Welcome to the DFW Disability Lawyer FAQ page

Social Security disability is a form of insurance – in fact, these benefits are actually called “SSDI” which stands for “Social Security Disability Insurance.”

Most of us pay for SSDI coverage when we pay our share of FICA taxes. Tax payments result in “Quarters of Coverage.” The number of years we have worked and paid FICA taxes contributes to our SSDI coverage. In short, we pay FICA taxes for SSDI coverage like we pay premiums for insurance coverage with an insurance company.

Example: if a worker earned 4 Quarters of Coverage per year in 2015 – 2020 and stopped working in 2020, then she would have 5 years of SSDI eligibility. She must establish that she became disabled before her date last insured in 2026. Some occupations like teachers and government workers allow the worker to opt-out from payment of FICA taxes, resulting in no Quarters of Coverage and no SSDI eligibility. However, these workers may have eligibility under a private insurance disability plan or Supplemental Security Income (“SSI”).

Supplemental Security Income (“SSI”) is a federal program for the disabled, blind, and those over 65 with very limited financial resources. SSI benefits are paid out of general revenues rather than the Social Security trust fund. Many states supplement the federal SSI benefit. Generally, a SSI claimant must:
(1) be “disabled” using the same definition as is used for the Social Security disability program;
(2) meet the income and asset requirements of the SSI Program;
(3) be a U.S. citizen or fall into a group of limited exceptions to the citizenship rule; and
(4) file an application. The asset limitation has long been $2,000 for an individual and $3,000 for a couple. However, certain assets are excluded such as the claimant’s home, household goods and personal effects, and one car.

It depends. Social Security uses a five-step sequential evaluation when determining if a claimant is disabled. Step-one is that the claimant cannot be engaged in “Substantial Gainful Activity” or “SGA.” As of 2023, there is a rebuttable presumption that a non-blind claimant is engaged in SGA if they earn $1,470 per month, or $2,460 for a blind claimant. A finding that the claimant is engaged in SGA means they are step-one barred.

Generally speaking, it will take several months to a year or more. The initial decision will generally take several months while it may take a year or more to reach a hearing. This is one reason why starting the process sooner than later makes good sense.

SSDI benefits are generally higher than SSI. SSDI benefits are calculated off earnings before stopping work. You can find out how much your SSDI benefit would be by accessing your my Social Security account at ssa.gov. As of 2023, the maximum SSDI amount is $3,627 per month. The government sets SSI at the same amount for all claimants. As of 2023, SSI for an individual is $914 per month and for an eligible couple is $1,371 per month. Benefits are calculated from your onset date of disability forward. Social Security will pay a lump sum amount for back-due benefits and then monthly benefits going forward.

If your initial claim is denied, then you have a right to request reconsideration. If denied again, you have a right to seek a hearing. If denied again, you have a right to appeal to the Appeal Council. If denied again, you have a right to file suit in federal court. Each denial carries important deadlines to proceed with your claim. Luke Radney has represented clients at all of these levels.

You can request reconsideration. If denied, you can seek a hearing before an Administrative Law Judge, an appeal to the Appeals Council, and file suit in federal court. There are important deadlines you must follow. A disability attorney may give you further guidance.

Yes. A questionnaire helps us better understand your situation. However, we require that we communicate directly with you to fully understand your case. We also require that we communicate with you directly before any hearing.

Cases are most often handled on a contingency fee basis. There is no fee unless we win. While we cannot guarantee success, if we take a case then we believe there is a likelihood that it will be successful.

You will have a licensed Texas lawyer on your side. Other national firms often employ non-attorneys to represent Social Security claimants. DFW Disability Lawyer™ is a law practice for the disabled founded by a Texas lawyer with experience and passion in advocating for the disabled client.

DFW Disability Lawyer™ primarily serves the DFW Metroplex and surrounding North Texas areas. However, we may take cases beyond Dallas-Fort Worth in certain circumstances and we will communicate with the potential client on a case-by-case basis about it.

Existing and potential clients are invited to meet 100% virtually so there is no need for travel, but if an in-person appointment is required, meetings can be held at Mr. Radney’s Dallas office or another location if desired.

DFW Disability Lawyer™ will send you an initial questionnaire and more information on the process and request that you email over relevant records you’d like reviewed. We’ll then set up a Zoom meeting (in person meetings also available) that should last around 30 minutes depending on the complexities of your case.

Short answer? Yes. An employer may have the ability to change an employee’s job when they go on Long-Term Disability (LTD), but it must be done for legitimate business reasons. If the change is solely due to the employee’s LTD status and lacks valid justification, it may be considered unlawful and discriminatory. Employees can consult with a legal professional to understand their rights and explore potential courses of action if they believe their job change is unfair or discriminatory.

In Texas, the eligibility criteria for long-term disability (LTD) benefits can vary depending on the specific terms of the insurance policy or benefits program. Generally, qualifying illnesses for LTD in Texas include a wide range of physical and mental health conditions that significantly impact an individual’s ability to work. You can check with your insurance provider or employer for more information on what conditions are covered. Otherwise, feel free to contact us with your questions about qualifying illnesses or conditions.

ERISA is a body of federal law called the Employee Retirement Income Security Act. ERISA preempts state law claims made under a disability insurance plan where the employer contributes in paying the premium for coverage.

Federal courts have jurisdiction over ERISA claims. However, an ERISA claimant must first exhaust her administrative remedies before she may file suit for wrongful denial of benefits. This means the claimant must appeal any denial directly back to the plan administrator – frequently an insurance company – before she may file suit. The claimant must adhere to deadlines listed in the plan when exhausting her administrative remedies.

First, because there is a chance that the plan administrator will reverse its denial if you provide the right kind of supporting evidence. Second, because the standard of review in court is often an “abuse of discretion” standard. In such a case, once the claimant exhausts her administrative remedies and files suit, the court will then analyze whether the records and arguments made in the administrative review were strong enough to find that the plan administrator abused its own discretion in denying the claim. DFW Disability Lawyer™ can help you build the record to show that the plan administrator’s denial was wrongful based on the definition of disabled in the plan and the record before the administrator.

Good news! There are more causes of action available under Texas law for wrongful denial of a disability insurance claim than under ERISA. Also, there often is a different standard of review in court. You should consult with a knowledgeable attorney to determine if your claim is an ERISA or a non-ERISA disability insurance claim.

Most group plans are ERISA plans when the employer contributes to payment of the premium. This is what many people think of as a fringe benefit, e.g. the employer pays for some of the disability insurance coverage and the employee pays the rest out of their wages. However, there are exceptions. One is the “Safe Harbor” exception which requires proof of certain specific elements. Also, ERISA applies to private businesses. Disability plans for state and local employees are often non-ERISA, such as for teachers and police officers.

In the State of Texas, the long-term disability (LTD) claim process typically involves the following steps:

Diagnosis and Treatment: The individual must first receive a medical diagnosis from a healthcare professional that establishes their condition as a qualifying disability under the LTD policy.

Notification: The employee should promptly notify their employer or the LTD insurance provider about their intention to file a claim for benefits. This step involves submitting the necessary forms and documentation, including medical records and supporting evidence.

Waiting Period: Most LTD policies have an initial waiting period, often called the “elimination period,” during which the employee must be disabled (meaning meet the definition of “disabled” under the plan) for a specified period before becoming eligible for benefits. This waiting period can range from a few weeks to several months.

Evaluation and Review: The insurance provider or plan administrator will evaluate the claim and review the medical documentation to assess the individual’s eligibility for LTD benefits. This may involve obtaining additional information or conducting an independent medical examination (IME) if required.

Decision and Approval: Based on the evaluation, the insurance provider or plan administrator will make a decision on the claim. If approved, the employee will receive notification of their eligibility for LTD benefits, including the amount and duration of the benefits. An unfavorable decision will result in a denial letter with certain deadlines for appealing the decision. ERISA LTD plans will then require the claimant to timely appeal and exhaust her administrative remedies before she may file suit for wrongful denial of benefits.

Ongoing Compliance: Throughout the LTD claim process, the employee must comply with any requirements set forth by the insurance provider. This may include providing updated medical information, participating in periodic reviews, or undergoing further evaluations as requested.

Appeals and Legal Action: If the LTD claim is denied, the employee has the right to appeal the decision. This may involve submitting additional evidence, engaging in negotiations, or pursuing legal action, if necessary. Legal action means filing a lawsuit in either state or federal court.

If you find yourself unable to work due to a job-related injury, you may be eligible for both workers’ compensation and short-term disability benefits. However, it’s important to note that receiving double benefits is unlikely and may be flagged. Typically, one type of benefit will offset the other, ensuring you do not receive duplicative payments.

There are multiple ways to apply for Social Security benefits:

1. Complete your application online https://www.ssa.gov/benefits/disability/apply.html
2. Call the SSA at 1-800-772-1213 (for deaf or hard-of-hearing: TTY 1-800-325-0770)
3. Call or visit your local Social Security office

If you were recently denied Social Security benefits or Supplemental Security Income (SSI), disability benefits or a non-medical related issue, you can appeal the decision if you disagree. DFW Disability Lawyer™ can navigate this for you to help ensure a positive outcome. Contact us today to set up your free consultation. NO FEES UNLESS YOU WIN!