Disability FAQs

Have you been denied Social Security Disability (SSD) or Supplemental Security Income (SSI) benefits?

Don’t delay! If your application for Social Security Disability (SSD) or Supplemental Security Income (SSI) benefits has been denied, you have a limited amount of time to file an appeal. You don’t want to miss any important deadlines.

Whether you were denied at the initial application stage, after your administrative hearing, or by the Appeals Council, Matthew D. Lane, Jr. can help. We represent claimants at all levels of the appeal process, including Federal Court. We have information on the Social Security Disability appeal process.

Call Matthew D. Lane, Jr. at 1-800-451-0300 to discuss how we can help with your Social Security Disability or Supplemental Security Income appeal.

What is the definition of "disability" under the Social Security Act?

As defined under the Social Security Act, the term “Disabled” means:

  • Unable to consistently perform full-time work
  • Due to medically-determinable physical or mental impairments
  • Or a combination of impairments
  • That will last one year or result in death

The medical disability standard for DIB and SSI is the same: “the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” 20 C.F.R. § 404.1505(a); see also, 20 C.F.R. § 416.905(a) (SSI).

“To meet this definition, you must have a severe impairment(s) that makes you unable to do your past relevant work . . . or any other substantial gainful work that exists in the national economy.” 20 C.F.R. § 404.1505(a); see also, 20 C.F.R. § 416.905(a) (SSI).

Under the Medical-Vocational Guidelines (a/k/a Grid Rules), the definition of disability can be modified for individuals age 50 and over depending on their education and work history.

As you can see from the above summary, determining whether you are disabled under the Social Security Act is a complicated process. That’s why you should consult with the experienced and knowledgeable lawyers at Matthew D. Lane, Jr. before making any decisions.

Fill out and submit a free Social Security Disability or Supplemental Security Income claim evaluation.

How does the Social Security Administration determine if you are disabled?

The process of determining if you are disabled under the Social Security Act is complicated and ultimately depends on the specific facts of your case. Nonetheless, below is a summary of the five-step process that the Social Security Administration (SSA) uses to decide if you are disabled. See 20 C.F.R. § 404.1520. The five-step process is sequential, and thus, if SSA determines you are not disabled at any step of the process, the analysis ends at that point. Generally speaking, you bear the burden of proving that you are disabled at the first four steps, and SSA bears the burden of proving you are not disabled at the fifth step.

  1. Are you working?

    At the first step, SSA considers your work activity. If you are working and your earnings average more than $1,000 a month (i.e., substantial gainful activity), you generally cannot be considered disabled.

  2. Do you have a severe impairment?

    At the second step, SSA considers whether you have one or more severe physical or mental impairments. An impairment may be considered severe if it interferes with basic work-related activities. Additionally, to be considered severe, your impairment must last or be expected to last at least one year or to result in death.

  3. Does your condition meet or equal a listed impairment?

    At the third step, SSA considers if you meet or exceed a listed impairment. SSA maintains a List of Impairments that describes medical conditions considered to be so severe that if your condition meets or equals the diagnostic criteria in the listings, you are deemed to be disabled under the Act.

  4. Can you return to your past work?

    At step four, SSA determines whether you can do any of your past work based on your residual functional capacity (RFC). Your RFC describes what activities you can perform despite your impairments. If you can return to your past work, then SSA will find you are not disabled.

  5. Can you perform any other work?

    At the fifth and final step, SSA considers whether, in light of your RFC and age, education, and work experience, you can adjust to any other work in the economy. If you can adjust to other work, then SSA will find you are not disabled.
Social Security disability law is complicated. At each step of the evaluation process, there are many rules and exceptions that may apply and which are not discussed here. That’s why you should consult with the experienced and knowledgeable lawyers at Matthew D. Lane, Jr. before making any decisions. Click here to fill out and submit a free disability claim evaluation.

How do I Apply for Social Security Disability (SSD) or Supplemental Security Income (SSI)?

You should apply for Social Security Disability (SSD) and/or Supplemental Security Income (SSI) benefits as soon as you become disabled. The Social Security Administration (SSA) has three convenient ways for you to begin the application process:

  • First, you can apply online at SSA’s website.
  • Second, you can apply by phone by calling SSA’s national toll-free number 1-800-772-1213. If you are deaf or hard of hearing, you can call SSA’s TTY number 1-800-325-0778.
  • Third, you can go in person to your local Social Security office. You can click here to find your local Social Security office.

Before beginning the application process, it is helpful to gather the following information and to have it available when you fill out the application:

  • Your Social Security number and proof of your age;
  • The names and birthdays of your spouse and minor children; 
  • Your most recent W-2 form or, if you were self-employed, a copy of your federal tax return;
  • Names, addresses and phone numbers of doctors, caseworkers, hospitals, and clinics that took care of you and the dates of your visits;
  • Names, dosages, and prescribing doctor for all medications you are taking;
  • Medical records and test results that you already have in your possession; and
  • A summary of where you worked and the kind of work you did for the last fifteen (15) years.

What is the difference between Social Security Disability (SSD) and Supplemental Security Income (SSI)?

The Social Security Administration has two programs that provide financial benefits to those who are disabled as that term is defined in the Social Security Act: Social Security Disability Insurance Benefits and Supplemental Security Income.

Disability Insurance Benefits

The purpose of Disability Insurance Benefits (DIB; Title II of the Act) “is to provide the measure of economic security for program beneficiaries.” HALLEX I-1-2-57(A)(1)

To qualify for Social Security Disability (SSD) benefits, (1) you must have “insured status” under the Social Security Act (Act), and (2) you must be found “disabled” under the Act.

Medical Disability Standard

The medical disability standard for DIB and SSI is the same: “the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” 20 C.F.R. § 404.1505(a); see also, 20 C.F.R. § 416.905(a) (SSI).

To meet this definition, you must have a severe impairment(s) that makes you unable to do your past relevant work . . . or any other substantial gainful work that exists in the national economy.” 20 C.F.R. § 404.1505(a); see also, 20 C.F.R. § 416.905(a) (SSI).

Under the Medical-Vocational Guidelines (a/k/a Grid Rules), the definition of disability can be modified for individuals age 50 and over depending on their education and work history.

Insured Status under the Act

Insured status is obtained by earning sufficient quarters of coverage under the Social Security Act through payment of FICA taxes, which are typically deducted from one’s paycheck (6.2%) or are paid directly if self-employed (12.4%).

Insured status can be checked by creating a “my Social Security” account at www.socialsecurity.gov/myaccount or by checking with your local Social Security Office.

The most important thing to know about insured status is that for purposes of disability insurance benefits, insured status expires. Once you leave the workforce and stop contributing FICA taxes, your insured status for disability insurance benefits will expire at some point in time; the longest your insured status will extend beyond your departure from the work force is five (5) years. The expiration of your insured status is referred to by SSA as your date last insured or DLI. Applying for benefits or proving you are disabled after your DLI is possible but it creates significant procedural and evidentiary hurdles that make success less likely.

Receipt of Disability Insurance Benefits

Disability Insurance Benefits provide for retroactive cash benefits up to twelve months before the date of application. DIB also will pay additional auxiliary benefits if you have a spouse or dependent minor children.

Once eligible for DIB and after receiving DIB benefits for 24 months, you become concurrently eligible for Medicare coverage. The total waiting period for Medicare coverage is actually 29 months as for the first five months you are eligible for DIB, you do not receive any cash benefits. This is referred to as the 5-month waiting period. Once the 5-month waiting period passes and after you receive 24 months of DIB benefits, you are eligible for Medicare.

Supplemental Security Income

The purpose of Supplemental Security Income (SSI; Title XVI of the Act) “is to assure a minimum level of income for supplemental security income recipients who otherwise do not have sufficient income and resources to maintain a standard of living at the established Federal minimum income level.” HALLEX I-1-2-57(A)(1)

To qualify for Supplemental Security Income (SSI), (1) you must satisfy strict financial requirements regarding income and assets; and (2) you must be found “disabled” under the Act.

Medical Disability Standard

The medical disability standard for DIB and SSI is the same: “the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” 20 C.F.R. § 404.1505(a); see also, 20 C.F.R. § 416.905(a) (SSI).

To meet this definition, you must have a severe impairment(s) that makes you unable to do your past relevant work . . . or any other substantial gainful work that exists in the national economy.” 20 C.F.R. § 404.1505(a); see also, 20 C.F.R. § 416.905(a) (SSI).

Under the Medical-Vocational Guidelines (a/k/a Grid Rules), the definition of disability can be modified for individuals age 50 and over depending on their education and work history.

Financial Criteria

SSI benefits are means-tested benefits available only to those with very limited income and assets. The financial certification requirements for SSI are very detailed; however, generally speaking, one’s home and one car are considered excluded assets that are not counted. Otherwise, an individual cannot have more than approximately $2,000 in assets and a couple cannot have more than approximately $3,000 in assets. The financial criteria for SSI eligibility are subject to change and this information is provided as a general guide only.

Receipt of SSI Benefits

Supplemental Security Income is available only from the date of application. No retroactive benefits are available. SSI does not provide auxiliary benefits for a spouse or dependent children.

Currently, individual SSI benefits for 2015 are capped at $733 per month. The monthly benefit amount can be reduced if you have any other sources of income or are living with a family member without paying rent. While receiving SSI, you are obligated to report all sources of income to SSA.

If you are found eligible for SSI, you become concurrently eligible for Medicaid coverage.

What does insured status mean? What does date last insured (DLI) mean?

Insured status is obtained by earning sufficient quarters of coverage under the Social Security Act through payment of FICA taxes, which are typically deducted from one’s paycheck (6.2%) or are paid directly if self-employed (12.4%).

Insured status can be checked by creating a “my Social Security” account at www.socialsecurity.gov/myaccount or by checking with your local Social Security Office.

The most important thing to know about insured status is that for purposes of disability insurance benefits, insured status expires. Once you leave the workforce and stop contributing FICA taxes, your insured status for disability insurance benefits will expire at some point in time; the longest your insured status will extend beyond your departure from the work force is five (5) years. The expiration of your insured status is referred to by SSA as your date last insured or DLI. Applying for benefits or proving you are disabled after your DLI is possible but it creates significant procedural and evidentiary hurdles that make success less likely.

How does the Social Security Disability (SSD) or Supplemental Security Income (SSI) Appeal Process work?

What are the steps in the disability appeal process?

The Appeal Process

  • Initial Denial by State Agency
  • Reconsideration (where applicable)
  • SSA Administrative Law Judge hearing
  • SSA Appeals Council review
  • Federal District Court

*60 day appeal deadline at each step

Receiving the Initial Denial and Requesting a Hearing

In Louisiana, if your initial application for Social Security Disability (SSD) and/or Supplemental Security Income (SSI) is denied by the Social Security Administration (SSA), you have sixty (60) days from the date of the denial to request a hearing before an Administrative Law Judge (ALJ).

The hearing before the ALJ is the most important part of the disability appeal process and is the part of the process where having a lawyer can benefit you the most. You should contact Matthew D. Lane, Jr. as soon as you receive the initial disability denial notice so we can evaluate your Social Security Disability claim, and if warranted, file your Social Security Disability appeal and help you prepare for your hearing.

Fill out and submit for a free Social Security disability claim evaluation or call 1-800-451-0300.

Administrative Hearing

You may have to wait up to one year from when you request a hearing until the actual hearing date. During that time, Matthew D. Lane, Jr. can help prepare for your hearing by gathering updated medical records, obtaining statements from your treating doctors, and meeting with you to ensure you are ready to testify at your hearing.

At the hearing, you will have the opportunity to testify under oath to the ALJ regarding your medical impairments, past work, education, and functional limitations. In short, you will get to tell the ALJ in your own words why you cannot work.

In addition, SSA may call vocational and medical experts to testify at your hearing. The attorneys at Matthew D. Lane, Jr. have the knowledge and experience necessary to effectively cross-examine SSA’s expert witnesses.

If you have a hearing already scheduled and don’t have legal representation, it’s not too late to call Matthew D. Lane, Jr. for a disability claim evaluation.

Following the hearing, the ALJ and his or her staff will prepare a written decision on your disability claim. It may take from 2-3 months to receive the ALJ’s written decision. If the decision is favorable, you will then begin to receive benefits.

Appeals Council

In the event you receive an unfavorable decision by the ALJ, you can then request review by the Appeals Council. The Appeals Council is part of the Social Security Administration and provides the initial level of appellate review of ALJ decisions. Appeals Council review can take a significant period of time.

Essentially, the Appeals Council is empowered to correct flawed ALJ decisions. The Appeals Council may either refuse to grant review, remand your claim for another ALJ hearing, reverse the ALJ’s decision and order that you be paid benefits, or affirm the ALJ’s decision.

If the Appeals Council denied your claim, fill out and submit for a free Social Security disability claim evaluation or call 1-800-451-0300.

Federal Court

If the Appeals Council refuses to grant review or affirms the ALJ’s unfavorable decision, you have sixty (60) days from the date of the Appeals Council’s decision to file a civil action in United States District Court to seek appellate review of the denial of your disability claim.

Matthew D. Lane, Jr. is one of the few law firms in the Lafayette, LA area (known as Acadiana) and Central Louisiana that has the knowledge and experience to effectively litigate Social Security Disability appeals in the Federal Court system. We have a long history of representing Social Security claimants in Federal Court and maintain an active Federal Court practice.

Fill out and submit for a free Social Security disability claim evaluation or call 1-800-451-0300.

Do I need to hire a lawyer to apply for disability benefits? When should I hire a lawyer?

How do I apply for disability benefits?

Matthew D. Lane, Jr. does not handle the filing of initial applications for disability benefits with the Social Security Administration (SSA). You do not need a lawyer to begin the application process as SSA has trained staff that will assist you in filling out the application forms. If you hire a lawyer to handle your initial application and you are approved for benefits, you will be required to pay the lawyer a fee for doing little more than filling out forms.

Consequently, Matthew D. Lane, Jr. only represents claimants once their initial applications have been denied; we appeal claims that have been initially denied by Disability Determination Services (DDS). We file the request for hearing, gather evidence from medical providers to support your claim, submit legal theories to the Administrative Law Judge (ALJ) who will hear your case, meet with you before your administrative hearing, and advocate for you at the hearing, including cross-examining any vocational or medical experts called by SSA to testify.

SSA has three convenient ways for you to apply for disability benefits:

  1. Apply online at SSA’s website, www.ssa.gov (ensure "Official Social Security Website" appears at the top of the page next to the SSA seal).
  2. Apply by phone by calling SSA’s national toll-free number 1-800-772-1213. If you are deaf or hard of hearing, you can call SSA’s TTY number 1-800-325-0778.
  3. Apply in person at your local Social Security office. Use SSA’s online Social Security Office Locator to find your local office.

Before applying, it is helpful to gather the following information and to have it with you when you apply:

  • Your Social Security number and proof of your age;
  • The names and birthdays of your spouse and minor children;
  • Your most recent W-2 form or, if you were self-employed, a copy of your federal tax return;
  • Names, addresses, and phone numbers of all medical providers (for example: doctors, psychologists, psychiatrists, physical therapists, hospitals, clinics) and the dates of your visits;
  • Names, dosages, and prescribing doctor for all medications you are taking;
  • Medical records and test results that you already have in your possession; and
  • A summary of where you worked and the kind of work you did for the last fifteen (15) years.

Once you have filed your initial application with SSA, it is important that you respond to any requests for information from SSA and that you attend any medical appointments that SSA may set up for you. It is very important that you cooperate with SSA's doctors, that you tell them all of your medical problems, and that you give your best effort on any tests administered. In addition, it is important that you continue to follow all treatment recommended by your personal doctor and that you continue to report all of your medical problems to your personal doctor.

If your initial application for benefits is denied, you have only sixty (60) days from the date stamped on the initial denial letter to file a request for hearing, Form HA-501. You should call Matthew D. Lane, Jr. for representation as soon as you receive a denial notice.

What should I consider when selecting an attorney to help me with my disability claim?

Selecting a Representative

  • When to hire (well before ALJ hearing)
  • Benefits of local attorney vs. national firm
  • Advantages of a specialist vs. a generalist
  • Seek a referral from National Organization of Social Security Claimants’ Representatives (NOSSCR)
  • Ask how the term “expenses” is defined.

For additional information, read our blog post: What to Ask before you hire a Social Security Disability Lawyer.

What is an Administrative Law Judge?

When you initially apply for Social Security disability benefits in Louisiana, the initial decision is made by Disability Determination Services (DDS), which is a State agency that applies Federal regulations.

If you receive an initial denial notice from DDS and then file an appeal (or request for review) of your Social Security disability claim, an Administrative Law Judge (ALJ) from the Office of Disability Adjudication and Review (ODAR) assigned to your area will hear your case.

In Lafayette and most of Acadiana, an ALJ from the ODAR in New Orleans will hear your appeal. The ODAR covering Lafayette changed in January 2015; Lafayette was previously under the jurisdiction of the ODAR in Alexandria.

The change in ODAR jurisdiction is significant for Acadiana residents applying for disability benefits in several ways. Both Alexandria and New Orleans are below the national average in processing time (defined as the average number of days until final disposition of the hearing request). At the end of fiscal year 2014, the national average processing time was 460 days. Alexandria’s average processing time was 288 days, which ranked as the fastest in the nation. And New Orleans’ average processing time was 399 days, which ranked 45th out of 163 hearing offices in the nation. Thus, the change in jurisdiction will likely cause longer processing times for Acadiana residents.

In addition, due to the greater distance from New Orleans to Lafayette than from Alexandria to Lafayette, ALJ’s from New Orleans are less likely to appear in person in Lafayette for hearings. This will likely lead to an increase in the number of video teleconference (VTC) hearings; in a VTC hearing, the ALJ appears by video on a television monitor rather than in person.

In selecting an attorney to represent you in connection with your disability claim, it is important to consider the recent change in ODAR jurisdiction. You should ensure that the attorney you select is familiar with recent change in jurisdiction and the practices followed by the ALJ’s in New Orleans.

What is required to prove I am disabled? Do I need to have current medical treatment to be found disabled?

To be found disabled under the Social Security Act (the "Act"), you must have medical records to prove your case. Your physical or mental impairments must be demonstrated by medically acceptable clinical and laboratory diagnostic techniques. Under the Act, "[y]our statements alone are not enough to establish that there is a physical or mental impairment." 20 C.F.R. § 404.1528.

Testimony regarding your symptoms is legally insufficient to prove you are disabled. "[R]egardless of how many symptoms an individual alleges, or how genuine the individual's complaints may appear to be, the existence of a medically determinable physical or mental impairment cannot be established in the absence of objective medical abnormalities; i.e., medical signs and laboratory findings." Social Security Ruling 96-4p.

Thus, without medical evidence, you cannot prove to the Social Security Administration that you are disabled. Listed below are local clinics in the Acadiana area that provide low cost medical treatment for mental and/or physical problems and which may be able to assist you in obtaining necessary medical care and documentation of your impairments.

Acadiana Area Clinics/Hospitals

Surrey Street Community Health Center
1004 Surrey St.
Lafayette, LA 70501
Phone: 337-261-9577

Iberia Comprehensive Community Health Center
806 Jefferson Terrace Blvd.
New Iberia, LA 70560
Phone: 337-365-4945

Abbeville Community Health Center
800 Charity Street
Abbeville, LA 70510
Phone: 337-893-3443

St. Martin Parish Community Health Center
317 Dernier Street
St. Martinville, LA 70582
Phone: 337-342-2566

SWLA Center for Health Services (Lafayette)
500 Patterson Rd.
Lafayette. LA 70501
Phone: 337-769-9451

SWLA Center for Health Services (Crowley)
613 John F. Kennedy Drive
Crowley, LA 70526
Phone: 337-783-5519

SWLA Center for Health Services (Lake Charles)
2000 Opelousas Street
Lake Charles, LA 70601
Phone: 337-439-9983

Fleur-de-Lis Community Health
376 Main Street
Cankton, LA 70584
Phone: 337-668-4141

Teche Action Clinic at Franklin
1115 Weber Street
Franklin, LA 70538
Phone: 337-828-2550

University Hospital & Clinics
(previously University Medical Center)
2390 West Congress St
Lafayette, LA 70506
Phone: 337-261-6000

Acadiana Area Behavioral Health Clinics

Joseph Tyler Behavioral Health Center
302 Dulles Drive
Lafayette, LA 70501
Phone: 337-262-4100

Crowley Behavioral Health Center
1822 W. 2nd Street
Crowley, LA 70526
Phone: 337-788-7511

New Iberia Behavioral Health Clinic
611 W. Admiral Doyle Drive
New Iberia, LA
Phone: 337-373-0002

Abbeville Behavioral Medicine Center
104 N. Hospital Drive
Abbeville, LA 70510
Phone: 337-893-5466

Vermillion Behavioral Health Center
2520 N. University Ave.
Lafayette, LA 70507
Phone: 337-234-5614

What type of evidence from a doctor can help prove you are disabled?

How Your Doctor Can Help

  • The treating source rule – well supported opinions are given more weight
  • A letter stating “my patient is disabled” is not enough
  • “My patient is disabled because. . .” is more helpful
  • What comes after the word “because” is what counts
  • Medical opinions that you cannot perform functional activities (e.g., patient can stand no more than 30 minutes at one time) must be properly considered by SSA

Will the Social Security Administration consider mental health problems, like depression, along with physical problems?

The Social Security Administration must consider the combined effect of all impairments, including physical and mental health problems (for example, depression). Thus, if you develop mental health problems due to your physical impairments, it is important to consult your physician so you can obtain proper treatment. This also serves the purpose of documenting your condition so it can be properly considered in evaluating your disability claim.

Where can I get low-cost medical treatment in Acadiana? Where can I get help for psychological problems in Acadiana?

Without medical evidence, you cannot prove to the Social Security Administration that you are disabled. Listed below are local clinics in the Acadiana area that provide low cost medical treatment for mental and/or physical problems and which may be able to assist you in obtaining necessary medical care and documentation of your impairments.

Acadiana Area Clinics/Hospitals

Surrey Street Community Health Center
1004 Surrey St.
Lafayette, LA 70501
Phone: 337-261-9577

Iberia Comprehensive Community Health Center
806 Jefferson Terrace Blvd.
New Iberia, LA 70560
Phone: 337-365-4945

Abbeville Community Health Center
800 Charity Street
Abbeville, LA 70510
Phone: 337-893-3443

St. Martin Parish Community Health Center
317 Dernier Street
St. Martinville, LA 70582
Phone: 337-342-2566

SWLA Center for Health Services (Lafayette)
500 Patterson Rd.
Lafayette. LA 70501
Phone: 337-769-9451

SWLA Center for Health Services (Crowley)
613 John F. Kennedy Drive
Crowley, LA 70526
Phone: 337-783-5519

SWLA Center for Health Services (Lake Charles)
2000 Opelousas Street
Lake Charles, LA 70601
Phone: 337-439-9983

Fleur-de-Lis Community Health
376 Main Street
Cankton, LA 70584
Phone: 337-668-4141

Teche Action Clinic at Franklin
1115 Weber Street
Franklin, LA 70538
Phone: 337-828-2550

University Hospital & Clinics
(previously University Medical Center)
2390 West Congress St
Lafayette, LA 70506
Phone: 337-261-6000

Acadiana Area Behavioral Health Clinics

Joseph Tyler Behavioral Health Center
302 Dulles Drive
Lafayette, LA 70501
Phone: 337-262-4100

Crowley Behavioral Health Center
1822 W. 2nd Street
Crowley, LA 70526
Phone: 337-788-7511

New Iberia Behavioral Health Clinic
611 W. Admiral Doyle Drive
New Iberia, LA
Phone: 337-373-0002

Abbeville Behavioral Medicine Center
104 N. Hospital Drive
Abbeville, LA 70510
Phone: 337-893-5466

Vermillion Behavioral Health Center
2520 N. University Ave.
Lafayette, LA 70507
Phone: 337-234-5614