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There are several types of Social Security benefits for which an individual may be eligible. Individuals may be eligible for more than one type of disability benefit, and are not required to choose only one disability benefit. You must be “disabled” before you can qualify for any type of benefit, and there may also be additional non-medical requirements depending on the benefit.

Social Security Disability Insurance (SSDI) – To be eligible for these benefits, you must have paid enough Social Security tax (FICA) over a period of time so as to have disability coverage in force. Generally, this means that you must have worked and paid Social Security tax for roughly 5 of the last 10 years before becoming disabled, although people with disabilities starting before age 30 have a different, easier rule.

Supplemental Security Income (SSI) – When an individual has a very low disability insurance rate or hasn’t paid enough Social Security tax to be eligible for SSDI benefits, SSI benefits may be available. SSI benefits are based on financial need, so you must have very little income and property (non-exempt assets must not exceed $2,000). Additionally, you must be “disabled” under the same guidelines that apply to the other benefits, or be blind or over 65 years old. In some circumstances, children under 18 years old with a severe disability can get monthly SSI payments if their family income is low.

Disability Widow/Widower Benefits (DWB) – This type of benefit is available for individuals that are between the ages of 50-60, have become disabled within a fixed number of years after the death of a spouse, and have been married for 10 or more years to the person who had Social Security coverage at the time of his/her death.

Disabled Adult Child Benefits (CDB) – Eligibility for this type of benefit requires that you be the child of a person who is already receiving Disability Insurance (SSDI) benefits or Retirement Benefits, or who died while being covered for Social Security. Additionally, you must be 18 years or older to apply, and you must show that the parent’s disability is continuing and began before you turned 22 years old.

The Supplemental Security Income (SSI) program makes payments to people with low income who are age 65 or older, or who are blind or have a disability.  The basic SSI amount is the same nationwide. However, many states add money to the basic benefit. Whether you can get SSI depends on (1) your income, and (2) your resources.

 

1. Income

Income is money you receive such as wages, Social Security benefits and pensions. Income also includes such things as food and shelter you receive. For example, if you are getting free room and board from a friend, the value of that food and shelter could count toward income. The amount of income you can receive each month to still be eligible for SSI depends in part on where you live.

However, Social Security does not count all of your income when it decides whether you qualify for SSI. For example, the SSA does not count:

  • The first $20 a month of most income you receive;
  • The first $65 a month you earn from working and half the amount over $65;
  • Food stamps;
  • Shelter you get from private nonprofit organizations; and
  • Most home energy assistance.

If you are married, the SSA will also include part of your spouse’s income and resources when deciding whether you qualify for SSI. If you are younger than age 18, the SSA will include part of your parents’ income and resources. If you are a student, some of the wages or scholarships you receive may not count. And, if you are a sponsored noncitizen, the SSA may include your sponsor’s income and resources.

If you are disabled but work, Social Security does not count wages you use to pay for items or services that help you to work. For example, if you need a wheelchair, the wages you use to pay for the wheelchair do not count as income when the SSA decides whether you qualify for SSI. Also, Social Security does not count any wages a blind person uses for work expenses. If you are disabled or blind, some of the income you use (or save) for training or to buy things you need to work also may not count.

2. Resources

Resources that the SSA counts in deciding whether you qualify for SSI include real estate, bank accounts, cash, stocks, and bonds. You may be able to get SSI if your resources are worth no more than $2,000. A couple may be able to get SSI if they have resources worth no more than $3,000. If you own property that you are trying to sell, you may be able to get SSI while trying to sell it.

Social Security does not count everything you own in deciding whether you have too many resources to qualify for SSI. For example, it does not count:

  • The home you live in and the land it is on;
  • Life insurance policies with a face value of $1,500 or less;
  • Your car (usually);
  • Burial plots for you and members of your immediate family; and
  • Up to $1,500 in burial funds for you and up to $1,500 in burial funds for your spouse.

Other rules you must satisfy…

To get SSI, you must live in the U.S and be a U.S. citizen or national. In some cases, noncitizen residents can qualify for SSI.

You may receive SSI if you live in certain types of institutions, a publicly operated community residence that serves no more than 16 people, a public institution mainly to attend approved educational or job training to help you get a job, a public emergency shelter for the homeless, or a public or private institution and Medicaid is paying more than half the cost of your care. You usually cannot get SSI if you live in a city or county rest home, halfway house, or other public institution (but there are some exceptions).

In order to receive social security disability benefits, you must (1) have earned at least 20 Quarters of Coverage (QC) during the last 10 years, and (2) be “fully insured.” See below for more details. Exceptions apply for those under 31 years old and in certain other instances.

You must be considered “fully insured” under the Social Security program before you can receive SSDI.  The SSA considers the number of quarters of coverage (now also called “credits”) you earned to determine if you are insured. A Quarter of Coverage (QC) is a block of 3 months, so you can earn up to 4 QCs in one year. You need to earn a minimum amount of money to earn a QC/credit.

To be considered “fully insured” for purposes of eligibility for social security disability benefits, you need at least one credit (QC) for each calendar year between the year you turned 21 and the year you become disabled, turn 62, or the year before you die. Regardless of age, you need at least 6 credits (QCs) to be determined to be “fully insured.” Any year (all or part of a year) that was included in a period of disability is not included in determining the number of QCs you need. The maximum number of credits is 40.

If you are fully insured and have earned the 40 quarters of coverage, you earn the “permanently insured” status. Being “permanently insured” means you will not lose your fully-insured status when you stop working. If you are not “fully insured,” you are not eligible to receive benefits, but just being fully insured does not guarantee that you will received benefits of course, because that determination is also based on your disability.

EXAMPLE: If you were born in 1949 and worked under covered employment from 1971-77, you would have earned a total of 28 QCs (7 years x 4 QCs a year). You had already attained age 21 in 1970 when you worked those years.

Under this scenario, you were “fully insured” after you earned 6 QCs. You continued to be fully insured through 1998 (you turned 21 in 1970 and you earned 28 QCs, so 1970 + 28 QCs = 1998). After 1998, you were no longer fully insured. Because you earned only 28 QCs, you were never “permanently insured.”

For Social Security purposes, “disability” is defined as 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.” The determination must be based on medical evidence that describes the severity of the impairment. Sometimes the claimant’s work history is relevant evidence in a “disability” determination as well.

The SSA’s regulations provide for disability evaluation by a process called the “sequential evaluation process.” For adults, this process requires sequential review of the claimant's current work activity, the severity of his or her impairment(s), a determination of whether his or her impairment(s) meets or medically equals a listing (see below for information on Listings), the claimant's residual functional capacity, his or her past work, and his or her age, education, and work experience. For children applying for SSI, the process requires sequential review of the child's current work activity (if any), the severity of his or her impairment(s), and an assessment of whether his or her impairment(s) results in marked and severe functional limitations. If an adult or child is found disabled or not disabled at any point in the evaluation, the evaluation ends at that point.

5-Step Sequential Evaluation Process:

Step 1 – Are you working (engaging in “substantial gainful activity”)?

“Substantial” means doing work involving “significant physical or mental activities.” If you cannot handle simple, ordinary tasks without supervision or assistance, then your work activity may not be considered substantial. The analysis of “gainful” usually depends on earnings, although for self-employed claimants the analysis will change. In 2011, if you worked and your earnings averaged more than $1,000 a month, you generally cannot be considered disabled. If the SSA finds you are engaging in “substantial gainful activity,” you are not disabled. If the answer is no, you can proceed to Step 2.

Step 2 – Is your impairment “severe”?

For your impairment to be severe, your condition must interfere with basic work-related activities. Your condition may be physical, mental, or a combination of both. The duration of your impairment must either be expected to result in death or be expected to last for a period of twelve (12) consecutive months. If the SSA determines that your condition does interfere with basic work-related activities, the SSA will then proceed to step 3.

 

Step 3 – Is your condition in the Impairment Listings (a list of disabling conditions)?

The Listing of Impairments describes impairments that are severe enough to prevent an individual from doing any gainful activity for each major body system (or in the case of children under age 18 applying for SSI, severe enough to cause marked and severe functional limitations). The Listing of Impairments criteria apply to both the Social Security disability insurance program and the SSI program. If your condition is not found in the Listings, it still is possible that the SSA can find that your impairments, or a combination of them, are "equivalent" in severity to an impairment in the Listings. If your impairment is on the Listings or determined to be medically equivalent to a Listing, the SSA will find that you are disabled. If it is not, your claim is not over yet; you move on to Step 4.

Step 4 – Can you do the work you did previously?

If your condition is severe but not at the same or equal level of severity as a medical condition in the Listings, the SSA must determine if it interferes with your ability to do the work you used to perform. The SSA makes this determination by assessing your remaining ability to do basic work functions and comparing them with the demands of your recent past work. The SSA only looks at your past work that it considers relevant to this decision. This usually means work that (i) you did in the 15 years before your case is decided, (ii) involved significant and productive physical or mental activities that was done or intended for a profit, and (iii) was done long enough for you to learn how to do it. If the SSA decides that the past work you did is relevant, it then compares your current residual functional capacity for work with the demands of the past relevant work. If the SSA decides that you can still perform your past work in the same way you did it or in the same way it is done in the national economy, it will find that you are not disabled and your claim will be denied. On the other hand, if the SSA decides your condition does not allow you to do past relevant work that you did previously or as it is done in the national economy, your claim will proceed to Step 5.

Step 5 – Can you do any other type of work?

If you cannot do the work you did in the past, the SSA determines if you are able to adjust to other work. In making this determination, it considers your age, your medical conditions, your education, past work experience and your working capacity. If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied. The SSA relies on The Medical-Vocational Guidelines, which are tables otherwise known as "the Grids" to make this determination. The older you are, the better the chance you will be found disabled according to the Grids.

Absolutely not. The entire application process can be completed from your house (using the phone or internet).

One way you can apply for Social Security Disability benefits is to go to the Social Security District Office and file the claim in person. Alternatively, you can call Social Security at (800) 772-1213, where they will arrange a telephone interview with your local office and mail all necessary forms to you. Applications can also be filed partially online; just follow the straight-forward instructions on www.ssa.gov.

You can apply at any time. You can even file on the day you become disabled if you believe you’ll be unable to work for one or more years.

Generally after a claimant files a Social Security disability claim, there are five levels of review available for which a claimant can prevail:

1. Initial Determination: Once a claimant files a Social Security disability claim, the Social Security Administration (SSA) sends the case to a disability examiner in the state where the claimant is located. The examiner consults with a doctor, evaluates the claim, and makes the initial decision on the claim. A large majority of claims are denied at the Initial Determination level, but there are more opportunities for reversing this denial and have the claim accepted later in the process, as explained below.

2. Reconsideration: If the claim is denied, the claimant can appeal for Reconsideration. The Claimant must make his or her request in writing within 60 days from the date of receipt of the denial. At this stage, the claim is sent to a different disability examiner who did not take part in the initial determination. The new disability examiner will look at all the evidence submitted for the claim when the original decision was made, in addition to any new evidence submitted for the reconsideration.

Most reconsiderations involve a review of the files on record without the need for the claimant to be present. However, when a claimant appeals a determination that he or she is no longer eligible for disability benefits because their medical condition has improved, that claimant can meet with a Social Security representative and explain why they believe they still have a disability. Only a small percentage of claims denied at the Initial Determination are reversed at the Reconsideration Phase.

3. Administrative Hearing: If a claim is denied at reconsideration, the claimant may then request a hearing. It can take quite a long time to get a hearing date (it can take over a year), which is conducted before an Administrative Law Judge who works for the Social Security Administration. The Administrative Law Judge makes an independent decision upon the claim at the hearing; this Judge had no part in the Initial Determination or Reconsideration. The hearing is usually held within 75 miles of where the claimant lives. It is very important for claimants to attend their hearings. Claimants unable to attend in person should make arrangements for appearance by video well in advance.

Unlike regular court cases, the administrative hearing is not truly an adversarial proceeding. In other words, there is not another attorney arguing against you. The procedures are less formal than a typical court proceeding and the rules of evidence are not as strict as they are in civil court.

Before the hearing, the judge may ask the claimant for more evidence or for clarification regarding the claim. At the hearing, the judge may ask claimant questions, and also ask questions to any witnesses that are in attendance, as well as other witnesses such as a Medical Expert (ME) or Vocational Expert (VE). MEs review the records from doctors you have seen in the past and evaluate them to determine if you meet the criteria for disability, and VEs evaluate what kinds of work you can do. Your attorney can also ask you questions, and may ask questions to the VE and ME too. Your attorney might also directly answer questions asked by the judge.

At the conclusion of the hearing, the judge will either issue a decision on the spot, or the claimant will be notified of the decision in the coming months.

4. Appeals Council Review: If the administrative law judge denies a claim, a claimant may request a review by the Social Security Administration's Appeals Council. The Appeals Council reviews the record and will deny the request if it believes the hearing decision was correct. If the Appeals Council does decide to review a claim, it will either: (1) decide the case itself and reverse the administrative law judge's denial; (2) modify the judge's decision; or (3) return the case to an administrative law judge for further review (called a "remand"). If the Appeals Council returns a case to an administrative law judge, the SSA will send the claimant a letter explaining the decision, along with a copy of the order.

5. Appeals to the Federal District Court and Upward: A decision not to review, or a denial by the Appeals Council is still not the end of the road. After such a denial, a claimant has the ability to appeal this claim by filing a lawsuit in Federal District Court in the district where the claimant lives. The Federal District Court then can affirm, modify or reverse the decision of the SSA, including remanding the case for a rehearing.

If the Federal District Court affirms the ruling of the SSA, further appeals may be made to the United States Circuit Court of Appeals. A Circuit Court affirmation of the decision (in other words, the Circuit Court refuses to overturn the order) leaves only the remedy of fling a writ of certiorari with the United States Supreme Court, which asks the Supreme Court to review the case. Such a writ would be granted in very rare circumstances.

Unfortunately yes. Most claims are denied on initial review, and around 90% of those denied claims are then denied again on Reconsideration (the second stage of review).

But don’t be deterred! Most appealed claims with legal representation at the Hearing (the third stage of review) are ultimately approved. Be persistent!

A large number of claims are denied due to a lack of proof in individual medical records that shows the degree and consistency of the disabling medical conditions. It is important to remember that only your doctor’s medical charts and records, and not the doctor himself, will be present when Social Security makes its determination. As such, medical records must be extensive and detailed enough to overcome any medical inquiries conducted by Social Security. Unfortunately, doctors are often not trained to routinely record such extensive information, so medical records frequently lack credible documentation or a showing of regular medical treatment.

No, a claimant can represent himself through the entire process. However, legal representation is strongly recommended. The application and appeals process can be complicated and overwhelming, and often involves precise legal definitions and inquiries that must be responded to appropriately. Additionally, claimants with experienced counsel win much more often than unrepresented claimants.

It is recommended that you hire a legal representative as early as you can in the claim process, in order to help prepare for the initial filing/appeals and to ensure that all important information is correctly provided.

Normally cases are handled on a contingency basis, where representatives will only receive a fee if your case is won. The typical fee is 25% of your back benefits only, and must be approved by Social Security. If there are any incidental costs or expenses, you will always be notified in advance.

The important thing to remember is that you can get experienced legal aid even if you don’t currently have money.

Yes. You can receive disability benefits so long as you have been disabled or expect to be disabled for at least 1 year, so you should file for SS disability benefits even if you hope to eventually return to work.

Yes, so long as gross earnings are below a specified amount. If you experience medical improvement, unlimited earnings are allowed for up to 9 months while disability benefits will still continue under a Trial Work Period.

Yes. In fact, we recommend that you do not wait until Worker’s Compensation benefits end before filing for SS disability, because individuals have been able to receive payments under both programs in many instances.

Yes. In determining an individual’s disability, Social Security is actually required to consider how the combination of health problems affects the individual’s performance. It is not uncommon for a disability claimant to have multiple health issues and still be able to receive benefits.

No, disability benefits will not be approved if the individual’s only disability is drug or alcohol addiction. However, if an individual has other independent impairments that render him/her disabled when combined with the drug or alcohol addiction, then benefits may be awarded for those medical conditions, although payees may be mandated.

If you cannot work due to HIV or AIDS, you may be eligible for disability benefits. Like other disabilities, the evaluation will depend on whether your disability will last at least a year or end in death, and prevent you from engaging in substantial gainful work. Supplemental Security Income (SSI) is also available if your child has HIV or AIDS, depending on the same household income threshold as other SSI claim.

Yes, there are special social security disability rules for people who are blind or have impaired vision. The SSA considers you to be legally blind if your vision cannot be corrected to better than 20/20 in your better eye, or if your visual field is 20 degrees or less, even with a corrective lens. Many people who meet the legal definition of blindness still have some sight, and may be able to read large print and get around without a cane or a guide dog. If you do not meet the legal definition of blindness, you may still qualify for disability benefits if your vision problems alone or combined with other health problems prevent you from working.

Many special rules exist for people who are blind that recognize the severe impact of blindness on an individual's ability to work. For example, the monthly earnings limit for blind people is typically higher than the limit that applies to non-blind disabled workers. The monthly earnings limit in 2011 was $1,640.

Not necessarily. Social Security makes its own independent decision regarding disability status; your doctor’s opinion will be part of the evidence and will be considered by Social Security, but is not conclusive.

For Social Security Disability Insurance (SSDI), the amount you receive will be dependent on how much you have worked/earned in the past. Currently, the maximum amount a person can receive is above $2000/month and there is no minimum amount. Additionally, you will typically a receive a raise in monthly payments at the start of each new year due to increased cost-of-livings, and in most instances your children under 18 will get benefits separate from your own. On average, workers receive around $800/month.

If you are a disabled widow or widower, the amount you receive from SSDI will depend on how much your late spouse worked/earned.

If you are awarded Disabled Adult Child Benefits, the amount of monthly benefits is based on a percentage of your covered parent’s rate.

Depending on state, there is a base amount for all types of SSI benefits that an individual with no income will receive. If an individual has other sources of income, that income will reduce the amount of SSI benefits for that particular individual.

If you are awarded disability benefits or disabled widow/widower benefits, the cash benefit starts after a 5 month waiting period (i.e. on the 6th month after the individual becomes disabled). It is also important to note that benefits can’t be paid more than 1 year before the date of the completed application.

If you are awarded childhood disability benefits, the cash benefit starts as of the onset date. However, benefits cannot be awarded for more than 6 months before the date of the completed application.

If you awarded SSI, benefits start at the beginning of the first month following the date of the completed application.

Once the social security judge awards you disability benefits, it can take anywhere from one to two months for you to start receiving payments for back benefits, sometimes as much as 3 months. Every state has different average waiting times and each judge operates differently. If it takes longer than 3 months, there may have been a mix-up in the payment, so you or your attorney should follow up with the Social Security Administration. When Supplemental Security Income (SSI) is involved it can take more time.  Keep in mind that sometimes a judge will issue a ruling at the conclusion of your social security hearing, but often times the judge will wait weeks or up to 3 months to actually issue the decision.

As your attorney, all we can do is make sure that your claim is processed correctly so that no additional unnecessary delays take place. Because of the slow process, it is important not to needlessly delay getting started.

State Aid Programs while you wait

The waiting time for receiving social security benefits places many Americans unable to work in an extremely difficult situation. Please check with your state to find out what kind of general assistance programs are available.

Local state agencies provide Interim Assistance to social security disability applicants. The following link provides a state-by-state guide to such benefits: http://www.ssa.gov/policy/docs/progdesc/ssi_st_asst/. Through this program, you are basically advanced a modest amount of money by the state to help with your living expenses if it seems likely that you are going to receive social security benefits. The amount of any payments advanced through this program is then withheld when you are approved. In order to be eligible for such benefits, you have to apply for social security disability and meet all of the other public assistance criteria except for the receipt of SSI.

Depending on you or your family’s total income, SSDI benefits may be taxable. On the other hand, SSI benefits are never taxable.

Yes, Medicaid and Medicare are two distinct programs.

Simply put, Medicaid is a poverty program that grants poor and disabled individuals with medical assistance. Most individuals who receive Medicaid qualify for it because they are on Supplemental Security Income (SSI), thereby showing they are poor and disabled. Eligibility for Medicaid may be retroactive up to three months before the date of the Medicaid claim. Medicaid also includes some coverage for limited prescription medication.

Medicare, on the other hand, does not depend on an individual’s financial status. Individuals qualify for Medicare if they have been receiving Social Security Disability Insurance (SSDI) benefits, disabled widow/widower benefits, or disabled adult child benefits for at least 2 years. Medicare typically pays doctors at a higher rate than Medicaid, so nearly all private doctors will accept Medicare patients though not all will accept Medicaid patients. While Part A of Medicare is free, Part B has a standard monthly premium of $99.90 for 2012 and Part D has a monthly premium for prescription coverage.

Appeal immediately if Social Security is trying to end your disability benefits and you think you are still disabled! Sending an appeal within 10 days of being notified by Social Security will allow you to request that disability and medical benefits continue throughout the appeal process. It is also recommended that you speak with an attorney about representation.

Usually Social Security won’t require you to go to scheduled Government consultative exams. Consultative examinations are normally requested by Social Security only when your own treating physician fails to provide enough information regarding the impairment for which they are treating you.

Should Social Security request for you to attend a scheduled Government consultative exam, an attorney can best advise you on when you can appropriately decline to attend an examination request.