This webpage is not intended to provide legal advice. For legal advice you should consult an attorney. The procedures described herein are current as of the time of April 2008 and are described for residents of New York State. Procedures may very in other states. Certain aspects of the procedures and requirements have not been set forth in complete detail.

Social Security Disability Benefits

Who Is Eligible For SSDB?

Social Security Disability Benefits are available to workers who:

  1. Are at least 18 years of age, but have not reached their full retirement age; and
  2. Have worked at covered employment 5 to 10 years (40 quarters) immediately preceding the date of disability.
    If you become disabled before age 31 you must have worked at least half of the quarters between age 21 and the date of disability, or a minimum of 6 out of 12 quarters.
  3. Are unable, due to medical reasons, to hold any substantial, gainful employment for at least a twelve month continuous period.

All three of these criteria must be met by applicants to be considered eligible.

Note: "covered employment" means employment the earnings from which were subject to withholding for Social Security.

What Are The Benefits For SSDB Recipients?

If your SSDB claim is approved, you will receive a monthly payment equal to the amount that you would receive if you were age 62 at the beginning of the 5 month waiting perio.

If you wait until normal retirement are to retire, benefits are calculate based on the highest 35 years of reported earnings. Persons with less than 35 years of reported earnings are assigned zero earnings for each of those missing years, thereby reducing their overall average earnings for the purpose of calculating Old Age & Survivor Benefits (herein reffered to as "OASB").

However, successful SSDB applicants have their benefits calculated based on actual years worked and eligible earnings received with no zero value years, even though there may be fewer than 35 years of eligible earnings.

Medicare coverage is provided to SSDB recipients beginning with the second anniversary of their eligibility to receive cash payments, as determined by the Social Security Administration (SSA). Part A coverage (essentially hospital room & board) is provided at no cost.
Part B coverage (physician visits, surgery, testing, etc.) requires a monthly payment which is deducted from your SSDB payment.

Careful consideration should be given before deciding whether or not to purchase the optional part B coverage. Do not assume that because you are covered under a health care policy held by a spouse or another coverage into retirement) that you should not purchase Part B coverage.

If you have any doubts, obtain a letter from the insurance company issuing the other policy concerning whether your coverage under that policy is primary to Medicare or secondary to Medicare. If that policy becomes secondary or you have no other coverage, you would be well advised to purchase the Part B coverage from Medicare.

When To Apply For SSDB

Though it is possible to apply for SSDB as soon as disability makes you unable to work, it is generally not advisable to apply so soon.

Since there is a threshold requirement that because of your disability you were unable to perform any substantial gainful employment for a least one year, and SSDB does not provide any payments for the first five months of disability, nothing is lost by waiting until the sixth month of disability before applying. By waiting until the six months to apply, it also becomes easier for your physician and a physician examining for SSA to conclude that you will be unable to perform any substantial gainful activity for at least one year.

What To Do If You Meet The Eligibility Requirements

Since CSEA has made SBB part of its legal service program, members and their dependents will be while well advised to consult Fine, Olin & Anderman, LLP to get information and advice immediately prior to applying for SSDB.

The actual application can be made, in person at that applicants local Social Security Administration office, via telephone by calling (800) 772-1213, or on the Internet by clicking on www.SocialSecurity.gov.

If you choose to apply in person, call the local Social Security office in advance to make an appointment.

Regardless of the method you choose for making your application, he sure you have the following in front of you:

  1. The names, address and telephone number of all medical providers for whom you have received treatment since the beginning of the period of disability;
  2. All of the medical conditions (physical and mental) for which those medical providers treated you; and
  3. A list by name, dosage and frequency of all medication that you are currently taken. Medications are important to your application, since their side effects may reduce your ability to keep a job.
  4. In applying, do not omit any illness or injury from which you suffer. Also, do not overlook any mental illness for which you are being treated. The SSA understands how disabling mental illness can be and gives great way to it.

After your application interview, the Social Security administration (SSA) will review your application and will contact your treating physician(s) for information. Be sure to ask your treating physician(s) to reply promptly. Failure by them to do so can have a negative impact on your application for SSDB.

As part of the review process, you may be asked to submit to an examination by one or more physician selected by the SSA. Be sure to attend the exam(s).

Though it may seem as though asked SBB is hard to get, the fact is that most people who persevere do get approved for benefits. The initial review by the SSA usually takes about 4 months. When the process is completed, the applicant is sent a letter advising whether or not a favorable determination has been made.

What To Do If Denied SSDB

In the event that initial application is denied, it is extremely important that you immediately call CSEA at (800) 342-4146 and follow the prompts for Legal Services Program, Injury Related Matters so you can be connected FOA. FOA will request a hearing on your behalf and represent you at the hearing. Kerry must be requested not more than 60 days after the date of the unfavorable determination letter. It is important that you caught us today to receive a letter of denial.

It is FOA's role, in addition to representing you at the hearing, together medical information and to take necessary steps to bring information to the attention of SSA. Frequently FOA is able to persuade the Law Judge to make a favorable determination on the record even prior to the hearing.

Attorney Fees

Attorneys fees for representing SSDB applicants are regulated by federal law. These are contingent upon success, so FOA will not get any fee of the law firm is not successful in obtaining SBB for you.

What a favorable decision is rendered, it is the practice of the Social Security administration to withhold 25% your retroactive benefits, pending receipt of the fee application from your attorney. FOA will offer you the opportunity to The fee at $5,300 or 25% of retroactive benefits, whichever is less. To obtain this, you will be offered a written agreement at the time FOA's representation begins.

Know Your Rights!

CSEA wants you to know your rights whether you are someone in danger of being removed from the payroll because disability has forced you to be absent from work for a period of one year pursuant to section 71 of the NYS Civil Service Law; or you are someone who has chosen to retire with a pension to "smell the roses"; or you are just physically and/or mentally unable to work anymore.

A call to CSEA at (800) 342-4146 following the prompts for Legal Service Program, Injury Related Matters, a connecting to Fine, Olin & Anderman, LLP, (FOA) the statewide law firm that will answer your questions and provide legal representation regarding Social Security disability benefits to CSEA members and their dependents.

For further explanation, or for answers to questions that you may have, you should call CSEA at (800) 342-4146 and follow the prompts for Legal Services Program, Injury-Related Matters. You will be connected to Fine, Olin & Anderman, L.L.P, (FOA) the statewide law firm that provides legal representation regarding Social Security Disability benefits to CSEA members and their dependents.

Are You Eligible?

Legal Services Program
(800) 342-4146

follow prompts for

Legal Services Program,
Injury Related Matters

Social Security Disability Insurance

Social Security Disability Insurance provides monthly benefits to workers who meet the Social Security Administration's definition of disabled If qualified, you or your family are entitled to receive monthly benefits until age 65, if you continue to be considered disabled. At age 65, you will start to receive Old Age and Survivors Benefits.

Steps to Obtain Coverage
  1. Initial Application
    Call or visit your local Social Security Administration office. They will contact all doctors that have treated you. Your claim will probably be denied, but you don't need an attorney at this level. Be sure to file for "reconsideration" immediately after your initial application is denied.
  2. Reconsideration Level
    You don't need an attorney at this level. A different Social Security Administration Examiner will review your file as well as any new medical reports you have submitted. Your claim will probably be denied again. Upon denial, you should promptly go to the Social Security Administration to request a hearing.
  3. Hearing Level
    An Administrative Law Judge will review your file and ask you questions at the hearing. Claimants represented by counsel are more likely to be successful at this level than those who are not represented.

The CSEA Workers' Compensation Legal Assistance Program attorneys can help prepare you for this process. They will conduct in-depth interviews with you, correspond directly with your doctors, obtain prior work histories, process all necessary forms, and represent you at the hearing. Be sure to contact the Program Attorneys at the same time that you request a hearing.

Who is Eligible

Every disability you suffer from, not just on-the-job accidents, is considered by the Social Security Administration in determining your eligibility for benefits. But there are certain requirements:

  • You must be unable to do any substantial gainful work due to a physical or mental impairment which has lasted or is expected to last for at least one year.
  • As a general rule if you are over age 31, you must have worked five of the last ten years preceding the onset of disability
  • You must have been subject to FICA deductions("off-the-book" jobs and some government workers are not eligible).
How to File a Claim

Through the Social Security Administration claims process can take longer than you would like, and at times may be frustrating to you, your financial security could be at stake. The tendency of the Social Security Administration has been to deny claims at the initial levels. Consequently, it is essential that you pursue your claim to the hearing level.

As a truly disabled person, however, it is vital that you make every effort to see that your claim application is granted. You can get assistance for doing this by contacting the CSEA Worker's Compensation Legal Assistance Program attorneys.

If you have a possible Workers' Compensation or Social Security Disability case, the CSEA Workers' Compensation Legal Assistance Program will provide you with honest, courteous and professional representation, at no out-of-pocket cost to you. The representation is provided by the firm of FINE, OLIN, AND ANDERMAN, P.C., through it's statewide network of offices staffed by attorneys who specialize in Workers' Compensation / Social Security Law.
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