Frequently Asked Questions
Many claims are denied at first. If your claim has been denied, don't give up! Dayes Law Firm PC can help you get the benefits you deserve.
If your initial claim has been denied, the first step of the appeals process is to ask for a reconsideration. During a reconsideration, a new SSA employee will review your information for a second time to determine if your initial reviewer made a mistake.
If you do not receive a favorable decision after your reconsideration, you can appeal your claim to an Administrative Law Judge (ALJ). The ALJ will hold a hearing, where you and your attorney will argue your case.
If the ALJ denies your appeal, you can also have your claim reviewed by the Appeals Council, which will review the ALJ's decision.
If you not agree with the Appeals Council's decision, or if the Appeals Council declines to hear your case, your only recourse would be to either re-file your initial claim with new evidence, or file a lawsuit in a federal district court.
If your initial claim has been denied, you have the right to request a reconsideration of your claim. During a reconsideration, a new SSA analyst will review your claim with fresh eyes and reconsider the decision of the first SSA analyst.
You will need to fill out a reconsideration request form within 60 days of your claim decision. You will be able to submit any new or additional medical evidence to support your claim with your reconsideration request.
Once your request is received, a new claim representative will review your information again and make a new decision.
If your initial claim and your reconsideration request were denied, you have the right to a hearing in front of an Administrative Law Judge (ALJ).
You must request a hearing within 60 days of receiving your denied reconsideration claim. If you miss the 60 day deadline, your claim may be permanently denied and you may have to begin the process again.
Once you have filed a request for a hearing, it generally takes at least a year for a hearing to be scheduled. In some parts of the country, it may take up to two years.
Yes, you have the right to appeal the decision of the ALJ to the Appeals Council.
You must send your request in writing to the Appeals Council within 60 days of receiving the ALJ's decision.
The Appeals Council is made up of 68 ALJs, 42 Appeals Officers, and several hundred support staff.
Members of the Council review over a hundred thousand appeals from individual ALJs every year (Appeals Council panels considered 172,000 cases in 2013).
The Appeals Council will review your case, and will decide on one of three options:
- Your claim may be scheduled for a hearing in front of the Council,
- Your claim should be sent back to your original ALJ for reconsideration, or
- Your claim will be denied and the decision of the original ALJ will stand.
At the hearing, your judge will ask you or your attorney questions about your medical condition and how your disability affects your life and your ability to work.
Your attorney can also ask you questions to solicit relevant testimony about your case. You may bring your doctor to the hearing to provide additional evidence, or expert medical witnesses may be called to explain your disability at greater length. You can also request that your spouse, former employer, friend, or other person testify about the effect your medical condition has had on your life.
It is unlikely that your ALJ will make a decision about your claim immediately. Usually, he or she will take some additional time to review evidence and testimony before making a decision about your claim.
In some circumstances, you can receive both Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits at the same time. This is commonly referred to as “concurrent benefits”. To receive concurrent benefits, you must be approved for SSDI, but receive low monthly payments through the program.
A low monthly SSDI benefit is caused by several factors:
- You have worked very little or not at all in the last 10 years
- You had very little work history at the time you became disabled
- You became disabled at a young age, before building a significant work history
- You earned relatively low wages throughout the course of your employment history
- All of these factors can influence the amount of SSDI benefits because payments are based on meeting minimum health eligibility requirements and having sufficient “work credits” built up over the course of your employment history.
SSI is an income-based or financial need-based program. All income from “countable sources” is reviewed to determine whether you meet the requirements for the SSI program.
Countable income is made up of earned income as well as several types of “unearned income”. SSDI payments are considered to be “unearned income”. In other words, any money you earn cannot exceed established minimums under the SSI program.
In most instances, SSI unearned income limits are set at $710 per month; however, in some states the limit is higher.
Eligibility for the SSI program is fairly complex. Income – both earned and unearned – is considered when determining financial-need, but so are other financial resources or assets.
Just as there is a monthly limit on income for SSI eligibility, there is also a total available asset limit. Asset limits are set at $2,000 for an individual and $3,000 for married couples.
If your income and assets are too high to qualify for SSI benefits, you may still meet the criteria for SSDI. Likewise, even if you don’t have the work history/credits to receive SSDI benefits, you may still qualify for SSI. However, if you meet the financial and medical requirements, there are instances in which you can qualify to receive both SSI and SSDI at the same time.
Yes, however the Social Security Administration may adjust or offset the amount they pay based on how much you receive from workers compensation. The general rule of thumb is that the total of your earnings through workers compensation combined with your Social Security Disability benefits cannot be more than 80% of your original earnings.
For example, let's say that the claimant earned $4000 per month before becoming disabled. The total amount of their workers compensation combined with their Social Security Disability benefits must be less than 80% or $3200. If your combined benefits exceed that threshold, the Social Security Administration will offset your benefit amount to keep it at or below that $3200 mark.
If your workers compensation expires, then the benefits received through Social Security will increase to the normal payment amount. The good news is that this rule only applies to public workers compensation programs. Privately funded pension and insurance benefits will not affect your Social Security Disability benefits.
In any case, there is no risk of being denied if you are getting public workers compensation payments during the application process or during the time it takes to have a claim approved. In addition, not all public benefits will fall into the category of this particular situation. If the claimant is receiving VA benefits, state and local government benefits or Supplemental Security Income (SSI), then their disability benefits will not be affected.
This seems confusing at first, but the end result is that eligibility for Social Security disability benefits are not based on workers compensation, and there is no penalty for collecting both. However, if you receive a lump sum compensation payment or your compensation amount increases or decreases, it is important to contact the Social Security office because your benefits can be adjusted to reflect these changes.
The number of dismissals is an important statistic when comparing judges. For example, there is a judge in California with an approval rating that looks like this:
- Dismissed: 50%
- Approved: 27%
- Denied: 23%
If we did not include dismissed cases in the approval rating, it would appear that this judge approves more than %50 of cases. However, if you talk to an attorney that appears regularly before this judge you will find that the judge often tells attorneys before the hearing that he has already made up his mind and is going to deny the claim. The attorney will then opt to not proceed and the case will get "dismissed" instead of denied.
Average Hearing Wait time is the average number of months from the hearing request date to the hearing held date.
Average Processing time is the average number of calendar days from the hearing request date to the disposition date.
There are many reasons why a judge might dismiss a disability case. Some of those reasons are:
- The hearing request was not filed on time
- The claimant did not show up for the schedule hearing
- The claimant withdrew the hearing request
Most of the cases that are dismissed are for claimants who are not represented by an attorney. Having a disability attorney will help insure that your claim is not dismissed because your attorney is going to help make sure that your hearing is filed on time and that you are either at your hearing, or your hearing is rescheduled.
Frequently Asked Questions
Many claims are denied at first. If your claim has been denied, don't give up! Dayes Law Firm PC can help you get the benefits you deserve.
If your initial claim has been denied, the first step of the appeals process is to ask for a reconsideration. During a reconsideration, a new SSA employee will review your information for a second time to determine if your initial reviewer made a mistake.
If you do not receive a favorable decision after your reconsideration, you can appeal your claim to an Administrative Law Judge (ALJ). The ALJ will hold a hearing, where you and your attorney will argue your case.
If the ALJ denies your appeal, you can also have your claim reviewed by the Appeals Council, which will review the ALJ's decision.
If you not agree with the Appeals Council's decision, or if the Appeals Council declines to hear your case, your only recourse would be to either re-file your initial claim with new evidence, or file a lawsuit in a federal district court.
If your initial claim has been denied, you have the right to request a reconsideration of your claim. During a reconsideration, a new SSA analyst will review your claim with fresh eyes and reconsider the decision of the first SSA analyst.
You will need to fill out a reconsideration request form within 60 days of your claim decision. You will be able to submit any new or additional medical evidence to support your claim with your reconsideration request.
Once your request is received, a new claim representative will review your information again and make a new decision.
If your initial claim and your reconsideration request were denied, you have the right to a hearing in front of an Administrative Law Judge (ALJ).
You must request a hearing within 60 days of receiving your denied reconsideration claim. If you miss the 60 day deadline, your claim may be permanently denied and you may have to begin the process again.
Once you have filed a request for a hearing, it generally takes at least a year for a hearing to be scheduled. In some parts of the country, it may take up to two years.
Yes, you have the right to appeal the decision of the ALJ to the Appeals Council.
You must send your request in writing to the Appeals Council within 60 days of receiving the ALJ's decision.
The Appeals Council is made up of 68 ALJs, 42 Appeals Officers, and several hundred support staff.
Members of the Council review over a hundred thousand appeals from individual ALJs every year (Appeals Council panels considered 172,000 cases in 2013).
The Appeals Council will review your case, and will decide on one of three options:
- Your claim may be scheduled for a hearing in front of the Council,
- Your claim should be sent back to your original ALJ for reconsideration, or
- Your claim will be denied and the decision of the original ALJ will stand.
At the hearing, your judge will ask you or your attorney questions about your medical condition and how your disability affects your life and your ability to work.
Your attorney can also ask you questions to solicit relevant testimony about your case. You may bring your doctor to the hearing to provide additional evidence, or expert medical witnesses may be called to explain your disability at greater length. You can also request that your spouse, former employer, friend, or other person testify about the effect your medical condition has had on your life.
It is unlikely that your ALJ will make a decision about your claim immediately. Usually, he or she will take some additional time to review evidence and testimony before making a decision about your claim.
In some circumstances, you can receive both Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits at the same time. This is commonly referred to as “concurrent benefits”. To receive concurrent benefits, you must be approved for SSDI, but receive low monthly payments through the program.
A low monthly SSDI benefit is caused by several factors:
- You have worked very little or not at all in the last 10 years
- You had very little work history at the time you became disabled
- You became disabled at a young age, before building a significant work history
- You earned relatively low wages throughout the course of your employment history
- All of these factors can influence the amount of SSDI benefits because payments are based on meeting minimum health eligibility requirements and having sufficient “work credits” built up over the course of your employment history.
SSI is an income-based or financial need-based program. All income from “countable sources” is reviewed to determine whether you meet the requirements for the SSI program.
Countable income is made up of earned income as well as several types of “unearned income”. SSDI payments are considered to be “unearned income”. In other words, any money you earn cannot exceed established minimums under the SSI program.
In most instances, SSI unearned income limits are set at $710 per month; however, in some states the limit is higher.
Eligibility for the SSI program is fairly complex. Income – both earned and unearned – is considered when determining financial-need, but so are other financial resources or assets.
Just as there is a monthly limit on income for SSI eligibility, there is also a total available asset limit. Asset limits are set at $2,000 for an individual and $3,000 for married couples.
If your income and assets are too high to qualify for SSI benefits, you may still meet the criteria for SSDI. Likewise, even if you don’t have the work history/credits to receive SSDI benefits, you may still qualify for SSI. However, if you meet the financial and medical requirements, there are instances in which you can qualify to receive both SSI and SSDI at the same time.
Yes, however the Social Security Administration may adjust or offset the amount they pay based on how much you receive from workers compensation. The general rule of thumb is that the total of your earnings through workers compensation combined with your Social Security Disability benefits cannot be more than 80% of your original earnings.
For example, let's say that the claimant earned $4000 per month before becoming disabled. The total amount of their workers compensation combined with their Social Security Disability benefits must be less than 80% or $3200. If your combined benefits exceed that threshold, the Social Security Administration will offset your benefit amount to keep it at or below that $3200 mark.
If your workers compensation expires, then the benefits received through Social Security will increase to the normal payment amount. The good news is that this rule only applies to public workers compensation programs. Privately funded pension and insurance benefits will not affect your Social Security Disability benefits.
In any case, there is no risk of being denied if you are getting public workers compensation payments during the application process or during the time it takes to have a claim approved. In addition, not all public benefits will fall into the category of this particular situation. If the claimant is receiving VA benefits, state and local government benefits or Supplemental Security Income (SSI), then their disability benefits will not be affected.
This seems confusing at first, but the end result is that eligibility for Social Security disability benefits are not based on workers compensation, and there is no penalty for collecting both. However, if you receive a lump sum compensation payment or your compensation amount increases or decreases, it is important to contact the Social Security office because your benefits can be adjusted to reflect these changes.
The number of dismissals is an important statistic when comparing judges. For example, there is a judge in California with an approval rating that looks like this:
- Dismissed: 50%
- Approved: 27%
- Denied: 23%
If we did not include dismissed cases in the approval rating, it would appear that this judge approves more than %50 of cases. However, if you talk to an attorney that appears regularly before this judge you will find that the judge often tells attorneys before the hearing that he has already made up his mind and is going to deny the claim. The attorney will then opt to not proceed and the case will get "dismissed" instead of denied.
Average Hearing Wait time is the average number of months from the hearing request date to the hearing held date.
Average Processing time is the average number of calendar days from the hearing request date to the disposition date.
There are many reasons why a judge might dismiss a disability case. Some of those reasons are:
- The hearing request was not filed on time
- The claimant did not show up for the schedule hearing
- The claimant withdrew the hearing request
Most of the cases that are dismissed are for claimants who are not represented by an attorney. Having a disability attorney will help insure that your claim is not dismissed because your attorney is going to help make sure that your hearing is filed on time and that you are either at your hearing, or your hearing is rescheduled.