HOW AN ATTORNEY CAN HELP WITH THE SSDI/SSI PROCESS
October 19th, 2017 | Donald C. Ligorio
In Pennsylvania, workers suffering from a work injury or illness may qualify for Workers’ Compensation. People who are unable to work due to non-work related injuries or medical condition aren’t eligible for Workers’ Compensation. In that case, disability benefits may be available through Social Security Disability Insurance (SSDI) or Supplemental Security Insurance (SSI). These federal programs are not limited to non-work related disabilities. In fact, it may be possible to receive both Workers’ Compensation and Social Security benefits. However, Workers’ Compensation typically serves as a temporary source of income while the injured worker heals or awaits acceptance for SSDI benefits. HKQ Law Attorney Donald Ligorio points out that a lawyer that is well versed in the intricacies of disability benefits can help you determine the best way to proceed with your claim.
SSDI versus SSI
Social Security Disability Insurance is funded by Social Security deductions from paychecks and serves individuals who have paid into the system. In general, to get SSDI benefits, you must meet two different earnings tests:
- A recent work test, based on your age at the time you became disabled; and
- A duration of work test to show that you worked long enough under Social Security.
Monthly SSDI benefit amounts are based on the insured worker's Social Security earnings record. Typically, the higher your salary was, the higher monthly benefits would be.
Supplemental Security Income is for people who are 65 or older, as well as blind or disabled people of any age, including children. To qualify for SSI, you must also have little or no income and few resources. SSI benefits are based not on a recipient's prior work history but rather on
an individual's financial need. Claimants who did not earn enough taxable income to be eligible for SSDI may apply for SSI. Monthly SSI payments are based on each individual applicant's income and resources, up to the maximum federal benefit rate. If you get SSI, you may be automatically eligible for Medicaid.
For the purpose of Social Security benefits, to be found disabled,
- must be unable to do any substantial work because of a medical condition (physical or mental); and
- that medical condition must have lasted or be expected to last at least 1 year or be expected to result in death.
- the child must have a physical or mental condition that very seriously limits his or her activities; and
- the condition must have lasted or be expected to last at least 1 year or result in death.
Applying for Social Security benefits
An application for SSDI or SSI can be made online, by phone or in person at any Social Security office. Applications are initially reviewed by the Social Security Administration (SSA) to determine financial eligibility. Eligible applications are then forwarded to Pennsylvania’s Bureau of Disability Determination (BDD) for determination of an applicant’s medical eligibility under the Social Security law. BBD determines:
- Severity of impairment
- Whether that impairment meets or equals the SSA’s "Listing of Medical Impairments"
- Applicant’s ability to do prior job
- Applicant’s ability to do any job
To make the determinations, medical evidence requested from the applicant’s doctors, hospitals and other institutions that provide medical treatment is reviewed.
The vast majority of applications (up to 70%) are initially denied. One of the most common reasons disability benefits are denied is the lack of sufficient medical evidence to prove the disability. However, even a minor clerical error in filling out the application can create a major issue, and lead to a denial. An experienced disability benefits attorney can be indispensable in developing medical evidence and accurately completing the application.
Appealing denial of benefits
A claimant whose application has been denied may simply file a new claim. However, the best option is to file an appeal. The hearing will be heard by a federally appointed Administrative Law Judge (ALJ). The approval rate of SSDI and SSI claims increases substantially at the hearing level
If the ALJ’s decision is unfavorable, the appeals process can be continued by requesting a review by the SSA Appeals Council. The Council considers every request it receives, but doesn't always grant review. Should the Council decline to review your case, or if you disagree with its decision, you can file a lawsuit in federal district court. The District Court Judge will reverse the SSA’s decision if it is deemed “arbitrary and capricious”. The claimant’s evidence must show that the decision was inherently unreasonable, or not based on fact.
In each step of the appeals process, you have 60 days to file for further review. Appealing a denied claim is a complex process; one that is best undertaken with the assistance of an attorney familiar with Social Security law.
Losing disability benefits
If it is determined that a beneficiary no longer meets the medical and financial requirements, their benefits will be stopped. If you’re receiving Social Security disability benefits when you reach full retirement age, your disability benefits will automatically convert to retirement benefits.
If your disability benefits are denied, modified, terminated, or less than you believe you’re entitled to, call HKQ Law Attorney Donald Ligorio at (800) 760-1529. No one will work harder for you.