Q: What's the difference between SSI and SSDI?
Supplemental Security Income (SSI) is a welfare program that offers cash benefits to elderly, blind, or disabled persons with limited income and resources. Although the program is administered by the Social Security Administration (SSA), it is financed through general tax revenues, not Social Security taxes or the Social Security trust fund.
Social Security disability insurance (SSDI) is a program that workers, employers, and the self-employed pay for through Social Security taxes. Workers who have paid into the system long enough to be considered "insured" may qualify for SSDI benefits if they become disabled. The monthly benefit amount is calculated based on the beneficiary's past earnings.
Social Security uses the same definition of disabled for both SSI and SSDI applicants.
Q: How does Social Security define a disability?
To be eligible for benefits, a person must be unable perform a substantial amount of work because of a physical or mental impairment (or a combination of impairments), that is expected either:
- to last at least 12 months, or
- to end in death.
According to Social Security regulations, the ability to perform "substantial gainful activity" (SGA) basically means the ability to earn $1,130 per month (the SGA threshold for non-blind individuals in 2016) or $1,820 for the blind. If your earnings exceed the SGA threshold, you will not be found disabled no matter how severe your medical impairments. If your earnings are beneath the SGA threshold, Social Security will then assess whether your impairments should keep you from performing SGA.
Q: Is there a list of diseases or illnesses that Social Security automatically covers?
Social Security's Listing of Impairments, also known as the "Blue Book," contains a long list of conditions that automatically meet SSA's definition of "disability." However, these illnesses and injuries tend to be of a very serious nature (for example, esophageal cancer, AIDs, or amyotrophic lateral sclerosis (ALS)), and for that reason it is not easy to be approved for disability benefits based on a Blue Book listing.
If your condition is listed, it's essential that the medical evidence in your case clearly satisfy each of the criteria contained in a listing. Proving that you suffer from a listing-level condition often requires the supporting opinion of a physician.
Q: What are all the possible steps I could go through before I win approval for Social Security benefits?
You begin by applying for benefits, either in person, over the phone, or online. Your application will be either approved or denied. If initially approved, there is a small chance it could go through a "Quality Control" review where the decision could be overturned. However, the majority of applicants for disability benefits are denied at the initial level.
If denied, the next stage is a "reconsideration" with the state agency that handles disability on behalf of the Social Security Administration. That agency can choose to approve or deny your application—but again, the vast majority of applications are denied on reconsideration. (Note that some states have eliminated the reconsideration process entirely.)
If you're still denied, you would then apply for a hearing with an administrative law judge (ALJ). Due to a long backlog of cases, there tends to be a lengthy wait for an ALJ hearing, generally from six to 18 months.
If the ALJ denies your application, you can then appeal to the Social Security Administration Appeals Council, a process that typically takes a year or more. If denied again, you can file an appeal in United States District Court.
Many disability applicants find it useful to hire a disability lawyer to assist them throughout the application process, and especially for the ALJ hearing and any appeals.
Q: Can a child receive disability benefits?
Yes, children with disabilities can receive SSI, as long as they meet the financial requirements of the program. But note that some of the income and resources of the disabled child's parents will be attributed to the child and potentially make the child ineligible for SSI. A child who has a disabled parent receiving SSDI may be eligible for dependents benefits based on the parent's earning record, regardless of whether the child is disabled.
Q: How much would I have to pay an attorney to help me get benefits? (Is there a set amount or percentage?)
In the standard Social Security disability case, the attorney is entitled to 25% of the disability applicant's back pay, up to a maximum of $6,000. In especially difficult cases, the attorney can file a fee petition seeking additional fees. Most attorneys charge nothing up front and only collect a fee if you win your case (although some will require you to reimburse the expenses related to your case, such as the cost of medical records, if you lose).
Q: Do I need to have an attorney to receive the benefits I'm entitled to?
Not necessarily, but it often helps. For your initial disability application, hiring an attorney or non-attorney representative is sometimes unnecessary, especially if your case is straightforward. However, if you're denied, you will likely want to hire a lawyer to assist in presenting your case for your appeal. Hiring an attorney to represent you at the ALJ hearing
, in front of the Appeals Council, or in federal court is highly recommended and almost certainly improves your chances of success. An experienced disability attorney will work with your health care providers to present the most persuasive case to the ALJ and on appeal.
Q: I am disabled. Can I apply for and receive SSDI even if I have money in the bank?
Yes, unlike SSI, SSDI (Social Security Disability Insurance) is not a means-tested program, meaning that how much income or assets you have doesn't matter.
Q: I've not been able to work for over a year. If I apply for Social Security now, will they pay me for the year I was not able to work?
It depends. While SSI pays only from the first of the month after you file your application, SSDI can pay for up to 12 months prior to the application date. However, there is a five-month waiting period after your date of disability in which you are not eligible for SSDI benefits. This means that you would have to have a disability onset date of 17 months prior to your application to be able to collect 12 months of retroactive benefits (if approved). if your disability began 12 months ago and you apply now, you would only get benefits going back seven months from today.
Q: How long do I have to wait before benefits start?
Benefits begin the month following the fifth full month of disability for SSDI, with a maximum of twelve months of backpay. For SSI, benefits are payable beginning on the first of the month following the date of your application, or on your disability onset date, whichever is later
. However, disability applications take several months to several years to process, so you may be waiting quite a while for benefits to start.
Q: What if I'm not permanently disabled? Can I still receive SSDI?
A: It depends upon the nature of your disability. If your disability hasn't lasted or isn't expected to last 12 consecutive months, then you don't qualify for benefits.
There are no "short-term" Social Security disability benefits, but it is possible that you could be awarded a "closed period" of benefits if your disability has lasted over twelve months but has since ended.
Or, if you have a disability caused by cancer or a kidney transplant, Social Security could award you benefits for one to three years and then reassess whether you still qualify for disability.
Q: When should I, or can I, apply for SSDI?
If you're unable to perform full-time work due to illness or injury, you should consider applying for Social Security disability benefits. You don't need to wait until your disability has lasted 12 months; however, your disability must be expected to last
at least that long. Because the disability application and appeals process can involve a wait of a year or more for a hearing, the 12-month durational requirement is usually satisfied by the time the hearing occurs.
Q: Can I get SSDI while I'm receiving long-term disability or workers' compensation benefits?
Yes, although you usually cannot collect the full amount of these benefits and
SSDI at the same time. Most long-term disability (LTD) policies contain an "offset" provision that reduces your monthly LTD payment by the amount of your SSDI payment. In addition, Social Security rules prevent those receiving workers' compensation and SSDI
from collecting a total of more than 80% of their pre-disability earnings.