Social Security Disability
People who choose J. Timothy Esper & Associates to represent them usually get their Social Security Disability Insurance (SSDI) award faster.
SSDI is available for individuals whose medical condition, or combination of conditions, leave them unable to engage in any substantial gainful activity for one full year. Substantial gainful activity generally means any full-time employment that exists in significant numbers in the local economy. Being disabled from your own job is usually not enough. There must be medical evidence to show that you can't do any full-time work at all, even at light duty, lower paying jobs.
At age 50, 55 and 60, special “grid” rules make it easier to qualify for SSDI. For instance, at age 50, an individual with a high school degree who can't do his previous work, has no transferable skills and is limited to sedentary employment, automatically qualifies for benefits.
Monthly SSDI benefits are based on your earnings record and begin as early as the sixth month following the onset of disability that will last for one full year. There is an important interplay between Social Security and other benefits, primarily workers' compensation and automobile no-fault. We make it our business to maximize benefits from all sources.
After two years on SSDI, a disabled individual is eligible for Medicare. There are also important interactions between Medicare, workers' compensation, no-fault, and third-party lawsuits. Settlement of any injury claim, including workers' compensation, no-fault and third-party liability cases, must include consideration of Medicare's interests. We keep abreast of all Medicare requirements so as to protect our client's medical benefits in all cases.
More people's initial application and appeals are approved if they have an experienced attorney involved than if they go it alone. Mark Aiello specializes in Social Security disability law and has practiced in this area for over 16 years. He has over a 90% success rate in SSDI cases and has recovered millions of dollars for our clients. Mark is available to respond to your inquiries regarding any Social Security disability claim.
If you are under the full retirement age (65-67), have a medical condition expected to last at least 12 months contact us to schedule your initial consultation. The initial consultation is FREE and there is No Obligation to hire us. We only charge an attorney fee if we obtain Social Security benefits for you. We will examine your claim and explain your rights under the law so you will understand how to best fight for the benefits you deserve.
Current State of SSDI
Only a small percentage of the American population with disabilities will qualify for SSDI. However, the number of people applying for and qualifying for SSDI has increased dramatically in recent years and will continue to do so in the near future.
A number of factors have created a large backlog in the processing of SSDI applications. For example, the average age among SSDI recipients is 53. Also, over the years new types of disabilities, such as mental disabilities, have been acknowledged by the SSA and this has increased the number of people who qualify.
The result is that both receiving and administering Social Security benefits has become extremely difficult for both those who need SSDI benefits and for the SSA. Though the SSA is working hard to cut through the backlog, improve its methods and add staff, those with disabilities who go at it alone will continue to face a complex and intimidating process – and long delays in obtaining the SSDI benefits they deserve.
Social Security Disability Insurance (SSDI) is a payroll tax-funded, federal insurance program. A portion of the FICA taxes you pay are set aside for SSDI (as well as Social Security Retirement and Medicare). SSDI, which was established in 1954, is designed to provide you with income if you are unable to work due to a disability or until your condition improves, and guarantees income if your condition does not improve. Then once you meet your retirement age – 65 or older – you move from SSDI to Social Security retirement income.
The Social Security Administration’s (SSA) definition of disability is different than other programs you may come into contact with through your employer or private insurance. The SSA pays only for total disability. No SSDI benefits are payable for partial disability or for short-term disability.
Eligibility for SSDI is based on your inability to work. You are generally considered disabled by the SSA if:
- You cannot do work that you did previously;
- It is determined that you cannot adjust to other work because of your medical condition(s); and
- Your disability has lasted or is expected to last for at least one year or result in death.
Social Security Disability Insurance (SSDI) benefits are not based upon or affected by your other income or assets (means based). Disability benefits are determined by how much a taxpayer has paid into the program (payroll taxes).
There are four levels in the Social Security Administration's (SSA) review and award system for disability. There is an additional level that takes you out of the SSA system to Federal Court, although only a small percentage of applicants will pass through all five levels.
Level One – Application. Complete the initial Social Security disability application and in most instances, a detailed Activities of Daily Living Questionnaire. There is an extensive amount of paperwork to complete at this initial level. According to the SSA, it is necessary for a doctor to verify information in the application with pertinent medical information and confirm that the disabling condition will last 12 months or longer. Being vague about your work history and exaggerating the impact of your disability will contribute to your claim being denied.
The Disability Determination Services (DDS) in your home state makes the initial disability determination. They secure medical evidence and arrange for one or more consultative exams if there is not enough evidence to make a decision. DDS employees gather and evaluate all the information to arrive at a disability determination. The wait period at level One may take as little as three months, but the average is four to six months.
Level Two – Reconsideration*. If the initial disability application is denied, you have 60 days to ask for a reconsideration or first appeal. Your medical and vocational information will need to be reviewed and updated. At this level, a different individual within the Social Security Administration reviews the application. The SSA will send you a letter explaining how it made its decision. The average wait period at level Two is three to five months. Approximately 87 percent of first appeals are denied.
*Level two does not exist in Alabama, Alaska, Colorado, Louisiana, MICHIGAN, Missouri, New Hampshire, New York, Pennsylvania and two offices (LA N 00057 and LA W 00056) in California.
Level Three – Hearing. If the reconsideration is denied, you must again notify the SSA within 60 days that you will appeal the decision, which moves the application to the hearing level or second appeal. This level takes you from the SSA claims processors and into the hands of an administrative law judge (ALJ). The ALJ will make an independent decision based on the evidence (including all testimony at the hearing). About 20 days prior to your hearing, you will receive a notice indicating the date, time and place of your hearing. The ALJ usually holds the hearing within 75 miles of your home. If the ALJ schedules a hearing, you and your representative must attend.
It is important that you submit any additional evidence you want considered to the ALJ as soon as possible. At your hearing, the ALJ will explain the issues in your case and may question you and any witnesses. The ALJ may ask other witnesses, such as a doctor or vocational expert, to provide information at the hearing. You and your witnesses answer questions under oath. You and your SSDI representative, if you have one, may question any witnesses and submit evidence. After the hearing, the ALJ issues a written decision after reviewing all of the evidence. In some cases, your representative may ask for a decision on the record, which means the ALJ reviews your claim and makes a decision without a hearing. The ALJ will send you and your representative a copy of the decision.
Approximately 62 percent of second appeals are awarded to the applicant. The SSA estimates the average time spent at this level was 360 days in 2011. If a disability hearing ends in another denial, the decision can be appealed again.
Level Four – Appeals Council. If the hearing ends in a denial, you have 60 days to ask for a review by the Appeals Council. At this level, the Appeals Council will review the disability hearing decision to determine if it was rendered properly according to the law. Only 2 percent of third appeals result in a favorable decision for the applicant. The SSA estimates the average time to receive a decision on this third appeal in 2011 was 358 days according to the SSA.
Level Five – Federal Court. There is also an additional appeal available which is pursued by less than one percent of claimants -- Federal District Court (FDC). Approximately 70 percent of these are denied with a small amount receiving a decision in FDC that resulted in an award. The remainder of those are remanded (sent back) to the hearing level for an additional hearing.
Award: If your claim is awarded, the general guidelines regarding when to expect payment, including retroactive payments (if applicable), are two to four weeks for claims awarded at levels one and two, and one to three months for claims awarded at levels three and four. These time frames represent an average or general guideline – specific time frames may be shorter or longer.
How much you receive is determined by a complicated formula using the amount of your past earnings that have been subjected to FICA taxes. The average monthly benefit for an individual was $1,072 in 2011. However, your monthly award is dictated by your lifetime earnings so for many people their award could be much higher.
Continuing Disability Review: Your eligibility for SSDI benefits is subject to review at certain intervals after benefits are first awarded. These intervals are based on if your condition is expected to improve. These reviews are usually at one, three, five or seven years. For example, if medical improvement is expected, a “CDR” (Continuing Disability Review) date of one year is established at the time your benefits are awarded.
Why You Want Social Security Disability Insurance (SSDI)
As you learn more about SSDI, you’ll find there are a number of other powerful and important financial and healthcare benefits that will be available to you.
The Benefits of SSDI:
Regular Monthly Income:
SSDI is a regular monthly payment and provides annual cost-of-living increases. A portion of these Social Security disability benefits may be tax free.
Regardless of your age, 24 months after your date of entitlement to SSDI benefits, you are eligible for Medicare, including Part A (hospital benefits) and Part B (medical benefits). A variety of Medicare Advantage plans are also available to you.
Prescription Drug Coverage:
Once you are entitled to Medicare, you are also eligible for Medicare Part D, the prescription drug plan.
If you receive SSDI benefits, the length of your COBRA benefits could be extended an additional 11 months.
Long-Term Disability (LTD) Benefits:
If you have private long-term disability insurance, your provider will often require you to seek SSDI. Complying with this requirement could help protect your ability to receive LTD income.
Protected Retirement Benefits:
When you reach retirement age, SSDI ends and you transition to Social Security retirement benefits. Social Security disability entitlement “freezes” Social Security earnings records during your period of disability. Because the years in which you collect SSDI benefits are not counted when computing future benefits, your Social Security retirement benefits may be higher than if your earnings were averaged over a greater number of years.
If you receive SSDI benefits and you have a dependent under age 18, he or she may also be eligible for benefits.
Social Security will provide you opportunities to return to work while still paying you disability benefits.
We know what you’re going through. Finding the right Social Security Disability Insurance (SSDI) representative can help you get through the Social Security disability backlog faster. But first, you need to know what to look for before making this important decision.
Nearly 1.8 million people are waiting to learn if they will receive their Social Security Disability Insurance (SSDI) award, a wait that averages two to four years. Newcomers to the cumbersome SSDI application process may not be fully aware of their options when seeking help.
The questions below are compiled from those most commonly asked about SSDI representation.
How knowledgeable and experienced is the attorney in representing individuals applying for SSDI?
You should look for an attorney who specializes in SSDI and understands the complexities and nuances of the process.
Attorney Aiello’s expertise is evident in his more than 16 years’ experience of representing individuals with the SSA process and 90% success rate.
Will the attorney help you file the initial application for SSDI?
It is to your advantage to use an attorney in the earliest stages of the process. This is especially true when completing the Activities of Daily Living questionnaire, which requires a level of detail that can easily derail you because you are unfamiliar with the process.
What specific activities will the attorney undertake on your behalf?
It’s important to choose an attorney who
- Consistently works the claim on your behalf throughout the process.
- Helps you complete the necessary paperwork.
- Makes sure forms and appeals are filed in a timely manner.
- Contacts your doctors to collect and/or update medical records for your claim independently of the SSA.
- Will be available to answer any questions you may during the process.
Does the attorney have experience representing someone with your disability?
Not all disabilities are alike—the SSA has specific Disability Impairment Criteria for hundreds of specific conditions, from AIDS and diabetes to fibromyalgia and strokes. It’s essential to prepare each case with details and in the language required by the SSA to avoid unnecessary delays, a reduced award or denial of benefits. It is essential that the attorney you choose is experienced in working with a variety of disabilities as well as knowledgeable about the SSA’s specific Disability Impairment Criteria.
Does the attorney file information electronically with the Social Security Administration?
Filing forms electronically can improve the chance of a timely response because it’s easier for the Social Security staff to review and process the information. J. Timothy Esper & Associates, P.C. utilizes electronic filing.
Will you have to attend any hearings?
Approximately one-quarter of SSDI cases proceed to the hearing level when the case comes before an administrative law judge (ALJ). However, this might not be necessary if an “on-the-record” favorable decision is received. This is when the judge makes a decision based on the information in the claim file.
What is the attorney’s success rate?
No attorney has a 100-percent track record, but consumers should look for a representative with a high success rate in gaining SSDI benefits for their clients. This indicates the attorney not only can deliver the desired result, but also probably has good credibility in the industry.
For example, our firm has a 90% percent success rate for those who are eligible and complete the process with us.
How much faster can the organization help you win your award?
There is no guaranteed timeline. External factors, including the growing disability backlog at the SSA in processing claims can affect the timing, but an attorney should know on average how long it takes their clients to get through the various stages of the SSDI process.
What does it cost?
The SSA determines the fee that an attorney can charge for SSDI representation. Currently, under the SSA's fee agreement approval process, it is 25 percent of the retroactive dollar amount awarded, not to exceed $6,000. Those who are approved quickly at the Social Security disability application level and receive no retroactive award typically pay much less.
SSDI Guidelines by Disability
To qualify for Social Security Disability Insurance (SSDI), you must:
- Have worked and paid into the program (payroll taxes) for five of the last 10 years preceding your disability,
- Have been disabled before reaching full-retirement age (65-67), and
- You must meet Social Security Administration's definition of disability.
What is SSI?
- Supplemental Security Income (SSI) is an income benefit program administered by the Social Security Administration (SSA) for people with limited income and resources who are disabled, blind, or age 65 or older. The SSI program is based on financial need established by income and assets requirements.
How does SSI differ from Social Security Disability Insurance (SSDI)?
- SSI and SSDI are both federal SSA programs that provide assistance to people with disabilities. SSI is a means-based program for low-income individuals, so eligibility is based in part on your income and resources. SSDI eligibility is not based on low income. It is only available to those people who have paid into the federal insurance program through FICA (or payroll) taxes and who meet the SSA’s definition of disability. However, some individuals are eligible for both SSI and SSDI.
Who is eligible for SSI benefits?
- Adults who are age 65 or older, blind or disabled
Disabled or blind children
- Must have limited income and resources (meet the SSI eligibility requirements), and
- Be a resident of the United States, and
- Not be absent from the country for more than 30 days, and
- Be either a U.S. citizen or national, or in one of certain categories of eligible non-citizens.
What are the SSI eligibility requirements?
Limited Income Requirements
- Includes money you receive, such as wages, Social Security benefits, pensions; also such things as free food and shelter. The SSA also includes part of your spouse’s income and resources if you are married.
- Additional stipulations may apply (e.g., you are a student, etc.).
Income the SSA does not count:
- The first $20 per month of most income you receive;
- The first $65 per month you earn from working and half of the amount over $65;
- Food stamps;
- Shelter you receive from private nonprofit organizations; and
- Most home energy assistance.
- Contact the SSA to find out the monthly income limits in your state for additional state supplements.
Limited Resources Requirements
- Resources are things you own and can include: real estate, bank accounts, cash, stocks and bonds.
- Individual limit: Total resources worth no more than $2,000.
- Couple limit: Total resources worth no more than $3,000.
Resources the SSA does not count:
- The home you live in and the land it’s on;
- Life insurance policies with a face value of $1,500 or less;
- Your car (usually);
- Burial plots for you and members of your immediate family; and
- Up to $1,500 in burial funds for you and up to $1,500 in burial funds for your spouse.
How is SSI different from Social Security disability benefits?
- There are several differences. For example, SSI benefits are not based on your prior work history. SSI is funded by general funds from the U.S. Treasury, while Social Security benefits are funded by FICA taxes you and your employer paid. In addition, in most states, SSI beneficiaries also may receive Medicaid (medical assistance) to pay for hospital stays, doctor bills, prescription drugs and other health costs.
What are the benefits of receiving SSI?
- In 2012, the federal benefit rate is $698 for an individual and $1,048 for a couple. Some states supplement your federal SSI benefit with additional payments. This makes the total SSI benefit levels higher in those states. SSI benefit amounts and state supplemental payment amounts vary based upon your income, living arrangements and other factors.
Can I apply for SSI on my own?
- Yes, you can. You may be eligible for both SSI and SSDI benefits if you have an eligible work history, limited income and resources. Our firm can help improve your chances of being awarded these benefits, and more quickly, and usually handles your SSI and SSDI claims simultaneously.
What is SSDI?
Social Security Disability Insurance (SSDI) is a payroll tax-funded, federal insurance program. Its purpose is to provide income to people unable to work because of a disability.
How do you qualify for SSDI?
You must be insured. That generally means you must have worked and paid into the program (payroll taxes) for five of the last 10 years. You must also have been disabled before reaching full-retirement age (65-67) and you must meet Social Security’s definition of disability. Your full-retirement age varies depending on your birth date. Specific details are available here.
Do I qualify for SSDI?
Contact our office to determine if you qualify.
What is Social Security’s definition of “disability”?
Generally, it’s being unable to work because of a verifiable mental or physical impairment expected to result in death, or has lasted, or is expected to last, for at least 12 months.
Is it difficult to get Social Security disability benefits?
It can be. The Social Security Administration (SSA) denies 65 percent of the people filing initial disability applications. It also can take a long time, on average two to four years.
What is our firm’s success rate?
Our overall award rate is about 90% percent for those who complete the process with us.
Do I need a disability representative or disability advocate working for me?
You can apply on your own. However, an attorney representing you through the process may dramatically improve – and speed – your chances of receiving disability benefits. Our firm has 37 of years in disability benefits experience. The vast majority of SSDI applicants have an attorney for their appeal.
Why should I choose J. Timothy Esper & Associates, P.C. to help me get SSDI?
- We will represent you at all levels of the SSDI process, from application through appeals.
- We have a 90% percent success rate and more than 37 years of experience representing claimants throughout Michigan.
- We simplify a very complicated process and assist you through all of the paperwork, collect medical records, prepare you for hearings and speak to the SSA on your behalf. We actively check the status of your claim on a regular basis.
- We’re here when you need us and we keep you informed on a regular basis.
What are our fees?
The SSA governs the fees of representatives. Our typical fee is 25 percent of the retroactive (back) award, not to exceed $6,000. We do not charge a fee unless we are successful in obtaining your benefits. And there are no add-on fees for travel, collecting medical records, etc.
How long does it take to get a decision?
Unfortunately, it’s not a quick process. Generally, it takes about three to five months for the initial decision. Reconsideration (first appeal) will take another three to five months. The second appeal is before an administrative law judge in Social Security’s Office of Disability Adjudication and Review. The average time to receive a decision at this level in 2010 was 426 days.
Tips on preparing for a hearing.
Your attorney will thoroughly prepare you for the hearing in advance.
How much will I receive?
The complicated formula is largely determined by the amount of your past earnings that have been subjected to FICA taxes and will have to be calculated.
Can Social Security take away my Social Security Disability Insurance benefits?
Yes. It doesn’t happen often, but you can lose your disability benefits if your condition improves to the point that you no longer meet the SSA’s definition of “disabled.” SSA must show there has been medical improvement related to your ability to work before they can cease your SSDI benefits.
Can I get additional benefits if I have children/dependents?
Children up to age 18 or who have not graduated from high school are entitled to benefits if a parent is deceased, retired or disabled. Generally, dependent children of a disabled parent will receive about 50 percent of the disabled parent's monthly benefit. The 50 percent is divided equally among all eligible dependents.
Why apply for Social Security Disability Insurance (SSDI) benefits?
SSDI provides income until your condition improves, offers assistance to help you return to work and provides ongoing income if your condition does not improve. You are entitled to it based on payroll taxes you have paid and your employer has matched. Also, when you receive SSDI, you qualify for other important programs like Medicare and prescription drug assistance, and protect your future Social Security retirement benefits.
Where can I get more information about Social Security Disability Insurance (SSDI)?
Go to the Social Security Administration’s website.
Can you get unemployment benefits while waiting for SSDI benefits?
The receipt of unemployment benefits does not necessarily preclude you from receiving Social Security Disability Insurance (SSDI) benefits. It is, however, a factor examiners consider when determining whether or not you qualify for SSDI benefits. Some administrative law judges (ALJs) may not award SSDI benefits if someone is receiving or has applied for unemployment. Disability onset dates (the date the disabling condition began or the date your condition required you to seek SSDI / affected your ability to be employed) may have to be amended to the day after someone received their last unemployment check.
The issue with unemployment versus SSDI benefits is the difference in why someone receives these benefits. When you receive SSDI, you are unable to do your past work or any other work. Unemployment benefits generally indicate you are ready, willing and able to work, but haven’t found employment yet. ALJs typically look at your individual circumstances when determining the significance of your application for unemployment benefits and related efforts to obtain employment when determining if you qualify for SSDI.
What is Supplemental Security Income (SSI)?
Supplemental Security Income (SSI) is a welfare based program. Monthly benefits are paid to people with limited income and resources who are disabled, blind or age 65 or older. Blind or disabled children, as well as adults, can get SSI benefits. If a claimant’s household income exceeds $674 per month for an individual and $1,011 for a couple, or the value of their resources are above $2,000 for an individual and $3,000 for a couple, then they are not eligible for SSI.
- OBTAIN SOCIAL SECURITY STATEMENT ONLINE
- SSA SERVICES FOR PEOPLE RECEIVING BENEFITS
- TICKET TO WORK
- MEDICARE PRESCRIPTION DRUG PLAN COSTS
- RETIREMENT ESTIMATOR
- APPLY FOR RETIREMENT ONLINE
- MEDICARE WEBSITE
- MEDICARE HANDBOOK
- MEDICARE BASICS
- MEDICARE HELP AND SUPPORT
- MEDICARE SECONDARY PAYER UNIT (MSPRC)
State of Michigan Programs
- MEDICAID/DEPARTMENT OF COMMUNITY HEALTH:
- UNEMPLOYMENT INSURANCE AGENCY (UIA):
- DEPARTMENT OF HUMAN RESOURCES ASSISTANCE PROGRAMS:
- HELPING HAND:
- HEALTH CARE ASSISTANCE:
- MEDICAL ASSISTANCE:
- NO CHILD LEFT BEHIND/CHILDREN PROGRAMS:
- FOOD ASSISTANCE PROGRAMS:
- CHILD SUPPORT:
- SUBSTANCE ABUSE PROGRAMS: