The law defines disability as the inability to do any substantial gainful activity due to a medically determinable physical or mental impairment, which can be expected to result in death or has lasted or can be expected to last for at least 12 months.
In addition, you must have an impairment, or combination of impairments, which makes you
Unable to do your previous job or
Any other substantial gainful work (usually full-time work) which exists in the national economy.
To determine if you can do any other work, the Social Security Administration will consider your age, education, and past work experience.
The Social Security Administration also requires a person to have a sufficient work history to qualify for Social Security Disability benefits.
For most persons (those at least 31 years old) this means that in the 10 years prior to the beginning of his / her disability, there must be sufficient earnings in at least 5 of those years.
This is because Social Security Disability Insurance (SSDI) benefits are "earned" with the contributions applicants have made through their Social Security taxes. Some blind applicants do not need to meet the recent work test.
Supplemental Security Income (SSI), on the other hand, is a needs-based program that helps disabled people with low income and few resources.
When should I file? Am I required to wait a certain amount of time before I can file for Social Security Disability benefits?
You can file for Social Security Disability benefits immediately after becoming disabled. But to qualify for benefits, you must be disabled, or be expected to be disabled, for a minimum of 12 consecutive months.
So it may not be a good idea to file an application for benefits as soon as you become unable to work because it may be difficult to prove that the disability will last for at least one full year. The initial decision can take several months.
If your claim is denied — which happens in a large majority of cases — the time it takes to appeal can last a year or longer, depending on where you live and the hearing office. If you think you may be out of work at least a year, you shouldn’t wait too long to start.
What kind of evidence do I need to supply to Social Security?
Social Security will need to get copies of your medical records to make a decision about your claim. If you have or can readily get copies of your records, bring them with you when you file your application.
Any records you do not have available will be requested directly from your doctors, and other treating sources.
You may also be called upon to discuss your formal education and work history for the last 15 years, including the duties and responsibilities you had on your jobs. You will need to provide your birth certificate and military record, if any.
The Social Security Administration may also have you evaluated by one or more of their physicians, or a psychologist if appropriate.
If you are filing for SSI, you will be asked about other information concerning your income and things you own, as well as your living arrangements.
You may also be called upon to complete additional forms concerning your daily activities, pain level, etc. Your family members may also be requested to fill out forms concerning your daily activities.
Following the receipt of the application, a federal Social Security Administration representative will review the information.
If the representative is satisfied that the application meets certain basic criteria, the application and evidentiary materials will be forwarded to a state agency that is charged with making a decision regarding the disability benefits application.
The state agency may develop the file further by gathering more medical or vocational evidence.
Social Security uses a five-step process to determine whether the applicant should receive benefits, asking:
Whether the applicant is working
Whether the medical condition is severe enough to render the applicant disabled
Whether the impairment is on a government list of impairments granting automatic disability status (if the impairment is not on the list, that does not necessarily disqualify the applicant)
Whether the applicant can do the work he or she did before
What other types of work the applicant can to do
The state agency will return the file to the federal Social Security Administration with its recommendation. The SSA almost always adopts the state agency's disability determination.
After considering all other eligibility questions, the SSA will mail the applicant a notice of its decision.
If your claim is denied or you disagree with any part of the decision made by the Social Security Administration, you may appeal that decision.
There are various levels of appeal. You usually have 60 days from the time you receive the decision to file an appeal to the next level. If you do not file a timely appeal, you may be waiving some of your rights.
Eventually, you will have a hearing before an Administrative Law Judge where testimony is taken and the medical evidence is reviewed.
Remember, you may hire an attorney at any level of the decision-making process, and an attorney’s assistance can be valuable at every level of the application process, particularly once a case reaches the appeals process
But why would my claim be denied in the first place?
Every case is different and there can be many different reasons why Social Security has denied a claim.
But many claims are denied because medical evidence wasn’t obtained by Social Security or because it did not give a medical condition the proper consideration.
Your attorney’s job is to help ensure that all relevant medical evidence is obtained and that all medical conditions that affect an individual’s ability to work are considered.
This may also involve taking steps to obtain information from family members, friends, former employers, and others who know you best and understand how you are affected by your medical condition and can help to show how your life has changed.
If my claim for Social Security Disability is approved, when will I receive benefits?
If your application is approved, you will receive your first Social Security benefit check for the sixth full month following the date the Social Security Administration determines your disability began.
For example, if your disability began on June 15, 2013, you would be paid for the month of December 2013, the sixth full month of disability. Social Security benefits are paid in the month following the month for which they are due.
This means that benefits due for December 2012 would be paid in January 2013.
Applicants may be eligible to receive retroactive payments for the 12 months prior to the application date, minus a five-month waiting period.
Since claims may take time to be reviewed and approved, back pay is often awarded to applicants for the time period between application and approval. This is usually paid in a lump sum, unless the payments are significant.
How much can I expect to receive after approval for Social Security Disability benefits?
Disability insurance benefits are based on past wages and the amount of time worked. Monthly SSI disability benefits are set by federal law and are increased each January to account for a rise in the cost-of-living.
Benefit calculators, available on Social Security’s website, “SSA.gov,” can help applicants estimate their potential benefit amounts. Benefits generally range from $500 to $2,000 per month, with the average monthly payment over $1,100.
If you have children under the age of 18 years, you may be eligible to receive additional monthly benefits for them. You are also entitled to Medicare Benefits beginning twenty-four months after the first month for which you receive a payment for disability.
After our initial consultation with you, we will be able to give you an idea of what your benefits are likely to be.
Can I receive Social Security Disability along with other benefits, such as Workers’ Compensation or Long-Term Disability?
Absolutely. Your eligibility for Social Security Disability is not affected by any other benefits you may receive.
If you are disabled you may also be entitled to Workers’ Compensation, Long-Term Disability or some other disability pension, State Employees Disability, No-Fault and company or union pensions, private disability insurance payments, and more.
However, the interplay between these different sources is complex and confusing, and some of these other benefits may offset the total payment amount of your Social Security Disability benefits.
If I am approved, how long will my Social Security Disability benefits last?
Your Social Security Disability benefits will last as long as you are disabled and unable to return to work. Social Security will periodically monitor your condition, and you are required to notify the SSA if your condition improves.
Do I need to have representation to win my disability case?
You are not required to have representation when applying for Social Security Disability or Supplemental Security Income; however, it is highly recommended.
The Social Security process can be complicated and frustrating, and individuals who do not hire an attorney can make mistakes without knowing or even miss important deadlines. Retaining a Social Security attorney may increase your chances of filing a successful claim.
With very rare exception, cases are handled on a contingency basis. This means that a fee is charged only if the claim is successful and benefits are paid.
Fees are regulated by Social Security and prior approval is required before an attorney can collect a fee. It is always wise to talk about fees with the attorney during your first conversation if you decide you want the assistance of an experienced lawyer.
Can I receive both Social Security Disability Insurance benefits and SSI?
If you are receiving a small enough amount in Social Security Disability benefits, you may also qualify for SSI.
Effective from January 1, 2017, the maximum federal SSI payment for an individual is $735 per month and for a couple is $1,103 per month; however, some states will supplement the federal SSI payment.
In general, the amount of SSI benefits you receive will be based on the amount of income you earn. If your countable income is over the allowable limit, you cannot receive SSI benefits; however, some of your income may not be considered “countable income” for the SSI program.