Social Security Disability Frequently Asked Questions

[Guest guest]

(I am posting this for anyone interested in Disability Benefits. There are some

changes that will be implemented starting next year, but for now this gives an

overview about Disability Benefits in the USA for your reference.~ Gretchen)

Social Security Disability Frequently Asked Questions

http://www.nosscr.org/hallfaq.html#06

National Organization of Social Security Claimants' Representatives

1. What is the definition of disability used by Social Security?

Under the Social Security Act, " disability " means " 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. "

2. How many different types of Social Security disability benefits

are there?

There are at least five major types of Social Security disability

benefits. Disability Insurance Benefits is the most important type of

Social Security disability benefits. It goes to individuals who have

worked in recent years (five out of the last 10 years in most cases)

who are now disabled. Disabled Widow's and Widower's Benefits are

paid to individuals who are at least 50 and become disabled within a

certain amount of time after the death of their husband or wife. The

late husband or wife must have worked enough under Social Security to

be insured. Disabled Adult Child Benefits go to the children of

persons who are deceased or who are drawing Social Security

disability or retirement benefits. The child must have become

disabled before age 22. For Disability Insurance Benefits, Disabled

Widow's or Widower's Benefits and Disabled Adult Child benefits, it

does not matter whether the disabled individual is rich or poor.

Benefits are paid based upon a Social Security earnings record.

Supplemental Security Income benefits, however, are paid to

individuals who are poor and who are disabled. It does not matter for

SSI whether an individual has worked in the past or not. SSI child's

disability benefits are a variety of SSI benefits paid to children

under the age of 18 who are disabled. The way in which disability is

determined is a bit different for children.

3. How do I apply for Social Security disability benefits?

The best, surest way to file a Social Security disability claim is to

go to the nearest Social Security office in person and wait (often

for a few hours) to see someone to file the claim in person. In the

alternative, a person may contact Social Security by telephone and

arrange for a telephone interview to file the claim.

4. I am disabled, but I have plenty of money in the bank. Do I have

to wait until this money is gone before I apply for Social Security

disability benefits?

No. If you have worked in recent years or if you are applying for

Disabled Widow's or Widower's benefits or Disabled Adult Child

benefits, it does not matter how much money you have in the bank.

There is no reason to wait to file the claim.

5. I used to work but lately I have been staying home taking care of

the kids. I have now become sick. Can I get Social Security

disability benefits?

Possibly. If you have worked five out of the 10 years under Social

Security before becoming disabled, you will have enough earnings in

to potentially qualify for Social Security disability benefits. For

individuals 31 or less, the requirements are a little different,

since such individuals have not had such a long time to work. Unless

a person has been staying home and taking care of their children for

quite a long time, however, it is very possible that they will

qualify for Social Security disability benefits based upon their own

earnings. Also a homemaker, if poor enough, can qualify for

Supplemental Security Income (SSI) whether he or she has worked in

the past or not.

6. How long do I have to wait after becoming disabled before I can

file for Social Security disability benefits?

Not even one day. You can file for Social Security disability

benefits on the very same day that you become disabled. Many

individuals make the mistake of waiting months and even years after

becoming disabled before filing a Social Security disability claim.

There is no reason to file a Social Security disability claim if one

has only a minor illness or one which is unlikely to last a year or

more. However, an individual who suffers serious illness or injury

and expects to be out of work for a year or more should not delay in

filing a claim for Social Security disability benefits.

7. 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?

No, you do not have to wait until the sick leave is exhausted. You

should file for Social Security disability benefits now, if you

believe that you will be out of work for a year or more.

8. I got hurt on the job. I am drawing worker's compensation

benefits. Can I file a claim for Social Security disability benefits

now or should I wait until the worker's compensation ends?

You do not have to wait until the worker's compensation ends and you

should not wait that long. An individual can file a claim for Social

Security disability benefits while receiving worker's compensation

benefits. It is best to file the Social Security disability claim as

soon as possible because otherwise there may be a gap between the

time the worker's compensation ends and the Social Security

disability benefits begin.

9. Can I get both worker's compensation and Social Security

disability benefits?

Yes. There is an offset, which reduces Social Security disability

benefits because of worker's compensation benefits paid, but in

virtually all cases, there is still some Social Security disability

benefits to be paid. In a few states the offset works the other way -

- worker's compensation benefits are reduced because of Social

Security disability benefits.

10. How can I tell if I will be found disabled by Social Security?

Unless your disability is catastrophic (such as terminal cancer, a

heart condition so bad that you are on a heart transplant waiting

list, total paralysis of both legs, etc.), there is no easy way for

you to tell whether you will be found disabled by Social Security. In

the end, the decision of whether or not to apply for Social Security

disability benefits should not be based upon whether or not the

person feels that Social Security will find them disabled. Attorneys

familiar with Social Security disability can make predictions about

who will win and who will lose, but even they can seldom be sure. An

individual should make the decision about whether or not to file for

Social Security disability based upon their own belief about their

condition. If the individual feels that he or she is disabled and is

not going to be able to return to work in the near future, the

individual should file for Social Security disability benefits. If

denied, the individual should consult with an attorney familiar with

Social Security disability to get an opinion as to the chances of

success on appeal.

11. Can you receive Social Security disability benefits for

_________________ (insert the name of whatever disease you are

interested in)?

In almost every case, no matter what the disease is, the answer is

the same - " Maybe, it just depends upon how badly you are affected by

the disease. " One example might be cancer. The word " cancer " is scary

to anyone, but there are many cancers which can be treated and cured

very quickly, with little or no lasting effect. On the other hand, of

course, there are cancers which cause great suffering and ultimately

death. The question in each individual case is " How sick is this

particular individual with cancer and how long is this person going

to remain sick? " Skin diseases are another example. The vast majority

of skin diseases, while annoying, would not be considered to be

disabling. On the other hand, there are some uncommon, very severe

skin problems which are clearly disabling. In extreme cases,

psoriasis, which is not rare, may be disabling. Thus, almost without

exception, the mere fact that an individual has a disease with a

certain name does not guarantee that the individual either will or

will not be found disabled. It all depends upon how sick the person

is.

12. Do you have to be permanently disabled to get Social Security

disability benefits?

No. You have to have been disabled for at least a year or be expected

to be disabled for at least a year or have a condition that can be

expected to result in death within a year.

13. I have several health problems, but no one of them disables me.

It is the combination that disables me. Can I get Social Security

disability benefits?

Social Security is supposed to consider the combination of

impairments that an individual suffers in determining disability.

Many, perhaps most claimants for Social Security disability benefits

have more than one health problem and the combined effects of all of

the health problems must be considered.

14. I got hurt in an automobile accident. I am disabled now, but I

expect that I will be able to return to work after I recover. Should

I file for Social Security disability benefits?

If you expect to be out of work for a year or more on account of

illness or injury, you should file for Social Security disability

benefits.

15. How does Social Security determine if I am disabled?

Social Security is supposed to gather your medical records and

carefully consider all of your health problems, as well as your age,

education, and work experience. In general, Social Security is

supposed to decide whether you are able to do your past work. If

Social Security decides that you are unable to do your past work,

they are supposed to consider whether there is any other work which

you can do considering your health problems and your age, education,

and work experience.

16. Who decides if I am disabled?

After an individual files a Social Security disability claim, the

case is sent to a disability examiner at the Disability Determination

agency in your state. This individual, working with a doctor, makes

the initial decision on the claim. If the claim is denied and the

individual requests reconsideration, the case is then sent to another

disability examiner at the Disability Determination agency, where it

goes through much the same process. If a claim is denied at

reconsideration, the claimant may then request a hearing. At this

point, the case is sent to an Administrative Law Judge who works for

Social Security. The Administrative Law Judge makes an independent

decision upon the claim. This is the only level at which the claimant

and the decision maker get to see each other.

17. Why does Social Security consider my age in determining whether I

am disabled?

Social Security has to consider age, because that is what the Social

Security Act requires. As people get older, they become less

adaptable, less able to switch to different jobs to cope with health

problems. A severe foot injury which might cause a 30- year- old to

switch to a job in which he or she can sit down most of the time,

might disable a 60- year- old person who could not make the

adjustment to a different type of work.

18. Is there a list of illnesses that Social Security considers

disabling?

Not really. Because most types of illness can vary from minor to

severe, there is no one simple list of illnesses which Social

Security considers to be disabling. However, if an illness has

reached a very severe level with certain medical hallmarks, Social

Security will award benefits on the basis of medical considerations

alone.

19. What can I do to improve my chances of winning my Social Security

disability claim?

Be honest and complete in giving information to Social Security about

what is disabling you. Many claimants, for instance, fail to mention

their psychiatric problems to Social Security because they are

embarrassed about them. In almost all cases, individuals who were

slow learners in school fail to mention this fact to Social Security,

even though it can have a good deal to do with whether or not the

Social Security disability claim is approved. Beyond being honest and

complete with Social Security, the most important thing that you can

do is just keep appealing and hire an experienced person to represent

you. It is important to appeal because most claims are denied at the

initial level, but are approved at higher levels of review. It is

important to hire an experienced person to represent you because you

do not understand the way Social Security works. Statistically,

claimants who employ an attorney to represent them are much more

likely to win than those who go unrepresented.

20. How do I find an attorney to represent me before on my Social

Security disability claim?

The National Organization of Social Security Claimants'

Representatives (NOSSCR) offers a referral service. You may call

NOSSCR at 1-800-431-2804 during regular Eastern Time business hours.

21. 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. Other income that an individual has reduces the amount of

SSI which an individual can receive.

22. How far back will they pay benefits if I am found disabled?

For Disability Insurance Benefits and for Disabled Widow's and

Widower's Benefits, the benefits cannot begin until five months have

passed after the person becomes disabled. In addition, benefits

cannot be paid more than one year prior to the date of the claim. For

a Disabled Adult Child, there is no five-month waiting period before

benefits begin, but benefits cannot be paid more than six months

prior to the date of the claim. SSI benefits cannot be paid prior to

the start of the month following the date of the claim.

23. What do I do if Social Security denies my claim for Social

Security disability benefits?

First, do not be surprised. Only about 40% of Social Security

disability claims are approved at the initial level. If you are

denied at the initial level, unless you have already returned to work

or expect to return to work in the near future, you should appeal,

that is, file a request for reconsideration. You should also consider

employing an attorney to represent you.

24. Why does Social Security turn down so many claims for disability

benefits?

There is no simple answer to this question. One reason is that there

is no simple way to determine whether an individual is disabled. Most

people who are disabled suffer from pain. There is no way of

determining whether or not another individual is in pain, much less

how much pain they are in. A second reason is that Social Security

over the years has been more concerned with making sure that everyone

who is receiving Social Security disability benefits is " truly "

disabled than with making sure that everyone who is disabled receives

Social Security disability benefits. An underlying reason is that

Congress has always believed that, given a chance, many people

will " fake " disability in order to get benefits.

25. I only want to get back the money I put in Social Security. Why

do they make it so hard for me to get my own money back?

Actually, when you file a Social Security disability claim, you are

not trying to just get " your own money " back. The money that an

individual may have paid into Social Security over the years would

not last very long if that was all that an individual could draw from

Social Security.

26. What is " reconsideration " ?

When a claim for Social Security disability benefits is denied at the

initial level, the claimant may then request " reconsideration " of

that decision. The case is then sent to a different disability

examiner for a new decision. Unfortunately, about 80% of the time the

reconsideration decision is the same as the initial decision - a

denial.

27. Who makes the reconsideration determination?

A disability examiner at the Disability Determination Section makes

the reconsideration determination. Most of the time, the claimant

does not see the disability examiner or even know his or her name.

28. What are my chances of winning at reconsideration?

Statistically, about 20% of the time a claimant wins at

reconsideration.

29. Do I have to go through reconsideration?

If you want to appeal a denial of Social Security disability

benefits, you have to go through reconsideration. There is no way to

avoid it.

30. How long does it take to get a hearing on a Social Security

disability claim?

There is much variation around the country. In a few areas of the

country the wait is only three months. In a few areas of the country

the wait is more than a year.

31. What is the Social Security hearing like?

The hearings are fairly informal. The only people likely to be there

are the judge, a secretary operating a tape recorder, the claimant,

the claimant's attorney, and anyone else the claimant has brought

with him or her. In some cases, the Administrative Law Judge has a

medical doctor or vocational expert present to testify at the

hearing. There is no jury nor are there any spectators at the

hearing. There is no attorney at the hearing representing Social

Security trying to get the judge to deny the disability claim.

32. What are my chances of winning at a hearing?

Statistically, over half of the claimants who have a Social Security

disability hearing win.

33. If the Administrative Law Judge denies my claim, can I appeal any

more?

Yes. You can appeal to the Appeals Council which is still within

Social Security.

34. What is the Appeals Council?

The Appeals Council exists to review Administrative Law Judge

decisions. The Appeals Council is located in Falls Church, Virginia,

and neither the claimant nor the attorney sees the people at the

Appeals Council who are working on the case.

35. Can I appeal a case beyond Social Security to the Federal Courts?

Yes. After being denied by the Appeals Council, it is possible for a

claimant to file a civil action in the United States District Court,

requesting review of Social Security's decision. A Social Security

disability claim can go all the way to the Supreme Court. Perhaps

once every year or two years, the United States Supreme Court

actually hears an appeal about a Social Security disability case.

36. If I get on Social Security disability benefits and get to

feeling better and want to return to work, can I return to work?

Certainly you can return to work. Social Security wants individuals

drawing disability benefits to return to work and gives them every

encouragement to do so. For persons receiving Disability Insurance

Benefits, Disabled Widow's and Widower's Benefits, and Disabled Adult

Child Benefits, full benefits may continue for a year after an

individual returns to work. Even thereafter, an individual who has to

stop work in the following three years can get back on Social

Security disability benefits immediately without having to file a new

claim. In SSI cases, things work a differently, but there is still a

strong encouragement to return to work.

37. Where can I go to get help with my Social Security disability

claim?

For help, go to a lawyer or other person who represents Social

Security disability claimants on a regular basis. If you need a

referral to a lawyer who represents Social Security claimants, call

the referral service of the National Organization of Social Security

Claimants' Representatives (NOSSCR) at 1-800-431-2804.

38. Do I really have to hire a lawyer to represent me in my Social

Security disability claim?

No. You can go through all of the levels of review on your own, if

you wish, but statistically claimants who are represented by an

attorney win a good deal more often than those who are not

represented.

39 How do lawyers who represent Social Security disability claimants

get paid?

In almost all cases, the attorney receives one- quarter of the back

benefits if the claimant wins and no fee if the claimant loses.

40. Can alcoholics and drug addicts really get Social Security

disability benefits?

Not anymore. There never were all that many people getting Social

Security disability benefits on account of alcoholism or drug

addiction, but Congress has now prohibited Social Security from

paying disability benefits on the basis of alcoholism or drug

addiction. However, alcoholics and drug addicts have heart attacks,

get cancer or get sick in other ways just like everyone else.

Alcoholics and drug addicts who become disabled apart from their

alcoholism or drug addiction can become eligible for Social Security

disability benefits.

41. I know someone who is on Social Security disability and he does

not look a bit disabled. Why do they put all of these freeloaders on

benefits?

When it comes to disability, looks can be very deceiving. There are

many people who look quite healthy but who are quite disabled by

anyone's standard. For instance, many individuals who suffer from

very severe psychiatric illness are physically healthy and able to do

things such as mow their yards.

42. I am disabled, but I have never worked at public work. Can I get

Social Security disability benefits?

If you are poor enough, you can qualify for Supplemental Security

Income (SSI) if you are disabled, even if you have never worked in

the past. It is also possible to qualify for Disabled Adult Child

Benefits on the account of a parent if you became disabled before age

22 or for disabled widow's or widower's benefits on the account of a

late husband or wife.

43. I am a widow. I have not worked in public work in many years. I

am disabled. Can I get Social Security disability benefits?

If you are over 50 and became disabled within seven years after your

husband or wife died or within seven years after you last drew

mother's or father's benefits from Social Security, you can get

Disabled Widow's or Widower's Benefits. Perhaps more important, if

you are poor, you can draw Supplemental Security Income benefits no

matter what age you are or when you became disabled.

44. I have a daughter who has been disabled by cerebral palsy since

birth and has never been able to work. Can she get disability

benefits from Social Security?

Very possibly. If the child is under 18 and you are poor enough, the

child may be able to qualify for SSI child's disability benefits. If

the child is over 18, she may be able to qualify for SSI disability

benefits without regard to the income of her parents. If her father

or mother is drawing Social Security benefits of some type or is

deceased, the child may be eligible for disabled adult child

benefits.

45. I am already on Social Security disability benefits, but I am

worried that my benefits will be stopped in the future. What are the

chances of this happening?

Social Security is not supposed to cut off disability benefits for an

individual unless his or her medical condition has improved. When

Social Security reviews a case of someone already on Social Security

disability benefits, they continue benefits in the vast majority of

cases. In recent years, Social Security has been doing few reviews to

determine whether or not individuals already on Social Security

disability benefits are still disabled. This is changing and Social

Security should be doing far more reviews in the next few years.

However, the vast majority of individuals who are reviewed will see

their Social Security disability benefits continued.

46. If Social Security tries to cut off my disability benefits, what

can I do?

You should appeal immediately. If you appeal within 10 days after

being notified that your disability benefits are being ceased, you

can ask that your disability benefits continue while you appeal the

decision cutting off your benefits. You may also want to talk with an

attorney about representation on your case, but you should file the

appeal immediately.

47. My doctor says I am disabled so why is Social Security denying my

Social Security disability claim?

Social Security's position is that it is not up to your doctor to

determine whether or not you are disabled. It is up to them and they

will make their own decision regardless of what your doctor thinks.

48. VA says I am disabled, so why is Social Security denying my

Social Security disability claim?

It is Social Security's position that VA decisions are not binding

upon them. Social Security and VA have very different standards for

approving disability claims.

49. I am 60% disabled. Do I get 60% of my Social Security disability

benefits?

No. There are no percentages of disability in Social Security

disability determination. For purposes of Social Security disability

benefits, you are either disabled or not disabled. There are no

percentages of disability, nor any percentages of disability benefits.

50. I am disabled by mental illness. Can mental illness serve as the

basis for a Social Security disability claim?

Yes. Mental illness is a frequent basis for awarding Social Security

disability benefits.

51. Will it help if I ask my Congressional Representative to help me

get Social Security disability benefits?

Many Social Security disability claimants become frustrated with

claim delays and eventually ask their U.S. Representative or Senator

to help. The local Congressional office typically will have staffers

who are experienced with Social Security procedures and personnel.

A " Congressional Inquiry, " as it is called at Social Security, may

help to get a stalled process moving again. Note that the inquiry

will have no impact on how Social Security decides the outcome of the

case.

52. How long does it take before Social Security makes a decision

once I file a claim for Social Security disability benefits?

In most cases Social Security makes the first decision within four

months.

53. How long does it take for Social Security to make a

reconsideration determination on my Social Security disability claim?

In most case Social Security makes the reconsideration determination

within four months.

54. How long does it take for Social Security to act upon a request

for Appeals Council review?

About a year, maybe longer.

55. I am disabled. I need help with medical bills even more than I

need a cash income. How do I get help with medical bills?

Getting help with medical bills is usually tied up with getting cash

benefits, that is, you don't start getting help with medical bills

until after you start getting the cash benefits, so you have to keep

going with the Social Security disability claim in order to get the

help with medical bills.

56. What is the difference between Medicare and Medicaid?

The short answer is that Medicaid is a poverty program and Medicare

isn't. Many disabled people who get Medicaid get it because they are

on Supplemental Security Income (SSI). This is called " categorical "

Medicaid eligibility. To get SSI and thereby get Medicaid you have to

be poor and disabled. Medicaid pays doctors at very low rates. People

who have only Medicaid can have a hard time finding doctors willing

to take them on as patients. Medicaid does pay for prescription

medications. Medicaid can go back up to three months prior to the

date of a Medicaid claim. Note that it is possible to apply for

Medicaid directly - through a local Medicaid office - without having

a companion claim for SSI.

For Medicare it does not matter whether you are rich or poor. If you

have been on Disability Insurance Benefits, Disabled Widows or

Widowers Benefits or Disabled Adult Child Benefits for 24 months you

qualify for Medicare. The good thing about Medicare is that it pays

doctors at a higher rate than Medicaid. Almost all doctors are happy

to take Medicare patients. The bad things about Medicare are that it

does not begin until after a person has been on cash disability

benefits for two years and that it generally does not pay for

prescription medications.

57. If I get Social Security disability benefits will I get Medicare?

If you are approved for any kind of Social Security disability

benefit other than SSI you will get Medicare after you have been

entitled to Social Security disability benefits for two years.

58. If I get Social Security disability benefits will I get Medicaid?

If you are approved for SSI you will get Medicaid. It is possible to

get both Medicare and Medicaid if you are entitled to SSI and some

other type of Social Security disability benefit. Also see #56, above.