Getting disability benefits from Social Security shouldn't be easy, but the sorting out the process to receive benefits should be. Here's a sketch of the benefits available, and the standards and process for getting them. Social Security offers more than retirement benefits; our payroll taxes fund aid for those who cannot work due to disability.
Benefits for Disability
The Social Security Administration (SSA) has two programs available for persons who are disabled and can't work. You need to know what type of benefits you can qualify for. Social Security Disability (SSD) benefits are based on what you've earned in the past ten years. Before going any further, let's ask, what if you don't have sufficient earnings in the past ten years? There's another program you can try: Social Security Income (SSI) benefits. The tricks are to find out which program is best for you, and convince SSA you qualify for it.
Factors That Determine If You Qualify
Your medical problems must be severe. A disability means you are unable to work due to an illness, injury or worsening of a medical condition. Unable to work means unable to work at all, not just at your usual job.
You can be unable to work due to reasons of physical or mental health, or both. Mental health disabilities are harder to prove. When Social Security was created, people thought mainly in terms of physical disability. Mental disability is recognized now, but the law and decisions on mental disability have not yet become as consistent as for physical disability.
You must have received medical treatment for your condition. Treatment history must be well-documented. Medical records are key to establishing disability. Without good records, you won't qualify for benefits no matter how disabled you are. You should keep this in mind if you've just become disabled, or just sought medical help. You should wait to apply for benefits until your doctor has diagnosed your condition and prescribed treatment.
A good relationship with your doctor helps. Your medical records alone probably won't say anything about your ability to work. Your health care provider probably will have to supply specific information about this on forms requested by SSA. Health care providers don't have to do this. Understandably they give these tasks lower priority than care giving. So it's good to have a doctor who is willing to take the time to do this. It's not a bad idea to offer to pay for this service if you can afford it. It could help get a timely, thorough and winning report.
Your disability must be long-term. SSD and SSI only pay benefits for long-term disability. Long term means lasting at least one year or likely to result in death. Broken bones, temporary illnesses and other short-term disabilities won't cut it. This is so even if you're completely out of action because of them.
Other factors. SSA will look at other things besides medical condition in evaluating your case. The older you are, the more likely your claim will be approved. Your claim is more likely to be approved if you haven't had advanced education or training. If your occupation required hard labor, or if your work skills have eroded, this also favors your claim. On the other hand, if you have never worked, this may be seen as a sign of malingering and play against you.
For SSD benefits, you must have worked in the ten years before applying. Continuous, full-time employment isn't required. But you must have a minimum amount of Social Security earnings. It's a complex calculation, but in general you will qualify if you worked some in at least 20 of the previous 40 quarters (10 years). The term is quarters of coverage. You can find out from SSA if you meet the standard without filing for disability.
Lots of people don't qualify. Examples include women who were homemakers, independent contractors and people who have been disabled their whole lives. While not eligible for SSD, these people can qualify for SSI.
Payments for dependants. SSI only pays benefits to you if you're disabled. If you can qualify for SSD though, you can get additional benefits for your dependants. Your children will be eligible, and possibly your spouse, your former spouse and other family members. So it pays to have those quarters of coverage.
Factoring other benefits. Availability of other benefits needs to be considered in deciding to apply for SSD or SSI. All things being equal, SSD pays a greater benefit than SSI. SSD is based on your reported Social Security earnings. It can total about $2,000 per month for an individual, and up to $3,400 for a family. In contrast, SSI, even with any supplemental payment from your state, won't be half that much. SSI is designed to supply a minimal standard of living. SSI recipients, however, are eligible for health insurance from Medicaid. SSD recipients become eligible for Medicare two years from the date of disability. These health insurance benefits can be more valuable than monthly cash SSD or SSI benefits.
Means testing. SSI is a needs-based program. If you or a family member has other income or assets, your monthly SSI benefits may be reduced. You may not be eligible to receive SSI altogether. For the most part, SSD is not limited by other income or assets. An exception applies if you're receiving workers' compensation benefits. In that case, your SSD may be reduced.
Do-It-Yourself or Get Help?
Social Security claims and appeals can be made by individuals without expert legal assistance. As it happens, many people find assistance helpful. This is especially true in appealing claim denials. Given the money at stake, it's wise to at least check into the option of hiring someone experienced in SSA claims.
Your representative need not be a lawyer. SSA will deal with anyone you authorize in writing. Your representative doesn't have to be licensed to practice law. You should choose someone with experience or ability to handle the process. A lot of people file the initial claim and hire a representative only if the claim is initially denied. A skilled representative can tell you the chances your claim will succeed. A good representative will put your claim on the best footing.
There are many lawyers and firms that specialize in Social Security cases. Social Security permits a representative to be paid on a contingency basis. In SSD cases the representative will collect a percentage of the back benefits owed a successful claimant. This direct payment fee option is not available in SSI cases. This means most private lawyers will not handle SSI cases. Legal aid or legal services offices in your state may be able to represent low-income claimants in SSI cases.
As with hiring a lawyer for any matter, it pays to do your research. Ideally your lawyer will be experienced. It's also important you're comfortable with your choice. Referrals from trusted sources should be considered. You can also check with your local bar association. The National Organization of Social Security Claimants' Representatives (NOSSCR) has a registry of qualified attorneys, too. You can start to find attorneys in your area who have these credentials by using the Lawyers.com directory.
The Process Begins
Have patience. Applying for disability benefits can be a long and frustrating process. You file the initial application at the SSA district office in your local area. Sometimes you dictate your information over the phone to a district employee who will send you the completed application for your signature. Expect to wait several months before hearing word of the initial decision.
This initial review takes place strictly on the application and supporting documents. Many applications are denied initially. This begins the appeals process. More than one appeal may be necessary to gain eligibility.
Your agency appeals may end up with an Administrative Law Judge (ALJ) hearing. This will be your first opportunity to present your claim in person to the person who decides your case. Unlike court trial, there is no opposing party. The judge however is there to judge your claim, not help you in getting benefits. At this stage representation can be very important. Unless you are very capable, the ALJ would appreciate a presentation from experienced counsel. If your claim is still denied, you can appeal this decision in federal court.
Making a disability claim requires patience. Making a successful claim requires preparation. If you haven't got both you'll need to hire someone to help get the benefits you're entitled to.
Questions for Your Attorney
- Are there doctors who specialize in disability determinations or diagnoses?
- What is the direct payment percentage you will earn from my disability award?
- Does a disability rating from my workers' compensation case factor into the SSD disability decision?