Social Security Disability and SSI Frequently Asked Questions
It has been estimated that about 30% of people entering the workforce today will become temporarily or permanently disabled before they reach retirement age. Frequently, people who are injured or otherwise become disabled and are unable to continue working in their current job begin looking into Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) as a means of obtaining short-term, long-term or even permanent income.
The SSDI and SSI application, appeals and hearings process can be a bit complicated, so I have outlined some of the most common questions someone new to the programs might ask.
What is Social Security Disability Insurance?
SSDI is a federally funded disability program which pays cash benefits for individuals who cannot work due to medical disabilities. Most of us know that our payroll taxes goes toward our retirement. But many of us don’t realize that those taxes act as an insurance premium toward coverage for Disability Insurance. This premium is called a credit or a quarter of coverage. In general, every three months of work earns us one quarter of coverage. So a full year of work earns us 4 quarters of coverage. You need 20 quarters during the last 10 years in order to be insured. But there are different rules if you are under age 31.
What is SSI, or Supplemental Security Income?
SSI also pays income benefits to disabled individuals who are poor whether or not they have worked and paid any payroll taxes. Only individuals with limited income and resources can technically qualify. This means that part of your spouse’s earnings will be considered and certain resources that are valued at $2000 or more may prevent you from qualifying. That figure is $3000.00 for a couple. Not every income source or resource is counted against you. For example, food stamps are considered income but they are not counted against you. Uncounted resources include the home you live in and the land it is on as well as life insurance policies with a face value of $1,500 or less. There are other uncounted resources.
Who is Eligible?
The actual definition of disability under the Social Security Act evolved in the 1950s. The law requires that:
An individual shall be considered to be disabled if he is unable to engage in 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.
This means that the claimant will have to show that their medical conditions will prevent work for at least 12 months or will lead to death.
When Should I Apply?
As soon as you know you will be unable to work, you should apply even if you are receiving other assistance such as worker’s compensation or private disability benefits thru your employer. Disability insurance benefits can go back a year from the application. There is an also a five month waiting period before benefits can begin for disability insurance. SSI benefits cannot begin any earlier than the date of the application. So every day you wait is a potential day of lost benefits.
How Do I Apply?
An application can be completed at the local Social Security Administration District Office. To find out where the closest Social Security District Office is to you call their toll-free number at 1800-772-1213. Or you can locate Social Security on line at http://www.socialsecruity.gov/locator/. We also assist our clients with the application process in our office or by phone. Disability benefit applications can be completed on the internet, but not SSI applications.
Can Children Get these Benefits?
Some disabled children can qualify for benefits, if they are from low income households. The criteria for children are different. While adults have to prove they cannot work, children must show that they are significantly limited in their ability to function. Social Security will consider what normal development at different ages is and compare the applicant to that. For instance, a 2 year old in diapers is not really functioning much different than other 2 yr olds. But a 6 yr old in diapers is really out of the norm. That is just one example. Many children have limitations in several areas of functioning. A child with asthma and ADHD will be limited physically and more so at certain times of the year. That child may also have problems paying attention and learning at school. The challenge in a child’s disability case is to show very significantly limited functioning.
How Long Does it Take?
If denied, an applicant can continue to appeal the decision, attend a hearing in front of a Social Security Judge and appeal again to the Appeal Council. It takes Social Security several months (usually 4 months) to make a decision at each step of the appeal process. Average processing times vary across the country. The important thing is to really stick with it and don’t give up. While only about 20% of those who appeal the initial denial are found disabled at the second stage, which is called reconsideration, over half of those who attend a hearing win.
Is There a Way to Speed up the Process?
Certain medical conditions (like terminal cancer, waiting on a heart transplant list or total paralysis in both legs, etc.) are considered so serious that Social Security will move the case faster if confirmed by your medical records. Also, certain financial hardship conditions can speed up the case, such as homelessness, etc.
Should I Try to Work While I am Waiting for a Decision?
We don’t discourage our clients from working or looking for work within their restrictions. Most are unsuccessful in securing full time employment. That does help to show the Social Security judge that they cannot work. But before Social Security looks at your medical condition, they ask if you are working and may decide that you are not disabled if the work you are doing is “substantial” and “gainful.” Of course, if you are able to work full time for an extended time Social Security may decide you are not disabled. Part time work does not necessarily guarantee that you can get past this first step. It will depend on how many hours you are working, how much you are earning, what you are doing, etc. It is difficult to predict exactly how Social Security will evaluate work activity while they are deciding whether you are disabled. But unsuccessful work efforts, especially those lasting 3 months are less or those lasting up to 6 months but where there is evidence that your medical conditions caused you to leave work or lose the job do tend to show that you are disabled, under their guidelines.
What Kind of Evidence Does Social Security Consider?
The most important evidence to supply to Social Security is your medical records. Social Security will review medical records and consider your statements to determine if you are disabled. They will review the medical records to find severe medical conditions or those that affect your ability to perform basic work activity.
Are Any Conditions Excluded?
All medical conditions that affect the ability to perform a full time job are considered, even if some are episodic in nature. Likewise, a combination of medical conditions which result in different limitations can be considered and result in a finding of disability. Social Security does have a “list of impairments” which are “per se” disabling. For example, if you have a seizure disorder and take medication but continue to have seizures more than once a month, you may meet the listing for epilepsy. Or here is another example, you may have arthritis. If your medical records show deformity in one or more major peripheral joints and have at least two of the constitutional symptoms associated with the disorder (such as severe fatigue, fever, malaise, or involuntary weight loss) you also probably meet one of the listings for arthritis. There are actually several ways to meet that particular listing. There are listed impairments in most of the major body systems (musculoskeletal, cardiac, blood, neurological, skin, mental etc.). But even if your condition isn’t listed (like fibromyalgia or reflex sympathetic dystrophy, or RSD, the medical records may establish that your health is just as bad as a listed impairment. There are actually lots of ways to argue this. And one of the best ways is to get your doctor’s help. A doctor who comments on the listing criteria or on your abilities and limitation can provide helpful information to Social Security. We work with our clients all the time to do just that.
If your medical records don’t show that you meet a listing Social Security will determine if you can do work you did before. If not, they will consider other work. This is actually a determination that considers your abilities, limitations, age, education, acquired skills, etc.
If I Hire a Lawyer to Help, What Will They Do For Me?
An attorney can help you complete the application and other forms, timely file your appeals, collect the medical records that will help you win and work with your treating doctor to prove you are disabled. The attorney can also get you ready for your Social Security hearing and go with you to argue your case to the Judge. The attorney can also later present written arguments to the Appeals Council. An experienced Social Security attorney will know how to assist with all these activities and should be especially familiar with the “Listings of Impairment” and the numerous rules regarding your vocational profile.
What is a Social Security Hearing Like?
It’s not like what you see on TV. Most hearings last about an hour and all are informal. The Judge will ask you how you feel and why you cannot work. No one will argue that you are not disabled. Your lawyer can argue that you are! Sometimes a doctor and/or a vocational expert will also answer questions posed by the judge about your case. Your lawyer can ask those questions too. The judge will make the decision after the hearing and send you a copy of the decision in the mail.
How Much Does it Cost to Hire a Lawyer?
There are no upfront costs. A lawyer is paid a percentage (no more than 1/4th) of your back pay and only if and when you are found disabled. Social Security will not withhold any expenses though. In some states, like Texas, your attorney can acquire your medical records free of charge from your doctors.
When is the Best Time to Hire an Attorney?
Anytime. We help our clients at any stage in the process.
How Much Will I Get When I Win?
The disability benefit is based on your average lifetime earnings which is available to you by requesting an earnings statement from Social Security. The SSI benefit is adjusted each year nationwide and the disability payment will be calculated based on your own financial situation, including the number of people in your household.
How Far Back will Social Security Pay Me if I Win?
Disability benefits can go back for up to one year from the date you apply. But disability benefits cannot begin until five months have passed from the date you are found disabled. SSI benefits can be paid no earlier than a month after the date you apply, even if you were disabled before you applied.
Will I Also be Entitled to Health Care if I Win?
If approved for disability benefits, you will be entitled to Medicare two years after your disability date. If you are approved for SSI Medicaid will start right away.
What is the Difference Between Medicare and Medicaid?
Medicaid is a poverty program run differently in every state while Medicare is, in fact a national health insurance program. The premium is deducted from the disability check. There are four parts to Medicare (A thru D). To find out more information about what these parts cover and when to enroll for benefits call 1-800 MEDICARE (1-800-633-4227) or go on line to www.medicare.gov.
Medicaid is states run (but jointly funded) program that pays for hospital and medical coverage for certain individuals with limited income and who fit into certain eligibility group. While no premium is paid, there can sometimes be a co-pay for services. The rules vary from state to state. Not all doctors accept Medicaid recipients as patients but Medicaid usually covers more prescription medications than does Medicare.
Some states will assist an SSI recipient with the premiums, deductibles and coinsurance for Medicare, when they qualify for Medicare. You may also be eligible for assistance with the co-pays for prescription drugs under Medicare Part D.
Will my Family Also Get Any Help if I am Found Disabled?
If you are approved for disability benefits, other family members (dependents) may also receive an auxiliary benefit. But this is not true for SSI. Social Security calls these auxiliary benefits. Examples of family members who can also receive a check are your spouse who cares for your children under the age of 16 and dependent children. A dependent child is an unmarried child, including an adopted child, or in some cases, a stepchild or grandchild. The child must be under age 18 or under age 19 if in elementary or secondary school full time. There is also a benefit for an adult child who is disabled. That person must also be unmarried, 18 or older, have a disability that started before age 22 and be currently disabled using the adult definition, i.e. unable to work due to severe medical conditions.
Will my Benefits Ever be Taken Away?
If you improve medically, Social Security may review your entitlement. Social Security calls this a “Continuing Disability Review (CDR). In fact, the law requires Social Security to do a review every three years unless they determine that you have a condition that is not expected to review. It is hard to say whether everyone on disability is actually reviewed. But it is best to stay in continuing treatment to be able to show that you are still disabled.
If you are on SSI and your financial situation improved, you may no longer be entitled to benefits. Social Security also will periodically “redetermine” income, resource and living arrangements for individuals receiving SSI. Again it is hard to say how often this happens but Social Security tries to do these reviews (which they call redeterminations) once every one to six years. For a child, the SSI benefit will be “redetermined” the month before the child turns 18. At that point, Social Security will use the adult definition of disability, not the child definition. So once you turn 18, you have to show you are unable to work because of your medical conditions.
What if I Get Better and Want to Try to Work?
There are Work Incentives Planning and Assistance Programs (WIPAs) around the country that provide free services designed to help you try to work and look for work while still receiving your benefits. Even if you are able to work for an extended period and then lose benefits, you may be able to get an “expedited reinstatement” of your benefits if you soon become ill again and unable to work.
We encourage our former clients who call us to ask about work to do several things. They should look into the “Ticket to Work” Program offered by Social Security. While using the tickle, you don’t risk Social Security reviewing your entitlement again. We also direct our former clients to the local WIPA. These are community-based organizations designed to assist folks on Social Security Benefits to get back into the workforce. You can locate the WIPA project nearest to you by calling 1-866-968-7842. You can also go on line for that information at www.socialsecrity.gov/work/ServiceProviders/WIPADirectory.html.
Feel free to contact us if you have more questions or need more help!