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SSDI and SSI Benefits Appeals in Boston

When we think of disability benefits from the Social Security Administration (SSA), most people are actually more familiar with the Social Security Disability Program (SSDI).  This is the program for people who have a history of working and have paid taxes into the Social Security disability fund and are no longer able to work due to a disability.   This is typically not a disability due to a work-related injury or illness, because that would require the claimant to apply for workers’ compensation benefits and is not administered by the SSA, but rather by the Department of Industrial Accidents (DIA), which is a state agency.

Boston SSDI CasePursuant to 42 U.S. Code Chapter 7, which is the federal Social Security Code, Subchapter II, a disabled person is entitled to Supplemental Security Disability Insurance benefits if they are disabled and have earned enough quarterly credits to have paid into the system. As our Boston SSDI benefits lawyers can explain, if you work at a job or for yourself, and pay taxes quarterly, a certain portion of that money gets paid to the U.S. Treasury department for payment of your income taxes, and some of your withholdings go to certain funds administered by SSA.  One of those funds is for the old age and retirement benefits system, which is the type of Social Security you receive when you reach retirement age.  It should be noted that if you are receiving Social Security disability benefits, and you reach retirement age, you will no longer receive disability benefits, because the retirement benefits will kick in.  You will also lose your Medicaid benefits that accompany Social Security disability benefits, but you should become eligible for Medicare, which is the other type of federal medical benefits.

The other type of Social Security disability benefits is through a program known as Supplemental Security Income (SSI).  SSI is not the same as SSDI for various reasons.  The program does not require to you have paid into the system from a job, but they are for disabled children in low-income households, disabled people who are below a certain income threshold and who have no work history, the elderly, and the blind.  The SSI program has some rather complex requirements.  While many people will apply for both together, it is actually better if you speak with an experienced SSI and SSDI lawyer about the differences between the programs to see which one you should apply for.  Many people will apply for both, but that is not always the proper course of action.

With respect to SSDI benefits, you must have earned enough quarterly credits at the time of the onset of your disability.  The number of credits you need depends on your age.  Someone who is 19 and becomes disabled will obviously not need to have the same work history as someone who is 50 when they become disabled.

In Gann v. Berryhill, as case from the United States Court of Appeals for the Eight Circuit, claimant filed for benefits and the application was initially denied.  If you are reading this blog, you are likely in the same situation where you applied for SSDI or SSI benefits and were told you were not disabled. While it is important to understand that the SSA has a vastly different definition of what it means to be disabled than your doctor, or even a lay person with any sense of reason, you should not think much of your application being initially denied. The reality is that the vast majority of all applications are initially denied. This is because SSA is constantly short of money, because Congress does not authorize enough funding for the program for political reasons, and this is one way the agency can save money.  If paying as little in benefits as possible does not seem like a fair thing to do, that is because it is not, but it is often the situation in which people find themselves. In addition to routinely rejecting disabled applicants who have paid into the system, the agency also drags out appeals to over a year in many cases as another means of saving money.

Once your paper application is denied, you are required to make a request for reconsideration.  There is a strict timeline for when you must submit this request, so it is best to make sure you speak with an attorney as soon as possible rather than waiting until the day before that request for reconsideration is due.  This doesn’t mean you should not still try to find an attorney after that point, but it is best to avoid waiting until the last minute if possible.

After you submit your request for reconsideration, that request will almost certainly be denied as well.  This is because there is not a doctor reviewing that application, as they use a peer review system. As strange as this sounds, a coworker of the employee who denied your initial application (and not a supervisor) will review the application again, along with your request for reconsideration, and decide if the first employee was correct in denying your application. As you might expect, it is very rare for a request for reconsideration to result in the payment of benefits.

At this point, you request a hearing with an administrative law judge (ALJ), which is what happened in this case.  It should be noted that it can take around a year to get that hearing, as discussed above, because this is another way to save money.

In this case, the ALJ determined claimant was not disabled and affirmed the denial of the initial application and request for reconsideration. While an ALJ is certainly allowed to deny a claimant’s application for both SSDI and SSI, that denial must be supported by adequate evidence, and the record must show the ALJ relied upon such adequate evidence when denying benefits.  Here, the court of appeals concluded that there was not sufficient evidence to deny benefits.

When making a decision to deny benefits, the ALJ asked a so-called vocational expert (VE) a hypothetical question about someone with the claimant’s disability conditions and if that person could work and if there were any jobs in the local or national economy that person could do.  While the VE told the ALJ there were jobs a person with that set of conditions could do, and those jobs were available in the local or national economies, this was not an accurate assessment.  The reason for this is because, while it is okay to use hypotheticals like this, the ALJ did not include all the claimant’s actual disabling conditions when suggesting the hypothetical.  This means the claimant was more disabled than the hypothetical claimant.  For this reason the court of appeals reversed the ALJ’s denial of benefits.

If you or a loved one is seeking Social Security Disability Insurance in Boston, call for a free and confidential appointment at 1-888-367-2900.

Additional Resources:

Gann v. Berryhill, July 28, 2017, U.S. Court of Appeals for the Eighth Circuit

More Blog Entries:

Acting Social Security Administration Commissioner Resigns, Feb. 6, 2017, Boston SSDI Lawyer Blog