FAQs

Social Security Disability

General information on Social Security Disability.

Am I eligible for Social Security Disability or Supplemental Security Income?

How do I file for Social Security Disability?

How does the Social Security Administration make a decision on my case?

I’m denied Social Security benefits, can I appeal the decision?

What can I do to help my case?

Workers’ Compensation

General Information on workers’ compensation.

What do I do if I’m injured at work?

Is my injury covered by workers’ compensation laws?

Can I pursue a lawsuit instead of workers’ compensation?

Veteran’s Disability

General information on veteran’s disability.

 

General information on Social Security Disability.

Social Security Disability is one of the benefits in the comprehensive federal benefits program that also provides workers with retirement income, Medicare, family benefits and survivors’ benefits. This program is funded with withholding FICA taxes from an employee’s paycheck.

There are five major types of Social Security Disability benefits that fall into two categories, Social Security Disability programs and Social Security Supplemental Security Income (SSI) programs.

Social Security Disability Programs:

1)     Personal Disability. A person must be legally “disabled” in accordance with the federal Social Security Disability Act to collect Social Security Disability benefits. Disability is defined as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or has lasted, or is expected to last, for a continuous period of not less than 12 months as maintained by the Social Security Disability Act.

2)     Disable Widow’s and Widower’s Benefits. If you have become disabled within a certain time after the death of your spouse and are at least 50 years old, you may be eligible for Disabled Widow’s and Widower’s benefits. Your spouse must have worked and paid into Social Security in order for you to gain coverage.

3)     Disabled Adult Child Benefits. Children disabled prior to the age of 22, and have a parent who is deceased or is drawing Social Security disability or retirement, may be eligible for Disabled Adult Child Benefits. The child must have become disabled prior to the age of 22.

Social Security Supplemental Security Income (SSI) Programs:

1)     Personal Benefits. If you are poor and disabled, you may be eligible for Supplemental Security Income benefits. It does not matter if the person has worked in the past or not for this type of benefit.

2)     Supplemental Security Income Child’s Disability. Disabled children under the age of 18 may be eligible for Supplemental Security Income Child’s Disability benefits.

To qualify for benefits, you need to have documentation to support your claim and complete specific forms. When, where and how to file may become complicated. If your case is denied, it may be appealed.

If you have any questions on this complicated process, the attorneys at Schott Mauss and Associates, PC specialize in Social Security Disability and can answer your questions and guide you through every step.

 

Am I eligible for Social Security Disability or Supplemental Security Income?

The basic requirement to qualify for Social Security Disability is that you have become disabled and unable to work in the occupation you did before and Social Security decides that you cannot adjust to other work due to your medical condition, age, education, and work skills.

Only total disability is covered by Social Security Disability and there is no coverage for partial or short-term disability. In addition, your disability must be expected to last for at least one year or expected to result in death.  You do not have to be disabled for one year to apply, rather you can apply as soon as you have reason to believe you will be unable to work for one year due to your disability.

You must meet non-medical and medical criteria to become eligible for disability benefits.

Non-medical criteria for Social Security Disability Benefits

You must meet certain “Earnings Tests” in order to collect Social Security Disability Benefits.  You must have built up sufficient “work credits” under Social Security rules.  A general guideline is that you must have worked in five out of the last 10 years.  There are special rules for younger workers.

Non-medical criteria for Supplemental Security Income

You must meet a “Resource Test” in order to collect Supplemental Security Income.  You must have less than $2,000.00 in assets or less than $3,000.00 in assets if you are married.  This includes bank accounts, retirement accounts, cash-value of life insurance, or other forms of monetary assets.  There are also limits on how many properties and vehicles you own.

Medical Criteria for Disability Benefits

The medical evaluation of your case is the same whether you are applying for Social Security Disability Benefits or Supplemental Security Income.  Social Security has a specific five-step evaluation process to determine your eligibility for disability benefits. This includes consideration of previous and current work activity, your medical condition and how the condition impacts your ability to work.

If you have any questions on this complicated process, the attorneys at Schott Mauss and Associates, PC specialize in Social Security Disability and can answer your questions and guide you through every step.
How do I file for Social Security Disability?

You should file for social security disability benefits as soon as you become disabled and are unable to work. The whole process can take a very long time. Therefore, the sooner you get started, the sooner you will be able to gain the money needed to avoid financial trouble.

You can apply for benefits:

Our office will be happy to advise and represent you on your initial application

Other alternatives include:

If you don’t know where the local office is, you can find it here: https://secure.ssa.gov/apps6z/FOLO/fo001.jsp

Your application process will go more smoothly if you are prepared. Following is a list of the information that will be needed to complete your application.

  • Your Social Security Number, place of birth, and mother’s maiden name.
  • Your child(ren)’s Social Security Number(s).
  • Information about current and former spouses (name, date of birth, date of marriage, etc).
  • The date you believe you became disabled. This is usually the date you last worked but in some cases may be earlier. We can work with you to determine the correct date.
  • Names and addresses of all medical and mental health providers you have seen you believe you became disabled.
  • Dates when you started seeing these medical providers and the dates of your most recent appointments.
  • A list of your medications.
  • Work history for the past 15 years (employers with dates of employment).
  • If you have a workers’ compensation claim, information about benefits you have received through workers’ compensation.

Providing accurate and thorough information is an essential step in getting your claim approved. The attorneys at Schott Mauss and Associates, PC specialize in Social Security Disability law and can evaluate your claim, help you avoid common application pitfalls, and help avoid unnecessary delays in approving your claim.

 

How does the Social Security Administration make a decision on my case?

Social Security Administration field offices receive applications for disability benefits. Once your application is filed, a Social Security representative will review the information you have presented.

First, they will verify all non-medical eligibility requirements that include Social Security coverage information such as age, employment, and marital status. Secondly, that your claim for disability benefits is supported by medical evidence.

They will ensure that these two primary concerns of eligibility are substantiated, and will, to an extent, help you  get medical records needed to evaluate your claim. This medical evidence generally comes from sources that have treated or evaluated the claimant for his or her condition. Once this is completed, your case will go to State Disability Determination Services (called DDS).

A step-by-step process is used by DDS, involving five main questions. Each of these needs to be answered for eligibility before moving onto the next one. For 2012, these questions are:

Step One – Are you working? 

If you are working in 2012 and your earnings average more than $1,010 a month, you generally cannot be considered disabled.

If your earnings are under $1,010 per month, your claim moves to Step Two.

Step Two – Is your condition “severe”? 

Your condition must interfere with basic work-related activities for your claim to be considered. If it does not, DDS will find that you are not disabled and your claim will be denied. (This is uncommon.)

If your condition is severe, your claim moves to Step Three.

Step Three – Is your condition found in the list of disabling conditions?

For each of the major body systems, DDS maintains a list of medical conditions that are so severe they automatically mean that you are disabled. If your condition is not on the list, DDS has to decide if it is of equal severity to a medical condition that is on the list. If it is, DDS will find that you are disabled.

If your condition is severe but not severe enough to meet the listed criteria at this step, your claim moves to Step Four.

Step Four – Can you do the work you used to do? 

At this step, DDS must determine if your medical conditions interfere with your ability to do the work you have done in the past. If it does not, your claim will be denied.

If you cannot do your past work, your claim moves to Step Five.

Step Five – Can you do any other type of work? 

At this step, DDS must determine if you are able to adjust to other work.

DDS considers your medical conditions and your age, education, past work experience and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved. This process will take approximately three to five months.

If your claim is denied, it is critical that you have an attorney review it to evaluate whether DDS made the correct decision.  It is common for valid disability claims to be denied by DDS.  You have the right to appeal this decision.

The Social Security Website has additional details in regard to these questions and more. It can be accessed here http://www.ssa.gov/dibplan/dqualify5.htm#a0=0.

Providing accurate and thorough information is an essential step in getting your claim approved. The attorneys at Schott Mauss and Associates, PC specialize in Social Security Disability law and can evaluate your claim, help you avoid common application pitfalls, and help avoid unnecessary delays in approving your claim.

 

I’m denied Social Security benefits, can I appeal the decision?

Unfortunately, 64% of initial Social Security Disability claims are denied at the initial level and even more are denied on Reconsideration (the first level of appeal) (2009 data, http://www.ssa.gov/policy/docs/statcomps/di_asr/2010/sect04.html#table59).  It is important to talk to an attorney to determine whether your claim should be appealed. You have 60 days to appeal, so do not delay.

After your claim is denied initially and on reconsideration, the next step is request a hearing.  Your claim will be sent to the Office of Disability Adjudication and Review (ODAR).  At hearing, you and your attorney will present testimony to an Administrative Law Judges (ALJ).  Even if you have never been to a “court” or a “hearing” before, your attorney will make sure you are well prepared and will present the judge with the strongest evidence in support of your claim.

Many claims are approved at hearing level.

There are additional levels of appeal.  The Appeals Council considers appeals from hearing decisions, and acts as the final level of administrative review for the Social Security Administration.

The last resort is appealing to the federal courts.  Non-attorney representatives cannot appeal denied claims to federal court.  Many attorneys are unwilling to appeal claims in federal court because it requires expertise and a lot of time.  This firm regularly appeals cases at all levels, including federal court.

The attorneys at Schott Mauss and Associates, PC specialize in Social Security Disability and can guide you through all levels of the appeals process.
What can I do to help my case?

In order to win your claim for Social Security disability benefits, we must show that you have medical impairments (physical or mental) that prevent you from working day-in and day-out.

The only way to show that you have medical impairments is through medical evidence. It is critically important that you get medical treatment for any physical or mental health problem that you feel interferes with your ability to work.

You need to:

  • Set appointments to see a doctor, therapist, and/or counselor
  • Inform the medical provider of all of your medical concerns (not just the one that is most painful or symptomatic)
  • Follow your medical provider’s recommendations (For example, follow through on diagnostic testing, physical therapy, and take medications as prescribed)
  • Avoid use of illegal drugs or excessive use of alcohol

We know that it is not always easy to get the medical care you need, especially if you do not have medical insurance.  You must make your health care a top priority in order to prove your disability case. Following are some websites that may help you access health care.

Iowa Cares              http://www.ime.state.ia.us/IowaCare/index.html

UIHC                       http://www.uihealthcare.org/

Broadlawns             http://broadlawns.org/

Medicaid                 http://www.medicaid.gov/Need-Health-Insurance/Need-Health-Insurance.html

Free Clinics             http://www.freeclinicsofiowa.org/

Mental Health          http://www.healthcare.uiowa.edu/icmh/iowa/documents/CMHCbycounty2-7-2011.pdf

Vocational Rehab    http://www.ivrs.iowa.gov/

Medicare                 http://www.medicare.gov/Default.aspx?AspxAutoDetectCookieSupport=1

We work with clients to help sort out the most important steps to take to access health care.

General information on workers’ compensation.

Workers’ compensation provides medical benefits and wage replacement for workers injured on the job. Workers’ compensation laws are set by each state and these laws can vary from state to state. Additionally, the federal government has workers’ compensation laws for federal government employees and employees in certain types of jobs.

In Iowa, the laws require every business to have some type of workers’ compensation insurance to cover employees injured on the job. When an employee is injured, that employee files a workers’ compensation claim. Filing this claim is similar to filing a claim with an insurance company. The employee isn’t filing a lawsuit against their employer. Instead, he or she is filing a request for benefits.

Workers’ compensation laws are designed to allow employees who are injured at work to obtain a fixed amount of compensation, without having to sue their employer. Workers’ compensation laws create an important “safety net” for employees who are injured at work or injured because of their job.

The workers’ compensation system is a “no-fault” system.  It doesn’t matter whose fault the injury was. Negligence, whether of the employee, the employer, or a co-worker is not an issue. The injured employee is simply compensated for his or her work-related injuries.

If you have been injured at your job, the attorneys at Schott Mauss and Associates, PC are experienced in workers’ compensation claims. They can help you understand your claim and assist you in obtaining the maximum benefits possible.

 

What do I do if I’m injured at work?

If you have been injured at work or on the job, the best way to protect your rights is to contact an experienced workers’ compensation attorney. An attorney will be able to help file a workers’ compensation claim as well as determine if you should file a lawsuit instead of, or in addition to, a workers’ compensation claim.

An attorney will also be able to determine if you are entitled to other types of compensation. For example, if someone other than your employer or a co-worker was at least partly to blame for your injury, you may be able to file a liability insurance claim against that person or business.

If your accident isn’t covered by the workers’ compensation system (for example, if your employer doesn’t have workers’ compensation insurance or if you are an independent contractor), an attorney will be able to help you determine people or businesses against whom you may be able to file a personal injury lawsuit. Under personal injury law, you may be able to receive compensation for expenses that wouldn’t be covered under the workers’ compensation system, such as pain and suffering as well as attorney’s fees.

The attorneys at Schott Mauss and Associates, PC specialize in workers’ compensation and are able to guide you through the process, from filing a claim, through building a case for your hearing or negotiating a settlement.

 

Is my injury covered by workers’ compensation laws?

Workers compensation coverage exempts some types of employment arrangements from the workers’ compensation system. Exempt employees may include agricultural workers, domestic workers and independent contractors.  But these rules are not black and white so you should discuss your injury with an attorney even if you fall in one of these categories.

You may be eligible for workers’ compensation benefits for a work-related injury that fits into one of the categories below:

  • Aggravation of a Pre-existing Condition. These types of injuries are unrelated injuries that you already had, which are aggravated or exacerbated by your workplace. One example is a back injury, even if the pain develops slowly over time or you don’t notice the pain caused by the injury until later.
  • Traumatic Injuries. This category includes injuries that happen at a moment in time.  This may be due to a workplace accident, a sudden physical pain caused by your work, or by your company’s facilities (such as a chair in the company break room). Injuries during work time also include those that occur during coffee breaks, on your lunch break, and during work-sponsored activities (for example, a company picnic).
  • Exposure to Toxins. This class includes injuries that results from exposure to toxins in chemicals from normal working conditions. An example of this type of injury is lung cancer, if you can show that it was caused by exposure to those on-the-job toxins.
  • Mental Strain. This category includes mental impairments (or physical manifestations of mental impairments) that emerge due to increased work duties or work-related stress.

However, there are some injuries that aren’t covered by workers’ compensation.  An employee may not be compensated for an injury that he or she received while joking around at work. An employee who intentionally injures him or herself for the purpose of getting benefits is not eligible for compensation.

Additionally, an employee generally won’t be compensated for injuries received while traveling to or from work. However, there are exceptions, including:

  • when the employer has agreed to provide transportation for the employee,
  • when the employer pays the employee’s costs for commuting,
  • the employee travels from home directly to work sites without going to the employer’s office, or
  • if traveling is required as a part of the employee’s job.

If you are unsure if you are entitled to workers’ compensation benefits, contact a lawyer in your area who is experienced in workers’ compensation cases. Remember that even if you aren’t entitled to workers’ compensation benefits, you may be able to sue your employer or a third party for compensation for your injuries.

The attorneys at Schott Mauss and Associates, PC specialize in workers’ compensation and are able to guide you through the process, from filing a claim, through building a case for your hearing or negotiating a settlement.

 

Can I pursue a lawsuit instead of workers’ compensation?

In Iowa, workers’ compensation is the “exclusive remedy” for work-related injuries. The term “exclusive remedy” means that unless an employee can show that there was a third party (another company or manufacturer) responsible for his or her injury, workers’ compensation is the only benefit or monetary award that an employee can obtain.

In essence, workers’ compensation is a substitute for a lawsuit against your employer. When you bring a workers’ compensation claim, the claim is controlled by the workers’ compensation system and not the courts.

Because you are bringing a claim under the workers’ compensation system, you are entitled to benefits, no matter if your accident was your fault or your employer’s fault. Before the workers’ compensation system was created, employees had to go to court to receive compensation for their work-related injuries. However, the current workers’ compensation system allows most employees to receive benefits. In addition, this system shields employers from lawsuits brought by employees.

Bear in mind that even if you file a claim in the workers’ compensation system you may still be able to file a lawsuit in the court system. Employees are often injured by machinery or products that they use at work. Many employees successfully sue the manufacturers of these machines or products for compensation for their injuries. A lawsuit against a third party generally takes place in civil court, as opposed to workers’ compensation claims, which are handled by Iowa’s Division of Workers’ Compensation.

The attorneys at Schott Mauss and Associates, PC specialize in workers’ compensation and are also able to advise you on Iowa laws if you think that a third party may be responsible for your on-the-job injury.

Veterans Disability

If you believe you are entitled to veteran’s benefits and have been denied or have received a decision that is not adequate for your medical disabilities, contact the attorneys at Schott Mauss and Associates, PC to discuss the merits of your case.

The attorneys at Schott Mauss and Associates, PC can help you understand the process and evaluate whether you have received all of the benefits to which you are entitled. Remember, a Veteran may receive service connected benefits and Social Security Disability Benefits at the same time.

Types of claims:

  • Proving a service connected medical condition
  • Survivors/dependents benefits
  • Increased rating
  • Total Disability Based On Individual Unemployability (TDIU)