In 1935, federal legislation was first passed to provide security for United States citizens suffering certain extreme, life-altering hardships that Congress felt were burdens best shared by the citizenry as a whole. The Social Security Program was not welfare; instead, the program provided workers and their families with old-age, survivors, and disability insurance benefits. It was called the Social Security Program, having its roots in the country’s response to the Great Depression.
As a federal agency, the Social Security Administration administers the Social Security Program. Over time, the program has been expanded to include providing health insurance benefits under the Medicare program. Federal Old-Age, Survivors, and Disability Insurance (“OASDI”) payments are distributed monthly by the administration to those determined to be entitled to benefits under federal law. Family members may be eligible for OASDI benefits. Here, state laws are used to determine the validity of the family relationship (e.g., marriage, adoption) to the Social Security recipient, and therefore the loved one’s eligibility under the Program.
OASDI is a social insurance program. Payroll contributions, in an amount based upon earnings, are paid into the program. Thereafter, benefits are paid out to those workers, and their eligible family members, when they retire or become disabled. Benefits are also paid to the survivors of deceased workers.
Disability benefits are also available under federal law through the Supplemental Security Income (SSI) program. The same process is used for both programs in order to determine a person’s disability; however, while eligibility for Social Security disability payments is based on prior work, SSI disability payments are made on the basis of financial need. A person determined to be disabled under one program will be consider disabled by the other; however, there are differences in eligibility requirements under the two programs, in addition to the financial need distinction.
The Social Security Administration defines disability as being unable to do any kind of work for which one is suited for at least one full year, or suffering a disability that has resulted in death. It is a definition that has been as been vehemently criticized for being too narrow; however, the legislation was passed with the assumption that working individuals and their families have other financial resources to meet short-term disabilities, including insurance, savings, investments, as well as state workers’ compensation programs.
Social Security disability benefits are available to any legal adult who is as a citizen of the United States. Recipients turning age 65 continue to receive the same monthly payments; however, the Administration will thereafter label them as “retirement benefits.”
Family members who may receive social security disability benefits are:
- unmarried, minor children (and sometimes, grandchildren or stepchildren);
- unmarried, adult children with a disability that originated before their 22nd birthday;
- spouses, beginning at age 62;
- spouses at any age who are caring for a child under the age of 16, who is disabled and also receiving disability benefits; and
- widows or widowers age 50 or older, upon the death of the recipient.
Disabled children qualify for SSI disability benefits. Many American children with severe mental retardation receive SSI disability.
In order to qualify for Social Security disability benefits, American workers must have earned “work credits,” which generally tally to four credits per working year. As a general rule, applicants must have earned 20 credits in the 10 years immediately preceding the individual’s becoming disabled in order to qualify for SSI, as well as meeting other criteria.
The process of applying for Social Security disability benefits is notoriously confusing — so much so, that many attorneys devote the entirety of their practices to assisting citizens in obtaining their proper disability benefits. For the majority of applicants, their initial application will be denied. It is imperative that they immediately begin the appellate process, including accumulating proper documentation confirming their disability, because there are rather short deadlines to be met before their appeal will be time-barred.
Legal representation during this appellate process can be important. Attorneys specializing in Social Security disability are able to determine accurately the amount and type of benefits for which the individual may be eligible. They know how to accumulate the proper documentation and evidentiary support for the disability, and they are adept at maneuvering through the bureaucracy of the Social Security appellate process. This process is complicated.
The Social Security disability appeals process involves five separate steps, or levels. At each level, benefits can be granted. These are:
- The initial determination;
- Agency reconsideration;
- Administrative hearing;
- Appeals’ counsel hearing; and
- Federal court decision.
Applicants have only 60 days from a denial at one level to appeal to the next level. Each new step involves a more complex procedure, and specialized legal counsel becomes more and more advantageous.
Their specialized training and knowledge enables them to identify legal issues that a layman might miss, for example. Furthermore, legal counsel is best able to properly address any challenges made to the applicant during the proceedings, as well as providing competent and complete preparation, documentation, and presentation of the legitimate need for reconsideration of a prior denial of benefits. It is very, very rare that a denial review results in benefits without the involvement of legal counsel acting on behalf of the applicant.
In fact, attorneys are assumed to be so much a part of the disability benefits process that statutes have been enacted to establish their fees. Usually, attorneys charge a percentage of any back pay the government is deemed to owe the applicant, and which is paid lump-sum when disability benefits are awarded. Federal law limits the percentage fee arrangement to 25% of any back pay due, with a maximum fee of the $5,300.00 absent special circumstances. In instances where back pay is not an issue, lawyers can charge an hourly rate, and sometimes a flat fee.
For More Information
- Social Security Administration (providing online downloading of the Social Security Handbook)
- Social Security Disability Coalition
- US Department of Justice, Civil Rights Division, Disability Rights Section: A Guide to Disability Rights Laws (July 2009)
- US Department of Justice: Americans with Disabilities Act (gathering of information and sources pertinent to the ADA)
- American Bar Association Commission on Mental and Physical Disability Law
- National Council on Disability (an independent federal agency whose purpose is to advise both the President and Congress on disability policy)
- National Organization of Social Security Claimants Representatives (professional organization of Social Security specialists)