This is not something you can request when filing your disability claim, Social Security computers will screen your alleged disability along with your medical evidence to determine if your claim is eligible for 20 day approval automatically. Social Security is not publicizing this program to the general public. When you call Social Security’s toll-free number, the representatives will not volunteer information about the Quick Disability Determinations program, unless you ask.

To find out if your claim is being processed under Quick Disability Determinations 20 day approval, call Social Security’s toll free number at 1-800-772-1213 and ask about QDD.

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Once the State agency, Disability Determination Services (DDS), has your claim the examiner will typically take 120 days to make a decision on your case. This 120 day timeframe is an average, and DDS examiners do not have set time limits for processing your claim. If the State schedules an appointment for you to see a doctor your case could take longer than the 120 day timeframe. The examiners that work for the State agency are not doctors. They have criteria for evaluating the medical evidence you have submitted to decide if your disability qualifies you for approval. If they do not have sufficient medical evidence to support your disability the examiner will deny your claim.

When dealing with the State, remember it pays to be polite. You don’t want to alienate the examiner working on your claim. While this individual’s personal opinion of you should have no bearing on the approval of your claim, you will find cooperation and courtesy go hand in hand.

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Social Security places limits on what this person can charge you for their services. Any fee agreement you sign with this person must be approved by Social Security.

Once you have designated a representative for Social Security this person will be able to access your Social Security record, provide medical information to support your case, and represent you at any meeting, interview, or hearing you are asked to attend. Your attorney or representative can also help any witnesses prepare their testimony on your behalf. When your case is finished Social Security will provide your attorney or representative with the decision on your case.

If you would like to find an attorney to represent you but don’t know where to start, contact your local Social Security office for a list of attorneys and organizations in your area. After you select a representative you are required to notify Social Security. The form used for this is the SSA-1696 which you can get by calling Social Security’s toll-free number. You must designate this person and sign the form before they will be allowed to represent you.

After you have designated your representative Social Security must approve the fee agreement that person will charge you. Your attorney or representative will submit the fee agreement for you and you will be required to sign it. Once the fee agreement is approved the representative cannot charge you more that what was agreed. This person cannot coerce you into paying anything more that the amount outlined in your fee agreement.

The fees outlined in your fee agreement cannot be more than 25% of any back pay you would collect upon winning your appeal or $5300. The lesser of these two amounts will be awarded to your attorney or representative upon the successful completion of your appeal.

Your attorney or representative may still be able to bill you for their out of pocket costs without having these expenses approved by Social Security. If your appeal is successful Social Security will typically pay the attorney for you from your past due benefits.

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The catch is you have to be very careful and monitor your monthly gross income so that you do not go over the limits. If you do go over the limit, Social Security could place you in what they call “Disability Cessation” due to your earnings. If this happens to you they will stop your monthly check and could charge you a hefty overpayment by backdating the time your record went into “Disability Cessation.”

How do you safely work and keep your benefits? Always keep your earnings below the pre-tax limit; in 2006 this pre-tax limit is $860 per month. (If you are blind this amount is higher: $1,450 per month.) This $860 amount is what Social Security refers to as “Significant Gainful Activity” or SGA. If you are working and earning over this SGA amount Social Security figures you can work full time just like everyone else and don’t need Disability payments.

Understand that this SGA amount ($860 for 2006) is the upper limit for your earnings. There is another amount that Social Security tracks when it comes to your earnings. This amount is called a “Trial Work Month.” When you receive Social Security Disability benefits you are eligible for 9 Trial Work Months every five years. A “Trial Work Month” is any month that your earnings are higher than $620 pre-tax. ($620 is amount for 2006)

Trial work months are unique because you can earn any amount you like; these months are not subject to the SGA limit. For example, if you went over the limit one month and earned $1200, you’re still okay because Social Security will count this month as a trial work month. (As long as you haven’t used them all up, remember you only get 9 every 5 years) You can use your trial work months as a safety cushion if you go over the $860 limit. Don’t make a habit of going over because if you use up all your trial work months Social Security will evaluate your disability and could stop your benefits.

To be safe, never earn over the $860 limit. You will use up all of your trial work months doing this; however, Social Security will not stop your benefits or charge you a hefty overpayment. Remember that all of the dollar amounts quoted here are pre-tax amounts; this is before anything is deducted from your gross earnings. As soon as you start working be sure and notify Social Security by calling their toll-free number.

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If you are a widow from a spouse you were divorced from, you may still be eligible to receive disabled widow benefits even if you are not eligible for Social Security Disability on your own record. To be eligible you need to have been married to your spouse for 10 years or longer and meet the medical requirements for disability benefits under Social Security. This includes being evaluated by your State disability determination agency. Additionally, your spouse needs to have earned a minimum of 40 credits (40 credits is 10 years of work) from working in jobs that pay Social Security taxes.

If you were married to your spouse when they passed, Social Security does not require that you were married for 10 years. In either case, you will need to provide proof of relationship in the form of your marriage certificate or divorce decree, along with your spouse’s death certificate when you file for benefits. As the surviving spouse you will be eligible for a one time payment of $255. This one time payment is only paid to a surviving spouse or a dependent child.

When you apply for disabled widow benefits the State will evaluate your medical condition. This process typically takes 120 days. If approved, you will be eligible to receive benefits as long as you continue to meet the disability requirements until age 65. At age 65 you may be converted to a retirement benefit on your own record if that amount is higher; if the amount is not higher you will continue receiving widow benefits but will not be receiving them for disability. Disability benefits are not paid after the age of 65.

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The appeal process for Social Security is relatively straightforward. The process for appeal is Reconsideration, Hearing, Appeals Council, and Federal Court. If your disability or SSI claim was initially denied by the State, the first step is called Reconsideration.

Request for Reconsideration

Reconsideration means that your claim is sent back to the State disability agency that denied your claim for reevaluation. Your claim will be assigned to a different examiner that had nothing to do with the original decision. The State will reconsider all the medical evidence submitted along with any new evidence have. It takes on average 120 days for the State to evaluate a claim. This 120 day time period applies to initial claims and reconsiderations handled by the State.

Not all states process reconsiderations. There is a pilot program designed to streamline the appeals process that eliminates the reconsideration step and sends your case directly to a hearing. States participating in this pilot program are called Disability Redesign Prototype States. If your initial claim for disability or SSI is denied in one of the Disability Redesign States you will be sent a hearing package to appear before an administrative law judge. These States include:

Alabama, Michigan, Alaska, Missouri, California, New Hampshire, Colorado, New York, Louisiana, and Pennsylvania

Social Security Hearings

If you live in one of the Disability Redesign States listed above or had your request for reconsideration denied by the State agency, your next step in the appeals process is a hearing. Hearings are held in Social Security’s Office of Hearings and Appeals (OHA). At your hearing you and a representative (if you choose one), will appear before an administrative law judge and make your argument as to why you should receive disability and/or SSI benefits.

The administrative law judge you appear before will not have been involved in the prior processing of your claim in any way. After you file the request for a hearing the regional hearing office in your area will contact you to schedule a time for you to appear. This can be a lengthy process; hearing offices are heavily backlogged with cases and it can take over a year to receive a hearing date.

When you attend your hearing you have the right to representation by an attorney and the right to present witnesses on your behalf. You will have the opportunity to review your files and present new information pertinent to your case. Your doctor, relatives, caseworker, and attorney can all attend the hearing and speak on your behalf. It is not required for you to attending the hearing; however, it is in your best interest to go.

After your hearing is held it usually takes the administrative law judge 30 to 60 days to render a decision. You will receive a letter advising you of the decision at that time.

Social Security Appeals Council

If you receive an unfavorable decision at your hearing, the next step in Social Security’s appeals process is review by Appeals Council.

The appeals council will review your request for review. The appeals council may not take your case if they agree with the decision made by the administrative law judge. If the appeals council decides to accept your case for review they will either render a decision or send your case back to the hearing office for another review. You will receive a letter with the outcome of the Appeals Council review usually within 60 days.

If the appeals council refuses to take your case or denies your appeal, the final step in the appeal process is to file your case in Federal Court.

Federal Court

The final step in Social Security’s appeals process is to file against the Social Security Administration in Federal Court. You will need an attorney to assist with your case in Federal Court.

You have the option of filing a new claim at any time after the reconsideration state in addition to your appeal rights. If your new claim is approved and you then receive a favorable decision for your appeal, Social Security will back pay you to your original filing date for the first claim.

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Representative payees are responsible for using the money from Social Security or SSI benefits for the needs of the individual. They are also responsible for saving any unused money and are required to account for how the money is being spent.

Children are required to have representative payees; this person is typically their parent or the guardian that has custody of the child. Whenever a child is approved for benefits from Social Security or SSI their parent or guardian is required to complete the representative payee application and present their identification in the Social Security office.

An adult that is determined to be incompetent will also be required to have a representative payee. The determination that an individual needs a payee can be made by the local Social Security office. A person’s family, social worker, or nursing home can also request that a payee be assigned to handle the benefits. If you need to apply to become a payee for a friend or relative, submit the application form SSA-11BK, along with your identification in your local Social Security office. Most payee applications require a face to face interview.

Representative payees are required to use the money from Social Security and SSI to meet the needs of the person receiving benefits. This includes seeing to the food, clothing, and shelter needs. Payees are required to save any unused money for future needs. Representative payees are also required to keep Social Security’s records current by reporting any changes of address, marital status, and employment status. They are responsible for seeing to the medical treatment of the individual and any Medicare claims that need to be filed. Payees are required to complete annual reporting of how the money is being used; they are responsible for any overpayments that may arise and ensuring this money is returned to Social Security.

Sometimes having a representative payee can cause a hardship for people receiving benefits from Social Security or SSI. Allegations of fraud and misuse of funds should immediately be reported to the local Social Security office. If you are payee for someone and no longer wish to continue in this role contact Social Security at 1-800-772-1213.

If you are receiving benefits from Social Security or SSI and have a representative payee but wish to manage your money for yourself, you will need to have your doctor write a letter stating you are able to do this for yourself. The doctor’s office will need to fax this letter to the local Social Security office. For more information on becoming your own payee contact Social Security at the 800 number given above.

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In addition to the medical requirements for Social Security disability you need to have worked in jobs that pay the taxes for a minimum of 5 of the last 10 years prior to the onset of your disability to be insured under Social Security. Even if you are not currently insured for Social Security Disability you may still qualify if you met the insured status requirements prior to when you became disabled. For younger workers Social Security does make some adjustments to the 5/10 rule; to find out if you qualify based on the work history you have contact a Social Security representative at the national 800 number given below.

One way to check if you are currently insured for Social Security Disability is to look at your Social Security Statement. On page two of the statement it will tell you if you have enough credits earned on your work record to qualify for Social Security Disability, and gives an estimate of your benefit amount. Again, Social Security makes some exceptions for younger workers. Because a disabled younger worker has less potential to earn credits under Social Security they typically receive a higher amount for the work that they do have.

Assuming that your doctor has told you that you will be out of work for 12 months or longer (or you have a terminal condition) and you meet the work requirements for Social Security Disability, you need to file an application. There are several ways to file. If you are already familiar with the Supplemental Security Income (SSI) program and know that you do not qualify based on your household income or money you have in the bank, the simplest way to file is online at Social Security’s website. (See the link below)

If you are unfamiliar with the SSI program or would like a determination for SSI, you need to call Social Security’s national 800 number and speak to a representative. Before you call you’ll need to gather some information. The representative will need to know the date that you first became disabled, what the nature of your disability is, and when you stopped working. They will also need to know if workmans compensation is involved through your State. Additionally, for the SSI screening, they will need to know how much income your household has per month, and how much money you have in the bank. They also need to know about any investment accounts you have including IRAs, 401k plans, stocks, mutual funds, and CDs. They will need to know how many vehicles you and your spouse own, what kinds of property you own, and how many children you have.

This information is important because SSI is a “need based program” and if you qualify the money you receive is paid from Federal Tax Revenues, not from the Social Security Trust fund. Once you have scheduled your appointment or applied online you will need to provide proof of citizenship or resident alien status. This is done by providing your original birth certificate, passport, or Resident Alien card to the Social Security office processing your claim. This office will provide you an application for signature and a medical release form where you will be required to list all of the doctors, clinics, and hospitals where you have been seen.

After your records are complete in the Social Security office, your case is transferred to your State’s Disability Determination Service (DDS). It is important to know that Social Security does not evaluate your disability or approve your initial claim. The determination that you meet the medical requirements is made by an agency of your State’s government. Once this decision is made, and it typically takes the State 120 days to evaluate you, you will receive a decision letter in the mail.

If you are approved, your case is sent back to Social Security where your folder goes to one of the many regional payment centers that will start your payments. Once you have an approval letter from the state it will take Social Security 30-60 days to process your record for payment. At that time you will receive an award letter from Social Security telling you how much you will receive and when. If your claim is denied by the State agency you will need to file an appeal. This appeal will be reconsideration with the State or a hearing before an administrative law judge depending on the State you live in. For more information on appeals refer to our section on appealing your claim’s decision.

To contact Social Security for scheduling an appointment to file for Disability and SSI call 1-800-772-1213.

To apply for Disability only (not SSI) online visit Social Security’s website at: http://www.ssa.gov/applyfordisability/

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