CBA Blog

Who evaluates medical and financial/legal eligibility for SSI/SSD?

By Stephen H. Olden, Lawyer Referral Service Panelist

The state agency in Ohio called the Division of Disability Determination makes the initial determination of medical disability.  It also decides any financial or legal issues that may affect eligibility, particularly on SSI claims where the family resources and income are considered.

To be legally eligible for SSD benefits, you must have 20 quarters of work coverage in the last 40 quarters.  This equates to approximately five of the last ten years.  Work quarter credits do expire, so if you’ve worked for 30 years, but none or only a few in the past ten years, you would not be eligible for SSD.  You could still seek SSI benefits though.

If you are told by the SSD office that you do not have enough quarters of work, but you have worked five or more of the last ten years, now would be a good time to contact an attorney to help evaluate your options.

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If I get approved for SSD, will I also get Medicare?

By Stephen H. Olden, Lawyer Referral Panelist

Generally yes, if you choose to, but you’re not required to accept Medicare if you have other medical coverage. There is a 29-month waiting period from your disability date before Medicare becomes available. This is due to a five-month (full months) waiting period from the date you became disabled before the cash benefits are payable, plus an additional  24-month wait to receive Medicare coverage. 

For example, if you become disabled on February 10, 2013, and perhaps are approved for SSD in August 2014, you would be able to receive Medicare in July 2015, 29 full months after the date of original disability. 

If your spouse has insurance that covers you or you are receiving veterans benefits, etc., you may wish to decline Medicare.  If you do decide to enroll for it, the cost will be taken out of your monthly SSD benefit amount.  Currently the cost is about $100 per month.

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I had a heart attack and was denied SSD. What are my options?

By Stephen H. Olden, Lawyer Referral Service Panelist

This is fairly common.  After a heart attack or stroke your medical state may be in flux for many months. After rehab and additional time, heart attack and stroke survivors hopefully will be able to return to work.  A claimant’s disability must be projected to last at least 12 months in order to be approved for benefits.  As a result, Social Security may take a wait-and-see approach to see if there is a chance you will return to work, which would make you ineligible for benefits. 

In these situations, it’s most important to be persistent and make sure your medical records are being updated with Social Security on a regular basis.   And remember, if you are denied, you can appeal.

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I was turned down for SSD and appealed twice. Now, I am scheduled for a hearing. What does that entail?

By Stephen H. Olden, Lawyer Referral Service Panelist

Statistically, the hearing level is when most successful SSD applicants are approved for benefits.  It is very important to make a strong case at this stage. This is when your case will be heard by an administrative law judge in the federal system.  You, a vocational expert witness, and sometimes a medical expert witness will testify under oath to answer questions the judge asks.  

The judge will evaluate your case, records, doctors’ opinions and other information in your file.  He or she will then make a decision as to your ability to work at either your previous job(s) or at any other jobs – even very simple jobs –in the economy.  This means it is critical that your file include all information that might help support your case.

Hearings are currently being scheduled about 10 months out, so if you are in the waiting period, it would be a good point to consult an attorney if you haven’t already done so.  The attorney will fully prepare the case, including preparing you for the kinds of questions the judge may ask you.

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I have filed twice and been turned down twice for SSD. What other options do I have available?

By Stephen H. Olden, Lawyer Referral Service Panelist

After you have filed your original claim for SSD or SSI and are denied, you can appeal the decision.  It’s important to make the distinction that you will be filing an appeal on your current application instead of filing a new application.  If you fill out a new application each time you are denied, it will start the whole process over again—typically resulting in the same decision denying your claim. 

Once your appeal is filed, the state agency will review your file again, including any updates of medical records, limitations in your ability to function, medications, and treatments.  If you are denied benefits at this stage, you can then file an additional appeal.  This next appeal will be where a hearing is set at which you will appear before a judge and testify about why you cannot work.  Going before a judge is usually the most important stage of the disability proceedings.

This also is typically a good time to consult an attorney about the appeal process and to get help with gathering information for your hearing.

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I have filed for Social Security Disability, but haven’t heard anything for months. Should I contact an attorney?

By Stephen H. Olden, Lawyer Referral Service Panelist

At the time of filing the application, a file is opened for the individual requesting SSD (or SSI) benefits.  Once Social Security opens a file, it is then sent to the corresponding state agency for review. The Social Security Administration has partnerships with each of the 50 states who take on the task of evaluating the claim for SSD or SSI benefits at this early stage of the process. This often includes gathering information from hospitals and doctors, finding medical records, and asking for further information from the claimant.  A physician then will review the data for Social Security and the decision is made.  Altogether, this process typically takes between four and five months. 

If you are originally denied for SSD or SSI, it would be beneficial to consult an attorney before filing an appeal.

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What if an attorney is not acting in my best interest?

By Steven F. Stuhlbarg, Lawyer Referral Service Panelist

The attorney-client relationship works best when there is a high level of trust between the parties.  If you have concerns about your attorney, talk with him or her openly about your concerns.  Ask questions.  As in any relationship, communication is the key to improving the relationship.

Though it may not be in your best interest to do so, one option you always have is to fire your attorney.  Your right to fire your attorney is absolute, with or without cause, and regardless of whether you owe your attorney any money.

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How do attorneys normally charge clients?

by Albert T. Brown Jr., Lawyer Referral Service Panelist

Lawyers who are retained to represent defendants in criminal matters frequently charge a flat fee payable in advance for the criminal representation, or for payment due at particular stages in the litigation. Those who handle criminal or divorce cases are prohibited from charging a fee that is dependent upon the outcome of the case.  Some routine matters are frequently billed on a flat fee basis.

The second fee system commonly employed is a contingent fee where a civil lawyer can charge a fee based upon the outcome of a particular project.  This could be the size of a verdict or settlement in a personal injury case, the amount of a tax reduction in a reevaluation case, or perhaps the amount of a tax refund in an income tax refund case.

Most other lawyers perform work on a time and materials basis, basing their charges on an hourly rate where the amount of time the lawyer spends on a case is multiplied by that rate to produce a fee due from the client plus expenses.

Lawyers are ethically prevented from charging an unreasonable fee and the factors which determine a reasonable fee are found in the Ohio Rules of Professional Conduct 1.5(a)

1. The time and labor required, the novelty and difficulty of the questions involved, and the skill requisite to perform the legal services properly;

2. The likelihood, if apparent to the client, that the acceptance of the particular   employment will preclude other employment by the lawyer;

3. The fee customarily charged in the locality for similar legal services;

4. The amount involved and the results obtained;

5. The time limitations imposed by the client or by the circumstances;

6. The nature and the length of the professional relationship with the client;

7. The experience, reputation and ability of the lawyer or lawyers performing the            services; and

8. Whether the fee is fixed or contingent.

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What if I fire my attorney?

by Steven F. Stuhlbarg, Lawyer Referral Service Panelist

Firing your lawyer can have a high cost.  It may be difficult to find a new lawyer in the middle of a case, and it may be expensive to bring a new lawyer up to speed.  It may be difficult for your new lawyer to meet deadlines that may exist in your legal matter.  And there is no guarantee that you will be any more comfortable with your new lawyer than you were with your old lawyer.

If you do fire your attorney, the discharged attorney still has obligations to you.  He or she must cooperate with you or with your new lawyer in making the transition.  The discharged attorney must return important documents or evidence to you or to your new lawyer.  If you are facing a deadline, the discharged attorney may be obliged to assist you by either getting the court’s permission to extend the deadline, or by helping you or your new lawyer to meet the deadline.  The discharged attorney has a continuing obligation not to disclose confidential information about you, even after he or she no longer represents you, and may not use confidential information about you to take unfair advantage of you.

When you fire an attorney in the middle of a case, the fired attorney is generally entitled to be paid for his or her legitimate work performed on your behalf.  In contingency fee cases, the fired attorney may be entitled to a percentage of the proceeds eventually obtained through settlement or judgment.

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What determines a medical malpractice case?

by John D. Holschuh Jr., Lawyer Referral Service Panelist

In determining if a case involves medical malpractice, it does not matter what the potential client or I as a lawyer might think about the case. In Ohio, whether a case is medical malpractice or not depends upon the expert opinion of a licensed physician, who after reviewing the medical records of the potential case, makes a determination as to its merits. In Ohio, Civil Rule 10 requires that before a medical malpractice complaint may be filed against a physician, there needs to be a sworn affidavit from a physician stating that he or she has reviewed the pertinent medical records and that in his or her opinion there was medical negligence resulting in harm to the client (Kentucky does not have this requirement). There is a provision where you can file a motion to request additional time to file the affidavit.

Additionally, not only does there have to be an affidavit, but the physician signing the affidavit has to be a licensed physician who spends a majority of his or her professional time in the active clinical practice of medicine and/or its teaching at an accredited institution. Further, the physician has to be in the same field of practice or specialty as the area of the potential claim.

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