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General Information
Generally, individuals who are not able to work and earn the maximum
statutory amount* per month at any job because of their physical
or psychological disabilities, may be eligible for Social Security
disability benefits. Benefits are of two types:
Disability Insurance Benefits (sometimes called Title II or DIB)
Supplemental Security Income (sometimes called Title XVI or SSI)
*This amount may change annually.
Disability Insurance Benefits (DIB)
If an individual has worked in the past and has made sufficient
quarterly contributions to the Social Security trust fund through
the Social Security tax on his or her income, he or she will be
"insured" and eligible for some type of DIB benefit. His or her
monthly benefit will be calculated based upon his or her past contributions.
This program is administered by the federal government and the disabled individual will be eligible for Medicare benefits two years after the beginning (onset) of his or her disability.
If the claimant files a claim more than 12 months after he or she becomes disabled, the claimant will only be able to claim entitlement to benefits for 12 months prior to his or her application. Even after establishing an entitlement date, a claimant must endure a five month waiting period before the benefits actually begin.
The Social Security Administration will generally withhold 25% of a claimant's back due benefits for payment of attorneys fees, if applicable.
Supplemental Security Income (SSI)
If an individual has not worked in the past or has worked but has
not made sufficient quarterly contributions to the Social Security
trust fund through the Social Security tax on his or her income,
he or she will be considered for an SSI benefit. This is a "need
based" program for low or no income individuals who do not have
sufficient income, assets or gifts/contributions from others to
be living above the poverty level. His or her monthly benefit will
be no more than the current defined "poverty level," but this benefit
may be reduced by the income and assets of the claimant and the
gifts or contributions the claimant receives from others (i.e. room,
board, transportation, etc.)
Although the funds are federal, this program is administered by the state government, and the disabled individual will be eligible for Medicaid benefits as of the date of the onset of their disability.
If the claimant files a claim more than 12 months after he or she becomes disabled, the claimant will only be able to claim entitlement to benefits from the date of their Social Security disability application.
The Social Security Administration does not withhold attorneys fees from these checks and claimants are responsible for paying their attorney 25% of the back due SSI checks they receive.
How is Disability Determined?
Every claim is determined by a five step evaluation:
- If you are working and your earnings average more than the
minimum statutory amount* per month, your income will not generally
be considered in determining your disability. If you are working
and your earnings average more than the maximum statutory amount*
per month, your income will disqualify you for benefits. If you
are earning between the minimum and maximum statutory amounts*
per month, the Social Security Administration will obtain additional
information about your work in order to determine if you are disqualified
due to your earned income (i.e. are you working a "make-shift"
or modified job which is not available in the competitive marketplace,
is your employer a friend or family member who is letting you
work when other employers would not, etc.)
- Is your condition severe? Your impairments must interfere with
basic work-related activities for your claim to be considered.
- Is your condition found in the list of disabling impairments
that the Administration maintains for each of the major body systems
that are so severe they automatically mean you are disabled? If
your condition is not on the list, the Social Security Administration
will have to decide if it is of equal severity to an impairment
on the list. If it is, your claim is approved. If it is not, the
evaluation goes to the next step.
- Does your severe condition or the combination of your conditions
prevent you from returning to work you have done in the past 15
years? If it does not, your claim will be denied. If it does,
you may be entitled to disability under Social Security formulas
(grids) which consider your age, education, work history, and
physical or mental work limitations in determining whether you
are disabled.
- If you prove that you can not return to your past employment and you do not fit within the grids, the burden of proof shifts to the Social Security Administration to prove that you are capable of doing other work for which you can earn at least the maximum statutory amount* per month. In determining whether you can do other work, the Administration will consider your age, education, past work experience, and whether your skills are transferable to jobs which exist in the national economy. If you cannot do any other kind of work, your claim will be approved. If you can, your claim will be denied.
*These amounts may change annually.
NOTE: While testimony under oath by the claimant or witnesses is helpful, the most important and indispensable evidence is medical documentation of the nature and extent of the claimant's medical or mental health conditions.
When to Apply
You should apply as soon as you become disabled. DIB benefits will
be paid beginning the sixth full month after the beginning of your
disability (but in no event more than 7 months prior to your application.)
SSI benefits benefits begin as of the date of your application.
Thus, if you delay your application for DIB or SSI, you may lose
some benefits.
Where to apply or file appeals
The North Carolina area is comprised of all the cities in the state
of North Carolina. The address, location, phone number, and hours
of operation for the ones in the major cities and surrounding the
Piedmont Triad are:
| Suite 200 5701 Executive Ctr Dr. Charlotte, NC 28212 704-532-8583 9:00 am to 4:30 pm |
3308 Chapel Hill Blvd. Durham, NC 27707 919-541-5442 8:30 am to 3:30 pm |
6005 Landmark Center Blvd. Greensboro, NC 27407 336-378-1751 9:00 am to 4:00 pm |
| Ground Floor 211 Lindsay Street High Point, NC 27262 336-886-8770 9:00 am to 4:00 pm |
117 Mayberry Mall Mt Airy, NC 27030 336-789-8179 9:00 am to 4:30 pm |
4405 Bland Road Raleigh, NC 27604 919-790-2782 9:00 am to 4:30 pm |
| 1816 E. Innes St. Salisbury, NC 28146 704-633-9432 9:00 am to 4:30 pm |
2038 Davie Avenue Statesville, NC 28625 704-872-8120 9:00 am to 4:30 pm |
Room 101, Federal Bldg 207 W Main Street Wilkesboro, NC 28697 336-667-8506 9:00 am to 4:30 pm |
| 5205 University Parkway Winston-Salem, NC 27106 336-767-3736 9:00 am to 4:30 pm |
If you need to contact any other local office, you can either call the toll free number 1-800-772-1213 or access the Social Security Administration website and click on the NC button for all of the North Carolina local offices.
How to apply
You can apply by calling the toll-free number, 1-800-772-1213. The
representatives there can make an appointment for your application
to be taken over the telephone or at any convenient Social Security
office. People who are deaf or hard of hearing may call the toll-free
"TTY" number, 1-800-325-0778, between 7 a.m. and 7 p.m. on Monday
through Friday.
What you need to apply
The claims process for disability benefits is generally longer
than for other types of Social Security benefits, from 60 to 90
days. It takes longer to obtain medical information and to assess
the nature of the disability in terms of your ability to work. However,
you can help shorten the process by bringing certain documents with
you when you apply and helping SSA to get any other medical evidence
you need to show you are disabled. These include:
- your Social Security number;
- your birth certificate or other evidence of your date of birth;
- your military discharge papers, if any;
- your spouse's birth certificate and Social Security number if
he or she is applying for benefits;
- your children's birth certificates and Social Security numbers
if they are applying for benefits;
- and your checking or savings account information, so your benefits
can be directly deposited.
The documents presented as evidence must be either originals or copies certified by the issuing agency. SSA cannot accept uncertified or notarized photocopies as evidence since SSA cannot verify their authenticity. Do not delay filing for benefits just because you do not have all of the information you need. The Social Security office will be glad to help you.
What else do you need to apply for SSI?
If you are applying for Supplemental Security Income benefits
you also need the following:
- information about the home where you live, such as your mortgage
or your lease and landlord's name;
- payroll slips, bank books, insurance policies, car registration,
burial fund records, and other information about your income
and the things you own; and
- information regarding contributions others have made towards your necessities, such as shelter, food, transportation, clothing, etc.
What other information could speed up processing
your claim?
- names, addresses, and phone numbers of doctors, hospitals,
clinics, and institutions that treated you and dates of treatment;
- the names and doses of all medications you are taking and
which doctor is prescribing them;
- complete medical records from your doctors, therapists, hospitals,
clinics, and caseworkers;
- laboratory and test results;
- a summary of where you worked in the past 15 years and the
kind of work you did;
- and a copy of your W-2 Form (Wage and Tax Statement), or if you are self-employed, your federal tax return for the past year;
What are the levels of decision?
Initial Evaluation:
The Administration will determine claimant's entitlement based
upon his or her medical records. Thus, the claimant should ensure
that the Administration knows about and has obtained all medical
or mental health evidence relevant to his or her claim.
If a claimant is denied at this level, he or she should not be discouraged. Many claimants do not win their claims until they reach the hearings level and are able to testify before a qualified Administrative Law Judge. A claimant should appeal the initial denial within sixty (60) days of the date of the decision. An appeal from this level is called a Request for Reconsideration.
Request for Reconsideration:
The forms for filing a Request for Reconsideration can be obtained
at the Social Security office near you, your local Legal Aid Society
or from any attorney who practices Social Security Disability
law.
At this level, you will be asked to update the Administration on changes in your condition or medical/mental health treatment since you filed your claim.
The decision at this level is made by the Disability Determiners in Raleigh and, once again, the decision is made only upon the records.
A claimant should appeal a denial at the reconsideration level within sixty (60) days of the date of the decision. An appeal from this level is called a Request for Hearing.
Request For Hearing:
If the claimant is denied at the initial level and at reconsideration,
he or she may request a hearing before an Administrative Law Judge.
The Judge must look at the case as if it has never been decided
before and is not bound by the previous denials. This is a claimant's
only opportunity to testify and present witnesses for the Judge's
consideration. Many cases previously denied have been won at this
level. Claimants should obtain legal representation at this level
to properly prepare the claimant and his or her witnesses to testify
and to cross examine any medical or vocational witnesses the Administration
may call to testify about the claimant.
The claimant may have further rights to appeal after the hearing level and should consult an attorney for further information, advice and assistance.
Where are the hearing offices?
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CHARLOTTE Suite 400 |
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GREENSBORO Suite 300 |
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RALEIGH Suite 200 |
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To obtain information about the Judges and staff at these locations or the addresses of the local offices in the cities which these offices serve, call the SSA toll free number at 1-800-772-1213.
What can Ms. Gelbin do for you?
Before the Social Security Administration evaluates a claim,
it obtains medical records from all of the claimant's medical
providers. It then uses its own doctors to analyze the records
to determine if the claimant is entitled to benefits. If there
is not enough medical information to make a determination, the
Administration may require the claimant to submit to examination
and testing by medical providers of its choice.
Ms. Gelbin will do the following:
- ensure that the Social Security Administration has a complete
copy of all the relevant medical records;
- obtain from claimant's medical providers additional information
which may prove claimant's claim;
- obtain medical or vocational information from additional experts
chosen by claimant and Ms. Gelbin;
- if the claimant's conditions meet or equal the severity of
the listing of impairments, provide a detailed analysis of the
medical records to the Administration to prove the claimant's
disability;
- prepare the claimant and his or her witnesses to testify at
the hearing and cross examine any medical or vocational experts
hired by the Administration who testify about the claimant at
the hearing; and
- present to the Judge at the hearing or in a post hearing brief, an analysis of the medical facts, the relevant law and the reason the claimant is entitled to benefits.
Ms. Gelbin's standard contract, subject to the approval of the Social Security Administration, provides for attorney fees in the amount of 25% of a claimant's back due disability benefits or $5,600, whichever is lesser.
If you are not entitled to back due benefits and you have no or low income, and you have been unable to find an attorney willing to pursue your claim, you should apply for assistance at your local Legal Aid Office. The Legal Aid office serving the Piedmont Triad Area is:
Legal Aid Society of Northwest North Carolina
216 West Fourth Street
Winston-Salem, North Carolina 27101
(336) 725-9166
Attorney-Mediator-Arbitrator
743 Big Tree Drive
Lewisville, NC 27023
©2002 Ellen Gelbin
Privacy Statement
Phone: 336 945-0214
Fax: 336 945-0217
Cell: 336-462-1803
ellengelbin@ellengelbin.com