Social Security Overview

When you realize that you are no longer able to work, it is time to find out realistically whether you qualify for disability benefits. I am Sara L. Gabin, and I have been a Social Security Disability lawyer in Portland and nearby communities over 30 years. My job is to help disabled Portland metropolitan area residents receive the benefits they deserve without having to navigate the complex Social Security bureaucracy alone.

I handle claims concerning several areas of benefits for ill and disabled people: Social Security Disability Income (SSDI), Disabled Adult Child (DAC), Disabled Widows Income (DWI) and/or Supplemental Security Income (SSI) benefits. I also represent clients at multiple phases of the disability claims process, including initial application, reconsideration, hearing before an Administrative Law Judge, Appeals Council Review, and Federal District Court Review.

Disability, for purposes of SSDI, DAC, DWI and SSI claims, means, basically, that for at least 12 continuous months, the inability to work 8 hours a day, 5 days a week, or an equivalent schedule, at acceptable productivity levels. If you are fairly certain you fit this definition, and, if a doctor who knows you agrees and is willing to say so, apply for all benefits to which you may be entitled.

Initial Application. Lawyers have differing opinions on whether they are necessary at initial application. It is only recently that lawyers have started taking cases at initial application. In my view, having a lawyer at initial application is a good idea only if you do not think you can complete the application on your own. Call me if you think you cannot complete the application on your own. Most applications will be denied whether you have a lawyer or not. But the claim can begin only with an application. If you apply on your own, go directly to the government website: www.SSA.gov These are the only words that will appear in the government URL. Websites that include in their URLs words such as “help,” “advocate,” “application,” or “representatives” are not government websites, but are private business establishments. Claimants have gone to these cites mistakenly, thinking that were at the government site.

Denied Claims. When your claim is denied on initial application, you need an experienced lawyer at your side to navigate the bureaucratic and procedural mazes that lie ahead, and to properly develop medical and vocational evidence showing you are disabled. In my experience, I have observed that it is too easy for a claimant to misstep and damage seriously what might have been a good, winnable claim. So, as soon as your claim is denied, call a lawyer. The first appeal is called reconsideration, followed by the hearing, Appeals Council Review, and Federal District Court Review.

There is no question the disability climate has changed dramatically. When not too long ago it was reasonable to expect a favorable outcome after going to a hearing, now more cases are lost than won at the hearing. This means that it is more important that is has ever been to build a record that will hold-up in federal court were about half of all disability claims are now headed. I have observed that a client has at least a 50 percent chance obtaining some positive relief in Federal Court. It is helpful to know why this is so. The Social Security Administration (SSA) is part of the executive branch of government. The Federal Court is part of the judicial branch of government. These are two separate and independent branches of government (Congress is the third branch where the laws are made). The Federal Court, therefore, conducts an independent review of the SSA final decision. Accordingly, the Federal Court will take an objective and unbiased look at what the SSA has decided and will tell the SSA when it has decided incorrectly.

Although you may not have a lawyer when you apply, remember that what you say is your “testimony.” You will live with what you say the duration of your claim process. Do not overthink your answers. Do not overstate or understate your symptoms or activity level. Do not explain what the disorder is all about or send articles about the disorder that you pulled off the Internet, because you are not a doctor. It is the job of your doctor to explain the disorder and why it causes your symptoms. Describe only your symptoms and how they limit you.

Know that when your claim has been denied, strict time limits apply to appealing. Good claims have been lost because a claimant has missed a critical deadline. You have 60-days to appeal any unfavorable notice you receive and you are presumed to have received the notice within five (5) days of the mailing date. So call promptly when you receive a notice denying your claim.

SSDI Claims. SSDI is a claim for disability benefits based on a claimant’s earnings history. When you were part of the work force and paid withholdings, effectively you paid insurance premiums known as FICA. If you were self-employed, you paid self-employment tax. When you made these payments every day of your working life, you purchased a disability policy that is intended to pay disability benefits should you become disabled before reaching full retirement age, and retirement benefits when you reach retirement age. On an SSDI claim, you must prove you became disabled while you still retained insurance coverage for SSDI benefits. The date this coverage lapses is known as “date last insured” (DLI). DLI is another way of saying “end of grace period.” The “grace period” typically ends about five years after you last paid withholdings. There is no requirement that a claimant apply before DLI. However, the further beyond DLI a claimant applies, the more difficult it is to prove disability on or before DLI.

Disabled Adult Child (DAC) Claims. DAC is a claim a disabled adult child brings on the account or earnings history of a parent who has retired, died or who has become disabled. The claimant must prove that s/he became disabled on or before age 22, and that the parent has paid sufficient withholdings to have qualified for retirement or disability benefits. Often a claimant does not realize until well until adulthood that they have been disabled since before age 22. As soon as you are aware that you or a loved one might have a DAC claim, call a lawyer about how to gather evidence showing disability on or before age 22.

Disabled Widow (DWI) claims. DWI benefits are available to a disabled individual on the account or earnings history of a spouse who has died when the benefits that would flow from the spouses earning’s history exceed those the claimant would receive on his/her own earning’s record. The claimant must prove the marriage lasted 10 or more years, must not have not remarried, and must show s/he became disabled on or before the expiration of 84 months after the death of the spouse. Although there is no requirement that a surviving widow-widower apply before the expiration of the 84 months, the further beyond this date the claimant applies, the more difficult it is to prove disability onset within the 84 months.

Supplemental Security Income (SSI) claims. SSI benefits are available to an individual when there are insufficient earnings history to qualify for SSDI, DAC or DWI benefits at a level equal to SSI benefits. SSI is a welfare program. So, a claimant must also be essentially indigent. On an SSI claim, there are no critical time periods for proving disability.

SSDI, DAC and DWI Claims. If you win your SSDI, DAC or DWI claim, you will receive back or retroactive benefits one year before you applied or 5 months after you became disabled, whichever is later.

SSI Claims. If you win your SSI claim, you will receive benefits back to the date you applied.

If you win your case at any time without proceeding to federal district court, fees are 25% of past due benefits with a maximum fee cap of $6,000.00 (or the statutory cap in effect on the date of the decision awarding benefits)

If your case goes to federal district court, and if you receive a remand for rehearing, I will request a fee for my federal court time to be paid by the government. If I win for you at a rehearing, you will pay a fee of 25% of past due benefits with a fee cap of $6,000 (or the statutory cap in effect on the date of the decision awarding benefits), just as if you had won your case without having gone to federal court. If I was unable to collect from the government fees for my federal court time, I will seek additional fees out of your past due benefits equal to the amount of fees I was unable to collect from the government. The combined fees I receive out of your past due benefits may not exceed 25% of these benefits.

If you receive a remand for payment of your benefits, I will request a fee for my federal court time, to be paid by the government. I will also request a full 25% of your past due benefits without a cap, offset by any fees I receive from the government.

In nearly all cases, I will incur out–of–pocket costs. These are not attorney fees, but are fees for such things as medical record duplicating charges, attorney/doctor conferences and treating doctor medical reports.

I incur expenses only when necessary to prepare properly. I am bound to follow Oregon State Bar ethical rules that require the client to assume responsibility for these costs if the client is able to pay. Therefore, I will bill for these costs but will not expect payment unless you can afford to reimburse me.

When unable to work, it is easy to feel trapped. As a Social Security Disability lawyer with over 30 years of experience, I have represented disabled persons in Lake Oswego and elsewhere in Multnomah, Clackamas, Washington and Yamhill Counties. I am dedicated to helping you earn all benefits to which are entitled. Contact Sara L. Gabin at (503) 620-3171 or online to discuss your case. Free Consultation.

• Applying for Benefits
• Losing Your Hearing – Appeals Council and Federal District Court Review
• Reconsideration and Hearing
• Your Credibility