FAQs

Social Security is a federally funded program. The funds come from everyone’s paycheck. If you look closely at your last paycheck, you will notice a percentage of your check is deducted because of the Federal Insurance Contributions Act, commonly referred to as FICA. Money paid out in Social Security and Medicare benefits is about 37% of all government spending.

President Roosevelt originally created this system in the 1930’s to pull America out of the Great Depression. Congress ratified his bill as part of the “New Deal.” The overall goal of the original bill was to reduce poverty levels among senior citizens. Over the years Social Security has expanded into what it is today.

When most people think of Social Security, they think of retirement benefits. Age 62 is the earliest age a person is able to start receiving retirement benefits. While this is true, Social Security includes much more. The other five main areas include, Social Security Disability Insurance (SSD), Supplemental Security Income (SSI), Disabled Widow/Widower, Disabled Adult Child, and finally SSI children.

“SSD” or “DIB” refers to a worker who becomes disabled before reaching the full age of retirement. This happens to about 3 out of every 10 workers. Social Security pays benefits to people who cannot work because they have a serious medical condition that is expected to last at least one year or result in death. For a person to collect SSD, they must have a good work history. For most people that means they must have worked five out of the past ten years. Younger people do not need as many work credits to be eligible. SSD is a type of insurance. A worker pays into the system when they are receiving a paycheck. When they become disabled, they can receive monthly disability benefits.

Your medical condition must significantly limit your ability to do basic work activities such as walking, sitting, lifting or paying attention. Your condition must also prevent you from being able to work. Social Security will evaluate your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work. If you are disabled with a good work history and cannot work, then you are eligible for SSD benefits.

Mental disabilities are “hidden” disabilities. They are often not taken seriously by the Social Security Administration. Yet, you can win if you have a disabling mental impairment. Anxiety and depression are real illnesses. Schizophrenia, personality disorders, and a host of other mental impairments can lead to a grant of benefits.

SSI is Supplemental Security Income. SSI uses the same standard for deciding if a person is disabled as they do for SSD, however SSI is for people without good work histories. SSI is a needs based system. People are eligible if their assets and income are below a certain level. SSI is also funded differently. SSD comes from the FICA section of your paycheck. SSI is funded by the U.S. Treasury–personal income taxes, corporate and other taxes. In general, you cannot have more than two thousand dollars’ worth of assets. Some assets like a home, life insurance policies, car (usually), and burial plots do not count as assets against you. Your SSI benefits may be reduced by as much as one third if you receive housing or food from other people without a loan agreement. Gifts or earnings will result in reduction in SSI benefits.

If a worker who is covered by Social Security dies, a surviving spouse may be able to receive benefits if they are disabled.

The surviving spouse must be at least 50 and have become disabled no later than seven years after whichever of the following occurs last:

1) Death of the wage earner upon whose account the claim is based

2) The last payment of mother’s or father’s benefits to the claimant on the wage earner’s account, or

3) The last prior payment of disabled widow or widower benefits to the claimant on the wage earner’s account.

In most cases, this means that if you become disabled within seven years of the death of your spouse you may be eligible.

This refers to a person who became disabled before their twenty-second birthday. A claimant will draw benefits off their mother’s or father’s work history. This benefit comes from FICA payments. The parents must be deceased or collecting Social Security disability or retirement benefits.

Social Security uses a five-step process in determining if you are disabled. This process is used for everyone all the way from Alaska to Maine. This is called the sequential evaluation process.

Question 1- Are you working?

Answer: No – move down to question 2
Answer: Yes – Are you making more than the substantial gainful activity limit  a month?

Answer No  – Move to question 2
Answer Yes – As a general rule you are barred from receiving disability benefits.

The dollar limit  changes every year with inflation. If you are blind then the amount is greater. This amount is referred to as substantial gainful activity (SGA). If you make below this amount you are eligible for benefits.

Off the books income still counts as income.

Question 2- Is your condition severe?

Let’s face it, everyone feels a little disabled at times. We all have achy backs or achy feet from time to time.  Social Security requires that your condition be severe. What is considered severe? The key is that your condition must interfere with basic work-related activities.  A condition like hypertension – although medically serious – may not limit your ability to work at all.

Question 3- Is your condition found in the list of disabling conditions? 

Below is a website, which insiders call “the Listing.” The Listing separates medical issues by major body system. For example, respiratory conditions are separated from digestive conditions.

http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

Even if your impairment is not listed on the website, Social Security will decide if your condition is of equal severity to a medical condition that is on the list.

If the severity of your condition meets or is equal to the severity of a listed condition, then you will be found disabled.

Question 4- Can you do the work you previously did within the past 15 years?

During your initial interview with a lawyer, the lawyer will ask questions as to your previous employment. The lawyer will want to know where you worked, how long you worked there, the maximum amount you had to lift, how long you were on your feet, and how long you needed to sit and the mental requirements of your job, etc.

If you cannot possibly do any type of work you did in the last fifteen years due to your current disability, then move on to question 5.

Question 5- Can you do any other type of work?

Social Security may have a vocational expert at the hearing to help the Judge decide whether there are jobs in the economy that you can do with your present impairments. The judge will take into account your age, education level and the transferability of your skills (if any) when deciding if you can do any other job. The rules change as you get older. Social Security also uses a “Grid” to help determine whether there are other jobs in the economy that you can do.

The first question is, when should I call an attorney? Some attorneys do not take cases until a claimant has been denied twice, and is ready to file for a hearing. Zimberlin Law LLC takes cases right from the start. If you are still working, we will see you before you file for disability to help you decide if you might possibly qualify for benefits. We believe that if we get involved early in the process, we can help prevent you from making mistakes which might hurt your claim.

When you first call a Social Security attorney the odds are you will be asked a series of questions. Questions will typically include;

How old are you?
When did you last work?
What is your prior work experience?
What are your impairments?
List all of them and include the severity of your impairment
Do you have any history of drug or alcohol use?
Who are your current doctors?
How many children under the age of 19?
What is the status of your claim, if you have started one?
How old were you when you were disabled?
Do you have medical insurance?
If applying for SSI only, what is your spouse’s income and source?
If you are applying for SSI only, what are your living arrangements?

It is important to fully answer all the questions.

Your first contact with a law firm will likely be by telephone. It may feel awkward and probably embarrassing when the person on the other side of the phone is asking intimate questions about your mental and physical health. This is not a time to hold back.

After your phone interview answering basic questions, the attorney may schedule an appointment with you, or may ask you to send in medical records first. The attorney may want your doctor to fill out forms. A personal meeting with the attorney at the start of a case is important. The attorney will explain the process and address any legal problems you may have in your case.

At this meeting, the attorney will inquire about all of your ailments and how your disabilities restrict you from working full-time. The attorney will also ask questions about your mental limitations. It is important let the attorney know exactly what is stopping you from working.

The attorney will estimate the time it will take you to go through the process. There are many delays built into the process. You must be prepared for a long wait for Social Security to decide your case.

When you meet with the attorney it is good to bring every piece of paper you have received from Social Security. This will make it easier for the attorney to see where you are in the claims process and why your previous attempts to obtain benefits have failed.

Bring medical records if you have them. If you have received worker’s compensation benefits recently, bring in documents that show the amount of your benefits, and when they started and ended.

Bring a list of all employers from the past 15 years with dates. The exact start and stop date for every job is not necessary, however approximate years of employment are helpful.

The attorney will discuss the fee at the first meeting. While many types of fee arrangements are possible, the typical fee is contingent on you winning the claim. That means that there is no fee unless you win. The typical arrangement is 25% of the back payments with a $6,000 cap. The cap is adjusted upwards from time to time. Social Security must approve all fees. Zimberlin Law LLC does not charge a fee unless you win.

Here is an example of the attorney’s fee in action:

Let’s say you became disabled on January 2, 2013 and that is also the date you stopped going to work. There is a five month waiting period for SSD. The first month of benefits would be June 2013. Let’s say you are granted in January 2014 and are entitled to $1,000 per month from June through November. You are entitled to six months of back benefits, for a total of $6,000.00. Your attorney will receive 25% of the lump sum payment you receive, which is $1,500.00. The attorney does not receive any of your future benefits.

The attorney fee is usually automatically withheld from the first lump sum payment you are set to receive. Social Security will send out two checks; one to your attorney and one to you. Social Security does not pay for expenses, such as costs of medical records and reports, postage, etc.

Initial claims for disability can be made online at https://www.ssa.gov/. The initial questionnaire will ask you general questions about yourself including; age, Social Security number, etc. You can also apply in person or by telephone. Social Security offices generally have been closed to the public during COVID.

After you apply, SS will forward your request for benefits to the Disability Determination Services (DDS) office of your state. DDS will ask you to provide them with all of your medical information relevant to your claim. You will need to give them names of your doctors.

The state agency may schedule a consultative exam (CE) with one of its doctors to determine if you are disabled. If you have your own treating doctor, you can ask DDS to schedule the exam with your doctor.

Doctors and disability specialists at DDS will evaluate your entire file and make a decision as to whether you are disabled.

If you are approved, a letter will be mailed to you with the amount you will receive in benefits and when they will start paying. If you are denied benefits, a letter will be mailed to you with reasons why you were denied. It is extremely important that you keep every piece of paper the Social Security office sends you.

Reconsideration

If you are denied, either you or your attorney will then have to send in a request for reconsideration. The request for reconsideration can also completed through the SSA website and the process is similar to the initial filing. You only have sixty days to file for reconsideration after the initial claim is denied. Do not miss this time limit.

Hearing

If the reconsideration is denied, and you still do not have an attorney, now is the time to get one. The next step of the process involves a hearing in front of a judge. The judge’s job is to be fair to the claimant and grant benefits if the person is truly disabled. They also have a duty to not burden the general taxpayer with paying for non- disabled people. The system in most states is backlogged. It may take several months from the time you request a hearing to the time you are actually sitting in front of a judge. Your attorney will be able to estimate the time it takes to get a hearing in your area.

You must request a hearing within 60 days of the denial. If you lose at the hearing, you can appeal to the Appeals Council, then Federal District Court, and then the Federal Circuit Court.

Right now, because of COVID, hearings are being held by telephone. You will meet with your attorney in his or her office, or you can participate from your own home. Hearings may also be scheduled by video. This situation is fluid and is changing rapidly. Your attorney will be able to tell you what kind of a hearing to expect.

The hearing room will typically have at least four people; you, your attorney, the ALJ, and the ALJ’s clerk. You may have a witness to testify and there may also be a vocational expert and possibly a medical expert. The hearing is closed to the general public. It is private.  Hearings typically last about an hour and sometimes if they go longer than expected, they will be extended into another day to finish up. Do not expect the ALJ to decide your case on the spot. A written decision will be sent, about two or three months after the hearing. If you win, it will take another month or two for you to receive your first payment.

The judge will ask you some questions and your  attorney will ask you some questions. If you have a witness, the witness may testify. The judge will ask questions of the vocational or medical expert. Your attorney will have a chance to question those witnesses. Your attorney may discuss points of law with the judge, or may make objections to preserve your rights if you need to appeal.

There are some general tips and guidelines you should follow when preparing for your hearing:

• Show up.
• Do not dress up, just wear what you normally wear during the day. Let the judge see you as you are during a normal day.
• If you are not sure what the judge is asking, just be honest and ask him or her to rephrase the question in different terms. If you genuinely do not know an answer, just say, “I don’t know.” This may seem like an easy tip, however many claimants provide an answer to a question that was never asked. Answer the question that was asked. Do not guess. Tell the truth.
• Telling people other than your doctor about your medical impairments is embarrassing, however to win a hearing, you should go into detail about how your impairments make it impossible for you to work at a full-time job. Do not exaggerate.

Yes, in certain circumstances. If you have received worker’s compensation payments recently, your Social Security disability benefits may be reduced. The amount of the reduction depends upon your earnings history, your expected Social Security benefit, and the amount of the weekly comp payment.

If you get SSI, the monthly amount will be reduced if you have other income, which can include worker’s comp, gifts, earnings, or “in kind” assistance such as free room and board.

Receipt of unemployment compensation is not an absolute bar to collecting Social Security benefits, although the judge can consider this as a factor. You should discuss this with your attorney before you apply for and collect unemployment compensation benefits. Be sure to check with your attorney as to the current legal requirements.

If you receive Social Security disability benefits, you will be able to also collect service connected veteran’s disability benefits. If you receive SSI, your veteran’s benefits may reduce or eliminate any entitlement to SSI benefits.

If you are eligible for a private insurance benefit from a Long Term Disability plan, then your LTD benefit may be reduced because of SSD. Your Plan documents will specify if SSD reduces benefits.

There are many ways a claimant can lose a hearing. Here is a list of the most common claim blunders.

• Skipping medical appointments. Some people say that ninety percent of life is showing up. The judge will see a series of missed appointments and think, “If this person was truly disabled, they would do anything to become healthy.” They do not want to hear excuses about why you didn’t show up at your appointments. If you know of an appointment you are not able to attend, then let the medical facility know ahead of time, and ask that it be rescheduled. If you have difficulty leaving your house because of a mental impairment, or you do not have transportation, call and tell your medical provider prior to the appointment. Every time you skip an appointment the doctor will write in big letters  NO SHOW. This sticks out like a sore thumb to anyone skimming through your records.
• Drug and alcohol use. Plain and simply put, judges do not like it when a claimant is using drugs or alcohol. STOP all substance abuse.
• Inconsistencies in statements. If the ALJ notices that you are telling your doctor a different story than you tell him or your attorney, he or she may find that you are not credible. If the doctor’s notes regarding your disabilities do not match your oral testimony during the hearing, the judge may deny your claim because he or she does not believe you. This will also happen if he or she thinks that you are embellishing the severity of an impairment. Many claimants do not tell their doctors about all of their problems in daily living because they forget or they think that the doctor is rushed. Write down your problems in daily living and bring that to the doctor at your appointments. It will remind you to tell the doctor about all of your impairments.
• You earn more than SGA. If you earn more than the current “substantial gainful activity” amount consistently you will not be approved in your claim. Your attorney will be able to tell you if your work can be considered an unsuccessful work attempt. If it is, then it will not be counted against you.
• Failure to adhere to doctor’s advice. Part of failure to adhere to doctor’s advice is skipping medical appointments, which is covered above. However, there is more to it than showing up. This also means taking all medications as they are prescribed and not altering the dosage on your own. If your doctor says you should go to a dermatologist, then you need to schedule an appointment with a dermatologist. If the doctor says do not do any strenuous activities while you recover, rock climbing is probably a bad idea.
• Your disability is short term. A disability needs to disable you from work for twelve consecutive months in order for you to receive social security disability.
• You must have medical insurance. With the passage of the Affordable Care Act, you should be able to obtain some kind of health insurance.  This will enable you to see medical providers for treatment. Social Security relies on doctor’s opinions to evaluate your impairments. Social Security will not take your word for it that you are disabled. The burden of proof is on the person applying for benefits to show that they are truly disabled and their disability prevents them from working.
•   Not hiring an attorney until right before the hearing. This is a mistake. It is      best to get an attorney as early in the process as possible. Don’t wait until right    before the hearing.
• Not meeting your attorney until the hearing. Some nationwide claimants’  representatives will not meet with you until the date of the hearing. This puts you  at a disadvantage. Find someone local who will meet with you at the start of your  case.

If you are in need of financial assistance during this time, there are resources for you.

Four sources of help during the claim:

1. SNAP, formerly called Food Stamps
   A program that helps low-income individuals and families buy food. The amount of income and the number of people in the household are factored in to figuring out eligibility.
   For more information, please go to https://www.ct.gov/dss/cwp/view.asp?a=2353&q=320232
2. Temporary Assistance to Needy Families (TANF)
   For more information, there is a handbook on the internet at https://www.ct.gov/dss/lib/dss/pdfs/TanfStatePlan.pdf
3. State Administered General Assistance (SAGA Cash). Call the Department of Social Services in Connecticut. They can also give you a Medicaid card.
4. Veterans Benefits
   These benefits are available from the Federal government.
   Service connected- Monthly cash payments available for medical problems which arose during military service.
   Non-Service connected- Needs based, only for vets who served during a time of war and only if permanently and totally disabled.