All about SSDI/SSI: An interview with Jamie R. Hall, Esq.
In this podcast from March 2015, Jamie R. Hall, Esq. talks with Kerry McKenzie of the National MS Society about SSDI/SSI and offers advice on some common questions, including the qualifications for applying, steps you can take to get approved and what you can expect throughout the process. Listen by clicking the “play” button above or read the transcription below:
Kerry: Hi. I’m Kerry Mckenzie with the National MS Society. And today, I got to sit down and talk with Jamie Hall. He’s an attorney based in Allentown, and he’s been really involved with the MS community now for almost six years. He specializes in disability, and he’s been so willing to answer any questions we have. And today, specifically, we talked about SSDI and SSI. Questions about these programs come up over and over again for him and for us. And we really wanted to sit down and learn more. So, if you’ve ever had any questions, like, why do people get denied? What can I do to get approved, if not the first time, then the next time around? What types of disability are there and who can apply? How long does it take and what can you expect? Jamie answers all these questions and more. So, if you’ve ever wanted to learn more about disability, this is a great opportunity to do so. So, let’s dive right in.
Jamie: Yeah. I began working with disability patients or clients about five or six years ago. I had a friend who had a fiance with Multiple Sclerosis, and they kind of brought me into the MS Community and taught me a little about the condition. Then from doing MS bike events, MS walk events and things like that, I became a little bit better educated and frankly got to working with the society. And, ever since that great experience I had, I’ve done more and more work with the community, and it’s brought me to where I’m at this point.
Kerry: Wonderful. So I’m not really too familiar with SSDI and SSI. Do you mind explaining to me what they are?
Jamie: Yeah, there are two federal disability programs. And frankly, if you look at your pay stub and you see where it says, “Social security taxes are taken out,” that’s part of what you’re paying for in that. And it’s what we typically refer to when you say someone’s on disability. The SSDI program is the better of the two programs. It does require that you worked some in the past, but it gives out a solid payment to most people between about $1,000 and $1,700 a month,, and it does give access to Medicare benefits after a waiting period. So, it’s a fairly decent program out there.
The other program you mentioned SSI is, Supplemental Security Income. That’s designed for more individuals who have a lower income history or no income history. It provides a smaller benefit just over $700 a month in most scenarios and Medicaid eligibility. SSI’s typically for individuals who have no work history, picturing a child with a condition or a stay-at-home wife or something like that with a minimal work history or typically SSI individuals.
Kerry: Okay. So, what I’m getting is that anybody can apply to these programs.
Jamie: Yeah. Anybody can apply. People with conditions, typically there’s a program out there for them. The people who wouldn’t be able to qualify for any of these programs, even with a notable medical condition, are people who have a minimal work history and have assets. The SSI program you mentioned earlier, your assets typically have to be less than a few thousand dollars. Including, retirement, 401k, things like that. And your spouse also cannot have significant earnings. So if you are a person who has a minimal work history and your spouse is currently working, you may not qualify for one of these programs. Absent that scenario, most people will qualify for one of the two programs financially. It’s more of a medical question.
Kerry: Okay. So if I wanted to apply, what would that look like? How would I go about doing that?
Jamie: There are three different ways to apply for social security benefits, whether it’s SSI or SSD. A lot of people do apply online. It’s convenient. You can go in and start and stop at your leisure and everything like that. It’s how most of my clients do it. Frankly, for people who have an attorney, most attorneys do the filing as well. You can also file via telephone in which the Social Security folks will call you and kind of walk you through the process and typing things on there. And some of my clients have done that. The quality of assistance does vary a little bit, and frankly, it’s difficult to get all the information together while you’re on the phone. They’re asking you for dates and, you know, where you’ve worked at, where you’ve treated at. That may be difficult to remember in a phone call type atmosphere. It’s a lot easier to do that online. You can stop and start as need be.
The other way to do it is in person at the Social Security office. Again, if you have the proper documentation, you can do that. It’s not terrible to do, but there’s some variation in the quality of assistance. Plus for an MS patient who doesn’t have an obvious condition, who looks like any other person does on an average day at the start at least, you may not want to go in face to face because they typically will note comments about how you present at the end of the application. So if as an MS patient, you walk in to apply and look just like a regular person with no condition, it may be looked at negatively by the SSI. That’s one consideration to keep in mind there.
Kerry: That seems like good advice to me.
Jamie: Yep. So those are the three ways to apply.
Kerry: Great. So can you give us an idea of how long it would take from start to finish?
Jamie: Yeah. Typically, there’s some variety based upon age and other conditions there, but typical cases are approved at the initial level or denied at the initial level, about five to six months after initial application. I’ve had it take longer and be quicker as well. I think our record’s an approval in 27 days. I think we’ve also had initial decisions after nine months or so. Those are outliers based upon extreme conditions though. For most people, the initial decision is a five to six-month decision. In that five to six months, Social Security is tracking down medical documentation. They are getting clarifications from both the claimant and possibly someone that claimant knows about their daily activities, and they are reviewing all that documentation. They may also have the claimant go to one of their doctors for an examination, and that can be a timely process because those exams don’t happen overnight. They’re typically scheduled several weeks out. By the time you take all that and consider it, it can be a five to six-month process in many cases.
Kerry: So you mentioned that they do you take age into consideration. How much do they weigh that? How important is age?
Jamie: Age is a very important factor in the Social Security Disability claim, specifically the age of 50. A person who’s under the age of 50, they haven’t worked quite as long as other people may have and they’ll collect for longer than most people would. So, Social Security gives them a fairly difficult standard. A person under 50 has to show they can’t do any job out there eight hours a day, five days a week. Not just the person’s past work. That includes a ticket taker at a movie theater, a greeter at Walmart, these very basic jobs from a physical standpoint makes it fairly difficult standard. We’ve had success with MS cases in showing that the person has fatigue that stops them from completing a full day or returning a second day, and that they have good days and bad days to where they may have to miss one or two days a month because of their condition or issues with the MS.
So, that’s how we typically prove a case for someone under 50. Over 50, it’s a bit easier standard because again, you’ve worked a bit longer, you’ll collect a bit less. So a person over 50 has to show, they can’t do their prior work, and they can’t do other light duty employment. Now you want a picture a cashier, picture an assembly line worker or something like that, where you’re standing up all day using your hands and everything there. You’ve got to show you can’t do something like that if you’re over 50.
Kerry: Okay. So, does it matter if the client had a high earning job or had a difficult job in the past? Do they take that into consideration?
Jamie: They don’t explicitly consider your earnings in the past as far as whether you’re disabled or not. So if you were a high-level CEO making a good deal of money, it’s not considered explicitly. However, judges, I believe, do look at credibility to an extent. And if you’ve left a really high paying job to go on disability, you’re giving up a substantial amount of income. I think that that provides some credibility to a person that they truly are disabled in that scenario.
Kerry: So you mentioned before that you don’t recommend people applying in person. If you’re living with MS, sometimes your symptoms don’t present themselves. So, are there any other ways that having MS makes a difference in this application process?
Jamie: Yes. The MS Society and other organizations have pursued special allowances for MS patients. The standard we talked about earlier, the under 50, over 50 type standard gets for anybody. A guy with a back injury, a female with a knee injury or an MS patient. There are special MS allowances, however, that are called listings. And there are listings for several conditions, and MS is the one we’re talking about today obviously. There are typically four different listings that are considered for MS. The first listing is based upon disorganization of motor function in two or more limbs. So if you’re an MS patient who has difficulty handling things or using their hands, walking, whatever it may be, you may qualify under that listing.
They typically look for issues with the use of two limbs, whatever it may be, two arms, two legs, or one of each. So if you’re a person who uses Canadian crutches, has used a walker because of gait dysfunction, that may support a claim there. They also look at fatigue as well. And typically, fatigue has to be of a fairly disabling note where it knock you out of the workforce. They look at vision as well. Vision is typically looked at as vision corrected, being 2200 or worse with glasses, or other dramatic changes in vision. Thinking like tunnel vision, loss of peripheral, things of that nature. The other item they look at is cognitive dysfunction. It is somewhat ill-defined in the act itself. But looking at it broadly, if you have significant issues with focus, with memory, those types of aspects of a job, cognitive dysfunction may get you approved under a listing as well.
In using the listings, we have found that much more of that time will social security approve someone under the generic standard, but use the listings to add credibility to what someone’s saying. When an MS patient says they’re fatigued and a judge sees a listing that says fatigue is a major part of MS, oftentimes the judge will give that statement more credibility than they would if it was a generic person with a random condition saying they’re fatigued. So we don’t see a lot of cases approved under the listings themselves. We see it giving credibility more of the time. But they are out there, and they certainly are helpful.
Kerry: Could you talk a little bit about…so this is my first time applying, what are the chances I’m approved?
Jamie: Yeah. There’s a common consensus out there with people who call me the first time that everyone gets denied on initial application. And it’s not true to an extent. We have a lot of clients who are approved on the initial application. And frankly, I believe that there are a lot of MS patients in general approved on the initial application. So it’s not a truity[SP] that you’ll always be denied on the first application. However, I always tell my clients, be prepared to be denied on the first application. Financially, emotionally, you just want to be ready for that long slog going forward. We talked about earlier on the initial application. It can take five to six months.
If you’re denied on that initial application in southeastern Pennsylvania, you can request a hearing, but it typically takes an additional 14 months or so. That is a long wait, about 20 months in total to get in front of a judge. Your best chance of being approved is typically before that judge when they can look you face to face and ask you questions, get a good idea of what’s going on. In southern New Jersey and in Delaware, there’s an additional step in there called Reconsideration, which may mean the process may take 21 to 29 months instead of 20.
It can be a long process here. Clients should be aware of that going into the process and going into the system before they actually do the application process. Now to get more to your question there as to whether everyone’s denied or what the approval percentages are, your best chance of being approved is typically in front of a judge. Simply because the judges can ask questions about issues they may have, they’re able to get a good read on an individual, and most people have their cases best prepared at that stage. Again, we have some people approved at the initial level, but a large number are approved at the hearing level as well.
Kerry: What can you do to increase your chances the first time around?
Jamie: Good communication with the adjuster is key. And whether it’s your attorney who’s handling that or someone doing it on their own, keeping the adjuster in the loop is important. Adjusters don’t know if you’ve had a new treatment, adjusters don’t know if you’ve had an exacerbation that’s increased your conditions. You have to keep them advised on that. The other issue adjusters have a lot of the time, is confirming that they get all the medical records they should. Some doctor’s offices are incredibly busy. And when they get that one request from an adjuster, they may not promptly respond. If you’ve contacted your adjuster, if you know that record hasn’t been received, you can try to take action on the adjuster’s behalf and get that started for them. Obviously, if your neurologist treatment notes or physical therapist notes aren’t in file, that’s gonna dramatically impact your chances at approval. So dealing with the adjuster, assisting them in their job is incredibly helpful there.
Kerry: So, if you’ve worked part-time, can you still apply or how does that work?
Jamie: If you’ve worked part-time in the past, you may still have qualification for SSDI. That’s the program you mentioned earlier that you have to show a work history. For SSDI, a full year of work is making about $6,500 or more in that range. So a part-time worker oftentimes will get a full year’s worth of credit for their part-time work. As far as working after you’ve applied, it has to be work of a fairly minimal amount. You can’t be making a good wage while applying for disability. You, to an extent, have to leave the workforce and commit to applying for disability. However, there is some part-time work allowance by Social Security. The numbers change every year, but at present, the figure is around $1,000 a month. If you’re below that figure, you can be working part-time and still apply for disability.
Now that money that you’re making has to be made on a part-time basis. There’s no fast and firm rule for that. For most people below 20 or 25 hours a week making below $1,000 a month in a position that is flexible. If you’re having a bad day because of MS, you cannot be able to come in that day, things like that. Those are typically my three touchstones for working part-time. But a person certainly can work part-time while they’re applying for and collecting disability. And frankly, especially for a younger MS patient, we strongly recommend that to keep them mobile and in the workforce.
Kerry: So what you’re saying is once you are receiving disability, you can go back and work part-time.
Jamie: You can work during the application process or return to work thereafter within those restrictions there. And again, a lot of that is finding the right kind of job. I’ve had a lot of clients who were former teachers. They may do tutoring on the side once they’re approved for benefits. It’s the perfect job. They do it at night, the amount they can physically deal with. They call it if they’re having a bad day. It’s incredibly flexible, incredibly easy to do. That’s the perfect kind of scenario. And if my clients find a job like that, we always encourage them to take it.
Kerry: Now, so you help people apply for disability. Can somebody apply on their own?
Jamie: It’s an excellent question,, and obviously there’s a little bit of bias here as an attorney answering that question. In my experience, I think attorneys do provide value. We help organize the application process a lot. We help interpret what Social Security is sending. A lot of folks get confused or get off put by some of the documentation Social Security may send. And just having a description of whether it’s normal, what they’re looking for, what kinds of information may be included, we believe is helpful.
The attorney’s fees in a scenario like this also are typically relatively reasonable. So we think attorneys help from day one. However, if a person was really motivated to apply on their own, they may be able to do so. They may be able to get away with it. However, if they have to go to a hearing, we strongly recommend you get counsel at that point. It’s much different to fill out some paperwork and send it in on your own than it is to sit in front of a judge in a pressure charged atmosphere and testify and represent yourself. So at the initial stage, we don’t recommend it, but it may be possible. At the hearing stage, we strongly advise people get counsel.
Kerry: And you said the cost really isn’t prohibitive. Can you expand on that a little bit? People might be worried about how expensive that might be, I think.
Jamie: And I’ll give you figures on what most attorneys charge for this kind of work, and it’s set to an extent by statute. So, most of us charge the same kind of fee. First of all, the fee is contingent, which means that if we don’t win your case, we don’t get any fee. Most people don’t know that, and they should know it. If a disability attorney ask for your money up front, you typically want to call around and ask for another name because that’s a bad sign. Most attorneys will charge 25% of the past due benefits at the time of approval. What that means is, once you’re approved for disability, it will have taken some time for that approval to come down. Social Security will owe you money that have backed up in time from the approval date, going back to when you last worked. They’re going to give you a lump sum check for that. The attorney’s fees is typically 25% of that.
The other thing you always want to ask your attorney is about our costs on a file because that’s where attorneys tend to get folks now and then. So, we ask for reimbursement of medical records if a person’s approved and only if they’re approved. Many offices out there opt to charge for postage, copying, mileage, things of that nature. Typically, we don’t request that from a client. We solely look at the 25% of past due benefits and other costs as well for medical records.
Kerry: That seems pretty reasonable, I think.
Jamie: I appreciate that.
Kerry: So, if a person has a disability through their employer, what kind of impact does that have on their claim?
Jamie: Yeah. Private disability plan exists in conjunction with Social Security disability claims. And by a private disability plan, we mean ones through Aetna, Cigna, Hartford, Sunlife, groups like that, typically. If you look down at your pay stub, you might see a notation there, a long-term disability or short-term disability withdrawals there. Generally, those operate in conjunction with SSDI, which is the program that you’d pay money into and everything like that. Typically, those programs will require an offset for Social Security disability if Social Security disability is approved.
And what I mean by that is, if the longterm disability plan you have, the private disability pay, say $3,000 a month and Social Security pays $2,000 a month, you wouldn’t get a total of $5,000 per month. You’d still get a total of $3,000. It’s just the private disability plan will pay a portion, Social Security pays the remainder. So, they do operate in conjunction with one another. And typically, Social Security disability claims are required by longterm disability because your longterm disability insurance company wants to save that money by having Social Security pick up some of the bill for your benefit plan there.
Kerry: So, is there anything else that you wanted to talk about? I think I asked a lot of questions.
Jamie: Yeah. What I can’t stress enough for MS patients is to call around and ask questions. A lot of attorneys out there, the MS Society, they’re excellent resources. And to an extent, we’re here to help everyone and help them get knowledge. The best clients I have, don’t call me the day they’re gonna apply. They call me two, three years before that while they’re still in the workforce. We can have a long discussion about what they should be looking for, when an application may be appropriate, what kinds of earnings they can have. All the things we’ve talked about here today on a more personal level.
That way when it comes time to actually apply for disability, they know the time is right to apply, and they know they’re making the right decision. Removing that kind of stress from a person is a huge benefit to them. And frankly, knowing a client has made the proper decision and knowing that they have planned for it financially and emotionally, it makes my job much easier as well. So that’d be my biggest piece of advice to people looking to apply is, simply ask questions.
Kerry: That’s always good advice. Well, thank you so much for coming in and talking to us about this, and I think I learned a lot.
Jamie: I appreciate that. It’s my pleasure to help you, folks, out and help the MS society out here. I do want to note though that this is not a firm legal advice here. If someone’s looking to file a claim, they should always contact counsel, or contact experts on the matter and talking about their specific case rather than just general information, which is what we’ve given you here today. Thank you, and I appreciate the time.
Kerry: Great. Thanks, Jamie. Well, that was our conversation with Jamie Hall. Hopefully, you learned a lot. I know I did. Jamie has got a website. If you’ve got any other questions. It’s jrhlegal.com. Again, that’s jrhlegal.com. So if you have any lingering questions or you want to speak with Jamie, that’s a good place to go. Well, that’s it for us. Thank you for listening and have a great day.