There are five kinds of Social Security Disability benefits available:
Disability Insurance Benefits are the most common kind of disability benefit. Social Security Disability is a benefit received from the Social Security Administration by disabled workers (who have worked enough to be insured) and in some cases their dependents, similar to those received by retired workers. (Currently the most an individual can receive is $3011 (2020) per month).
Disabled Widow's and Widower's Benefits are paid to people who are at least 50 years old and who became disabled within a certain amount of time after the death of their spouse. The deceased spouse must have worked enough under Social Security to be insured.
Disabled Adult Child Benefits are paid to the children of people who are deceased, disabled or retired under Social Security. The child must have become disabled before age 22. For people who've applied for Disability Insurance Benefits, Disabled Widow's or Widower's Benefits and Disabled Adult Child benefits, whether they are rich or poor is irrelevant.
Supplemental Security Income (SSI) benefits are paid to poor and disabled people, whether or not they've ever worked.
SSI child's disability benefits are paid to children under the age of 18 who are disabled.
WHAT IS THE DIFFERENCE BETWEEN SOCIAL SECURITY DISABILITY AND SSI?
Both programs are administered by the Social Security Administration. For most people, the medical requirements are the same and the person's disability is determined by the same process. The major difference is that SSI disability program decisions are also made on the basis of financial need.
Social Security Disability Insurance (SSDI or DIB or Title II) is a program financed with Social Security taxes paid by workers, employers and self-employed persons. Disability benefits are payable to disabled workers, disabled widow(er)s or adults disabled since childhood, who are otherwise eligible. Auxiliary benefits may be payable to a worker's dependents, as well. The monthly disability benefit payment is based on the Social Security earnings of the insured worker on whose Social Security number the disability claim is filed. When you become entitled to twenty-four (24) months of SSDI you are entitled to Medicare at a cost.
Supplemental Security Income (SSI or Title XVI) is a welfare type program financed through general tax revenues. SSI disability benefits are payable to adults or children who are disabled, meet the income, resource and living arrangement requirements, and are otherwise eligible. (Currently can have no more than $2,000 in assets for an individual and $3,000 for a couple). No Auxiliary benefits are paid with SSI.
The monthly amount of SSI payments are different in every state and can vary by the persons income and resources. (In Virginia and many other states the maximum amount is currently $783 (2020) per month for an individual and $1,175 (2020) a month for a couple). You can be eligible for SSI even if you have never worked or paid taxes under FICA. Generally, however, to be eligible for SSI payments you need to be a U.S. citizen or meet certain requirements for non-citizens. If you receive SSI you are entitled to Medicaid which is free.
HOW DOES THE PROCESS WORK TO GET BENEFITS?
Once you file a claim, your case is sent to a disability examiner at the Disability Determination Service (DDS). If the claim is denied and you request a reconsideration, the case is sent to another disability examiner at the same agency, where it is reviewed again.
If a claim is denied at reconsideration, you can request a hearing. At this point, the case is sent to an Administrative Law Judge (ALJ) at an Office of Disability Adjudication and Appeals that serves your area. The ALJ will make a decision in your case, usually after a hearing at which you appear and testify. This hearing is the only time you'll actually meet the person making the decision in your case.
WHAT IS THE EARLIEST AGE THAT A PERSON CAN RECEIVE SOCIAL SECURITY DISABILITY BENEFITS?
There is no minimum age. However, to qualify for Social Security Disability benefits, you must have worked long enough and recently enough under Social Security. You can earn up to a maximum of four (4) work credits per year. The amount of earnings required to earn one credit increases each year.
The number of work credits you need for Social Security Disability Benefits depends on your age when you became disabled. Generally you need a total of forty (40) credits with twenty (20) credits earned in the last ten (10) years ending with the year you became disabled. However, some younger workers, depending on their age, may qualify with fewer credits.
Disability means the "inability 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 has lasted or can be expected to last for a continuous period of not less than 12 months."
This means that to receive benefits under the Social Security Disability program, you must have a physical or mental health problem (or a combination of problems) severe enough to keep you from working in any regular paying job for at least one year or a condition which will result in death during the year. The test isn't whether or not you are able to go back to your old job, and the test isn't whether or not you have been able to find a job lately. Rather, the test is whether you are capable of doing any job available in the national economy (even if this job involves different skills or pays less than your previous work.) By using an extensive set of regulations, the Social Security Administration takes into account your medical condition, your age, your abilities, your training and your work experience in deciding your case.
Generally, you're disabled if you can't earn more than $1,260 per month (in 2020) because of a mental and/or physical condition that is expected to last at least one year.
The Five Step Evaluation that Social Security uses to determine if you are disabled is as follows:
Are you working? If you are and you are earning more than the current SGA amount (currently $1,260 a month--2020), you generally cannot be considered disabled;
Is your condition severe? Your impairment must be expected to last one year or result in death during that year and interfere with basic work related activities;
Is your condition found in the list of disabling impairments? Social Security maintains a list of impairments for each of the major body systems that are so severe they automatically mean you are disabled. If your condition is not on this list, Social Security has to decide if it is of equal severity to an impairment on this list. If it is, your claim is approved. If it is not, Social Security goes on to the next step;
Can you do the work you did previously? Does you condition prevent you from doing any work that you did in the last fifteen (15) years. If it does not, your claim will be denied. If it does, your claim will be considered further; and
Can you do any other type of work available in the national economy? Social Security considers your age, education, past work experience, and transferable skills against the job demands of occupations as determined by the Department of Labor. If you cannot do any other kind of work, your claim will be approved. If you can, your claim will be denied.
WHERE CAN I GET THE LIST OF SOCIAL SECURITY CONSIDERED DISABLING IMPAIRMENTS UNDER STEP 3?
WHAT HAPPENS IF I QUALIFY FOR SOCIAL SECURITY DISABILITY BENEFITS?
Disability Insurance Benefits and Disabled Widow's and Widower's Benefits cannot begin until five months have passed from the month you became disabled. This is called the waiting period. Also, benefits cannot be paid more than one year prior to the month you filed your claim.
Disabled Adult Child Benefits cannot be paid more than six months prior to the date of the claim; however, there is no waiting period
SSI benefits cannot be paid before the beginning of the month following the month you filed your claim.
If you have received Disability Insurance Benefits, Disabled Widows or Widowers Benefits or Disabled Adult Child Benefits for 24 months, you qualify for Medicare . Medicare pays for doctors visits and for acute care in a hospital, among other things. You are responsible for deductibles and co-payments.
In Virginia and many other states, if you are approved for SSI, you automatically qualify for Medicaid (but not the other way around). It is possible to get both Medicare and Medicaid if you are entitled to SSI and some other type of Social Security disability benefit.
HOW MUCH MONEY WILL I RECEIVE IF I QUALIFY FOR SOCIAL SECURITY DISABILITY BENEFITS?
For disability insurance benefits, your monthly benefit is based on how much you've worked and earned over the years. A disabled claimant will receive the same monthly benefit that he or she would receive had he or she retired at full retirement age (65 years old or more depending on age). (Currently the most an individual can receive is $3,011 (2020) per month).
For disabled widow's or widower's benefits, your monthly benefit is based on how much your late husband or wife worked and earned.
For disabled adult child benefits, your benefit is based on how much the child's parent worked and earned.
For all types of SSI benefits, there is a maximum amount that an individual with no other income can receive. The maximum amount is currently $783 (2020) per month for an individual and $1,175 (2020) a month for a couple. Other income can reduce the amount of the benefit.
IF I RECEIVE SOCIAL SECURITY DISABILITY BENEFITS AND MY DISABILITIES GET WORSE OR I AM DIAGNOSED WITH OTHER HEALTH PROBLEMS, CAN MY MONTHLY BENEFIT AMOUNT BE INCREASED?
No, your benefit is based on the amount of your lifetime earnings prior to your disability and not the degree of your disability.
WILL MY WORKERS' COMPENSATION PAYMENTS AND OTHER DISABILITY PAYMENTS AFFECT MY SOCIAL SECURITY DISABILITY?
Ordinarily, disability payments from other sources do not affect your Social Security Disability benefits. However, if the disability payment that you receive is workers' compensation or another public disability payment (such as some civil service disability benefits, some military disability benefits, some Federal, State or Local government retirement benefits if they are based on disability) yours and your family's Social Security benefits may be reduced. If this is the case, in general, your Social Security Disability benefit will be reduced so that the combined amount of the Social Security Disability benefit you and your family receives plus your workers' compensation payment and/or public disability payment does not exceed eighty percent (80%) of your average current earnings.
HOW LONG WILL I BE ABLE TO RECEIVE SOCIAL SECURITY DISABILITY BENEFITS?
You will receive Social Security Disability benefits as long as you remain disabled and unable to work. Your benefits will not run out because you did not contribute enough into the Social Security system.
Social Security may review your case after you get benefits. However, in most cases Social Security will not terminate your benefits unless your medical condition has improved or you have returned to work. Most people who have their cases reviewed continue to get benefits. If Social Security proposes to end your benefits, you have the right to appeal their decision. If you appeal within ten days of being notified of their decision, you can ask Social Security to continue your benefits while your appeal is considered.
WHEN SHOULD I APPLY FOR SOCIAL SECURITY DISABILITY BENEFITS?
You should apply for Social Security Disability benefits as soon as possible after you become disabled and unable to work. You do not need to wait 12 months to apply, your disability need only be expected to last for at least one year or will result in death during that year.
If you are getting sick pay from your employer or short term/long term disability from an insurance company you do not have to wait until these payments end before filing a claim for disability benefits.
HOW DO I APPLY FOR SOCIAL SECURITY DISABILITY BENEFITS?
You can fill out an application for Social Security Disability benefits at the local Social Security office nearest to your home, online, or by telephone. The address and telephone number of your local Social Security office can be obtained by calling 1-800-772-1213. When applying you should be prepared to give Social Security a list with the names, addresses and phone numbers of all the doctors, hospitals or clinics who have treated you for your condition. You should also bring a list of where you have worked in the past 15 years.
You will also need to provide Social Security with an original or certified copy of your birth certificate, your last earnings documents (W-2, last pay stub, statement of your employer, etc.) and copies (keep the originals) of any medical records you may be able to obtain.
Please note, however, that you should not delay filing for benefits if all documents are not immediately available.
WHAT DO I DO IF I AM DENIED BENEFITS?
Appeal! Many disabled people become disheartened and frustrated after they receive a disability benefits denial notice and do not appeal. This is often a mistake. Nationally, about 80% of all applicants are denied initially and about 90% are denied at the first appeal stage--Reconsideration. But many of these people ultimately receive their benefits.
What may be most frustrating about applying for Social Security Disability benefits is the process itself. Those who apply are often made to feel like they are asking for something that they do not deserve, and nothing could be further from the truth. Social Security Disability is not a welfare program; these benefits are paid for by you and were intended to act as a financial buffer in case you or a family member became seriously ill or injured. Therefore if you are unable to work, but you have been denied benefits, you should appeal.
DO I NEED AN ATTORNEY?
You have the right to have an Attorney represent you in your Social Security Disability case. Statistics have clearly shown that claimants who are represented by Attorneys win their Social Security Disability benefits much more than those who appeal on their own.
Social Security makes the process very difficult. Waiting lines are long. Forms are complicated. Social Security Disability Benefits are often denied to people who are truly Disabled. As a result, many people who apply for Social Security Disability Benefits become frustrated, so they simply give up, and do not appeal even though they are genuinely entitled to their Social Security Disability benefits. You should seriously consider the advantages of having an Attorney represent you by examining what they would do in your Social Security Disability case.
WHAT WOULD MY ATTORNEY DO TO REPRESENT ME IN MY SOCIAL SECURITY DISABILITY CASE?
Every case is different. Your Attorney's role depends on the particular facts of your case. However, a few of the things an Attorney may do are:
Gather medical and other evidence;
Analyze your case under Social Security Regulations;
Contact your doctor and explain Social Security Regulations to obtain a report consistent with those regulations;
Obtain documents from your Social Security Disability file;
Ask that a prior application for benefits be reopened;
Advise you how to best prepare yourself to testify at your hearing;
Protect your right to a fair hearing by objecting to improper evidence and procedures;
If you win, make sure that the Social Security Administration correctly calculates your benefits;
If you lose, request review of the hearing decision by the Social Security Administration's Appeals Council; and
If necessary, represent you in a Federal Court review of your case.
HOW MUCH DOES IT COST TO HIRE AN ATTORNEY?
Most Attorneys who handle Social Security Disability cases will accept them on a contingent fee basis of 25% of past-due benefit or $6000 whichever is less. That is, there is no fee if you lose, although you will be obligated to pay any out-of-pocket expenses incurred by the Attorney in your representation. Such expenses usually involve charges for photocopying and payments to doctors and hospitals for medical records and reports, and other miscellaneous charges.
WHEN SHOULD I CONTACT AN ATTORNEY?
As soon as possible, preferably as soon as your initial application is denied. An Attorney will then be able to start assisting you in determining if you are disabled, as that term is defined by the Social Security Act. You will then be able to decide whether or not you want to pursue the first appeal stage--Reconsideration; and your Attorney can begin developing ways to prove to the Social Security Administration that you are disabled.
Attorneys in Social Security Disability cases do much more than sit in at a hearing and ask a few questions. Much pre-hearing preparation, analysis and evidence gathering go into adequate representation for your case. For this reason you should not wait until a week or two before your hearing to contact an Attorney. The earlier an Attorney is able to start working on your case, the better your chances of winning.
Please note that not all Attorneys practice before the Social Security Administration. You will do best to find an Attorney familiar with the complex Social Security Disability regulations and the somewhat unusual Social Security Disability procedures.
For more information contact the law office of Sheri R. Abrams at (571) 328-5795 or visit our contact page here.