In past columns, I have encouraged people who qualify to learn about and apply for Social Security Disability Insurance (SSDI) benefits. The Social Security Administration has a strict definition of who is disabled. You must have an impairment severe enough to prevent you from doing substantial work, and that condition must have lasted (or must be expected to last) more than a year.
Some individuals with low income and resources may be eligible for Supplemental Security Income (SSI), which is a more modest benefit. It covers severe disabilities such as blindness, as well as the aged and people with very limited resources.
If you want to know basic information about eligibility for SSDI and/or SSI, the National Organization of Social Security Claimants’ Representatives (NOSSCR) website (go.madison.com/nosscr) is an excellent resource. In addition to eligibility information, this site also contains information about Medicare coverage and about the various appeal processes if your initial application is not accepted.
A more detailed explanation of Social Security disability benefits is available in Andy Landis’ book “Social Security: The Inside Story“ and in “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security“ by Laurence J. Kotlikoff, Philip Moeller and Paul Solman.
An experienced attorney or a “non-attorney representative” can assist you in filing your initial application or appealing an initial denial. There is no financial advantage in hiring a non-attorney representative. Social Security Administration regulations specify that the fees for all professional representatives are the same.
Representatives work on a contingency basis and receive fees from retroactive benefits. They are not awarded any fees until your application is approved. Specifically, the fee is limited to 25 percent of the past due benefits you are awarded, to a maximum of $6,000. They receive their fee from the first payment(s) you receive after your application is approved.
Representatives can bill you for costs, which can be a few hundred dollars. I recommend that before you hire a representative, you inquire about the expected out-of-pocket fees.
About two-thirds of initial applications are rejected. If your initial application is rejected, file a request for reconsideration within 60 days of receiving the denial notice. The reconsideration process generally takes about four months. If your request for reconsideration is denied, the next step is a hearing with an administrative law judge (ALJ).
Some states do not provide the request for reconsideration, in which case you would request the ALJ appeal process after the initial denial. As of June 2017, the expected case process time for this stage of appeal is over 620 days. There are other additional appeal processes after the ALJ appeal, which generally take longer than a year.
Representatives are especially advantageous during the appeal processes. History shows that experienced representatives are much more likely to prevail in a disability hearing with an ALJ than a claimant without representation. There are several reasons: They understand disability impairment listing criteria, are familiar with vocational guidelines, understand the significance of past work history, and are able to document the inability of the claimant to perform other types of work.
Experienced representatives know what updated medical information is needed for the appeal hearings. They also are able to get the needed information into the claimant’s file immediately. In some cases, the ALJ can make an immediate decision that the initial rejection was unfounded and approve the appeal “on the record” without a long waiting time for the disability hearing.
Because of the lengthy process times, using an experienced representative can be valuable both in getting an initial application approved and mounting a successful appeal. In addition, if you file an initial application unsuccessfully by yourself, it can take time to hire a competent representative. Naturally, it is advantageous to expedite the appeal process when required.
For all these reasons, I recommend hiring a representative, even for assistance with the initial application. As stated previously, the representative will receive his fee only if your application is approved, and the fee will come from retroactive benefits.
Editor's note: This story has been updated to correct the rejection rate of initial applications for Social Security disability benefits.