socialNsecurity Chap 14

Chapter 14

Frequently Asked Questions

(Most of these questions can be found at www.ssa.gov)

What is the legal definition of disability for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)?

The Social Security Administration defines disability 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 is expected to last for a continuous period of not less than 12 months."  

What is Social Security Disability Insurance, SSDI, Disability Insurance Benefits and DIB?

These are common terms for the Title II Social Security Disability program that provides monthly and Medicare benefits.  Generally, you must have worked five out of the last ten years, unless you are under 31 years of age, or are blind.

What is Title XVI or Supplemental Security Income benefits (SSI)?

These are monthly benefits and Medicaid paid to disabled individuals who are low-income individuals or families whether or not the disabled individual has worked in the past.  SSI child's benefits are paid to poor disabled children who are under 18 years old and to their parents or guardians. 

Who is eligible for Social Security Disability Benefits?

If you worked at a job for the required years covered under the Social Security Act, and become disabled, you may qualify for Social Security Disability benefits.

Your disability may be due to physical problems, emotional conditions, or both.  SSA grants benefits if you have a disability that is severe enough to keep you from working in any regular paying job for at least 12 consecutive months, or if your disability is one that can result in death.

Your doctor must state that you are disabled based on medically acceptable clinical and laboratory findings.  This means that the doctor must provide evidence to support the opinion.  Many disabling conditions are difficult to diagnose with laboratory findings.  In cases like that, it is your representative or attorney that must present your doctor's opinions and reports properly to persuade officials that you are entitled to benefits.

What is the process for determining whether I am disabled?

The Social Security adjudication process for deciding whose disabled contains complicated rules, law, program operating instructions, exceptions, court decisions and federal regulations.   

Can I apply for Social Security Disability or SSI?

Anyone may file for an application for Social Security Disability benefits, but SSA denies most applications.  Disabled claimants that are represented by experienced representatives win cases much more frequent than those who apply for benefits without professional assistance.   

SSA has complex, difficult and time-consuming rules and processes.  Even SSA cannot manage their disability process.  The Government Accounting Office (GAO) designated the Social Security Disability program as a high-risk program.  Forms are complicated.  Waiting times are long.  Decisions are often incorrect.  Records are lost or misplaced.  Appeals are rampant.  Judges are overworked.  Officials are frustrated benefits denied or delayed.  We want to increase your chances of winning your case and eliminate some of the stress connected with the process.   

How much money do I receive in monthly payments?

The monthly rate is based upon your previous earnings.  The more money you make, the higher the monthly payment to you.  The average Social Security Disability check is about $880 per month.  

When should I apply for Social Security Disability or SSI?

As soon as your doctor tells you that you have a severe disability that is expected to last for at least a year or a disability that may result in death. 

Can I work and receive Social Security Disability?

Yes, but you must immediately tell SSA about your work activities. There are special rules that govern work activities depending on whether you are a claimant or a beneficiary.   
Concerning collecting Social Security Disability Benefits (SSDI) and working, the rules are a bit complicated. They are often confused with the rules for individuals that are applying for benefits.
When applying for benefits, a person cannot engage in what is called “substantial gainful activity” (SGA). The definition of “SGA” is a certain amount calculated each year. In 2013, “substantial” was defined as $1,040/month or $1,740/month if the individual is blind.
When an individual is already on SSDI, the rules are a little different. A disabled individual can work after receiving benefits but there are certain restrictions. These restrictions include how much you can make and for how long.
For example, if at any point while receiving benefits, the disabled individual has earnings of more than $750/month, the recipient will be deemed to start what is called a “Trial Work Period”. The “Trial Work Period”” is a period where the Social Security Administration (SSA) allows the individual to make more than (or equal to) the $750/month but only for nine months.
After those nine months, the individual can work for another 36 months so long as he does not make more than the SGA amount for that year. If the individual makes more than the SGA amount, or works past the 36 months, the benefits will stop that month. SSA allows you to “reinstate” those benefits within five years if you stop working again because of your disability. To reinstate benefits within five years, the individual does not need to file a new application; he/she will just need to file for reinstatement.

Is my family entitled to Social Security Disability benefits?

Dependent children under 18, and those living with you who attend high school may be entitled to Social Security Disability benefits.

I receive Social Security Disability Benefits, but I cannot live on this amount.  Can I get more money from the state or Social Security?

Perhaps, if your monthly rate is below the state poverty line, you may be entitled to additional state funds. 

How long will I receive Social Security Disability Benefits?

Until the Social Security Administration completes a Continuing Disability Review (CDR) and finds evidence of medical improvement, or you regain your ability to return to work.

As a mother with children, I stay at home and have not worked in a few years; can I get Social Security Disability Benefits and/or SSI?

If you were employed five out of the last ten years under Social Security before becoming disabled, you have enough earnings for benefits.  If you are 31 years of age or less, the requirements are less since such individuals have not worked for a long time.  Unless an individual has been staying home and taking care of their children for a long time, it is possible that they will qualify for disability benefits based upon their previous earnings.  In addition, poor homemakers can qualify for Supplemental Security Income (SSI) even if he or she has never worked in the past.

I am presently collecting early retirement.  Does being disabled entitle me to collect some Security Disability Benefits and/or SSI?

Depends, but most likely, if it is proved that your disability began before you “elected” to retire; you may be entitled to benefits. 

How can I increase my chance of winning my Disability and/or SSI benefits?

Individuals who retain representatives with significant Social Security Disability experience are more likely to win than those without an advocate.  The Social Security Act permits both non-attorneys and attorneys to practice social security disability law and serve as representatives in proceedings before the Social Security Administration.  Attorneys are not necessarily better representatives than non-attorneys.  In fact, some easily confuse disability program expertise with the practice of law.  When selecting a representative, examine their background and disability expertise.  By hiring an advocate, you reduce the stress of dealing constantly with SSA and you increase the chance of winning. Usually, you pay no legal fees unless you win, and even then, the legal fee is limited to the amount approved by SSA.  Because most individuals are denied at the initial level, it is important that you immediately file an appeal to protect your status. Some claimants hire us from the start. Call us and have an experienced disability program expert or disability examiner evaluate your case. 

Does having a representative help my Social Security Disability and/or SSI case increase my chances of winning?

Absolutely, claimants represented by an experienced representative are more likely to win. A representative knows what evidence is needed for your case.  We get paid fees only if you win.  

Can I receive workman's compensation and Social Security Disability benefits?

The Social Security Administration reduces your disability benefits, if you receive worker's compensation benefits that are calculated into your claim, and it depends upon the type of worker’s compensation that you receive.

What diseases are considered for Social Security Disability benefits and SSI?

SSA considers all diseases and their disabling effects, the length of illness, and likelihood of improvement.  SSA considers learning disabilities and other neurological conditions.  It is important that your representative or attorney have experience handling the types of disabling problems that you may have. 

Must your condition be “permanent" to get Social Security Disability benefits and/or SSI?

No, if you are disabled for one year or more you may qualify.  The words permanent and temporary are terms of art for doctors and many programs.  It is possible to have a “temporary” impairment and qualify but it is also possible to have a “permanent” impairment and not qualify for benefits.

HOW DO I APPEAL A DENIAL OF BENEFITS?

To appeal a denial of an initial claim, complete Form SSA-561-U2 (Request for Reconsideration). If you are appealing the denial of disability benefits, you'll also need to complete Form SSA-3441-BK (Disability Report -- Appeal).

If you have been receiving disability benefits and you wish to appeal a decision to stop your disability benefits, you'll need to use a different form. In that case, you'll complete Form SSA-789-U4 (Request for Reconsideration -- Disability Cessation) and Form SSA-3441-BK (Disability Report -- Appeal).

The forms ask you for basic information, such as your name and Social Security number. You will also need to state the reasons why you think you were unfairly denied benefits. When you submit your form(s), you can attach other material for the administrators to consider, such as recent medical records or a letter from a doctor or employer about your ability to work. All of the forms are available at your local Social Security office or from the agency's website at www.ssa.gov.

If you are at this level of the disability appeals process, you know that the SSDI application process requires a lot of paperwork. Some of it may even seem duplicative. However, you can’t take shortcuts.

You can go online at the SSA Web site to request a hearing with an Administrative Law Judge, or print out the Request for Hearing form HA-501, available on the SSA site, and mail it to your local Social Security office. ODAR will also send you several forms for updating information on your medical condition. You will also need to fill out another work history document.

ODAR will notify you about 20 days before the date of your hearing. Considering the time it takes to get scheduled, it is very important to keep this date.

How Long Will It Take To Get A Hearing Before A Social Security Judge?

Applying for Social Security benefits is a journey, not an event. It may take a long time, but 95 of 100 applicants eventually receive benefits. The Office of Disability Adjudication and Review (ODAR) must assign your claim to a hearing office (HO) that is within 75 miles of your home. There are 143 HOs across the USA. A full list of HOs is posted on the SSA Web site that shows how each office ranks according to its processing time. Times vary from about 270 days to 635 days with an average waiting time of 444 days. Some claimants have waited over 5 years to get a hearing before an ALJ. The hearing can last from 10 minutes to 2 hours. The average hearing length is about 30 minutes. Claimants can wait 5 years to get a 15 minute hearing, and 2 months later get a letter notifying them that they did not win their case. Take heart. Be prepared to appeal. Always appeal. If you appeal, chances are overwhelming that you will win.

Will My Hearing Be Conducted By A Real Judge?

You have already received two denials from SSA via the State Disability Determination Service. Your hearing is an opportunity to meet a judge. It may be in person or through a specially arranged video conference. The ALJ may be in another city in another hearing office. The judge will appear on a television screen. You may have to testify in front of a video camera with only a clerk in the room to operate the camera and recorder. This is a special type of video conferencing.

Must I Have My Own Personal Doctor?

The opinion of your treating physician is entitled to controlling weight. It will decide whether you get paid, if it cannot be discredited. If you do not have your own doctor, then the consultative examiner’s opinion will control. A treating physician's opinion is accorded controlling weight only if the opinion is "well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in the case record." 20 C.F.R. § 404.1527(d)(2).

Should I Hire A Lawyer?

Yes, you need a lawyer. Any person who represents himself has a fool for a client. That is a very old and wise statement. Lawyers speak another language. They know the system and understand the process. An experienced lawyer has done this many times, you probably are doing this for the first time. The lawyer knows what to look for. Most lawyers will take you case on a contingency fee basis. If you do not win your case, they will not get paid. Also, the SSA will withhold up to 25% of any benefits you are entitled to receive in order to pay your attorney. You do not pay your attorney yourself. The SSA will do it for you.

 In this instance, what you do not know can and will hurt you. The appeals court will have little sympathy for you. If you through yourself on the mercy of the court, you will find that there is no mercy in today’s courts.

What is the difference between Social Security disability and Supplemental Security Income (SSI) disability?

 The Social Security Administration runs two major programs that provide benefits based on disability: Social Security Disability Insurance (SSDI) and SSI. SSDI is financed with Social Security taxes paid by workers, employers, and self-employed persons.

To be eligible for a Social Security benefit, the worker must earn sufficient credits based on taxable work to be "insured" for Social Security purposes. Disability benefits are payable to blind or disabled workers, survivors, or adults disabled since childhood, who are otherwise eligible. The amount of the monthly disability benefit is based on the Social Security earnings record of the insured worker.

SSI is a needs-based program financed through general revenues. SSI disability benefits are payable to adults or children who are disabled or blind, have limited income and resources, meet the living arrangement requirements, and are otherwise eligible. The monthly payment varies up to the maximum federal benefit rate, which may be supplemented by the State or decreased by countable income and resources.

Can I get both Supplemental Security Income (SSI) benefits and Social Security benefits at the same time?

Yes, many people eligible for SSI may also be entitled to Social Security benefits. In fact, the application for SSI also is an application for Social Security benefits. Eligibility for SSI depends on your income and resources, so if you receive a large Social Security check, you won't be eligible for SSI. However, if your Social Security payment is low and your overall income and resources are low, you might be eligible to receive an SSI payment to supplement your Social Security benefits.

What Is A “Compassionate Allowance”?

A Compassionate Allowance are a way of quickly identifying diseases and other medical conditions that qualify under the Listing of Impairments, based on objective medical information.

SSA implemented its original Compassionate Allowance initiative in October 2008. At that time, the list consisted of 50 conditions: 25 rare diseases and 25 cancers. Rather than waiting months, and often years, for a hearing, individuals with these conditions could qualify for expedited review and approval of their disability claims, sometimes in a matter of days.

I am receiving Supplemental Security Income. Can my children receive dependent’s benefits based on my benefits?

No. SSI benefits are based on the needs of one individual and are paid only to the qualifying person. Disabled children are potentially eligible for SSI, but there are no spouse’s, dependent children’s, or survivor’s benefits payable as there are with Social Security benefits. For more information, see our publication, Supplemental Security Income, available online at www.socialsecurity.gov/pubs. Simply type the title of the publication in the publication search box on the left side of the page. You also may want to read Understanding Supplemental Security Income (SSI), available at www.socialsecurity.gov/ssi/text-understanding-ssi.htm. For even more information, visit our website at www.socialsecurity.gov.

Is it true that if you have low income you can get help paying your Medicare premiums?

Yes. If your income and resources are limited, your state may be able to help with your Medicare Part B premium, deductibles and coinsurance amounts. State rules vary on the income and resources that apply. Contact your state or local medical assistance, social services, or welfare office, or call the Medicare hotline, 800-633-4227, and ask about the Medicare Savings Programs. If you have limited income and resources, you also may be able to get extra help paying for prescription drug coverage under Medicare Part D.

If I receive Supplemental Security Income (SSI) disability benefits, what is the effect on my benefits if I work? 

In most cases, your return to work would reduce your benefit amount. Unlike Social Security Disability (SSDI), there is no “trial work period” for people who get SSI disability benefits. If your only income besides SSI is from your work, you can earn up to $1,505 in a month (in 2013) before the Social Security Administration stops your payments. The agency has several publications about SSI, including Reporting Your Wages When You Receive Supplemental Security Income, available at socialsecurity.gov/pubs. Simply type the title of the publication into the publication search box on the left side of the page.

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