The information provided on this site is to assist and educate individuals about the disability benefits available to them from their Federal Government. The Social Security Administration of the Federal Government provides monetary disability benefits and health insurance to those individuals who are disabled and unable to engage in any type of gainful employment. Most individuals who initially apply for Social Security Disability benefits are denied and need an experienced attorney to get their case approved. I am Attorney Edward Pepe, and I am dedicated to helping disabled individuals obtain Social Security Disability Benefits. I will be your advocate when you need it most. If you are injured or suffer from an illness that prevents you from working call me for a free consultation. Thank you for visiting, Attorney Pepe.
JUST THE FAQS
What benefits are available to me from the Federal Government if I am disabled and unable to work? The Social Security Administration is a branch of the Federal Government that provides assistance to people with disabilities. There are two programs that provide income and medical insurance to individuals who meet the criteria to qualify for these benefits. Social Security Disability Insurance ("SSDI") pays benefits to a disabled individual and certain family members if such individual is insured, meaning that you worked long enough and paid Social Security taxes. The second program, Supplemental Security Income ("SSI"), also pays income and medical insurance benefits to a disabled individual based upon financial need.
What is the difference between the Social Security Disability Insurance Program ("SSDI") and the Supplemental Security Income Program ("SSI") ? Although both programs use the same definition of disability as noted above, the SSDI program is available to individuals who have a significant work history and have built up sufficient credits of eligibility through payment of payroll taxes. By contrast, SSI is available to a claimant who does not have a significant recent work history and who is income and resource eligible. For more information on such resource limits go to http://www.ssa.gov/ssi/text-resources-ussi.htm.
What is the amount of cash benefits available in a Social Security Disability claim? SSI cash benefits are set in accordance with the federal poverty guidelines and the maximum benefit for an individual in 2017 is $735.00. Please see http://www.ssa.gov/oact/cola/SSIamts.html. SSDI cash benefits on the other hand, are not derived from any poverty guidelines, but from the payroll taxes one has paid over time. For further information please go to the following website http://www.ssa.gov/policy/docs/ssb/v66n3/v66n3p53.html.
What health insurance is available to me from the Social Security Administration if I am granted disability benefits? Under the SSI program an individual granted benefits is eligible for Medicaid. For further information regarding the Medicaid program please visit http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/By-State.html. Under the SSDI program an individual granted benefits is eligible for Medicare. For more information regarding the Medicare program please visit http://www.medicare.gov/.
What type of disability qualifies me to receive Social Security Disability Benefits? A "disability" is defined by the Social Security Administration as "the inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." The disability need not be permanent. The Social Security program provides disability benefits to individuals who meet a "listing" which is a description of an illness or injury as defined by the Social Security Regulations. In addition, the Social Security program provides disability benefits to someone under the age of fifty (50) if they are totally disabled, and unable to perform not just his or her prior employment, but any type of employment that he or she can perform based upon the individual's work experience for the last fifteen years, and level of education viewed in the light of the limitations imposed by the illness or injury.
If I am over the age of fifty is it easier to prove that I am disabled and in need of Social Security Disability Benefits? Yes. For individuals over the age of 50, the closer an individual gets to retirement age, then the closer the law comes to only requiring that the individual cannot perform past relevant work. A person age 50-54 will be considered disabled if that person: 1) cannot perform past relevant work; and 2) is limited at most to sedentary work; and 3) has no vocational skills that transfer to sedentary work; and 4) they lack the education that would allow for direct entry into skilled work. If the applicant is age 55-59 an applicant must prove inability to perform past relevant work; that they are limited to, at most, light work (work involving lifting no more than 20 pounds); that they have no vocational skills that transfer to light work; and that they lack the education which would allow for direct entry into skilled work. A person 60-64 is considered disabled if he or she is limited to no more than light work and cannot perform past relevant work, and needs only to prove that he or she cannot perform any work which would involve almost no vocational adjustment. Also, as noted above any individual, regardless of age, who meets a listing which is a description of an illness or injury as defined by the Social Security Regulations, will qualify for benefits.
How do I prove that I am disabled so I can obtain Social Security Disability Benefits? A disability determination by the Social Security Administration requires medical documentation of an injury or illness. It is extremely important that a person applying for benefits have a medical record from their treating physicians to submit as evidence at a hearing. Thus, if you currently have insurance to cover that cost it is extremely important that you continue to treat during the time your claim is pending. Unfortunately, many people are unemployed when they apply for Social Security Disability benefits, and loose their health insurance and lack the medical documentation to prove their claim. To help prevent this problem a claimant should contact the Rhode Island Department of Human Services to determine if they are eligible for medical benefits from the State of Rhode Island. In addition, the Federal Affordable Care Act, should alleviate this problem and provide a mechanism for an individual with limited or no income to obtain insurance at little or no cost because of new federal subsidies. To obtain health insurance in Rhode Island you can access the State's healthcare exchange by going to http://www.healthsourceri.com/.
How do I apply for benefits with the Social Security Administration?
To apply for SSI please go to http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/270.
To apply for SSDI please go to http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/326.
Can a child qualify for Social Security Disability Benefits? Yes. A child younger than age 18 can qualify for SSI if he or she meets Social Security’s definition of disability for children, and if his or her income and resources fall within the eligibility limits. Your child must meet all of the following requirements to be considered disabled and therefore eligible for SSI: 1) The child must not be working and earning more than a certain amount. (This earnings amount usually changes every year.); and 2) The child must have a physical or mental condition, or a combination of conditions, that results in “marked and severe functional limitations". This means that the condition(s) must very seriously limit your child’s activities. The child’s condition(s) must have been disabling, or be expected to be disabling for at least 12 months, or must be expected to result in death.
What if my claim is denied can I file an appeal? A Social Security disability claim goes through an administrative law process. First, an application is filed with the Social Security Administration and is evaluated at an initial level. If the claim is denied at the initial level the claimant has 60 days to file a request to reconsider the adverse decision. If that is denied, the claimant has 60 days to file a request for a hearing before an Administrative Law Judge of the Social Security Administration. If the Administrative Law Judge denies the claim the claimant has 60 days to file a Request for Review by the Appeals Council which is the final stage of the administrative review. If the claimant is again denied he or she has right to file a Complaint in the Federal District Court against the Commissioner of the Social Security Administration. It is important to note that if an appeal is to be filed it must be made timely, because if the appeal at any stage is not filed timely it will cause the claimant to have to refile another initial claim and begin the process anew.
Should I hire an attorney to apply for Social Security Disability Benefits? Generally, an attorney does not become involved in a person's initial application for disability benefits. If you receive a denial letter after your initial application you need to contact an attorney immediately so he has time to file the appropriate paperwork within the 60 day appeal period. If you fail to file within that period a new application has to be filed which will delay your receipt of benefits.
What is the cost to hire an attorney to represent me? There is no out-of-pocket costs to retain an attorney to represent you in the process of obtaining Social Security Disability benefits. An attorney is paid only if successful in getting your claim approved and is paid from the back benefits due and owing to the claimant. The attorney's fee is regulated by federal law and cannot exceed 25% of the back benefit owed or $6,000, whichever is less.