A Basic Guide to Social
Security Disability Benefits
Presented by Matthew Lane and
Nancy Goodwin of
Ziegler & Lane, LLC
Definition of Disability
• As defined under the Social Security Act
– Unable to consistently perform full-time work
– Due to medically-determinable physical or
mental impairments
– Or a combination of impairments
– That will last one year or result in death
Disability Insurance Benefits
• Must be disabled and have insured status
• Insured status obtained by payment of
payroll taxes for enough quarters
• Insured status expires
Advantages of DIB
• Retroactive benefits available
• Eligible for Medicare after 24 months of
benefits
• Auxiliary benefits available for spouse and
children
Your Social Security Statement
• Insured status based on reported earnings
• Obtain a copy of your Social Security
Statement online at www.ssa.gov
• Look for SSA seal and the words “The
Official Website of the U.S. Social Security
Administration”
Supplemental Security Income
• Must be disabled and have limited income
and resources
• SSI benefits available only from date of
application
• Concurrent Medicaid eligibility
SSI Resource Guidelines
• Very detailed requirements
• Generally speaking, $2,000 for an
individual and $3,000 for a couple
• Excluded assets: home and one car
• Deeming of income
SSI for Children
• Standard: a physical or mental condition,
or combination of conditions, that cause
“marked and severe functional limitations”
• The whole child standard
• Household resource limits apply
Disability Evaluation Process
• 5 step sequential evaluation process
• If not disabled at any step, evaluation ends
• You have the burden of proof
The 5 Steps
1. Are you working and performing
substantial gainful activity?
2. Do you have one or more severe
impairments?
3. Does your condition meet or equal a
listed impairment?
4. Can you return to your past work?
5. Can you perform any other work?
Listing for Coagulation Defects
• Listing 7.08: “Coagulation defects
(hemophilia or a similar disorder) with
spontaneous hemorrhage requiring
transfusion at least three times during the
5 months prior to adjudication.”
– Found at 20 C.F.R. Part 404, Subpart P,
Appendix 1, Part A, Section 7.00:
Hematological Disorders
Listing for Children
• Listing 107.08: Inherited coagulation
disorder
• Requires repeated spontaneous or
inappropriate bleeding; or
• Hemarthrosis with joint deformity.
– Found at 20 C.F.R. Part 404, Subpart P,
Appendix 1, Part B, Section 107.00:
Hematological Disorders
The Application Process
Initial application
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Online, by phone, in person
Be specific in your application paperwork
65% of applicants are initially denied
Takes 4-8 months
Appeal vs. reapplication
60 day appeal deadline
The Administrative Appeal Process
•
Administrative Law Judge hearing
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6-12 month wait for hearing
Approval rates vary widely
Benefits of legal representation
Appeal of ALJ decision v. new application
Appeals Council review
– 6-12 month wait
– 75% denial rate
Federal Court
• Final SSA decisions may be appealed by
filing suit in Federal District Court
• Must demonstrate application of improper
legal standard or that decision is not
supported by substantial evidence
• You need an experienced attorney
• 12-18 month process
Proving Disability
• Medical problems must be documented
– Must have records to support allegations
– Discuss side effects of medication with doctor
– Ensure recurrent problems are recorded at every visit
• Symptoms alone cannot prove disability
• SSA must consider combined effect of all
impairments, both physical and mental (e.g.,
depression and anxiety)
• Significance of mental health treatment
• Document reasons for loss of employment
How Your Doctor Can Help
• Why “my patient is disabled” is not enough
• The treating source rule – well supported
opinions are given more weight
• Obtain a narrative statement explaining
diagnosis, basis of diagnosis (lab tests, xrays, signs), frequency and duration of
symptoms, and resulting functional
limitations
Frequent Problems
• Gaps in medical treatment
• Non-compliance
• Drug and alcohol abuse that materially
contributes to disability
• Work activity
• Financial hardship and the benefits of
planning ahead
Ziegler & Lane, LLC
Social Security Disability Law is
all we do.
1-800-451-0300
www.ZieglerLane.com