Maine Social Security Disability Appeals

What are the disability requirements for an adult?
The Social Security definition of disability is a strict one. To be eligible for disability benefits, a person must be unable to do any kind of substantial gainful work because of a physical or mental impairment (or a combination of impairments);

which has lasted or is expected to last for a continuous period of at least 12 months, or
that is expected to result in death.

You should be familiar with the process we use to determine if you are disabled. It's a step-by-step process involving five steps. They are:

Are you working? If you are and the work you are doing is substantial gainful activity, we will find that you are not disabled regardless of your medical condition or your age, education, and work experience. In 2003 we will generally find that you are doing substantial gainful activity if your earnings average more than $800 a month. If you are not, we will go to the next step.
Is your condition severe? Your impairment or combination of impairments must interfere with basic work-related activities for your condition to be considered severe. If you do not have an impairment or combination of impairments that is severe, we will find that you are not disabled. If you do have a severe condition, we will go to the next step.
Does your impairment meet the severity of an impairment in the Listing of Impairments? The Listing of Impairments contains examples of impairments for each of the major body systems that we consider so severe as to prevent you from working. If your impairment’s severity meets the severity of an impairment on the list and you meet the duration requirement, we will find you disabled. If your condition is not on the list, we have to decide if your impairment or combination of impairments is of equal severity to an impairment on the list. If it is and you meet the duration requirement, we will find you disabled. If it is not, we go to the next step.
Can you do work you did in the past? If your condition is severe, but not at the same or equal level of severity as an impairment on the list, then we must determine if it prevents you from doing work you did in the last 15 years. If it does not, we will find that you are not disabled and your claim will be denied. If it does, your claim will be considered further.
Can you do any other work? If you cannot do work you did in the last 15 years, we then look to see if you can adjust to any other work. We consider your age, education, and past work experience, and we review the job demands of occupations as determined by the Department of Labor in making this determination.

If you cannot adjust to any other kind of work, and your impairment meets the duration requirement, we will find you are disabled and your claim will be approved. If you can do other work, even if that work involves different skills or pays less than your past work, we will find that you are not disabled and your claim will be denied.
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What is the difference between Social Security disability and SSI disability?
Both programs are administered by the Social Security Administration. For most people, the medical requirements for each program are the same and the person's disability is determined by the same process, although each program has some distinctions, as noted below.

Social Security Disability Insurance (SSDI) is a program financed with Social Security taxes paid by workers, employers and self-employed persons. In order to be eligible for a Social Security benefit, the worker must earn sufficient credits based on taxable work. Disability benefits are payable to disabled workers, disabled widow(er)'s or adults disabled since childhood, who are otherwise eligible. Auxiliary benefits may be payable to a worker's dependents, as well. The monthly disability benefit payment is based on the Social Security earnings record of the insured worker on whose Social Security number the disability claim is filed.

Supplemental Security Income (SSI) is a program financed through general tax revenues. SSI disability benefits are payable to adults or children who are disabled or blind, who have limited income and resources, who meet the living arrangement requirements, and are otherwise eligible. The monthly payment varies up to the maximum federal benefit rate which is standardized in all States, but not everyone gets the same amount because it may be supplemented by the State or decreased by other countable income and resources.
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Do I need a lawyer for my disability case?
While a lawyer is not required, most people find that legal representation throughout the process can make things go more smoothly and with less confusion. The Social Security disability process is a paper intensive procedure and these forms can seem daunting to those who do not handle disability cases every day. A lawyer who specializes in disability claims can help you with the paperwork and can also provide the Social Security Administration with the medical and legal documents that can provide an quick and favorable decision. Ask your lawyer how many disability hearings he has handled to make sure that he has the experience in this specialized area of the law.
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How much does a lawyer cost?
A social security attorney charges 25% of the retroactive benefits, up to a maximum of $5300, to handle your claim. The lawyer may also charge for out-of-pocket expenses incurred in obtaining medical records and doctor’s opinions. The 25% contingent fee is only collected if you win your case and is the standard fee charged by all social security attorneys around the country.
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What is the earliest age that I can receive Disability benefits?
There is no minimum age. However, to qualify for Social Security disability benefits, you must have worked long enough and recently enough under Social Security. You can earn up to a maximum of four work credits per year. The amount of earnings required for a credit increases each year as general wage levels rise.

The number of work credits you need for disability benefits depends on your age when you become disabled. Generally you need 20 credits earned in the last 10 years ending with the year you become disabled.
However, younger workers may qualify with fewer credits. The rules are as follows:

Before age 24 - You may qualify if you have six credits earned in the three-year period ending when your disability starts.
Age 24 to 31 - You may qualify if you have credit for having worked half the time between 21 and the time you become disabled. For example, if you become disabled at age 27, you would need credit for three years of work (12 credits) out of the past six years (between age 21 and age 27).
Age 31 or older - In general, you will need to have the number of work credits shown in the chart shown below. Unless you are blind, at least 20 of the credits must have been earned in the 10 years immediately before you became disabled.

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How do I apply for disability benefits?
Apply for disability benefits online at socialsecurity.gov/disability

Or call our toll-free number, 1-800-772-1213. Our representatives can make an appointment for your application to be taken over the telephone or at any convenient Social Security office.

People who are deaf or hard of hearing may call our toll-free "TTY" number, 1-800-325-0778, between 7 a.m. and 7 p.m. Monday through Friday.

You can find the most convenient Social Security at socialsecurity.gov/locator

What You Need:
The claim process for disability benefits is generally longer (from 90 to 120 days) than for other types of Social Security benefits. It takes time to obtain medical information and to assess the nature of the disability in terms of your ability to work. You can help shorten the process by bringing certain documents with you when you apply and helping us to get any other medical evidence you need to show that you are disabled. These include:

your Social Security number;
your birth certificate or other evidence of your date of birth;
your military discharge papers, if you were in the military service;
your spouse's birth certificate and Social Security number if he or she is applying for benefits;
your children's birth certificates and Social Security numbers if they are applying for benefits;
your checking or savings account information, so your benefits can be directly deposited;
names, addresses, and phone numbers of doctors, hospitals, clinics, and institutions that treated you and dates of treatment;
names of all medications you are taking;
medical records from your doctors, therapists, hospitals, clinics, and caseworkers that you have readily available;
laboratory and test results;
a summary of where you worked in the past 15 years and the kind of work you did;
a copy of your W-2 Form (Wage and Tax Statement), or if you are self-employed, your federal tax return for the past year; and
dates of prior marriages if your spouse is applying.

The documents presented as evidence must be either originals or copies certified by the issuing agency. We cannot accept uncertified or notarized photocopies as evidence since we cannot verify their authenticity. Do not delay filing for benefits just because you do not have all of the information you need. The Social Security office will be glad to help you.

If you are applying for Supplemental Security Income benefits, you also need the following:

information about the home where you live, such as your mortgage or your lease and landlord's name;
payroll slips, bank books, insurance policies, car registration, burial fund records, and other information about your income and the things you own.9) What is Supplemental Security Income (SSI)?

The SSI program provides monthly income to people who are age 65 or older, or are blind or disabled, and have limited income and financial resources. Effective January 2004 the SSI payment for an eligible individual is $564 per month and $846 per month for an eligible couple. If you are married, and only one person is eligible, a portion of your spouse's income may be counted. In addition, your financial resources (savings and assets you own) cannot exceed $2,000 ($3,000 if married). You can be eligible for SSI even if you have never worked in employment covered under Social Security.
Generally, to be eligible for SSI, an individual also must be a resident of the United States and must be a citizen or a no citizen lawfully admitted for permanent residence. Also, some no citizens granted a special status by the Department of Homeland Security (DHS) may be eligible.
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Can I apply for Social Security benefits on the Internet?
Yes. You can now apply for Social Security Retirement benefits, Spouse's benefits or Disability benefits online by going to www.ssa.gov/applyforbenefits/ and following the instructions.
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What is Supplemental Security Income (SSI)?
The SSI program provides monthly income to people who are age 65 or older, or are blind or disabled, and have limited income and financial resources. Effective January 2004 the SSI payment for an eligible individual is $564 per month and $846 per month for an eligible couple. If you are married, and only one person is eligible, a portion of your spouse's income may be counted. In addition, your financial resources (savings and assets you own) cannot exceed $2,000 ($3,000 if married). You can be eligible for SSI even if you have never worked in employment covered under Social Security.

Generally, to be eligible for SSI, an individual also must be a resident of theUnited Statesand must be a citizen or a no citizen lawfully admitted for permanent residence. Also, some no citizens granted a special status by the Department of Homeland Security (DHS) may be eligible.
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Can I receive Social Security benefits and SSI?
You may be able to receive SSI in addition to monthly Social Security benefits, if your Social Security benefit is low.The amount of your SSI benefit depends on where you live. The basic SSI check is the same nationwide. Effective January 2004, the SSI payment for an eligible individual is $564 per month and $846 per month for an eligible couple. For January 2003, the SSI payment for an eligible individual is $552 per month and $829 per month for an eligible couple. However, many states add money to the basic check.
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Why is there a five-month waiting period for Social Security disability benefits?
The philosophy behind the waiting period requirement is that this period is long enough to permit most temporary disabilities to be corrected or for the person to show signs of probable recovery within less than 12 months after the onset of disability. The intent is to help assure that Social Security disability benefits are provided only to persons with long-term disabilities and to avoid duplicating disability payments by private disability plans and employer sick-pay plans during the early months of disability. Originally, the disability waiting period requirement was six months, but the 1972 Social Security Amendments reduced the waiting period to five-months to help diminish financial hardships by individuals who might have little or no savings or other resources to fall back on during the early months of a long-term disability.
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How do workers' compensation payments affect my disability benefits?
Ordinarily, disability payments from other sources do not affect your Social Security disability benefits. But, if the disability payment is workers' compensation or another public disability payment, yours and your family's Social Security benefits may be reduced.

Your Social Security disability benefit will be reduced so that the combined amount of the Social Security benefit you and your family receive plus your workers' compensation payment and/or public disability payment does not exceed 80 percent of your average current earnings. (Note that the unreduced benefit amount is counted for income tax purposes.)
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What Payments May Affect Your Disability Benefits?
As we said, the kinds of payments that affect your Social Security disability benefits are a workers' compensation payment and/or another type of public disability payment.

A workers' compensation payment is one that is made to a worker because of a job-related injury or illness. It may be paid by federal or state workers' compensation agencies, employers, or insurance companies on behalf of employers.

Public disability payments that may affect your Social Security benefit are those paid under a federal, state, or local government law or plan that pays for conditions that are not job-related. They differ from workers' compensation because the disability that the worker has may not be job-related. Examples are civil service disability benefits, military disability benefits, state temporary disability benefits, and state or local government retirement benefits which are based on disability.
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How many credits are required to be eligible for disability?
To qualify for Social Security disability benefits, you must have worked long enough and recently enough under Social Security. You can earn up to a maximum of four work credits per year. The amount of earnings required for a credit increases each year as general wage levels rise.

Family members who qualify for benefits on your work record do not need work credits.

The number of work credits you need for disability benefits depends on your age when you become disabled. Generally you need 20 credits earned in the last 10 years ending with the year you become disabled.
However, younger workers may qualify with fewer credits. The rules are as follows:

Before age 24? You may qualify if you have six credits earned in the three-year period ending when your disability starts.
Age 24 to 31? You may qualify if you have credit for having worked half the time between 21 and the time you become disabled. For example, if you become disabled at age 27, you would need credit for three years of work (12 credits) out of the past six years (between age 21 and age 27).
Age 31 or older? In general, you will need to have the number of work credits shown in the chart shown below. Unless you are blind, at least 20 of the credits must have been earned in the 10 years immediately before you became disabled.

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I only have 36 credits and need four more credits to qualify for Social Security benefits. Can I contribute money to Social Security to earn the additional credits?
No. People cannot get additional Social Security credits by voluntarily contributing money to Social Security. They can earn credits only by working in a job or business covered under Social Security.
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I applied for disability benefits 3 months ago and still haven't received an answer. When should I expect to be notified of the decision?
In the year 2002 the average processing time for a Social Security Disability claim was 104 days. This is an average and the actual time it takes to process your claim may be more or less based on:

the State you live in;
Disability determinations are made by a Disability Determination Service in the State where the disability applicant lives. These State agencies are required to comply with federally prescribed policies and procedures, which helps assure that the programs are administered consistently from State to State.
the nature of your disability;
how quickly we can obtain medical evidence from your doctor or other medical source; and
whether it is necessary to send you for a medical examination.

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What do I do if I disagree with the decision that SSA has made on my application for benefits?
The Social Security Administration wants to be sure that every decision made regarding a Social Security or Supplemental Security Income claim is correct. We consider all the information in a claim before a decision is rendered regarding eligibility or benefit amount.

If we decide a person is not eligible or is no longer eligible for benefits, or that the amount of payment should be changed, we send a notice explaining our decision. If an individual disagrees with the decision, they can request a review. This is called an "appeal." The request for an appeal must be made in writing within 60 days (plus 5 days mailing time) from the date of the notice they receive. Under certain conditions, an extension of this time frame can be granted.

There are four levels in the appeals process. They are:

RECONSIDERATION: A reconsideration is a complete review of the claim by someone other than the individual who made the original decision. All evidence, plus any additional evidence submitted, will be reevaluated and a new decision will be rendered. If an individual disagrees with the reconsidered decision, they can choose to go to the next level of the appeals process.

HEARING: A hearing will be conducted by an Administrative Law Judge (ALJ). The individual and/or their representative may come to the hearing and present their case in person. The ALJ will evaluate all the evidence on record, plus any additional evidence brought to the hearing, and will render a decision. A "Notice of Decision" will be issued to the individual and their representative. If they disagree with the hearing decision, they can choose to go to the next level of appeal.

APPEALS COUNCIL: The Appeals Council may decide to issue its own decision, remand the case to the ALJ to issue another decision, or allow the ALJ's decision to stand. The appellant will receive a copy of the Appeals Council's action.

FEDERAL COURT REVIEW: If the claimant disagrees with the Appeals Council's action, he or she has the right to file a civil suit in Federal District Court.

Many people handle their own appeals, but they can choose an attorney or non-attorney to help them. Your representative cannot charge or collect a fee from you without first getting written approval from Social Security.
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I have been receiving Social Security disability benefits for the past four years and my condition has not improved. Is there a time limit on Social Security disability benefits?
No. You will continue to receive a disability benefit as long as you continue to be disabled and otherwise meet work or other eligibility requirements. However, your case will be reviewed periodically to see if there has been any improvement in your condition and whether you are still eligible for benefits. If you are still eligible when you reach full retirement age, disability benefits will automatically be converted to retirement benefits.
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