1. Understanding Social Security & SSI Presented by Matthew D. Lane, Jr. www.zieglerlane.com

2. Definition of Disability As defined under the Social Security Act –Unable to consistently perform full-time work –Due to medically-determinable physical or mental impairments –Or a combination of impairments –That will last one year or result in death

3. Two Types of Disability Benefits The purpose of Disability Insurance Benefits (DIB; Title II of the Act) “is to provide the measure of economic security for program beneficiaries.” The purpose of Supplemental Security Income (SSI; Title XVI of the Act) “is to assure a minimum level of income for supplemental security income recipients who otherwise do not have sufficient income and resources to maintain a standard of living at the established Federal minimum income level.” See HALLEX I-1-2-57(A)(1) (available online at http://www.ssa.gov/OP_Home/hallex/)

4. Disability Insurance Benefits Must be disabled and have insured status Insured status obtained by payment of payroll taxes for enough quarters Insured status expires

5. Advantages of DIB Retroactive benefits available (1 year) Eligible for Medicare after 24 months of receiving benefits Auxiliary benefits available for spouse and children

6. Supplemental Security Income Must be disabled and have limited income and resources SSI benefits available only from date of application Concurrent Medicaid eligibility

7. SSI Resource Guidelines Very detailed requirements Generally speaking, $2,000 for an individual and $3,000 for a couple Excluded assets: home and one car Income from spouse deemed to claimant

8. Disability Evaluation Process 1.Are you performing substantial gainful activity (making over $1,000 per month)? 2.Do you have one or more severe impairments? 3.Do you meet or equal a listed impairment? 4.Can you return to your past work? 5.Can you perform any other work?

9. Most applicants do not meet Listings Most cases are decided at Step 5 of the evaluation process. Once you have proven you cannot return to your past work, the issue becomes whether you can perform any other work.

10. The Appeal Process Initial Denial by State Agency Reconsideration (where applicable) SSA Administrative Law Judge hearing SSA Appeals Council review Federal District Court *60 day appeal deadline at each step

11. Deciding to Apply Work and self-identity –DIB is funded by your payroll taxes (6.2% FICA tax out of every paycheck) Many claimants experience severe financial hardship during the disability application process and less than half are approved even after appealing

12. Proving Disability Symptoms alone cannot prove disability Medical conditions must be documented with treatment records Letter from last employer about why you could not do your job duties because of your medical problems

13. How Your Doctor Can Help The treating source rule – well supported opinions are given more weight –A letter stating “my patient is disabled” is not enough –“My patient is disabled because...” is more helpful –What comes after the word “because” is what counts. –Medical opinions that you cannot perform job duties must be properly considered by SSA

14. How Your Doctor Can Help SSA is concerned with functional limitations (e.g., patient can stand no more than 30 minutes at one time). Doctor can validate and explain episodic problems and symptoms of your impairment or disease

15. Mental Health SSA must consider the combined effect of all impairments, including physical and mental health problems (e.g., depression) Importance of seeking help for depression from a mental health provider

16. Returning to Work Substantial Earnings –Impairment Related Work Expenses (IRWE) SSA’s Ticket to Work program –SSA’s Trial Work Period –Extended Payment Eligibility Different rules apply for SSI

17. Selecting a Representative When to hire (well before ALJ hearing) Benefits of local attorney vs. national firm Advantages of experience vs. a generalist Seek a referral from National Organization of Social Security Claimants’ Representatives (NOSSCR; www.nosscr.org) Ask how the term “expenses” is defined.

18. Attorneys’ Fees in DIB/SSI cases Attorneys’ fees are regulated by the Act Fees are contingent; thus, if you are not awarded benefits, there is no fee. Typically, at the administrative level (through the ALJ hearing), fees are limited to 25% of your past-due benefits (back pay) with the maximum fee being $6,000. For example, if your back pay is $12,000 ($1,000 per month for 12 months), then the attorney fee would be $3,000. The $6,000 cap can be removed if extended appeals become necessary.

19. Your Social Security Statement Enables you to confirm your earnings are properly reported, which is how insured status is determined Obtain a copy of your Social Security Statement online at www.ssa.gov Look for SSA seal and the words “Official Social Security Website”

20. Matthew D. Lane, Jr. Ziegler & Lane, LLC Disability Law is all we do. 1-800-451-0300 www.ZieglerLane.com info@zieglerlane.com