Orlando Social Security Disability Lawyer

If you filed a claim for Social Security Disability Insurance (SSDI) benefits or Supplemental Security Income (SSI) and received a denial, you have the option to appeal, and we can help. 

Bogin, Munns & Munns represents clients in their appeals process to receive Social Security Disability benefits and assists them in going over the options best suited for their individual situations. Don’t get deterred if you get denied. Our lawyers serving Orlando can explore your options and handle your appeal from start to finish. 

Benefits Available Through the Social Security Administration

The Social Security Administration (SSA) has two programs for providing benefits for those who are unable to work: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). As a general rule, you should sign up for both programs. 

Social Security Disability Insurance (SSDI)

Social Security Disability Insurance (SSDI) are benefits for people who have earned enough work credits by working and paying Medicare and Social Security taxes. The general rule to determine eligibility for SSDI benefits is whether you worked five out of the last ten years, earning a minimum amount as set forth by the SSA. You should be eligible if the answer is “yes.”

You can also check your eligibility by looking at your annual Social Security earnings statement sent to you by the SSA. Your prior earnings will determine the benefit amount.

Supplemental Security Income (SSI)

Supplemental Security Income (SSI) are benefits intended for people with less work history, children, or non-payment into the system. This is a needs-based program.  Benefits are affected by the financial assets, household income, or other benefits/income received. It should be noted that there are limits to household income/assets. 

Exceeding the limits could potentially cause a medically disabled person to be unable to qualify for benefits.

Disability Insurance and Pension

The Employee Retirement Income Security Act of 1974 (ERISA) addresses funding, vesting, reporting, disclosure, and distribution issues regarding pension plans. Employers who establish pension plans are required to report information about the plan to the U.S. Department of Labor (DOL) and provide this information to participants upon request. If a participant requests, the employer must provide a calculation of accrued and vested pension benefits.  

This federal law requires pension plans to provide vesting to a participating employee after a specified number of years. Typically, a pension plan must become vested at 100% either after three years or under a two to six-year graded schedule (20% a year for each year of service beginning with the end of the second year and ending with 100% after six years).

ERISA also regulates the manner in which pension plans pay benefits. For example, a defined benefit plan must pay a married participant’s pension as a joint and survivor annuity that provides benefits to the surviving spouse unless both the participant and spouse waive the survivor coverage. 

COBRA, HIPAA, and SPD

COBRA, HIPAA, and SPD are a few of the acronyms under ERISA which address issues that arise in relation to the rights and duties of beneficiaries and participants, and employers, insurers, and benefit plan administrators regarding health insurance.

Consolidated Omnibus Budget Reconciliation Act

Consolidated Omnibus Budget Reconciliation Act (COBRA) is the law that requires that beneficiaries under an employer-provided health insurance plan be provided notice of their right to continue coverage. The extended coverage period is 18 months from the end of health benefits upon termination of employment(including resignation) and 36 months from divorce or legal separation of the covered employee from the employee’s spouse. 

There are other extensions available in the event of death or SSA disability of the covered employee. Notice of rights to continue coverage, which must explain the premium amount, the election deadline, and the duration of coverage, must be provided within 44 days of the qualifying event, termination of employment, or divorce.

Health Insurance Portability and Accountability Act

Health Insurance Portability and Accountability Act (HIPAA) is a law that dictates various duties to health insurers and health service providers. This law mandates that someone who was insured under a group health insurance plan for at least a year will not be subject to a pre-existing condition exclusion provided they obtain group coverage within 63 days of the end of their prior coverage. 

If someone has met the required coverage period and has not had their insurance lapse for greater than 63 days, insurance obtained under COBRA is considered.

Summary Plan Description

Summary Plan Description (SPD) is a required written document that must contain an intelligible description of all circumstances that may result in disqualification, ineligibility, or denial or loss of benefits. An employee benefits handbook may not satisfy the requirements of ERISA, depending on its contents. 

An SPD must be provided within 90 days of commencement of benefit coverage and must contain COBRA rights information. Further, an SPD must be provided to a participant or beneficiary who requests an SPD in writing to the plan administrator. Civil penalties of up to $110.00 per day may apply for a failure to provide the required information.

Challenging a Denial of Benefits

In addition to COBRA, HIPAA, and SPD, a beneficiary has a right to challenge a denial of a claim for health benefits. First, a denial must be appealed to the appeal entity provided in the plan. Then, a formal lawsuit in federal court is available to address ERISA issues.

Reconsideration

Reconsideration is the first step in the appeals process. Another official, aside from the one who originally handled your claim, will review the evidence of your claim. You may also submit new evidence for review. 

Hearing

If the reconsideration process does not grant your appeal, you can ask for a hearing with an Administrative Law Judge (ALJ). 

Review By the Appeals Council

If you disagree with the administrative law judge’s decision, you can request a review by the Social Security Appeals Council. This council may send your case back to the ALJ for further review or make an independent decision. 

Federal Court Review

Sometimes, filing an official appeal is all that is needed to address the issue. If the Appeals Council does not grant your appeal, you can take legal action by filing a civil suit in a federal district court. 

Issues that have been resolved through court cases regarding pensions include: 

  • Failure to pay a surviving spouse their survivor annuity due to a mistaken belief there had been a waiver of coverage
  • Misrepresentations to participants as to the amount of benefits at the time of a merger of two companies
  • Miscalculations as to benefits which resulted in either an underpayment or overpayment
  • Claims by terminated employees believing their termination was intentional and for the purpose of interfering with their attainment of vesting (ERISA has anti-retaliation and anti-discrimination provisions).

When we handle your case, we will look into all the possible issues that occurred with your claim. 

Work with Bogin, Munns & Munns

We are happy to assist you with your Social Security Disability claim. We can also help you appeal a denial of benefits. Our attorneys work to ensure your social security matter is handled with the care you should expect from a firm that has been around for over 40 years. Call us at 407-578-1334

We can meet you in the location that is most convenient for you. Our main office is in Orlando, but we also have 12 other locations throughout Central Florida, including Clermont, Cocoa, Daytona, Gainesville, Kissimmee, Leesburg, Melbourne, Ocala, Orange City, St. Cloud, Titusville, and The Villages.  

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Request a consultation by filling out the form below, or call us at 855.686.6752. We have over a dozen offices located in Orlando and across Central Florida. We’re happy to answer any of your questions.