Hiring an attorney to assist you with your SSDI appeal requires no immediate out of pocket funds. Generally, attorneys work on a 25% contingent fee that is capped at $6,000.00, paid out of your award of back benefits owed. This fee structure is standard throughout the administrative appeal process. If your case is denied after hearing and the appeals counsel upholds the denial your claim or denies review, your attorney will discuss the difference in the fee and costs associated with filing a case in Federal Court.
Even though your doctor has documented you cannot work, Social Security regulations require that you meet Social Security's definition of disability. This is more stringent than not being able to perform your usual occupation. Generally, you have to be unable to perform any and all jobs.
Social Security defines disability as "the inability to engage in any substantial gainful employment (SGA) by reason of any medical 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 a continuous period of not less than 12 months."
The definition has several parts to it, and it can be confusing to try to navigate how to prove your entitlement to benefits without an experienced attorney.
SSDI is a type of social security disability insurance based on work credits that you earn while you are employed. 40 work credits are required for you to be fully insured under the SSDI program. The amount of money you receive under SSDI is based on your earnings while you were employed and paying your Social Security taxes out of your paycheck.
SSI, is an economic needs based program for people that do not have enough work credits, but are still disabled. SSI has household income limitations and resource limitations, and the social security benefits payment per month is set by the government and usually lower than what you would receive under the SSDI program.
Ideally if you can get social security benefits established under the SSDI work credit program, your monthly amount is usually more than the SSI monthly amount, and the household income and resource limitations do not apply. If you have sufficient work credits, it's important to apply for social security disability as soon as possible. Social Security does assign a date last insured (DLI) to everyone once they stop working and are no longer paying into the system. In order to obtain SSDI benefits, Social Security must find you disabled prior to your DLI.
You've been awarded social security disability benefits, and have been doing what you can to make ends meet while trying to follow your doctor's orders with regard to your condition, then you receive a letter from Social Security informing you they are going to "review" your file to see if you are no longer disabled. Social Security has set time limits for different claims when your medical records will be reviewed to see if your situation has improved, or if you remain disabled. For a lot of claimants this occurs approximately ever two (2) years. However, if someone has a condition that has been determined to be permanent due to the type of condition or illness, SSA may elect not to do continuing disability reviews.
Unfortunately, as of late, the government has been looking at increasing the frequency and amount of continuing disability reviews in an effort to save money by cutting off benefits. This means, you could have your claim reviewed even if two (2) years has not yet passed. Because claims are periodically reviewed, it is important that even after you obtain social security benefits, you continue to go to your doctor, and still report any and all issues you continue to have. If you go to your doctor after benefits are granted and downplay your symptoms, or report "I'm doing excellent," or "I'm great and have no problems or pain today" you may end up dealing with Social Security trying to cut off your social security benefits. Whatever happens, always timely file any appeal.
A lot of people applying for social security disability fail to get benefits because they have not gone to the doctor and documented vital "medical record evidence" to prove the nature and extent of their disability and how their impairment impacts their ability to function. Social Security is not permitted to grant social security benefits to someone, unless there are sufficient medical records in their file that clearly support their entitlement to benefits. Even if you have a condition that was diagnosed in the past, and there is not much your can do in the way of treatment, you MUST go to the doctor and report your symptoms, and the ongoing challenges you're having. It is not a question of whether the Administrative Law Judge or person reviewing your file is willing to grant you benefits, it's that even if the person reviewing your file wants to grant you benefits, the law does not allow them to do so, without having adequate documentation in the form of medical record evidence.
No attorney, no matter how excellent they advocate, can successfully get you social security benefits, if you fail to follow up with your treating health care provides while your claim is pending. Seeing your doctor is a vital part of getting and keeping your social security disability benefits.
Information provided through this site is for informational purposes only. No attorney client relationship has been formed, and you may need individual legal counsel to deal with your specific situation. You are strongly encouraged to contact an attorney.