Millions of Americans rely on Social Security disability benefits (namely, SSDI and SSI) to pay bills and maintain financial stability after an accident, life change, or health condition leaves them physically or mentally unable to work. Unfortunately, Social Security disability benefits have become more-and-more difficult to access because of shifting political winds and administrative overreaction to cases of fraud and abuse. Today, some people truly deserving of Social Security disability benefits have their applications for those benefits denied for improper or unfair reasons.
The hard-working Social Security attorneys at Boohoff Law have years of experience representing Americans whose Social Security disability claims have been denied and who need help pursuing the appeals process to obtain the benefits they deserve. If you or a loved one faces an unfair or unjust Social Security benefits claim denial, we can help. Contact us today to learn more.
About Boohoff Law
For years, Tatiana Boohoff and her team of top-flight attorneys have represented Americans struggling to obtain the Social Security disability benefits they rightly deserve. Boohoff Law opened its doors in Florida more than a decade ago, and recently expanded its practice to the Seattle area, bringing with it a reputation for providing clients with smart, effective, diligent legal services, delivered with a personal touch. When you find yourself in need of a superstar legal team to fight the toughest battles against federal and Washington State bureaucracy, Boohoff Law is your best choice in the Seattle area for getting results.
Of course, no matter we handle has a guaranteed outcome. Every case we handle has its own unique facts and circumstances. But the lawyers at Boohoff Law have the know-how and resources to untangle even the most complicated legal knots. Unlike some law firms that shy away from contending with government red tape, we spend every day using our cutting edge skills and relentless determination to achieve our clients’ goals, even if it means wading neck-deep into government regulations.
About Social Security Disability Benefits
The following information borrows heavily from the Social Security Administration‘s (SSA’s) guidebooks on the SSDI and SSI benefits programs. We encourage anyone with questions about those programs to supplement the information provided in our summary below by reading those guidebooks and other helpful materials found on the SSA’s website as well as on the website of the Washington State office for Disability Determination Services.
Overview of SSDI
SSDI stands for “Social Security Disability Insurance.” It is a federal program that pays benefits to disabled workers who worked long enough to qualify for them and who paid Social Security taxes. When someone is “on disability,” that usually means SSDI.
To be eligible to receive SSDI, a worker must meet a two part test.
- First, the worker must have a work history set by the following formula: Subtract the year you turned 22 from the year you became disabled. Divide that number by 4. That is the number of years you need to have worked since you turned 22 to be eligible. So, for example, if you became disabled in 2019 and you turned 22 in 2003, then you need to have worked 4 years since 2003 to be eligible.
- Second, the worker must be “disabled” within the legal definition of that term. According to the SSA, this means the worker “can’t work because they have a medical condition that’s expected to last at least one year or result in death.”
In addition to the worker, certain other family members may also have the right to receive SSDI benefits. They include spouses over age 62, spouses of any age caring for a child who is under 16 or is disabled, and unmarried children under age 18 or who are disabled.
Applying for SSDI benefits involves submitting employment and medical paperwork to the SSA for an initial determination of your eligibility (principally, whether you meet the work history requirement). If the SSA decides you meet basic requirements, it then forwards your file to the Washington State office for Disability Determination Services to make a final evaluation of your disability status. According to the SSA, the government generally asks five basic questions in determining whether you are “disabled:”
- Are you working? If so and you earn over a certain amount, then generally speaking you won’t be considered “disabled.”
- Is your medical condition “severe”? According to SSA, to be considered severe, “your medical condition must significantly limit your ability to do basic work activities — such as lifting, standing, walking, sitting, and remembering — for at least 12 months.”
- Does your medical condition meet or medically equal a listing? The SSA maintains a “listing” of conditions it considers to be disabling. This is a shortcut, essentially. If your condition fits one of the “listings” already considered a disability, you will be deemed disabled. If not, then the government will ask two additional questions.
- Can you do the work you did before? Obviously, if you are still able to do your former job, you will not be considered disabled.
- Can you do any other work? If there are other types of jobs you can do, then you will not be considered disabled.
As you might imagine, most disputes about eligibility for SSDI revolve around whether you are “disabled” under the criteria above.
If you are deemed disabled, the amount of benefits you receive will be based on your average lifetime earnings.
Overview of SSI
SSI stands for “Supplemental Security Income.” It is a program for elderly, blind, or disabled (as defined above) persons who have low incomes and limited financial resources. SSI acts, essentially, as a “safety net” for people of extremely limited means. It does not have a work history requirement.
Eligibility for SSI depends on a person being over 65, blind, or disabled, and having very limited income and financial resources (namely, the value of things you own). In certain instances, a disabled person may continue to work and still receive SSI. Washington State supplements the amount of basic federal SSI, subject to certain additional eligibility requirements.
Applications for SSI benefits can be filed online at SSA.gov or a local Social Security Administration office. The application process consists of providing detailed financial information to demonstrate financial need.
If SSI is approved, the amount of payment depends in part on where the applicant lives. As of 2019, the amount for an individual is about $700/month in Washington State, and about $1,100/month for a couple.
About Benefits Denials, Reviews, and Appeals
As you might imagine from reading the overview above, disputes arise from time-to-time about eligibility for benefits. Most of these disputes center on disagreements over a disability determination, although sometimes disputes arise for other reasons (such as the size of “resources” a person applying for SSI has). Disputes also come up when the State reviews a prior disability determination and decides someone is no longer disabled and thus, no longer eligible for benefits.
Generally speaking, there are four levels of appeal of a denial of SSDI or SSI benefits. They are:
- Reconsideration. This is a request you make to the agency to “take a second look” at your application. The agency goes over the whole file again and issues a written decision. There is no hearing.
- Hearing. If you disagree with a reconsideration, you can ask for a hearing before an administrative law judge. The hearing is typically held within 75 miles of your home. A hearing is a sort of “trial lite,” where the administrative law judge asks questions of you and any witnesses you bring to the hearing. You will also have a chance to ask questions. After the hearing, the administrative law judge issues a written decision.
- Appeals Council review. If you disagree with an administrative law judge’s decision, you can seek to have the SSA’s Appeals Council review it. The Appeals Council has discretion whether or not to grant a review. If it grants a review, it will review the decision and make a written ruling.
- Federal court. If you disagree with the Appeals Council decision, or the Appeals Council refuses your request for a review, then you can take action in federal court challenging those outcomes.
The levels above are successive, meaning you must start at reconsideration, and if you lose at one level you can opt to go on to the next one. As a general matter, each level involves more complications and legal technicality than the previous one.
Typical Appeal Issues
Some of the most common issues that arise in appeals are:
- Medical diagnosis. A significant number of appeals center on the medical diagnosis of the applicant for SSDI or SSI benefits. Most often, an applicant to contest a doctor’s conclusion that the diagnosis is not sufficiently “severe” to qualify for benefits automatically or does not impair the applicant’s life functions as much as the applicant claims. These disputes often turn into a “battle of the medical experts” over the proper medical diagnosis of the applicant.
- Malingering. Related to disputes over medical diagnosis, sometimes disability determinations conclude the applicant is “malingering” (or faking their disability). In these appeals, the applicant sometimes faces the vexing problem of proving they are in pain, which can be highly subjective.
- Ability to work. These disputes focus on whether the applicant can, in fact, do any job and whether any such jobs are available. Because this question depends on a wide variety of factors, only some of which are within the applicant’s control, disagreements over the ability to work can become especially contentious.
- Formula technicalities. Eligibility for SSDI and SSI depends, in part, on calculations of work history, income, and financial resources. Although these ought to be relatively straightforward calculations, they sometimes trigger highly technical legal disputes. For instance, there might be substantial disagreement over whether someone was “employed” during certain periods of time, or whether certain personal property or real estate counts as a financial “resource” for the applicant.
This is just a sampling of appeal issues in Social Security disability benefits determinations. As government agencies continue to crack down on suspected (or imagined) cases of fraud and abuse, they continue to come up with new and creative reasons to deny benefits.
How a Seattle Social Security Attorney Can Help
The SSA’s website tries to make it seem easy for a person to apply for SSDI and SSI benefits. But, don’t be fooled. In this day and age, applying for benefits can seem to go from “simple” to “complicated” to “hopeless” in the blink of an eye. The fact is, to succeed in an application for benefits, applicants should not take any part of the application, review, or appeal process lightly. Every step requires special attention to detail. A mistake at any phase of the process can prove fatal to a claim.
That is why at Boohoff Law we encourage anyone thinking of applying for SSDI or SSI to seek help from an experienced Social Security attorney before beginning the process. The sooner you connect with an attorney, the better your chances of avoiding mistakes that can doom your application process.
Not everyone thinks to hire an attorney to help them apply for SSDI or SSI. An attorney, however, can still be a huge help with your appeal if you retain one after your claim was denied. Again, the sooner you speak with an experienced Seattle Social Security lawyer after your denial, the better. Yes, you can request a reconsideration of your application on your own, but it’s better to give your attorney the chance to review your file first. That way, an attorney can identify your strongest arguments for reversing the decision, and prepare you to make the case for them.
At all stages, you have the right to have an attorney speak for you and appear for you at hearings, conferences, and court appearances.
Boohoff Law: Your Seattle Social Security Lawyers
Do not wade into the bureaucratic mess of applying for SSDI or SSI benefits, or appealing the denial of an application, without an experienced Social Security attorney by your side. In Seattle, Boohoff Law can help. Contact us today, or call us at (877) 999-9999.