Social Security
Disability Benefits
When Is A Person
"Disabled" For Social Security Purposes? The essence of a
"disability" under Social Security rules is the inability to work.
Generally, if a physical or mental condition causes a person to be unable to do
any kind of work for which s/he is suited (given the person's age, education,
and work experience) and the disability is expected either to last for at least
one year or to result in death, then that person will be considered disabled for
Social Security purposes.
In deciding if an applicant is
disabled, the Social Security asks five questions:
- Is the applicant working?
- if so and his or her earnings average more than $760 per month, s/he
generally will not be considered disabled. (This is the amount you can still
make per month and not have a reduction in SSA benefits once you are on the program
too.)
- Is the applicant's
condition "severe"? - the
answer to this question depends on the extent to which the condition
interferes with basic work-r with basic work-related activities.
- Is the applicant's condition
found in SSA's list of disabling impairments? SSA keeps a list of
impairments that are so severe that they automatically warrant a finding of
disability.
- Can the applicant do the
work s/he did previously? -
if an applicant's condition is severe, but not as severe as any listed
impairment, the SSA must determine if the condition
interferes with the applicant's ability to do the work s/he did in the last
15 years.
- Can the applicant do any
other type of work?
- if the applicant cannot do the
work s/he did in the last 15 years, the SSA evaluates whether s/he can do any other type of work,
considering the applicant's age, education, past work experience, and
transferable skills.
What Benefits Are Available
For A Person With A Disability? Social Security administers four separate
benefit programs for individuals with disabilities - Social Security Disability
Insurance (SSDI), Supplemental Security Income (SSI), Disabled Widows and
Widowers benefits (DWB), and Disabled Adult Child Benefits (DAC). The medical
requirements to prove disability, as well as the process for making disability
determinations, are the same uns, are the same under each program. The primary
difference among the programs is that eligibility for SSDI, as well as the
calculation of benefits, is based upon the applicant's prior participation in
the Social Security system (i.e., working and paying Social Security taxes).
Eligibility and benefit calculation for SSI, on the other hand, depends upon
financial need. DWB and DAC benefits are based on the Social Security payment
record of another person: a deceased spouse for DWB, and a parent who is
deceased or receiving Disability or Retirement Insurance Benefits his or herself
for DAC.
A person who is eligible to
receive SSDI will automatically be enrolled in Medicare after receiving 24
months of benefits. Medicare has two parts - hospital insurance (which is free
for SSDI recipients) and medical insurance (which requires a monthly premium). A
person who is eligible to receive SSI payments qualifies for Medicaid.
What Steps Must A Person Take
to Obtain Disability Benefits? A person who becomes ill or injured and, as a
result, is unable to work should take the following steps to apply for
disability benefits:
1. Obtain appropriate medical
care for the illness or injury. Appropriate medical information documenting the
condition is essential.
2. File an application with any
Social Security office. Just when to file a claim can be a tricky question
because of the requirement of prequirement of proof that the disability must
prevent a person from working for at least one full year. Applications may be
filed by phone, mail, or in person. If the applicant has questions about
completing the application or about the claims process, it may be helpful to
consult with an attorney at Crowe & Shanahan, a law firm concentrating in
Social Security disability law.
3. The application will be sent
to a Disability Determination Services (DDS) office. Based upon the application
and available medical data, DDS will decide if the applicant qualifies. If the
information provided to DDS is insufficient, the applicant may be asked to
undergo an examination. Although DDS uses qualified physicians, these exams are
sometimes criticized for being quick and superficial, perhaps because DDS is
allowed to pay very little for them.
4. Once DDS makes a decision, SSA
will adopt that decision and the applicant will receive a written notice - if
the claim is approved, the notice will show the benefit amount and the month
payments begin; if the claim is denied, the notice will state why.
5. In most cases, an initial
claim for benefits is denied. Three levels of administrative appeal are
available:
- First, a request for
reconsideration - this will be decided by a different team than the one that
issued the initial determination. Very few reconsiderations result in a
different decision.
- If the claim is still denied,
the applicant may request a hearing before an administrative law judge (ALJ).
Although some people choose to have legal counsel from the initial filing of
a claim, representation by an attorney experienced in Social Security law is
most important at the administrative hearing.
- If the ALJ denies the claim,
the applicant may request a review by the Social Security Appeals Council.
After all administrative appeals
are exhausted, the claimant may file an action in federal court. The time limit
for each level of the appeal process, including administrative appeals and court
actions, is 60 days from the date the applicant receives an unfavorable
decision.
Applying for disability benefits
can be a frustrating ordeal, but it need not be overwhelming. Simply knowing
what to expect at each stage of the process and, where necessary, seeking the
advice of competent medical and legal professionals, can reduce anxiety - that
and a good dose of patience.
How
To Apply for Social Security - LINK to SSA Page
Some
Of The Information Contained Herein Courtesy
of Crowe-Shanahan Disability Law Group
