Nicholas C. Howie - Licensed in MA & NH
SSDI
Social Security (SSI & SSDI) Claims & Appeals
 
What is the difference between Social Security disability and SSI?Social Security disability (SSDI) is awarded to disabled people who have generally worked five of the past ten years and have paid a Social Security tax on their income. The work requirement can be waived for applicants under age 22.Supplemental Security Income (SSI) payments are made on the basis of financial need to adults and children who are disabled, blind, or have limited income and resources. Whereas Social Security disability (SSDI) is funded from the Social Security tax, Supplemental Security Income (SSI) is financed by general tax revenues.Should I apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)?Social Security Disability Insurance (SSDI) is meant for disabled people who are “insured,” which means that you have worked long enough and have paid Social Security taxes. To qualify for Social Security disability benefits, the Social Security Administration states that you must have earned 40 work credits, 20 of which must have been earned in the last five years. However, younger workers can qualify with fewer credits. Usually, if you are working full-time, you can earn up to four credits per year. Thus, you must have worked at least five of the last ten years in some kind of full-time work, unless you are under age 31.Supplemental Security Income (SSI) offers benefits based on financial need and does not have any employment requirements. SSI benefits are paid not only to disabled people who do not have much income, but also to blind and disabled children. To qualify for SSI benefits, you must meet the criteria outlined by the Social Security Administration (SSA). The amount you receive for SSI is determined by Social Security, but the income requirements depend on the state in which you currently reside.Can SSI/SSDI benefits be paid retroactively?In the case of Supplemental Security Income (SSI), there is no truly retroactive payment. Individuals who are approved for benefits can only receive payments going back to the initial date of application, regardless of the date of onset and duration of disability. Because many SSI cases become quite lengthy (routinely taking up to several years), a claimant can be reimbursed for payments they would have received during the time of the approval process.For Social Security Disability Insurance (SSDI) cases, those approved can be awarded back payments for up to twelve months prior to the date of application if it is determined that they were disabled for that entire length of time. Even if the duration of an individual’s disability extends back further than that, the SSA will not reimburse people for more that one year prior to their initial application date.If you are currently involved in an appeal for SSI or SSDI and are unsure if you will be awarded the appropriate back pay, contact a qualified Social Security lawyer now.SSDIIf my doctor says that I am disabled, does that automatically qualify me for disability Benefits?Even if your physician states that you are disabled, it is important to remember that Social Security has a very strict definition of disability. Accordingly, you cannot obtain disability benefits solely on the basis of your doctor’s report.Why is there a waiting a period for Social Security disability Benefits?The Social Security Administration (SSA) has instituted a five month waiting period to ensure that benefits are not paid to people with short-term disabilities. The SSA will award disability benefits only for total disability and only after you have shown that you have been disabled for at least five complete calendar months. Benefits will be paid on the sixth full month after the onset of disability. You will not be entitled to any benefits during the waiting period.How does Social Security define Disability?Social Security has a very strict definition of “disability.” To be considered disabled in accordance with the guidelines set forth by the Social Security Administration (SSA), you must meet the following criteria:
  • You cannot perform your previous occupation
  • You cannot adjust to other work because of your medical condition(s)
  • Your medical condition(s) must last or be expected to last for at least one year and/or to result in death
What are the requirements for SSDI?The qualifications for Social Security Disability Insurance (SSDI) are more rigorous than those for SSI. To qualify for SSDI benefits, you must meet all of the following criteria:
  • Worked in a job covered by Social Security
  • Worked in that job for 5 of the past 10 years
  • Have a medical condition that prevents you from working and renders you disabled (according to SSA’s definition of “disabled”)
The most common factor that disqualifies SSDI applicants is not having worked five of the last ten years. However, even if you do not meet the Social Security’s requirements for SSDI benefits, you may still be eligible to receive Supplemental Security Income (SSI).I don’t understand the work requirements for SSDI. What are work credits?In order to qualify for disability benefits, Social Security usually requires you to have worked at least five of the past ten years. The Social Security Administration awards you work credits when you are employed in a job and pay Social Security taxes. These credits are based solely on earnings and are used to assess your eligibility for disability, retirement, and survivor’s benefits.For 2009, you will obtain one credit for every $1090 of earnings, with a maximum of four credits awarded per year. The credits earned remain on your Social Security record even if you change jobs or remain unemployed for some time.What is the earliest age that I can collect Social Security disability?Social Security has a very strict definition of “disability.” To be considered disabled in accordance with the guidelines set forth by the Social Security Administration (SSA), you must meet the following criteria:
  • You cannot perform your previous occupation
  • You cannot adjust to other work because of your medical condition(s)
  • Your medical condition(s) must last or be expected to last for at least one year and/or to result in death
How long do I have to work to qualify for Social Security Disability?The amount of work necessary to qualify for disability benefits depends on your age. Social Security quantifies your work history in terms of work credits. Usually, you need 20 work credits earned in the last 10 years.However, younger workers can qualify for disability benefits with fewer work credits. If you become disabled before age 24, you must have earned 6 credits in the three years prior to the onset of your disability. If you become disabled between age 24 and 31, you need credits for half the time between age 21 and the onset of your disability. For example, if you become disabled at age 29, you would need four years of prior work, or 16 credits.How long does the application process for disability benefits take?In the past year, the number of applications for Social Security disability benefits has skyrocketed. This has led to an increase in application volume and longer wait periods. The Social Security Administration (SSA) states that you will be notified of a decision within 3 to 5 months of the application date.Despite the statements of SSA, very rarely does the application process take less than 6 months. If you do not complete the application properly, or do not have your medical records in order, it may be up to one year before you receive a decision.However, a qualified disability advocate can assist you in completing the application properly, gather and organize your medical records, and sometimes even expedite the application process so that you receive a decision within a couple of months.What are my chances of being approved for Social Security disability benefits?Unfortunately, because of the vast influx of new applications and the economic uncertainty of Social Security, over 60% of disability applications are denied at the Initial Stage. Even if you suffer from a disabling condition that prevents you from working, you will most likely be denied disability benefits when you first apply. Further, 86% of those who appeal their denials and seek Reconsideration are again denied, while 37% of those who request a hearing before an Administrative Law Judge (ALJ) are also denied.There are many reasons why the Social Security Administration (SSA) denies claims for disability benefits. Some of these include:
  • Claimant currently working
  • Not enough medical evidence of a disabling condition
  • Claimant does not regularly treat with a physician
  • Application not completed properly
The most effective way to find out whether you qualify for disability benefits is to seek the assistance of a qualified disability advocate/attorney. A qualified disability advocate/attorney can assess the merits of your claim and tell you whether you have a reasonable chance of obtaining benefits. In addition, disability advocates and attorneys can ensure that all documents are completed properly and that enough medical evidence of your disabling condition exists. Legal representation is not required to file a disability claim, but statistics tend to favor those who have representation. In fact, some disability law firms and advocacy groups obtain benefits for over 90% of their clients.What are various application stages for disability benefits?There are four stages for SSDI and SSI applications: Initial, Reconsideration, Hearing, and Appeals Council.Stage 1: InitialWhen your first apply for disability benefits, you complete an Initial application. This can be filed at your local Social Security office, over the phone or online. Rarely, your application will be approved at the Initial stage. More likely, your application will be denied and three options remain: do nothing, file a new Initial claim, or file a Request for Reconsideration (recommended).Stage 2: Request for ReconsiderationIf your Initial application is denied, you have 60 days from the date of denial to file a Request for Reconsideration (Recon). At this stage, your claim is reviewed again by Social Security. If your Recon claim is approved, you will receive disability benefits. If not, three options remain: do nothing, file a new Initial claim, or file a Request for Hearing (recommended).Stage 3: HearingWhen your Request for Reconsideration is denied, you again have 60 days from the date of your most recent denial to file a Request for Hearing. You have the greatest chance of being approved at this stage. The hearing takes place before an Administrative Law Judge (ALJ) and claimants will receive a Notice of Hearing approximately 30 days before the hearing date. The hearing usually takes place at your local Office of Disability Adjudication and Review (ODAR). While legal representation is not required for the hearing, it is highly recommended. A qualified disability attorney/advocate can present and defend your case in the most favorable manner. Going to a hearing without adequate representation is not a good idea.Step 4: Appeals CouncilYou will usually receive a decision from the ALJ within a few months after your hearing. If your claim is approved you will receive both a Notice of Decision and a Notice of Award. If your claim is denied, you can appeal the decision before the Appeals Council. However, the Appeals Council frequently upholds the decision of the ALJ. At this point, you may wish to seek the assistance of a qualified disability attorney/advocate and file a new Initial claim.Who decides whether I am Disabled?All Initial and Reconsideration filings are reviewed by Disability Examiners. Disability Examiners work for state agencies collectively referred to as Disability Determination Services (DDS). These examiners must determine the medical eligibility of disability claimants. DDS examiners are not federal employees, but since they are government workers, it is not surprising that they deny the majority of claims at the Initial and Reconsideration stages. By contacting DDS, you can speak to the Disability Examiner who is assigned to your case. However, it is highly recommended that you do not contact DDS directly, but rather have your disability attorney contact them on your behalf.At the Hearing stage, your claim is reviewed by an Administrative Law Judge (ALJ). The hearing tends to last slightly less than one hour and the atmosphere is casual. During the hearing, the ALJ will review the claimant’s entire Social Security file, which is called the exhibit file. The ALJ may defer to expert testimony provided by medical and vocational experts, but will also permit the claimant to present new medical evidence that may not be contained in the exhibit file. Rarely is a decision on the matter made in the claimant’s presence. Instead, the claimant will receive a Notice of Decision, which contains a detailed report of the ALJ’s findings, a few months after the hearing. Again, you should not attend the hearing without the representation of a disability attorney/advocate.Can a person who attends a rehab clinic qualify for SSDI?Attending a rehabilitation clinic should not automatically disqualify you from receiving SSDI benefits.The Social Security Administration does require, however, that your disability be classified as “permanent,” meaning that it must be expected to last more than 12 months and it must interfere with your ability to complete basic work related activities.If your rehab program gives the SSA reason to believe that you will be able to obtain gainful employment within 12 months, or your condition improves to the point that an SSA medical examination determines you are fit to work, you may lose your benefits.If you’re currently enrolled in a rehabilitation program and have been denied SSDI, or you are considering applying for the first time, contact a qualified Social Security lawyer now.Can I qualify for SSDI if I have another source of benefits (Social Security, private pension, workers comp., etc.)Social Security Benefits such as SSDI can be reduced if you become eligible for other benefits programs such as worker’s compensation, or even certain federal, state, and local government aid programs. However, the total combined payments after such a reduction should never be less than the original amount of the SSDI payment, so a person’s net payments should remain the same.Also, receiving a private pension from work on which you did NOT pay Social Security taxes (such as civil-service or nonprofit work) can reduce your level of SSDI benefits. If your SSDI benefits are already set up to compensate for such a pension, be sure to notify the SSA immediately of any changes as they occur as you will be responsible for repaying any money you receive in error.If your disability payments have been wrongfully reduced or denied due to supplemental income, contact a qualified Social Security lawyer now.How do Military Retirement benefits or VA disability benefits affect eligibility for SSDI?Because the Social Security Administration (SSA) is a completely separate entity from the Department of Veterans Affairs (VA), it is possible to receive benefits from both organizations concurrently. In many cases, however, even veterans receiving 100% disability benefits from the VA are denied by Social Security, so it is always advisable to seek legal counsel before proceeding with an application.Unlike SSI (Supplemental Security Income), Social Security Disability Insurance is not need-based, but rather based upon an individual’s capacity for gainful employment. Therefore, receiving military retirement benefits will not affect a candidates eligibility for SSDI.If you are a disabled veteran receiving military retirement or VA disability benefits and you are considering applying for SSDI, contact a qualified Social Security lawyer now.SSICan I obtain Social Security retirement benefits and Supplemental Security Income (SSI)?Depending on the amount of your Social Security retirement benefits, you may qualify to receive additional funds through SSI. However, your SSI benefits depend upon the state in which you reside. Also, receiving SSI may allow you to obtain food stamps, Medicaid, and other forms of state/local aid.What are the requirements for SSI?Supplemental Security Income (SSI) differs from Social Security Disability Insurance (SSDI) in that SSI payments are made from the general funds of the United States Treasury whereas SSDI benefits are paid from the Social Security Trust Fund. Accordingly, no previous work history is required. To qualify for SSI benefits, you must have little or no income and meet any of the following three criteria:
  • Age 65 or older
  • Blind
  • Disabled (according to SSA’s definition of “disabled”)
Does receiving Social Security Retirement Benefits affect SSDI/SSI?If you are receiving Social Security Disability and reach full retirement age, the full amount of your benefits will be transferred from SSDI to Social Security Retirement.If you are receiving Supplemental Security Income and are over the age of 62, you may be able to receive Social Security Retirement benefits in addition to your SSI if you have worked and paid into Social Security long enough to be eligible.If you are receiving SSI and are approaching retirement age, it is always a good idea to contact a qualified Social Security lawyer to review your options.What is an RFC?RFC stands for “Residual Functional Capacity” and refers to the maximum you can do in spite of your physical/psychological impairment(s). Social Security assesses residual functional capacity on a case-by-case and only after all medical records are examined. The Social Security Administration (SSA) must organize your complete medical history. In addition to the reports submitted by your own physicians, you may be asked to undergo a consultative examination by a doctor who works for Social Security.The purpose of residual functional capacity is to identify how your current limitations prevent you from meeting the physical, sensory, mental and other requirements of the workplace. The residual functional capacity (RFC) questionnaire is usually completed by a DDS (Disability Determination Services) physician. Unfortunately, RFC forms completed by DDS doctors are often written to ensure that the claimant is denied disability benefits.In response to any of the questions listed below, it is best to consult Attorney Patrick Shanley for case specific answers, but for general questions, responses follow:Question 1: At what point would a person be viewed as eligible to receive SSD or SSI benefits?Answer: To be viewed as eligible to receive SSD or SSI benefits, a person must be considered disabled.  The disability can range from that being physical, psychological, medical; and it must be one that is so severe, the person is not able to work or earn above a certain limit within a twelve (12) month period. If this criteria is met, then it is possible that the person would be considered disabled and may be eligible to receive SSD or SSI benefits.Question 2: At what point would a person apply for SSD or SSI benefits?Answer: If a person is suffering from any of the above mentioned disabilities and these impairments are keeping the person from maintaining a steady job and income, then the person should apply to try to receive SSD or SSI benefits.Question 3: How does a person go about applying to receive SSD or SSI benefits?Answer: To apply for SSD or SSI benefits there are three different options: a person can call the local Social Security office and request an appointment for an interview, the person can fill out an application online or the person can go into the local office and wait to speak with someone directly.  Through our experience, we have found that calling the Social Security office is most efficient.Question 4: How is it determined whether or not a person qualifies for the SSD or SSI disability claim?Answer: The key determining factor is medical evidence which supports the person’s claim.  It is very important that all medical history, doctor’s visits, reports, exams, and testings be listed in as complete a manner as possible.  The examiner has to see that there is proof behind the claim being made or else it is likely the case will be denied right away.Question 5: What type of information is gathered to examine and ultimately decide the disability benefit claim?Answer: There are various types of information gathered to aid in deciding whether a person will qualify to possibly receive the benefits.  Information can be in the form of a doctor or primary physician’s recommendation, medical files, any notes regarding recent blood work, tests, x-rays or scans that have been done and completed.Question 6: What is the length of time expected before a decision is made on SSD or SSI claim for benefits?Answer: This is a complex question because there is no specific time frame.  The length of time is typically case specific, but generally can take anywhere from 30 days to 3 years.Question 7: If it so happens that a person gets denied on either the SSD or SSI benefits claim, what can the person do?Answer: If a person is denied on either SSD or SSI, it is crucial the person appeal in a timely fashion, no later than 60 days after the initial denial.Question 8: If a person was to appeal a denied claim, how would the person go about doing so?Answer: To appeal a denied claim, it is important to call the local Social Security office as soon as possible.  Once a person has put in a request for an appeal, the form along with all paperwork will be sent out in the mail.Question 9: How long is expected for an appeal to take on a SSD or SSI claim?Answer: Again, this is a complex question because there is no specific time frame.  The length of time it could take is typically case specific, but generally an appeal can take anywhere from 6 months to 2 years.Question 10: Would there be more than one appeal necessary, i.e.: SSD and SSI or just one of the two?Answer: Just one appeal would be necessary, but be aware that in the majority of cases, a claim that was denied to begin with, will more than likely be denied on the first appeal as well.Question 11: How can a person financially stay afloat when waiting for SSD and SSI to be finalized?Answer: The answer to this question isn’t a simple one.  By the end of the appeals period, a person could be over a year and a half out, which means a very sticky financial situation for most, or for some it might be nonexistent.  It is important to get all affairs in order beforehand, try to settle up on any outstanding bills or debts and it is key to not make any sudden impulse buys.Question 12: Can a person seek outside financial assistance while waiting for the SSD or SSI  case to be decided?Answer: A person could try to seek additional resources like food stamps, or other public types of assistance.  It is important to make sure to take care of any debts or outstanding balances and more importantly, to not incur any additional financial issues while waiting for this process to finalize.Question 13: Can a person try to seek employment while waiting for a decision to be made on the SSD claim?Answer: A person can try to seek employment without fear of that interfering with the decision for or against approval of the SSD claim.  The person just has to make sure that if they find employment, the monthly pay cannot be greater than $900.00 or that is a disqualifier.Question 14: Would an attorney help my chances of winning the disability case?Answer: It isn’t mandatory to get an attorney to assist in the process and by having one doesn’t necessarily mean that the person will for certain win the case, but the chances of getting all paperwork in and making deadlines is increased when hiring someone that knows what he or she is doing.Question 15: What are the advantages to having an attorney represent me in my disability case?Answer: Attorney’s who deal in this area on a daily basis have a greater understanding of how the process works, from start to finish.  An attorney is aware of deadlines, the appeals process, the paperwork involved, and so forth, which can help make it an easy process for the client.Question 16: What are the attorney’s fees in regards to a SSD or SSI claim?Answer: Most attorney’s do not make anything unless they win the case for the client.  If the attorney wins the case, they usually get 25% of the total amount.Question 17: What can someone do on their own accord to help their case?Answer: There are a few important matters that people can stay on top of, in an effort to help the case.  It is always important to make sure that throughout the entire process, all deadlines are kept and met.  People should be aware of the status of the claim, and this can be done by  placing calls to Disability Determination Services and speaking with the person assigned to the specific case.  It is also important to keep the attorney updated with any new medical appointments, treatments, doctor recommendations or such things as personal changes in address or phone number.Question 18: What are the differences between SSI and SSD?Answer: SSI stands for Supplemental Security Income and it helps to supplement an income for those elderly or disabled people who can’t work or those who earn very little money.  SSD is Social Security Disability, this is for those who have been deemed mentally or physically challenged by a physician. The disability or impairment must last more than twelve (12) months and the person must have worked within the last ten (10) years.Question 19: What can a person expect to receive if their SSD case is won?Answer: Typically, if a case is won, a person can expect to receive a monthly stipened which for SSD cases, it depends on what the person’s income was when they were working.  In an SSI case, the government already has a fixed rate set.  A person can expect that the predetermined rate will be adjusted on a yearly basis.Question 20: Can a person expect to be contacted should they win their claim?Answer: A person can expect that if they win the case, they will receive a written notice from the Social Security Administration detailing the monthly benefit that the person can expect to receive and if at all, any back pay they might have qualified for.Question 21: Should a disability case be won, what is the time frame for receiving the benefits?Answer: There is no set time frame in which a person can expect to start receiving the benefits, but there have been ranges from sixty (60) days to a couple months
.Question 22: What makes someone eligible for back payments, and how are they dispersed?Answer: It depends where the benefits are being taken from and how much a person may be entitled to receive.  If the backpayment is less than $6,000, then a person may receive it in one check, but if it is more than the $6,000, then it is possible the payment would be made in 2 or more installments.Question 23: Should the disability case be won, what is the time period in which one can continue to receive the benefits?Answer: Again, this is another tough question because there is no specific answer.  It is common though that if a person has been approved to receive disability benefits, it is difficult to put a stop to those as long as the person’s medical records show no improvement in the mental or physical condition.Question 24: Should a judge deny my SSD claim, what are the next steps in the process?Answer: If a judge denies the SSD claim, a person can either appeal the ruling to the next level of the Appeal’s council or start over by filing a brand new claim with the Social Security Administration.  With either option listed above, it would be best to contact an attorney to help represent you with this matter.