Attorneys who represent Social Security disability claimants generally do so under a "contingency fee agreement." That is, the client does not pay the attorney unless and until the case is resolved and Social Security benefits have been awarded. A representative who wants to charge or collect a fee from a claimant for services provided in any proceeding before the Social Security Administration (SSA) under the Social Security Act (the Act), must first obtain SSA's authorization. To do so, a representative must use one of two mutually exclusive fee authorization processes: the fee agreement process or the fee petition process. Under the fee agreement process, an attorney can collect no more than 25% of of back benefits recovered, or $5,300, whichever is less. If the attorney is unsuccessful in obtaining benefits, there is no charge.

Fee Agreement Process Before SSA decides the claim, the representative or the claimant may file a fee agreement. Generally, SSA will approve an agreement (under § 206(a)(2)(A) of the Act) if the other statutory conditions are met and no exceptions apply. If SSA approves the fee agreement and no one requests administrative review, the fee specified in the agreement is the maximum fee the representative may charge and collect.

Fee Petition Process After the representative's services in the case have ended, he or she may petition for a fee. SSA reviews the fee petition and authorizes a "reasonable" fee (under §206(a)(1) of the Act) for the specific services provided.

A fee agreement is a written statement signed by the claimant and his or her appointed representative specifying the fee the representative expects to charge and collect, and the claimant expects to pay, for services the representative provides in pursuing the claimant's benefit rights in proceedings before the Social Security Administration (SSA). For SSA to approve a fee agreement, the representative must submit it before the date of the first favorable determination or decision SSA makes on a claim after the representative's appointment. If the representative does not submit a fee agreement by that date, SSA assumes the representative either will file a fee petition or waive a fee.

If the representative submits a fee agreement before the date SSA makes a favorable decision, SSA will approve the fee agreement at the time of the favorable decision if the statutory conditions for approval are met and no exceptions to the fee agreement process apply. Once SSA approves the fee agreement, the fee specified in the agreement is the maximum fee the representative may charge and collect for all services in the claim.

A fee petition is a written statement signed by a claimant's representative requesting the fee the representative wants to charge and collect for services he or she provided in pursuing the claimant's benefit rights in proceedings before the Social Security Administration (SSA).

SSA presumes that the representative will either file a fee petition or waive his or her fee if the representative does not file a fee agreement before the date SSA makes the first favorable determination or decision. A representative who elects to use the fee petition process generally files the petition after his or her services in the case have ended. Based on this petition, SSA will authorize a reasonable fee for the specific services provided.

The fee agreement and fee petition process are not interchangeable. However, if a representative elects the fee agreement process but SSA does not approve the agreement, or if an SSA reviewing official upholds a disapproval of a fee agreement on administrative review, the representative must file a fee petition if he or she wants to charge and collect a fee for their services.

The Social Security Act and SSA regulations prohibit representatives from charging or collecting any fee for representational services that SSA has not authorized, or that is more than the maximum amount SSA authorized. Any representative found to have charged or collected an unauthorized fee may be suspended or disqualified from practice before SSA and will be barred from appearing before SSA until full restitution is made. The representative also is subject to fines and imprisonment.



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Types of Social Security Disability Benefits

The Social Security Administration has established a number of different types of disability programs. Although the medical rules are similar under each program, the technical rules on eligibility set each program apart. What program you may be eligible for depends on a number of factors, including your work history, age, household income and marital status. You may be eligible for more than one type of benefits, but generally SSA will pay you the higher benefit amount of any one program you may be entitled to.

Disability Insurance Benefits: This program, also known as "DIB" or Title II benefits, awards benefits to individuals who, because of a physical or mental impairment, are unable to work at a "substantial" gainful level, and their condition has existed or is expected to exist for at least a 12 month period. By "substantial," SSA means the claimant would be unable to earn over $900.00 per month because of their disability. This dollar amount increases slightly every year. To be eligible for DIB, a claimant must have worked long enough and paid enough into Social Security through their FICA taxes to be "insured." As a general rule, if a claimant worked at least five of the last 10 years, he would be "insured" for purposes of DIB. How much a claimant receives each month if found disabled and entitled to DIB is based on how much he "paid into" the system during his working life. Generally, the longer someone has worked and the higher his earnings, the more he would be paid if found disabled. Individuals found disabled and entitled to DIB benefits may be awarded retroactive benefits. Retroactive benefits can only go back one year from the date of the initial application. There is a five-month waiting period from the date the claimant is determined to be disabled until entitlement to DIB benefits begin. To illustrate this, if a claimant files a claim for DIB on January 1, 2006 alleging disability as of February 2005, and SSA determines he is disabled and his disability began February 1, 2005, he would be eligible for retroactive benefits starting in July 2005. In addition to receiving individual DIB benefits, your minor children may also qualify for auxiliary benefits based on your disability. These benefits are granted in addition to any benefit you receive. To ensure any minor children are awarded any benefits they may be entitled to, it is important you furnish the names and Social Security numbers of any minor children you have to SSA. The children do not have to live in the same household to be eligible for auxiliary benefits.

Supplemental Security Income: This program, also known as SSI or Title 16 benefits, is a "needs-based" program in which individuals with little or no resources or assets may receive disability benefits. The medical criteria for SSI eligibility is the same as that used for DIB - a physical or mental impairment which prevents you from working at a "substantial" gainful level, and the condition has existed or is expected to exist for at least a 12 month period. Effective January 2007 the SSI payment for an eligible individual is $623 per month and $934 per month for an eligible couple. There is no retroactive eligibility for SSI benefits: benefits can go back only to the month in which your claim was filed. Unlike DIB, there is no five-month waiting period for entitlement to SSI, so your eligibility would begin the month in which you filed your claim or were determined to be disabled, whichever is later. A claim for SSI benefits can also be filed on behalf of any minor children with a disability; however, as with Adult SSI claims, to be entitled to SSI benefits the household income must be below certain limits.

Disabled Adult Child: This program provides disability benefits to adult children of deceased or disabled parents. In addition to the medical requirement that you have a physical or mental impairment which prevents you from working at a "substantial" gainful level, and the condition has existed or is expected to exist for at least a 12 month period, you must also show that your condition has existed and has been disabling since before your 22nd birth date. In addition, you must be the adult child of a parent who is currently receiving DIB benefits, or the Adult child of a parent who is deceased and was "insured" for purposes of eligibility for DIB benefits. It is not necessary that the adult child ever worked because benefits are paid on the parent's earnings record. The adult child must not have worked and earned "substantial earnings" for an extended period at any point after turning 22; however, certain expenses the adult child incurs in order to work may be excluded from these earnings. An adult child already receiving SSI benefits should check to see if benefits may be payable on a parent's earnings record. Higher benefits might be payable and entitlement to Medicare may be possible.

Disabled Widow's/Widower's Benefits: If you are a disabled widow or widower age 50 or older you may be able to receive benefits off your spouse's (or former spouse's) Social Security record. If you are a widow or widower from a spouse you were divorced from, to be eligible for benefits you need to have been married to your spouse for 10 years or longer and your disability must have started before age 60 and within seven years of the date in which the worker died. If you were married to your spouse when they passed away, Social Security does not require that you were married for 10 years. In either case, you will need to provide proof of relationship in the form of your marriage certificate or divorce decree, along with your spouse's death certificate when you file for benefits. If you file a claim for Disabled Widows/Widower's benefits and DIB or SSI benefits, you will receive only the higher monthly benefit amount of the two programs.

Medical Insurance: Once you are found disabled and entitled to Social Security disability benefits, you will also be eligible for medical insurance though Medicare or Medicaid. If you filed a claim for DIB, Disabled Adult Child or Disabled Widow's/Widower's benefits, you may be eligible for Medicare. However, eligibility for Medicare does not start until you have been disabled for 25 months. If you are approved for Social Security benefits under any of the above-listed programs, SSA will contact you approximately two months before your eligibility for Medicare begins. If you have already been disabled for 25 months, be sure to keep a record of all medical bills as you may be reimbursed by Medicare for these expenses. There is no waiting period for Medicaid; however, your income and resources must be very low to qualify. If you have applied for and have been approved for SSI you probably qualify for Medicaid. You may think that Medicaid and Medicare are the same, but actually they are two different programs. Medicaid is a state-run program that provides hospital and medical coverage for people with low income and little or no resources. Each state has its own rules about who is eligible and what is covered under Medicaid. Some people qualify for both Medicare and Medicaid. For more information about the Medicaid program, contact Social Security or your local social services or welfare office.

This article has been written to give you a general overview of the Social Security disability programs and the disability process. As this article may not address all questions you might have, please contact us for further information.



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