In consideration for legal services performed in connection with my application for Social Security benefits and/or Supplemental Security Income, if my claim is approved I will pay the undersigned attorney(s) the lesser of 25% of the amount of past due benefits awarded to me and any auxiliary beneficiaries, or $7,200.00. I understand that the maximum authorized fee may be increased by the government in the future above $7,200 and agree that the amount in effect pursuant to 42 U.S.C. § 406(a)(2) at the time my case is approved will apply. No legal fee will be owed if benefits are not awarded.
I understand that if my case does not result in past due benefits, I will still be responsible to pay a fee. In that case, my attorney will petition for a fee. I will have the right to object to the amount so requested and any such fee will be subject to approval by the Social Security Administration.
My attorney and I understand that one or both of us may request review of the fee amount, in writing, within 15 days after SSA has notified us of any amount my representative can charge. I agree that the undersigned may ask SSA to increase the fee, and I have been informed that he intends to do so if the claim is awarded, but the fee received is less than two thousand dollars ($2,000.00). The undersigned attorney may then file a fee petition with the Social Security Administration asking approval of a fee not in excess of Two Thousand dollars ($2,000.00). I understand that I may ask SSA to reduce the fee.
I further agree that I am responsible for out-of-pocket expenses incurred on my behalf. This includes, if any, costs medical providers may charge for providing necessary medical records, whether my claim is decided favorably or not. My attorney will notify me in advance of any such costs.