Navigating the process of applying for Social Security Disability (SSD) or long-term disability (LTD) benefits can be a daunting and arduous journey, particularly when you are already contending with a serious medical condition. The rules and regulations are complex, the evidentiary requirements are stringent, and initial denials are common.
Securing the assistance of an experienced disability lawyer can substantially increase your chances of success. However, not all lawyers are equally equipped to handle these highly technical cases.
The initial consultation is your opportunity to interview a potential attorney and determine if they have the requisite expertise and approach to effectively advocate on your behalf.
Inquiries into Experience and Specialization
Disability law is a niche field that demands specialized knowledge. A general practice attorney is unlikely to possess the depth of understanding necessary to successfully navigate the intricacies of the SocialSecurity Administration (SSA) or to litigate against a large insurance company.
How much of your practice is dedicated to disability law?
This is a critical threshold question. You should seek an attorney or firm that specializes in disability claims, whether they are Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), or private long-term disability (LTD) insurance cases. An attorney who focuses on this area will have a deep familiarity with the specific laws, regulations, and procedural requirements, including the SSA’s five-step sequential evaluation process and the Employee Retirement Income Security Act (ERISA) which governs most employer-provided LTD plans.
Have you handled cases involving my specific medical condition?
While an attorney is not a medical doctor, an experienced disability lawyer will have a working knowledge of various medical conditions and how they typically cause functional limitations that prevent work. Ask if they have represented other clients with your diagnosis. Their familiarity with the medical evidence needed to prove your specific impairments—and their ability to communicate effectively with your treating physicians—is a significant advantage. This ensures your condition is represented wholly and accurately, which is crucial for demonstrating how it affects your ability to earn a living.
What is your experience at the hearing and appeals levels?
A large percentage of initial SSDI/SSI applications are denied, meaning many cases must be won at a hearing before an Administrative Law Judge (ALJ) or through further appeals. It is therefore essential to ask about the attorney’s experience in these later stages. Inquire about their success rate at the hearing level and whether they handle appeals to the Appeals Council and in Federal Court. For LTD cases, ask about their experience with ERISA appeals and federal court litigation, as these have very specific and unforgiving procedural rules.
The Strategy and Process for Your Claim
A competent disability lawyer should be able to outline a clear plan for developing and presenting your case.
How will you handle my claim and gather the necessary evidence?
Ask the attorney to describe their process. A thorough approach to an SSD claim involves a comprehensive investigation of your medical records and work history. The attorney should explain the tools they use to strengthen a claim, such as :
- Medical Source Statements: Obtaining detailed forms from your treating physicians that describe your functional limitations (e.g., how long you can sit, stand, or walk; how much you can lift).
- Consultative Examinations: Arranging for an independent medical examination to provide a new expert opinion on your condition and limitations.
- Vocational Evaluations: Using a vocational expert to provide an opinion on how your impairments prevent you from performing not only your past work but also any other work that exists in the national economy.
What do you see as the primary challenges in my case?
An honest attorney will provide a candid assessment of your claim, identifying both its strengths and its potential weaknesses. This could be a lack of objective medical evidence, a history of not following prescribed treatment, or work activity that exceeds the Substantial Gainful Activity (SGA) income limits set by the SSA. Understanding these challenges upfront allows the attorney to develop a strategy to overcome them.
What can I do to help my claim succeed?
Your cooperation is vital. The attorney should provide you with clear instructions on your role in the process. This typically includes continuing with regular medical treatment, following your doctors’ advice, being completely honest about your symptoms and limitations, and keeping the law firm updated on any changes in your condition or treatment.
Clarifying Fees, Costs, and Communication
The financial and logistical aspects of the attorney-client relationship must be clearly established to avoid future misunderstandings.
How do you charge for your services?
This is a critical question. For Social Security disability cases, the fee structure is regulated by federal law. Attorneys almost universally work on a contingency fee basis, meaning they only get paid if you win your case. The fee is typically capped at 25% of your past-due (or “back pay”) benefits, up to a maximum amount set by the SSA (currently $9,200). You should also ask about any other case-related costs you might be responsible for, such as the expense of obtaining medical records, and whether you must pay these costs even if you lose. For private LTD cases, the fee structure may be similar but is not federally regulated, so it is essential to get the terms in a written agreement.
How will we communicate, and who will be my point of contact?
Disability claims can take a long time to resolve. You need to know how the firm will keep you informed. Ask how often you can expect updates and what the best way is to contact the office with questions. Determine if your primary contact will be the attorney directly or a dedicated paralegal or case manager, and ensure you are comfortable with this arrangement.
Frequently Asked Questions (FAQs)
Q1: What is the difference between SSDI and SSI? Social Security Disability Insurance (SSDI) is an earned benefit based on your work history and the Social Security taxes you have paid. Supplemental Security Income (SSI) is a needs-based program for individuals who are disabled, blind, or aged and have very limited income and resources, regardless of their work history.
Q2: My initial application was denied. Is it worth appealing? Yes. A large majority of initial disability applications are denied. The denial is often just the first step in the process. Filing an appeal and proceeding to a hearing before an Administrative Law Judge, where you can testify and your attorney can present evidence and arguments, significantly increases the chances of approval.
Q3: Can I work while applying for disability benefits? You can work, but your earnings must not exceed the Substantial Gainful Activity (SGA) limit set by the Social Security Administration. The SGA amount is adjusted annually. If you earn more than the SGA limit, the SSA will generally find that you are not disabled.