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TWO-TIER FEE AGREEMENT

SOCIAL SECURITY DISABILITY/SSI

 

ATTORNEY FEE: I employ Neil H. Good to represent me before the Social Security Administration in my Social Security Disability case and Supplemental Security Income (SSI) case, or both.  If I win at or below the level of the ALJ hearing after the date of this agreement, I agree that the attorney fee will be the lesser of twenty-five percent (25%) of all past due benefits awarded to my family and me, or $6,000.00 ( or such higher limit as the Commissioner of Social Security may set under 42 U.S.C.§ 406(a)(2)).  I understand that my attorney has the right to seek administrative review to increase the amount of the fee set under the preceding sentence of this agreement; but if that happens, my attorney will not ask for a fee of more then 25% of total past due benefits awarded in my case.  If I lose at the ALJ hearing and my attorney agrees to appeal and I win my case later, the fee will be twenty-five percent (25%) of all past due benefits awarded in my case.  I understand that if I do not win benefits, then the attorneys will get no fee.

 

PAYMENT OF ATTORNEY FEE: I understand that the Social Security Administration will hold out 25% of past-due social security disability and SSI benefits and pay my attorneys for their work on the social security disability part of my case.   If I receive both social security disability and SSI benefits, I understand that my total fee will not be more than 25% of all past-due benefits, or no more than the limit set by the first paragraph of this agreement - if the limit applies.

 

I WILL PAY EXPENSES: In addition to attorney fees, I agree to pay my attorneys for reasonable expenses that they pay in my case.  These may include medical records and reports, photocopying.   I will get a bill for these expenses that show how and when my attorneys spent the money.

 

I HAVE NOT BEEN PROMISED THAT I WILL WIN: My attorneys promised that they will do their best to help me.  They did not promise me that I will win.

 

I accept and approve this agreement:

 

 

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Date

 

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Signature

 

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Attorney Signature

 

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Name printed or typed

 

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Social Security Number