The Social Security system provides two benefit programs for disabled persons: Social Security Disability (Title II) and SSI (Supplemental Security Income).

Social Security Disability (Title II) is for workers covered by Social Security who have contributed to a Social Security account while working for a specified period of time, usually 5 out of the last 10 years of work. Disabled widows and widowers of Social Security wage earners may also qualify.

SSI (Supplemental Security Income) provides disability benefits for low income persons not covered by Social Security. It can also be added to Social Security benefits which are lower than a certain minimum level.

II. Benefits

Social Security disability beneficiaries receive two primary benefits: a monthly check and medical benefits. The amount of the monthly check is determined by a formula which takes into account the amount paid into Social Security and the length of time of employment.

SSI (Supplemental Security Income) does not require previous employment, and monthly benefits are based upon "need", considering the individual's other income and assets. Special rules apply for legal residents who are not citizens.

III. Medical Benefits

Medicare

Social Security Disability recipients are entitled to Medicare benefits if they have been disabled for two years after a five month waiting period. A small "premium" of $93.80 is deducted from the beneficiaries' Social Security check.

This entitles them to have certain medical expenses covered by Medicare.

MEDICAID (In California "MEDI-CAL")

SSI beneficiaries are entitled to Medi-Cal benefits. These are similar to Medicare benefits, but may be more restrictive in terms of medical providers and may cover items which are excluded from Medicare coverage. Medi-Cal benefits are available from the first month the recipient is entitled to SSI benefits.

There is no waiting period.

Social Security recipients (Title II) receive Medicare. SSI recipients receive Medi-Cal. Certain eligible recipients who receive both Social Security Disability and Supplemental Security Income receive both Medicare and Medi-Cal.

The health care benefits provided by Social Security are essential for disabled persons.

The standard of disability which must be shown is the same for both programs. You must have physical or mental problems (or a combination of problems) severe enough to keep you from working in any regular paying job ("substantial gainful activity") for at least 12 months. Disability due to drug and alcohol addiction is not covered, but certain physical or mental conditions as a result of a prior addiction may be covered.

In determining disability, the test is not whether you would be offered a job, but whether there are jobs which you could perform.

For those over 55 years old, new regulations allow a more realistic look at age, education, and experience in making this test.

V. The Claims Process

Application: For either Social Security or SSI, an application for disability benefits may be filed at the local district Social Security Office. Our office can assist you in filing a disability application in the appropriate cases, particularly if you have been disabled for at least 12 months with documented significant disability.

Denial: You should not become discouraged if your claim is denied at first. It is estimated that 80-90% of the applications are denied. This is an appropriate time for you to seek legal representation. Our office can discuss the circumstances of the case with you and give you an opinion of the merits of your claim. The earlier we start working on the case, the better chance we have of being successful.

Reconsideration: The next step in the process is the "Request for Reconsideration" from Social Security. After approximately three to four months, a decision will be reached on the Reconsideration request.

The case will either be granted benefits or denied. If the case is denied, it is then time to request a hearing before an Administrative Law Judge. This may involve another delay of approximately 1 year until the hearing.

In certain designated areas in the city, claimants who are denied at the initial level do not file reconsideration appeals. These are called “prototype cases,” and the reconsideration appeal step is eliminated. Instead, claimants must file directly for a hearing before an Administrative Law Judge.

Request for Hearing: At this stage in the process, it is critical to have competent legal representation to give you the best chance of winning the appeal.

Preparing for the Appeal: An important service of this office is to make sure that you have the right kind of medical and other evidence to give a true picture of your condition. If appropriate, we may refer you to specialists to examine you and may request reports from them. These doctors will give an honest appraisal of your disability. (of course, we do not guarantee that they will find you disabled).

If you are receiving Medi-Cal, we will attempt to obtain a comprehensive report from your own doctor. Most doctors charge for preparing a report. If that is the case, we will discuss the fee with you before obtaining the report or referring you.

We will write to the doctors who have examined you, including your own treating doctor, to explain the Social Security regulations. Often times, doctors feel they are writing the kind of report which you need, but they may not understand what Social Security requires. It will be much more helpful to you if the doctor writes his report with the regulations in mind.

The hearing is the most crucial stage of the appeal process, where the attorney's representation is most helpful. An Administrative Law Judge will preside and testimony will be taken under oath, but the hearing is generally somewhat informal. It is private, usually held in a small room with only the Judge and his assistant, you, your attorney, and possibly your spouse or a friend.

The medical records will be admitted into evidence. You will be asked questions, either by the Judge or by your attorney, which you must answer to the best of your ability or recollection. The Administrative Law Judge may call experts including "Vocational Experts" and "Medical Advisors," to testify about the possibility of training for a new job and the severity of the medical condition.

The attorney will prepare you thoroughly for the hearing, so there is no need to be apprehensive. Its purpose is to seek the truth and to carry out the purpose of the Social Security Act.

VII. The Decision

The Judge will not announce a decision at the hearing, though we can sometimes tell from the general atmosphere of the hearing whether it appears that the decision will be favorable. A written decision will be sent to your lawyer and to you. It usually takes at least two to three months after the hearing to receive the decision, if not longer. You should always contact your lawyer after you have received a decision from the Administrative Law Judge.

Our office handles Social Security disability and SSI cases on a contingent fee basis. In other words, we are paid only if we succeed in getting benefits for you. A written copy of the retainer agreement will be given to you. All fees or fee agreements must be approved by the Social Security Administration. We generally request a fee of 25% of the retroactive benefits, although we may have a specified minimum fee.

In Social Security and SSI cases, the attorney's approved fee is withheld from the lump sum payment.

Although we do not charge for our services unless we are successful, you are responsible for paying costs as they occur, including payment of any fees charged by doctors for their reports.

If you have any questions once you leave our office, feel free to telephone us. You should advise us if you experience any change in your condition, if you receive any notice from Social Security, or if you move or change your telephone number.