1. How does Social Security define disability?
The Social Security Administration (SSA) defines “disability” as the “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months”. The disability may be, but does not have to be, permanent. Even if your disability is not expected to improve, SSA will still review your case periodically.
2. What kinds of benefits are there?
There are several kinds of disability benefits for which a person can be eligible. Depending on the facts, you may be entitled to one or more of these benefits. The medical rules are the same for all categories – you must be just as disabled to qualify for one as for another. The non-medical requirements are different for each category. SSA will generally have you file for the correct program(s).
(A) Disability Insurance Benefits (SSDI) – You are eligible for these benefits if you have paid a certain amount of Social Security (FICA) tax over a period of time, enough to have disability coverage in force. In general, you also must have worked and paid Social Security tax for five out of the last ten years before you became disabled. If your claim is approved, the monthly payment you will receive is determined by your earnings (and Social Security tax payments) during your working career.
(B) Supplemental Security Income (SSI) – SSI can be paid when a person has not paid enough Social Security tax to get disability insurance benefits or to people whose disability insurance rate is very low. You must be disabled under the same rules as for SSDI. You must also have very little income or property because this benefit is based on financial need.
(C) Disabled Widow/Widower Benefits (DWB) – This is a benefit for certain widows and widowers based on the Social Security tax paid by his or her deceased spouse. In order to qualify, you must be between the ages of 50 and 60, have become disabled within a fixed number of years after your spouse’s death and have been married for at least 10 years to the person who was covered under Social Security at the time of his or her death. If you are awarded DWB benefits, your monthly rate is determined by your spouse’s income and Social Security tax payments. However, a surviving spouse’s pension can usually be paid at the age of 60, regardless of any disability.
(D) Childhood Disability Benefits (CDB) – In order to be eligible, you must be a child of a person already receiving disability insurance benefits or retirement benefits, or who died while covered for Social Security. You must be at least 18 years old, and must prove total disability began before the month you turned age 22, and is continuing. The monthly benefit rate is based on a percentage of your parent’s rate.
3. When can I file for Social Security Disability benefits?
You can file for Social Security disability benefits at any time, including as early as on the day that you become disabled if you believe that you will be out of work for one year or more. Green & Greenberg can help you file the application online. This will ensure that your claim is handled in a more efficient manner.
4. Is it necessary to hire an attorney to represent me in my Social Security disability claim?
No, but it is strongly recommended. The process can be confusing, intimidating, and frustrating. Our attorneys and paralegals at Green & Greenberg know how to apply the law to your case.
5. When should I hire an attorney?
It is better to hire an attorney as early as possible. You can retain an attorney before you begin the claims process. You can get an evaluation of your claim even before you file. Green & Greenberg can help you with the initial filing and ensure important information is correctly provided at the beginning of the claim and throughout the entire claim process. You do not have to wait until you are no longer working before you consult an attorney.
6. Do I have to pay my attorney?
Cases are generally handled on a contingency basis. That means Green & Greenberg only receives a fee only if you win your case. Normally the fee is 25% of your back benefits and must be approved by Social Security. If you do not win your case there is no fee. There are also occasionally costs in each case for which you will be responsible.
7. Can I get Social Security Disability benefits if I expect to get better and return to work?
Yes, as long as you have been disabled for at least one year or expect to be disabled for at least one year. If you expect to be out of work for one year or more due to illness or injury, you should file for Social Security benefits. Most claimants retain the hope of someday getting back to work.
8. Can I work while receiving Social Security disability?
Your work activity may have an impact on your disability claim. It depends on various factors including when you returned to work, how much you earn, how long you worked, why you stopped working, etc. In most cases, a brief work activity will not adversely impact your disability claim if you work less than 6 months and stop working because of your medical condition. Talk to your attorney to discuss the specifics of your work situation and its impact on your disability claim.
9. I got hurt on the job. I am drawing Workers Compensation benefits. Can I file a claim for Social Security disability benefits now or should I wait until the Workers Compensation ends?
You do not have wait until the Workers Compensation ends. An individual can file a claim for Social Security disability while receiving Workers Compensation, and in many cases, can receive payments under both programs. In some circumstances, an offset may be calculated that could result in a reduction of SSDI/SSI payments.
10. If I am approved for Social Security disability benefits, how much will I get?
For disability insurance benefits, it all depends upon how much you have worked and earned in the past. For disabled widow’s or widower’s benefits, it depends upon how much the late husband or wife worked and earned. For disabled adult child benefits, it all depends upon how much the parent worked and earned. For all types of SSI benefits, there is a base amount that an individual with no other income receives that changes every year. Other income that an individual has reduces the amount of SSI which an individual can receive.
11. If I am found disabled, how far back will Social Security pay benefits?
For Disability benefits and for Disabled Widow and Widower benefit, the cash benefit begins after a five-month waiting period after the person becomes disabled. Also, benefits cannot be paid more than one year prior to the date of the completed application.
Childhood Disability Benefits begin as of the onset date, but benefits cannot be paid more than six months prior to the date of the application.
SSI benefits begin the month following the date of the application.
12. What is the difference between Medicare and Medicaid?
The short answer is that Medicaid is an income-based medical program and Medicare is not income-based. Many people with disabilities who get Medicaid (Medical Assistance) get it because they are on Supplemental Security Income (SSI). To get SSI and thereby get Medicaid you have to have low resources and be disabled. Medicaid does pay for limited prescription medication. Medicaid eligibility can be retroactive up to three months prior to the date of a Medicaid claim. Depending on your state, you may qualify for Medicaid based on low income without having to apply for SSI.
Medicare is not based on your income or resources. If you have been on Disability Insurance Benefits, Disabled Widow or Widower Benefits or Disabled Adult Child Benefits for 24 months you qualify for Medicare. Medicare will pay doctors at a higher rate than Medicaid. Almost all doctors accept Medicare patients, whereas many private doctors will NOT accept Medicaid patients. The bad thing about Medicare is that it does not begin until after a person has been on disability benefits for two years. Part A of Medicare is free, but Part B has a monthly premium. Part D, for prescription drug coverage, also has a monthly premium that varies by plan.
13. Can a person receive disability benefits solely due to drug or alcohol addiction?
No. If this is your only disabling condition, benefits will not be approved. If the person has other independent disabling impairments, benefits can be paid due to those medical problems despite the presence of drug or alcohol issues. However, a representative payee may be required.
14. Are Social Security or SSI Benefits Taxable?
SSDI benefits CAN be taxable depending on you or your family’s total income and what state you live in. SSI benefits are NOT taxable.
15. What is the most typical reason claims are denied?
Lack of regular medical treatment or lack of credible documentation in the medical notes. When records do not contain detail as to continuing symptoms and their severity, there is not enough proof found of your medical symptoms. The records may also not support the consistency of the functional limitations.
16. I am still on sick leave from my employer. Can I file for Social Security disability now or do I have to wait until the sick leave is exhausted?
Yes, you can file while on sick leave. You should file for Social Security disability benefits as soon as you believe that you will be out of work for a year or more.