Questions

Burden of Proof:

  • Is the claimant engaging in substantial gainful (employment) activity? This means is the claimant willing to work but literally unable to drag himself out of bed to do so. If claimant makes over $810.00 per month, does not meet this requirement.
  • Does the claimant have a severe impairment, e.g., unable to lift?
  • Does the claimant meet a listing – per doctors’ records?
  • Is claimant capable of doing his past work?
  • Is the claimant capable of performing other work?

Miscellaneous

  • Length of time from initial application to hearing
  • Attorneys’/representatives fees
  • Soapbox – system stops people from helping themselves
  • Physical symptoms of pain – face drawn, no complaints – no energy for it – shifting in seat.
  • Effect of age, level of education, training and experience.