Who Qualifies for Social Security Disability Benefits?

Individuals with limitations who can no longer earn substantial income must qualify for benefits both financially, as well as medically.  The medical requirements are addressed below.  There are several qualifications an individual must fulfill in order to be considered disabled and qualify for benefits by Social Security.  These qualifications are addressed in a five step sequential evaluation process by Social Security.  An individual seeking Disability benefits must meet these criteria in order to be found disabled. 


Types of Benefits Available

There are two types of Disability benefits through Social Security. 

◦ Benefits from Social Security Disability Insurance

◦ Benefits from Supplemental Security Income.  

Both types are for individuals under age 65 (Supplemental Security Income benefits can continue after retirement in some situations), who meet the medical criteria for Disability.  The difference in benefits depends on an individual’s work history.

SSDI – Social Security Disability Insurance

In order to qualify for SSDI, an individual must have paid enough into Social Security through their taxes.  This is judged by financial quarters.  The amount of quarters you must have paid in varies depending on your age at the time of disability.  But generally, an individual must have paid into SSA- Social Security Administration for at least 20 quarters, or 5 years of taxes within the last 10 years prior to disability.  The more an individual pays in through their taxes, the more money they financially qualify for.  As a result, everyone’s monthly benefit rate is different.  Social Security Disability Insurance benefit amounts may be affected by certain types of public disability benefits, discussed in more detail later on.

SSI – Supplemental Security Income

For individuals who have not worked enough quarters to financially qualify for SSDI, SSI provides some income when you otherwise medically qualify for Social Security benefits.  SSI is more limited than SSDI in that it may consider income coming into an adult individual’s household in determining financial eligibility.  So if you have a spouse who lives with you and works full time, they may earn too much income for your household for you to qualify for SSI benefits.  There are strict financial qualifications for SSI benefits, which is why it is important to discuss SSI benefits with an experienced attorney to find out more.

Why do I need an Attorney or Representative to Safeguard My Interests?

The primary reason you need an experienced attorney to guide you through this process, is that SSA is not your advocate!  They are currently inundated with claims to process.  This is a long, confusing, nerve-wracking, difficult process.  And the standards that SSA uses to determine disability are well beyond what many doctors would use to judge a person disabled.  One of the many vital tasks your attorney performs is to obtain specialized information from your treating doctors about how you feel daily, and how your illnesses/injuries cause your limitations.  This is accomplished through obtaining what are called Residual Functional Capacity evaluations from your doctors.  There are dozens of formats to this, and only experienced representatives can determine what analysis is appropriate for your specific case. 

Social Security Disability attorneys play another crucial role in the development of a case.  Since SSA’s standards for disability are well beyond what most doctors would use to determine medical disability, it is the role of the representative to work hard to gather the appropriate evidence, and translate your individual limitations into a series of impairments significant enough to find you disabled.  This is a painstaking process which requires a large knowledge and skill base about the nature of disability within SSA’s standards.  It is like a skilled mason carefully adding each brick to build a solid wall.  With every brick that is added by your attorney, the wall itself grows, and becomes stronger.  With every fact your attorney uncovers to show the judge, your case for Disability grows stronger and more solid.  This is why it is so important to hire an attorney who specializes in this area of law, and knows the disability standards they must work within.

How do Attorneys and Representatives get Paid?

Claimants often wonder whether they need to pay money up front in order to obtain experienced representation for pursuing Social Security Disability benefits.  Rest assured that attorneys and representatives are paid on a contingent fee basis, meaning that we do not get paid unless your claim is successful, and there is a sufficient award of back benefits.  So you should not have to present money up front in order to pursue your Disability claim.

All approved representatives can charge a fee of 25% of a Claimant’s back payment award, up to the statutory cap in place at the time.  Right now, that cap is $6,000, but it can be increased from time to time.  So that means your attorney can receive 25% of your back payment award, but only up to $6,000, and less if their percentage is less than $6,000.  Attorneys can also charge for case expenses.

Back payments are payments dating back from the first month you are eligible to receive benefits, up until you begin receiving regular monthly benefits.  So that means your attorney cannot charge a fee on future benefit payments. 

This does not apply to cases that go beyond the administrative agency level.  Cases going into federal court are subject to separate fee agreements.

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