Here are fifteen important questions about disability benefits that people have asked Pds -- and the answers.
- What Is Social Security Disability Insurance ("SSDI")?
"SSDI" stands for "Social Security Disability Insurance," an insurance program for workers who become unable to work. It is administered by the Social Security Administration ("SSA"), funded both by "FICA" tax withheld from workers' pay and by employer contributions, and pays qualifying disabled workers both cash and health care benefits. Workers who have worked and paid FICA tax for at least 5 of the 10 years prior to the date they become disabled typically are covered by
Social Security Disability Insurance. Another way of expressing this is: applicants must have worked 20 out of the 40 calendar quarters immediately preceding the onset date of disability to be covered. Younger workers can qualify with fewer years of work. You can apply for
Social Security Disability Insurance benefits at any SSA office. See the free booklet "Social Security Disability Benefits," SSA Publication No. 05-10029, available from your Social Security office and by calling SSA toll-free at 800-772-1213. You also can apply via the Internet, at www.ssa.gov, but the procedure is relatively new and untested.
For help organizing the information needed for your social security disability insurance claim,
see the Disability Workbook for Social Security Applicants
and Recipe for Winning
Disability Insurance Benefits from SSA.
- Is "SSDI" the same as "SSI?"
The "SSI" or "Supplemental Security Income" disability program has marked similarities to
Social Security Disability Insurance: both programs are run by SSA, both offer disability benefits, and both use the same legal definition of "disability." But the programs also differ significantly in their financial qualifications and benefits. For example:
BENEFIT AMOUNTS. The Social Security Disability Insurance
benefit is calculated on a disabled worker's past earnings, which means that different workers may receive different monthly checks. SSI pays a standard monthly benefit of
for an individual (in 2005). A couple, both of whom qualify for SSI, may receive a total monthly benefit of
(However, individual checks may vary because of deductions required by law.) Some states pay a supplement to SSI recipients.
HEALTHCARE BENEFITS. Recipients of Social Security Disability Insurance
qualify for Medicare benefits 24 months after their first monthly check. SSI recipients get Medicaid benefits immediately, without a waiting period.
EFFECT OF INCOME AND RESOURCES OF OTHER PEOPLE. Benefits of
Social Security Disability Insurance recipients are not affected by the incomes of others, or by the beneficiary's own income that is not earned from current work. For example, one's investment income does not affect his or her
Social Security Disability Insurance benefits. But benefits of SSI recipients may fluctuate (or end) because of income and resources received by the beneficiary, or the income and resources of others who contribute to the beneficiary's support.
When you apply for either disability benefit, SSA should automatically check to see whether you qualify for
Social Security Disability Insurance, SSI, or both. Get the free booklets "Social Security Disability Benefits," SSA Publication No. 05-10029; and "Supplemental Security Income," SSA Publication No. 05-11000. Also see the Pds booklet,
Recipe for Winning
Disability Insurance Benefits from SSA, and
Disability Workbook for Social Security Applicants.
- Why might I need Social Security Disability Insurance?
People who become disabled typically have a large drop in income, which
Social Security Disability Insurance can partially replace. This helps pay living expenses, and the "disability freeze" feature
of Social Security Disability Insurance keeps a disabled person's earnings record current so he or she can receive a larger Social Security retirement check at age 65.
- Can people qualify for Social Security Disability Insurance
after age 65?
Social Security Disability Insurance benefits cut off at age 65, and ordinary Social Security retirement and Medicare benefits take over. See the Social Security Handbook, 2005, section 501, available in many public libraries.
- If I have been self-employed, can I get
Social Security Disability Insurance if I become disabled?
Self-employed people who become disabled can get Social Security Disability Insurance
if they have paid the government enough self-employment tax and/or FICA tax to qualify for
Social Security Disability Insurance coverage. However, many self-employed people neglect to pay the tax and do not qualify. Get two free booklets from SSA: "Social Security: How You Earn Credits," SSA Publication No. 05-10072; and "If You're Self-Employed," SSA Publication No. 05-10022.
- Will my spouse's income affect my
Social Security Disability Insurance?
Your spouse's income will not affect your Social Security Disability Insurance
benefits. SSA considers your work capacity -- not the income or resources of your spouse. Your savings and investments also will not disqualify you.
However, a spouse's income could disqualify you from SSI or reduce your SSI benefits. SSI is not insurance like
Social Security Disability Insurance; it is a welfare type program limited to people with very little income and resources. The government may reduce SSI benefits or end them if the beneficiary, the spouse, or anyone contributing to their support has significant income or resources. See the free booklet "Supplemental Security Income," SSA Publication No. 05-11000.
- How does Social Security Disability Insurance
differ from workers' compensation, state DI, and private DI coverages?
WORKERS' COMPENSATION: Workers' compensation statutes typically require that your illness or injury is work-related before you can receive workers' compensation benefits; but
Social Security Disability Insurance does not require a causal connection between your medical condition and your work. You may receive workers' compensation benefits for partial incapacity; but
Social Security Disability Insurance requires that you be totally incapacitated from substantial gainful work. Workers' compensation may pay benefits for periods of disability shorter than a year; but
Social Security Disability Insurance requires that your disability persist at least a year.
STATE DISABILITY INSURANCE: Five states and the Commonwealth of Puerto Rico reportedly have disability benefit programs for illnesses and injuries not caused by work. The states are California, Hawaii, New Jersey, New York and Rhode Island. These state benefits help many people meet expenses until
Social Security Disability Insurance benefits become payable.
PRIVATE DISABILITY INSURANCE: Many people purchase private disability insurance policies to assure that they continue to have income in the event of disability. Employers sometimes purchase the policies for their employees. Private policies often start paying more quickly than
Social Security Disability Insurance. Some private policies do not reduce their monthly checks if a person receives disability benefits from SSA. Other private policies do reduce their monthly checks in an amount equal to any benefit that SSA pays; they also require their insured to apply for
Social Security Disability Insurance and to make a reasonable effort to win
Social Security Disability Insurance benefits. Some private policies may have definitions of "disability" more lenient than the SSA definition.
- What does the Social Security Administration ("SSA") mean by the term, "disabled?"
SSA considers a person "disabled" if he or she: (1) lacks the ability to engage in any substantial gainful activity; (2) the incapacity is due to one or more medically determinable physical or mental impairments; and (3) the incapacity has lasted or can be expected to last for a continuous period of at least 12 months or to result in death. (Other guidelines govern blindness and claims of disabled children.) Applicants must supply SSA the evidence that proves that their condition meets these criteria. "Substantial gainful activity" is defined as working on a regular and continuing basis and earning over $830 a month (in 2005).
If you are working and earning over $830 a month, SSA may be reluctant to accept your claim because they consider you to be doing substantial gainful activity. However, this should not be a problem if the income is not from current earnings. For example, sick pay, investments, and private insurance are not substantial gainful activity because you are not currently working to earn them.
Also, an employer sometimes keeps paying a person full pay temporarily despite a drop in productivity. Examples of people receiving this "subsidy" may include employees who have special knowledge or who are contact persons for important clients; employees who are relatives or close friends of the employer; or employees whose employers are specially sensitive to the needs of the disabled person's family. If the employer explains the circumstances to SSA and that the person's current output is worth less than $830 a month, SSA may treat earnings above $830 as unearned "subsidy" and disregard them. For more complete information order the Pds booklet
Recipe for Winning
Disability Insurance Benefits from SSA, and Disability Workbook for Social Security Applicants.
- How do I apply for Social Security Disability Insurance
You can apply for Social Security Disability Insurance
benefits in-person at any SSA office, or by telephone and mail. Going in-person for your disability interview will get you free advice from the claims representative, an examination of your papers for errors and oversights, an opportunity to correct them before the papers are filed, and the opportunity to demonstrate your honesty and credibility to a representative of SSA. However, to save time, SSA may try to persuade you not to come to the office and may instead propose a telephone interview. For the reasons given above, an in-person interview may be more beneficial to your claim. You have the right to an in-person interview. If SSA does not allow you one, ask the office of your U.S. Senator or Member of Congress how to obtain an in-person interview. For more complete information order the
Disability Workbook for Social Security Applicants, or
Proving Disability to SSA: How to Manage Your Disability
- What information do I submit with my
Social Security Disability Insurance claim?
The booklet "Social Security Disability Benefits," SSA Publication No. 05-10029, says, "you can help shorten the process by bringing certain documents with you when you apply and helping us to get any other medical evidence you need to show you are disabled. These include:
* The Social Security number and proof of age for each person applying for payments. This includes your spouse and children, if they are applying for benefits;
* Names, addresses, and phone numbers of doctors, hospitals, clinics, and institutions that treated you and dates of treatment;
* Names of all medications you are taking;
* Medical records from your doctors, therapists, hospitals, clinics, and caseworkers;
* Laboratory and test results;
* A summary of where you worked in the past 15 years and the kind of work you did;
* A copy of your W-2 Form (Wage and Tax Statement), or if you are self-employed, your federal tax return for the past year;
* Dates of prior marriages if your spouse is applying;
* A certified copy of your birth certificate.
Also provide at least one doctor's report based on a recent examination that:(1) establishes the diagnoses of injuries or illnesses that are causing severe impairment of work capacity; (2) explains the restrictions on work capacity resulting from the diagnosed medical conditions; (3) gives examples from real life of what the patient can and cannot do; (4) explains whether severe impairment is expected to last at least 12 months or result in death.
For doctors, the Physicians' Disability Services, Inc. ("Pds") booklet, Disability Evaluation in a Nutshell, provides concise guidance on SSA needs in medical reports, containing evaluation checklists and a sample medical report.
For applicants, the Disability Workbook for Social Security Applicants, by disability lawyer attorney Douglas Smith, shows how to document, file and manage a claim for benefits. It also is available from Pds.
- My doctor says he will not write a report; will only fill out the SSA forms; is that okay?
Very few doctors in private practice know how to write disability reports that satisfy the exacting standards that SSA applies in evaluating medical evidence. This is not surprising, because SSA typically does not furnish treating doctors a full set of evaluation criteria. However, SSA evaluates their reports as if treating doctors knew the criteria.
Treating doctors typically fill out an SSA form that has10 questions. Government doctors then evaluate these SSA treating doctors' forms, using other SSA forms that have more than 100 questions and multiple choices on physical function and another 100 on mental function. Therefore, it is not surprising that SSA often finds treating doctor reports inadequate; the agency looks for answers to questions it did not ask. The system seems designed to promote inadequate reports.
Your doctor can quickly acquaint himself or herself with the
unique characteristics of medical reports for Social Security Disability by devoting a few minutes to the Pds booklet,
Disability Evaluation in a Nutshell: A Three Minute Guide to Effective Medical Reports.
- What does SSA do after I file my claim?
After you apply for Social Security Disability Insurance
benefits at an SSA office or by telephone or mail, a claims representative interviews you and identifies all your sources of medical evidence. The representative also confirms that you meet the
Social Security Disability Insurance insured status requirements, and sends the case to a state disability determination service ("DDS"). The DDS, operating as an agent of SSA, makes the initial determination of disability or non disability.
Requesting Reconsideration: If SSA denies the claim initially or makes a serious error in an otherwise favorable decision, you can request reconsideration within 60 days after receiving the notice of decision. The state agency reconsiders the claim, but assigns a different decision-maker than the one who decided the claim initially.
Note: Ten states do not offer a "reconsideration" appeal stage. As part of a test, SSA has eliminated the "reconsideration" appeal stage in: Alabama, Alaska, California (Los Angeles North and West areas), Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York (Brooklyn and Albany areas), and Pennsylvania. In these states and locales, applicants whose claims are denied in the initial SSA decision can appeal directly for a hearing before an administrative law judge ("ALJ"). This appeal must be made within 60 days of the SSA notice of decision.
Requesting a Hearing: If SSA reconsiders the claim and denies it, you can request a hearing before an administrative law judge ("ALJ") within 60 days of receiving the notice of decision. An ALJ hearing is like a court hearing or trial, but less formal. You normally testify under oath and submit additional evidence.
Asking Appeals Council Review: If the ALJ denies your appeal, you may request review by the Appeals Council within 60 days. The Appeals Council also may review an ALJ decision on its own initiative within 60 days after the date of the decision.
Typical Actions by the Appeals Council: The Appeals Council may affirm, modify or reverse the decision of the ALJ, or may send the case back to the ALJ for further action. SSA notifies you in writing of the final action of the Appeals Council, and of the right to obtain further review by filing suit within 60 days in a U.S. District Court.
Many appeals result in benefit awards. For more information and charts that show how a claim moves through the disability claim process, see the Disability Workbook for Social Security Applicants
or the Pds booklet Proving Disability to SSA: How to Manage Your Disability
- Are there recent changes in Social Security Disability Insurance
procedures that I should know about?
Several important changes come to mind. Recently SSA gave state disability examiners
greater latitude to approve meritorious claims in the initial claim decision. That happened
because the agency found that many denied claims eventually were approved when claimants
Also, in ten states SSA is testing a major new disability decision-making process (see "Different Disability Decision Process in Ten States").
At the same time, SSA is trying to restrain ALJs because the agency thinks they make too many decisions favorable to
applicants At the same time, SSA is trying to restrain ALJs because the agency thinks they make too many decisions favorable to applicants.
These changes are important because they remove
one level of appeal (reconsideration) in ten states
and de-emphasize reconsideration in the other
states, commonwealth, and territories. We
conclude that wise applicants will focus their maximum effort on proving disability at the initial stage of the claim process, rather than doing a mediocre job at the initial stage and hoping to overcome an unfavorable decision by appealing. The Pds publications,
Disability Workbook for Social Security Applicants
and Disability Evaluation in a Nutshell
show what you and your doctor must do to prove your disability at the earliest possible stage.
- Where can I find out about other federal or state assistance for my disability?
To learn about federal or state assistance that may be available to people with disabilities, check with the social services department of your clinic or hospital; state and local social services agencies; private nonprofit health groups; and your state vocational rehabilitation agency. Click here for examples of state and local resources.
Or go to www.govbenefits.gov for a federal perspective.
- Where can I get more help with my disability claim?
For information about legal representation, contact the National Organization of Social Security Claimants' Representatives ("NOSSCR), telephone 800-431-2804.
Also, you may call the lawyer referral service of your state or local bar association, and ask for an experienced
disability lawyer. For information about SSA office locations and publications, contact the Social Security Administration, 800-772-1213.
Or on the Internet, go to: ssa-custhelp.ssa.gov