Frequently Asked Questions - Wilkes-Barre, Scranton Personal Injury Lawyers

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Frequently Asked Questions

1. How does Social Security define “disabled?”

Answer: Social Security defines disability as the inability to engage in substantially gainful activity due to an impairment or combination of impairments that is expected to last for 12 months or result in death.

2. Can I still work and collect disability benefits?

Answer: Remember, Social Security’s definition of disability is not the inability to work.   You cannot engage in substantial gainful activity.  Social Security considers substantial gainful activity as work where you earn more than $980 per month.  Thus, you can work and collect disability benefits as long as you do not exceed $980. Be careful.  Social Security will try to recoup any benefits paid to you if you earn more than $980 per month.

3. Why did I receive two denials from the Social Security Administration?

Answer: When you apply for disability benefits with the Social Security Administration, you apply for two types of benefits.  The two types of benefits are: Social Security Disability Insurance benefits, or Title II benefits, and Supplemental Security Income benefits, or Title XVI benefits.  If you want to determine which denial applies to which benefit, then look at the upper left hand corner of the Notice of Disapproved claim and it will either say Supplemental Security Income or Disability, Survivors and Retirement Insurance.

4. What is the difference between Social Security Disability Insurance benefits (SSDI) and Supplemental Security Income (SSI) benefits?

Answer: SSDI is a monthly disability benefit.  You become eligible for SSDI benefits  based upon your work history.  With every quarter of a year that you work, you earn a work credit.  To be eligible for disability benefits, you must have earned 20 work credits in five years or 30 work credits in 10 years.  The benefit of SSDI is that it does not fluctuate with the fortunes of your family, your children may receive benefits based upon your finding of disability and you will be eligible for medicare benefits.

SSI is also a monthly disability benefit, thus, you must be disabled in order to qualify for the benefits, but it is based also upon your living arrangements.  You cannot have assets more than an amount set by the Social Security Administration.  Also, if you only receive SSI, you children will not receive automatic benefits and you will not be eligible for medicare benefits.

5. I have received a denial of my benefits, should I re-apply for benefits or should I file an appeal?

Answer: APPEAL! APPEAL! APPEAL! Security will not admit this, but they deny most cases initially.  Social Security uses a State Agency to make disability determinations.  The State Agency enlist the services of Doctors who, in some circumstances, do not even examine you.  These Doctors typically opine that you are limited to light duty work and under the law, you are not disabled if you are limited to light duty work unless you are over the age of 54 and even then they might deny you.

Statistically, you are better off appealing the decision and seeking counsel to argue the rules to an Administrative Law Judge who will actually look at the evidence in a clear and impartial manner.

Additionally, there may be legal ramifications if you do not appeal.

6. How long do I have to appeal?

Answer: You only have 60 days from the date that you receive the Notice of Disapproved Claim to file an Appeal, which is to request a hearing before an Administrative Law Judge.  Social Security deems that you have received the Notice five days from the date of the Notice.

Social Security may allow your request to continue if you file it after the 60 days have elapsed, but you must show good cause for the day.  We suggest that you do not risk it and contact our office as soon as possible to file an appeal.

7. How long does it take before I get a hearing?

Answer: Unfortunately, as Social Security denies most cases initially, a large backlog of appeals has resulted.  Several news articles have been written that document this backlog.  It also depends upon where you live and which hearing office will hear your request.  In North East Pennsylvania, the typical waiting period is one year from the date that the request for a hearing is filed.

8. Since I have to wait so long, am I paid retroactive benefits?

Answer: Yes, you are paid retroactive benefits.  For SSDI, you are eligible for retroactive benefits that begin one year from the date that you file your application for benefits.  For SSI, you are eligible for retroactive benefits from the date of your application.

However, for SSDI, you have to be disabled for five (5) consecutive months before you are eligible for benefits.  For example, Jane gets in a car accident on May 25, 2006.   She is disabled as of that date.  However, Jane does not file for benefits until May 25, 2007.  She is denied and appeals.  She is awarded benefits after a hearing that takes place on June 3, 2008.  She is owed SSI benefits from May 25, 2007.  She is owed SSDI benefits from November 25, 2006.  Even though she became disabled one year prior to her application, you are not paid for the first five months from the date that you became disabled.

9. What is my date last insured?

Answer: Social Security Disability benefits are an insurance benefit that you have with the Social Security Administration because you worked and paid into the system.  However, when you stop working, the clock starts ticking for you to prove that you are disabled.  Typically, you have a six year window from the date that you stopped working to prove that you are disabled.  If you prove that you are disabled after that six year window ends, you are not entitled to SSDI, although you may be entitled to SSI, depending upon your living arrangements and household assets.

Here is an example: Jane worked ten years as a teacher from 1988 to 1998.  In 1998, she decided to raise a family and stopped working December 31, 1998.  She did not return to work at all after that date.  On June 25, 2009, Jane was involved in a motor vehicle accident, which resulted in her being completely paralyzed.  She is disabled.  Prior to June 25, 2009, she had no health issues.  Jane’s date last insured is December 31, 2006.  Unfortunately, despite Jane’s severely disabling impairment, she is not entitled to SSDI benefits based upon her earnings record as of June 25, 2009 because it is after her date last insured.

10. Do I need an attorney and when should I get one?

Answer: Most Administrative Law Judges would strongly suggest that you should have an attorney for your Social Security Disability Claim.   I suggest that you hire an attorney as soon as possible.  Attorneys play a valuable role in building the record so that a Judge can find that you are disabled.  Social Security will not be gathering your records when you file an appeal.  It is your burden of proof, so you should have an attorney building your case from the beginning.

Further, get an attorney who specializes in disability claims.  Social Security Disability Law is a highly specialized practice.  Social Security has hundreds of regulations of which the typical attorney is not aware.  Our office knows these regulations through years of experience and we know exactly what you need to be successful.

11. How can I afford to pay an attorney when I can barely pay my bills?

Answer: We do not charge a fee unless we recover for you.

We work on a percentage fee basis.  We receive twenty five (25%) percent of the past due benefits owed to you.  However, our fee is capped at $6,000.  So, we are paid which ever is the less of the two.  Additionally, Social Security deducts our fee and pays us directly.  This fee arrangement is set by a Social Security regulation.  Social Security must approve the fee agreement in order for us to get paid.

However, our fee does not include the costs that we incur.  We ask that our costs, (i.e. fees incurred for obtaining your medical records), be reimbursed only if we are successful.  Again, we do not ask that our costs be reimbursed unless we recover for you.

12. Why Abrahamsen, Conaboy & Abrahamsen instead of one of those national firms?

Answer: Here at ACA, you are not just a number.  You meet with an attorney from day one and an attorney guides you throughout the entire hearing process.  With some of those national firms, you have an attorney fly in the day before the hearing and the first time you meet the attorney is fifteen minutes before the hearing.  That hardly seems appropriate when your future livelihood is at stake.

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