Disability can strike anyone at any time. You can be taken down by disease, illness or injury and find that your ability to work has been significantly impeded or rendered impossible. As if that weren't enough, disability also comes with the stress of being unable to provide for yourself and your family. If you live in the United States, you may be entitled to disability insurance, provided that you satisfy the Social Security Administration's (SSA) key requirements. Here we'll take a look at some of the basics of filing a disability claim.
Types of Disability Claims
There are two types of claims that you may be able to pursue if you have a disability and are unable to work:
- Social Security Disability Insurance (SSDI)
Potential recipients of SSDI are those who have worked for a number of years and have contributed to the Social Security trust fund through payroll taxes. In order to qualify for SSDI, you must be under 65 and meet the strict criteria for being categorized as disabled. The payments awarded by SSDI allow disabled workers to cover food, clothing and shelter, as well as necessary medications. On average, most people who claim SSDI will receive half of their pre-disability earnings, amounting to around $1,100 for individuals and $1,900 for families. There is also a five-month waiting period for benefits, so even if you qualify you will not receive benefits right away. The amount you receive after this waiting period is over depends on the tax contributions made from your earnings.
- Supplemental Security Income (SSI)
This program is for low-income seniors (aged 65 and over), those who have never worked or have not earned enough to qualify for SSDI, and severely disabled adults and children. SSI is means-tested and is decided purely on financial need. The average payout is $500 per month for individuals. All SSI claimants must meet strict income and asset limits, which will vary from state to state. In general, an individual must have less than $2,000 in assets ($3,000 for a couple) and a very small income. If you are entitled to SSI, you will usually also be entitled to Medicaid. There is no waiting period for SSI claimants; benefits will begin on the first day of the month after you submitted your application.
When Should I Make a Disability Claim?
Social Security disability claims are prone to inordinate delays, although the benefits may be paid retroactively. That means that you should make a claim as soon as you sustain a debilitating injury or become aware that you will be unable to work. Visit your doctor’s office or a hospital as soon as possible and obtain proof of your disability as well as a copy of your medical records.
You can also make a claim online by filling out the standard application form. The information that you will need to have handy includes:
- Social Security number
- Birth certificate
- Medical records including names, addresses and dates of all medical visits
- A list of all current medication
- A summary of recent work
- Your most recent W-2 or tax return
- Details of your bank accounts
The whole application process can be dealt with conveniently online from the comfort of your own home, but you can also send in your benefits claim by post or leave it at your local Social Security office or State Disability Insurance agency.
What Happens after I Apply for Disability Benefits?
Although the application process can, in theory, be completed without too much interaction between the claimant and Social Security office, this is highly unlikely. When your application is received, the claims representative will either arrange a time to conduct an interview at the local office, or set up a time to conduct a telephone interview.
The interview will last for around an hour, provided you were organized enough to have collected all of the information on your past work and medical histories. The claims representative will ask you a series of questions about these, such as where you have worked in the past 15 years, your work duties, the nature of your medical condition, and what medical treatment you have taken for your disability in the past 12 months. The claims officer will also request non-medical information, such as your marital status, number of children, and whether you are receiving or have received workers' compensation.
The interview is a fact-finding mission, and no decision regarding your claim will be taken at this stage.
What if My Disability Benefits Claim is Denied?
This is not unusual. More than 65% of disability claimants have their initial applications for disability payments rejected. You will receive a notice of denial from the SSA, which will include a brief description of your medical state and impairments, the medical and non-medical records that were reviewed, and an explanation for the denial.
All is not lost. There is an appeals process that you can follow yourself, although you will need to go through your denial letter very carefully to identify the SSA's concerns. Prepare to address them fully if you wish to avoid rejection the second time around. In particular, do not miss the 60-day deadline in which to file your appeal. If you fail to meet the deadline, you will lose your right to appeal and will have to make a new SSDI or SSI application. You may also need to gather more comprehensive medical records from your doctor as well as seek more detailed information about your work history and duties from your employer.
Should I Retain a Lawyer?
If you need assistance in making your claim, you might wish to contact a Social Security advocate. These advocates are not necessarily lawyers, but will be trained persons who work on a contingency basis, meaning they get paid only if you win your case. All advocates can charge fees for out-of-pocket expenses, such as photocopying and postage. It may be possible to find a community service agency that can put you in touch with pro bono Social Security advocates as well.
You should certainly hire a lawyer if you have had two appeals rejected and wish to have a hearing before an administrative judge. If you do need the assistance of a lawyer, you should try to retain one who is a member of the National Organization of Social Security Claimants’ Representatives. These lawyers are also paid on contingency and will engage many strategies to ensure that an SSDI or SSI claim stands the best chance of winning. This includes demonstrating a thorough understanding of SSA regulations and of prior rulings.