From my experience, there are protections and benefits afforded by our laws that people know that they are entitled to if they are injured. For example, people seem to know that they are entitled to workers' compensation benefits if they are injured on the job. Also, people seem to know that if they are injured in a motor vehicle accident, they can look to the at-fault driver's auto insurance or their own uninsured motorist coverage (or both), for compensation for their injuries.
What most people do not seem to understand are the overlapping benefits that Social Security provides to injured people. A common misconception is that individuals with work-related injury claims or motor vehicle accident claims are not eligible for Social Security disability benefits. As a result, Social Security is often overlooked as a continual source of benefits for injured people, and thousands are missing out on benefits that they are eligible to receive. Sadly, they are missing out on those benefits simply because they are unaware of their rights.
This article is a basic review of Social Security disability benefits and provides answers to 10 of the most common questions that we get asked about Social Security. To better help our readers understand their rights, these answers are as direct and to the point as possible.
1) AM I ELIGIBLE?
ANSWER: Social Security is a system into which you pay during your working years through the FICA contribution on your pay check. To be eligible for disability benefits, you must have worked long enough and recently enough under Social Security guidelines, depending on your age. If you have worked about half the business quarters in the last 10 years, you are probably eligible.
2) AM I DISABLED ENOUGH?
ANSWER: Social Security pays benefits to anyone who can establish that they meet the definition of "disabled." According to the Social Security Administration, "disabled" means "an inability to do any substantial gainful activity by reason of a medically determined physical or mental impairment which can be expected to continue for not less than 12 months."
3) HOW DO I APPLY?
ANSWER: Lawyers are not involved in the application process when you initially file for Social Security benefits. Social Security claims can be filed online or in person at a Social Security office. A call in advance to set up an appointment may be helpful in speeding up the application process.
4) WHAT HAPPENS AFTER I APPLY?
ANSWER: When you apply for Social Security benefits, usually months will go by with no word whatsoever from the Administration. You might not hear anything for 6 months or even longer after you submit your application. During that time, the Social Security Administration is gathering your medical records and submitting those records to a case worker to determine whether you are entitled to benefits. Eventually, after many long months of waiting, you will get their determination.
5) HOW OFTEN DO PEOPLE GET DENIED BENEFITS FOLLOWING APPLICATION?
ANSWER: All the time. Nearly everyone who applies for benefits waits months to hear from Social Security, and when they do, it's usually a denial.
6) SO, SHOULD I GIVE UP WHEN I GET THAT DENIAL?
ANSWER: No way! When you find out that your benefits have been denied, you should quickly submit the necessary forms to appeal that denial. In Social Security matters, your case is brought before an administrative law judge only after you appeal the initial denial of your application. This is the stage that you can, but are not required to, hire an attorney to help you with your case.
7) HOW DO I APPEAL?
ANSWER: The denial letter that you receive will detail the forms that you must submit and the deadline to lodge your appeal. Once those forms are filed, it is up to Social Security to ready your matter for the hearing in front of an administrative law judge. Hearings are set anywhere from 8 months to even as much as a year or longer from the time you file your request for an appeal.
8) WHAT SHOULD I EXPECT AT THE HEARING?
ANSWER: Hearings are conducted in several locations throughout Colorado. Each hearing is attended by one judge, the judge's clerk, and usually by a vocational rehabilitation expert that is retained as a consultant for the judge. Sometimes, a medical doctor consultant will attend, usually by telephone, to assist the judge. There is no opposing counsel at the hearing. That's right there is no one at the hearing who has been hired to try and keep you from receiving benefits. Hearings generally last from 30 to 45 minutes.
9) HOW DOES THE JUDGE DECIDE?
ANSWER: Administrative law judges are trained to use a 5 step sequential process to determine whether you qualify for Social Security benefits. If you fail to meet any of the requirements, you lose.
Step 1: The judge determines if you are currently performing work that is both substantial and gainful. If you are, you lose.
Step 2: The judge determines whether your impairment or a combination of impairments would be considered "severe." If the judge determines that it is not, you lose.
"Severe" is defined as more than a minimal effect on an individual's ability to do basic work.
"Impairment" must result from an anatomical or physiological or psychiatric condition.
Step 3: The judge determines if the impairment has lasted or is expected to last 12 consecutive months. If it is a condition that will not last 12 months, you lose.
Step 4: The judge must determine whether you can perform past relevant work.
This step requires the judge to determine what your impairment level still allows you to do. They call this your "residual functional capacity" or RFC. The judge then reviews the physical and mental demands for the type of work that you performed in your past, usually the last 15 years. For assistance in answering these questions, the judge will ask the vocational rehabilitation expert in attendance to detail the demands for the type of job that you performed in the past. To answer these questions, the vocational expert refers to a book called The Dictionary of Occupational Titles. Lastly, once the judge determines the generic requirements of your past work, the judge then considers your age, education, and RFC, and then determines whether you are restricted from returning to your past relevant work. If the judge determines that you can return to your past relevant work, you lose.
If the judge determines that you can no longer perform any past relevant work, then the judge proceeds to the 5th step of this sequential process.
Step 5: The judge considers your RFC along with your age, education, and past work experience to determine whether other work exists in the national or regional economy that you could perform on a regular basis.
Again, to answer these questions, the judge will turn to his vocational consultant for clarification. The questioning goes something like this: "Assuming I rule that Mr. Jones is unable to return to his former jobs as either a mechanic or a security guard, based on his background, education, and relevant work experience, and not considering for a moment any physical limitation, are there other jobs that Mr. Jones is qualified to do?" The vocational consultant might then say, "Based on Mr. Jones' background, he would be qualified to be an auto parts clerk and a dispatch operator for a security company."
Then the judge will ask something like, "Assuming I find that Mr. Jones' current physical restrictions are that he must alter his position sitting and standing every 15 minutes, he will require 15 minute breaks every 45 minutes, and he can lift no more than 5 lbs, and assuming he can do no bending, stooping, squatting, no climbing ladders, no climbing stairs, and no work from any elevation, would Mr. Jones qualify physically to do either of the two jobs you described that of a dispatch operator, or auto parts clerk?"
The vocational consultant will then review for the judge the requirements for these jobs using The Dictionary of Occupational Titles and express his opinion as to whether these jobs fit within the restrictions laid out by the judge. If the vocational consultant convinces the judge that you qualify for these jobs by experience or training, that you could perform these jobs according to your RFC, and that those jobs are plentiful in the economy, you lose.
10) HOW OFTEN DO PEOPLE WIN BENEFITS AFTER HEARING?
ANSWER: Nationally about 60-65% of those who go through the hearing process after originally being denied benefits win at hearing.
At Anderson Hemmat, we believe that when you are injured, you should get all of the benefits and compensation to which you are entitled. Thousands of people who are injured on the job or in car accidents overlook Social Security as a continual source of benefits only because they are unaware of their rights. If you have been injured and you have questions about your eligibility to receive Social Security benefits, please call us today for a free consultation.