The Social Security Administration (SSA) has the responsibility of overseeing the distribution of retirement, disability and survivors' benefits to qualifying persons.
Social Security Disability Benefits
There are two benefits programs that you may be able to apply for if you are restricted in your ability to work because of a medical disability:
- Social Security Disability Insurance (SSDI or SSD)
SSD is a form of medical insurance paid for by monthly payroll deductions made by workers and administered by the SSA. The goal of SSD is to provide supplemental income to individuals under the age of 65 who were—or would like to be—employed, but are unable to work because of their disability.
- Supplemental Security Income (SSI)
The SSI program is administered by both the SSA and your state government. It is available to people over the age of 65. A claim for SSI is based on a certain income level, and only individuals who remain below that income level can continue to receive SSI benefits. The amount of SSI that you can receive will be affected by your marital status and depend on whether your particular state pays a state supplement.
In order to claim disability benefits under either benefits program, you must prove that you have a notable disability. Conditions such as strains, sprains or routine pregnancies, however uncomfortable, will not meet the eligibility criteria.
How do I qualify for Social Security disability benefits?
You will generally qualify for SSD if:
- You are under the age of 65; and
- You have a physical or mental ailment that stops you from participating in any "substantial gainful activity"; and
- Your condition is likely to last for at least 12 months or may result in death; and
- You have amassed 20 social security credits through employment in the last 10 years before you became disabled.
If you can prove that you came disabled before the age of 22, the work aspect will be disregarded by the SSA and you may be allowed to claim your parents' social security credits.
You must meet the following criteria to qualify for SSI:
- Be blind, disabled or age 65 and over; and
- Your monthly income must not exceed a certain threshold to be assessed; and
- Your property should be worth less than $2,000, or less than $3,000 as a couple; and
- You must be a United States citizen or meet the requirements for permanent residency.
In most states, if you are approved for SSI, you will also be eligible for food stamps and Medicaid.
Depending on your circumstances, it may be possible for you to claim both SSD and SSI, which are referred to by the SSA as "concurrent benefits."
Social Security Disability Eligibility
The Social Security disability system is quite a complex one to navigate, and even though you may appear to be eligible for SSD benefits, you may find that this is not the case. For example, if your work history is quite short and you have not made enough contributions to the Social Security fund, you may not be eligible to make a claim for benefits. However, SSD does not depend on your income. It is possible to receive SSD regardless of your income level if you are legitimately disabled as determined by a medical assessment.
How does SSDI work?
Once it has been established that you are eligible to claim SSD, you will need to provide your chosen representative with the necessary medical documents to prepare your case for a rigorous screening process. There are many qualifying rules and regulations that may be difficult for the ordinary individual to follow. Guidelines have been developed by the SSA and the courts to assist applicants with understanding them. Substantial medical evidence will be required to demonstrate your medical and or physical impairment. Letters and statements from your doctors or hospitals that have treated you will be critical to your application.
Your claim will be assessed by a disability examiner. In addition to the evidence that you provide, the evaluation of your disability will be done by the SSA's medical experts. These examiners will determine whether you are in fact disabled based on their own list of mental and physical conditions. It is important to bear in mind that their medical experts may not agree with your doctors' conclusions.
How do I get social security disability coverage if I become disabled? What is the claims process?
The initial claims application usually takes an estimated 90 to 120 days to process. However, this estimated time frame is based on the information and medical documentation provided by you. The process can take considerably longer if the SSA requires further documentary evidence from your medical practitioner, or further records from you.
Tips for Filing Social Security Disability Claims
To initiate your disability benefits claim, you will need to file your application with a claims representative at your local Social Security office. You need to be fully prepared for the disability claims process, which can appear adversarial in nature because of the complexity of the process and the lack of initial success for claimants. Providing the claims representative with a bundle of supporting evidence will assist your filing and should make the experience less stressful. You should:
- Obtain records of your work history going back 15 years before your disability, including where you worked, your title, pay stubs and the type of daily activities carried out.
- Request copies of medical records relating to your disability, and ensure that they are arranged in chronological order. If you are unsure about the content of any of your medical reports, you should seek clarification from your medical practitioner.
- Keep a log of your pain symptoms, when and where they occur, and how they affect your ability to move.
- Provide evidence of your medical treatment, including the names of medical practitioners, hospitals, and when and where they treated you, as well as pharmacy receipts.
Your claims representative at the Social Security office will pass your file on to a disability examiner. Having all of your records from the outset will allow the disability examiner to commence the processing of your claim without undue delay, although they might make a request for further medical evidence. You should consult your disability advocate in advance if you have any concerns about what medical information to provide in support of your disability claim.
What's the difference between permanent and temporary disability?
Your disability must be permanent in order to be eligible for SSD. A permanent disability is a physical or mental disability that is lasting and restricts an employee's ability to make a living. A doctor will determine whether your condition is lasting, is expected to last for over a year, or can lead to your death.
Social Security does not provide temporary disability benefits. A temporary disability is one that can be remedied by time and treatment, such as a broken arm. At present, only five states (California, Hawaii, New Jersey, New York and Rhode Island) offer a short-term disability benefit, which is sometimes referred to as temporary disability insurance or TDI. If you are based within one of these states, you may be able to claim TDI benefits if you are unable to work for less than a year.
Is it possible to qualify for partial social security disability benefits?
The Social Security benefits program does not provide for temporary or partial disability benefits. If, for example, you have lost your sense of vision, hearing or smell, the SSA will not assess you to be disabled unless your condition conforms with one of the many qualifying disabilities on their list, and renders you unable to work and earn a gainful income.
Any claim for partial disability will have to be made under a private insurance scheme or workers' compensation, if you are eligible. Worker' compensation does pay temporary disability benefits. Depending on the state in which you live, these benefits can be paid for up to two years while you are recovering from illness or injury.
Where can I get Social Security disability income help?
You can contact a local disability representative in your state. It is estimated that over 70% of initial disability applications made by individuals without formal assistance will fail. It is therefore in your best interest to seek the assistance of a disability advocate when you are considering making a claim under either of the benefits programs. Your representative is trained to help assist qualified applicants pursue their claims and provide guidance in complex areas.
The fee that your disability representative may charge you is regulated by law and cannot exceed 25% of the past benefits amount due to you (not to exceed $6,000). If no back benefits are awarded, then your disability representative cannot charge a fee.
What is the list of conditions that qualify as disabilities?
Both mental and physical conditions may qualify as disabilities for the purposes of the SSA. Your medical condition must be one that is mentioned in the Social Security disability list of impairments—often referred to as "the Blue Book." There are multitudes of mental and physical ailments listed, including such life-threatening disabilities as congenital heart disease, heart attacks, diabetes, cancers, kidney disease, thyroid disorders and epilepsy. Mental impairments include ailments such as depression, memory loss, panic attacks and bipolar disorders.
What is the eligibility income for SSDI?
SSDI eligibility is not determined by the amount of income you receive. Your average monthly earnings are used to calculate the benefits due to you. The average monthly payout in 2016 was $1,166; however, most claimants received between $700 and $1,700. Your disability representative can help you to estimate your likely benefit payment. If you are receiving other benefits, such as a workers' compensation settlement, your SSD benefits may be reduced.
If I qualify for benefits, what would the SSDI benefits be?
If you qualify for disability benefits, this will be paid in the form of a monthly allowance and will differ depending on the individual. The monthly amount paid to you will be based on your average lifetime earnings before you incurred your disability. The SSA uses a complex weighted formula to calculate your entitlement based on the Social Security taxes you paid over the years.
How long does the benefits assessment process take?
The length of time that it takes to complete the benefits assessment process will differ for all applicants. The timescale will depend on whether you are successful with your initial application for benefits. This initial application can take anywhere between 30 and 90 days. If your disability claim is approved, you can expect to start receiving your benefits after a five-month waiting period.
What happens if I file a disability claim and I'm denied?
The denial notice is not the final word on your quest for disability payments. If you filed a disability claim without any assistance from a disability advocate, you should now consult one to help you mount a first appeal. Your disability representative does not have to be a lawyer; many are individuals who have vast experience as former SSA claims representatives or former disability examiners, and therefore have an inside knowledge of the SSA assessment and decision-making process.
This first appeal against the denial can take up to 60 days to be assessed. If the appeal is also unsuccessful, you should request a disability hearing before an administrative law judge. There will be another long delay before you get your day in court. This delay will depend on the backlog of hearings at the particular court, and can be for up to 12 months or longer.
You may appear in person at that hearing and show the relevant parties that you are in fact disabled. It is estimated that over 60% of claimants represented by an advocate are successful following a disability hearing.
Where can I find more information about social security disability?
For further advice you may wish to consult your local disability advocate, contact your local Social Security office or visit the SSA website.