WHAT ARE DISABILITY BENEFITS?
The full name of the Social Security Administration's benefits for those unable or unexpected to work is Social Security Retirement, Survivors, and Disability Insurance. It is designed for those who reach their retirement age, are disabled, or are surviving dependents in certain situations.
When this benefit relates to a disability, it can be referred to as SSD (Social Security Disability), SSDI (Social Security Disability Insurance), DIB (Disability Insurance Benefits), Type II benefits, or simply "disability." Adding to the confusion, there is a seperate-but-similar benefit program called SSI (Supplemental Security Income, see below).
​
Generally, you must have earned wages (and paid taxes out of those wages) for long enough and recent enough to becoming disabled to be eligible for Social Security Disability (but not for SSI, see below). SSD benefit amounts should be the same as your full retirement benefits (averaging around $1,000/month). If a claim takes a while to be approved (which is very common) there will also be past due benefits (aka back pay), representing the benefits that should have been paid all along had the claim been approved without delay.
​
At the Law Office of Thomas W. Gooden, we are not paid anything until the claim is approved. In most cases, the fee is paid out of the approved claim's past due benefits and is sent directly to the attorney by the SSA. Our fee is 25% of the awarded past due benefits, with a maximum fee of $6,000.00 per claim.
​
​
WHAT COUNTS AS A DISABILITY?
The SSA defines "disability" as an inability to engage in substantial gainful activity (or "SGA") due to medically determinable physical or mental impairment(s). The period of disability must have lasted or is expected to last for at least 12 months or is expected to result in death. Social Security Disability is therefore generally designed to help those with permanent and severe conditions, not "short term" injuries or illnesses. In addition to someone's medical conditions, an applicant's age, education, and work experience also factor in to the determination.
​
There are a number of regulations, rulings, and factors that go into whether an individual will be found disabled by the SSA. For a free consultation regarding your case and your situation, call the Law Office of Thomas W. Gooden at 704-360-0719.
​
HOW DO I APPLY?
There are four administrative stages to a claim for disability/SSI benefits before the SSA - (1) Application, (2) Reconsideration, (3) Administrative Law Judge Hearing, (4) Appeals Council Review. Generally speaking, a disability claim will either be a short one (approved on the application) or a long one (requiring a hearing or even multiple hearings).
​
Application - a disability claim begins with lots of questions and paperwork. SSA wants to know your educational history, your work history, your medical history, and more. The level of detail the forms request can be overwhelming. The Law Office of Thomas W. Gooden can guide you through this process by explaining what the SSA is really looking for and why, submitting the application on your behalf, and telling you what to expect next.
​
Reconsideration - many, if not most, applications are denied. To move the case forward, the claim is appealed with a Request for Reconsideration within 60 days of the initial denial. Unfortunately, a claim is very unlikely to be approved at Recon, but it is a necessary step toward eventually requesting a hearing.
​
ALJ Hearing - making a hearing request within 60 days of the Recon denial will move the claim to a regional hearing office, which will assign the claim to an Administrative Law Judge. North Carolina Hearing Offices are located in Charlotte, Greensboro, Raleigh, and Fayetteville. The wait for hearings is long (usually over a year) and proper preparation of medical records, testimony, and arguments is critical. Once the hearing is scheduled, our clients are always given a thorough pre-hearing appointment. ​ At the hearing, we will present written and oral arguments, review the case with the ALJ, take your testimony, and more, to give the claim the best chance of approval.
​
Appeals Council - if an ALJ issues an Unfavorable or Partially Favorable Decision, the claimant can request (again, within 60 days) the Appeals Council to review the decision. The AC looks for errors of law the ALJ committed during the hearing or in the decision itself. The AC will either "deny review" (essentially agreeing with the ALJ), remand the claim for a new hearing, or (rarely) overturn the decision directly.
​
Navigating an SSD/SSI claim is a complex, frustrating, and often confusing process. While many cases take over a year to be approved, the groundwork for an approval starts at the very beginning of a case, so don't delay in getting professional representation from an experienced attorney. Disability claims can also move beyond the SSA's administrative process and into Federal Court, even the U.S. Supreme Court.
For more information, call the Law Office of Thomas W. Gooden, PLLC at 704-360-0719.
WHAT IS SSI?
Supplemental Security Income (or SSI, or Type XVI benefits) is an additional benefit program for disabled individuals. Instead of eligibility based on previous wages and taxes, it is based on financial need. If someone has little to no income, little to no resources, and little to no assets, they may be eligible for SSI. If eligible, they go through the same application-appeal-hearing process as SSD applicants to prove they are disabled.
​
There are several factors that go into SSI eligibility and the exact amount of SSI benefits one would receive upon approval. For example, one house and one car do not count toward the asset limit, but a portion of a spouse's earnings do count toward the income/resource limit. The best part of receiving SSI benefits is immediate and automatic Medicaid eligibility. The worst part is the requirement to continually report your financial situation to SSA, so they can determine and re-determine exactly how much benefits you "need" under their rules.
​
Some disability applicants are eligible for only SSD, others only SSI, others both, and sadly, sometimes an applicant is not eligible for either. For a free discussion regarding your likely eligibility for SSI, call the Law Office of Thomas W. Gooden, PLLC at 704-360-0719.