Frequently Asked Questions

1. What does "disability" mean?

Disability under Social Security is determined by the definition adopted by Congress in the Social Security law. The official definition contains several parts: the inability to engage in substantial gainful employment; the cause being a medically determinable impairment; and an impairment has lasted, or is expected to last, for at least 12 months. A working definition might be an injury or illness that can be proven by medical tests; that has lasted or will last for 12 months; and keeps the claimant from performing a job, as it is usually performed, on a full-time basis.

2. How is my lawyer paid?

Social Security disability cases are handled on a contingent fee basis, the lawyer is not paid unless the claimant wins. Social Security law has set the fee at a maximum of 25% of the back benefits or $6,000, whichever is smaller. The fee is withheld by the Social Security Administration from the back benefits and paid automatically to the lawyer if benefits are awarded. (Different rules apply if a case is appealed to federal court.)

3. I've been turned down, why should I appeal?

In Missouri almost 75% of all claimants are turned down at the initial level. Unfortunately many claimants give up and don't appeal; in fact almost half don't bother to appeal. To quit is a mistake, at the second level (hearing) more than 60% of claimants are awarded benefits.

4. Should I file my own claim with Social Security or let my lawyer do it?

At the initial claim level some claimants represent themselves. This is possible, but several variables are important. Social Security requires that initial claim forms be completed, then about three weeks later Disability Determinations, a state agency, will send another 8 to 12 pages of forms to be completed. Some claimants are comfortable in representing themselves because they are used to filling out lots of forms and know the technical aspects of their illness. However, most claimants are not familiar with the completion of complicated forms and are not comfortable to write about their illness in writing.

5. How long does a claim take?

Every claim is different. The review of the claim at the initial takes from 3 to 4 months depending on how fast the medical records are obtained and how fast the records can be reviewed. If the claim is denied, as the majority are, an appeal is filed with the Office of Disability Adjudication and Review-Columbia, Springfield, St. Louis Creve Coeur, St. Louis Downtown, or Kansas City, depending on the residence of the claimant. In the last few years some waiting times have gone as long as 2 years or more. However, waiting times have improved, and can be from 1 to 2 years. If an unfavorable decision is issued by the judge after an administrative hearing, an appeal is filed with the Appeals Council in Falls Church, VA. The appeal times vary greatly, 3 months is not unusual nor is 18 months! (The Council can receive new evidence, but there is no hearing.) Finally, if a claimant is unsuccessful at the Appeals Council, a lawsuit can be filed in the United States District Court. The court does not have a hearing on the evidence. This can take approximately 1 year. The case may be remanded to ODAR for another hearing. The bottom line: some cases indeed go very quickly, but the majority will take a year or more.

6. What are out of pocket expenses?

When we accept a Social Security case we expect to win and we expect to do that by properly documenting the elements of disability. This means that we request medical records from doctors, hospitals, psychologists, etc. Most medical providers in Missouri charge a statutory minimum of almost $25 for records. Our agreement with our clients is that we will pay for the records as the case progresses because we assume that this would be a financial hardship to our clients who, by definition, can't work. The other part of the agreement is that our clients will reimburse us when we win the case and they get paid. This is important so that we can put the money to use immediately to help someone else with their benefits.

7. Is the Social Security Administration a good place to go for help with a Social Security claim?

What a tough question! Social Security has very competent and well-trained employees. But it is understandable that if you ask a question about the agency, they should properly give you the official agency response. That would be expected by any employer. So in response to the question, "I was turned down at the first level, did they seriously consider my claim?" anyone at Social Security would have to say yes. It would not be appropriate for a Social Security employee to say, "Probably not, but your chances are twice as good at the next level." It is also important to remember that each Social Security employee is generally familiar with only how their office works. They have not spent a lot of time in other parts of the decision-making chain.

8. I am already getting long-term disability from my employer. Can I get Social Security disability, too?

Long term disability is similar to Social Security disability. However, it is based upon an insurance contract. The contract is usually meant to cover employees and the actual contract is between the insurance carrier and the employer. Sometimes it is based on a contract that is paid for, and signed by, the employee. Almost 100% of the contracts paid for by employers include an agreement that the employee will "offset" payments eventually received by Social Security. In other words, the long term disability payments, often involving past benefits, are to be reduced by Social Security payments when they are received. Long term disability payments often pay 60% of the employee's most recent salary. If for example, the Social Security payment equals 50% of the salary, the employee would be expected to repay to the insurance carrier the 10% difference. Almost every carrier allows a credit for attorneys' fees and costs that are spent to acquire the Social Security benefits.