SOCIAL SECURITY DISABILITY CLAIMS AND BENEFITS
OVERVIEW OF CLAIMS AND BENEFITS
Social Security: Applying for Benefits
Many disabled workers have learned an unfortunate
paradox of dealing with a chronic disease-it often seems
that the sicker we get, the more adversarial the social
systems designed to protect us become. If your disease has
become severe enough for you to consider filing for
disability, the process of qualifying can be
overwhelming-often filled with complex regulations,
ambiguous interpretations, frequent disappointments, and
endless delays. Below are some questions and answers
that may help you understand how the application and
appeal processes work should you need to apply for
What is STD/LTD Disability Insurance?
Basically, disability insurance provides income to people
with medical conditions that are so severe they are unable
to work. Employers may offer group short term disability
(STD) and/or long term disability (LTD) plans, and individual
plans can be purchased from many insurance companies.
What Types of Disability Benefits Are Available through the
Social Security Administration?
In addition to premium-based programs like LTD and
individual disability plans, a 1956 amendment to the Social
Security Act of 1935 provided for two types of monthly
benefits payments to be paid to individuals who cannot
work due to a disability. Social Security Disability Insurance
(SSDI), created by Title II of the Act, provides income for
disabled people under age 65, who have worked in recent
years (generally, 5 out of the last 10 years) and paid Social
Security taxes. SSDI is not based on need, but on the
recipient's past contributions (or those of a parent or
spouse) to the Social Security trust fund.
Supplemental Security Income (SSI), created under Title XVI,
covers disabled people who have never been able to work,
or who worked so little or so long ago that they are not
eligible for SSDI. SSI eligibility is determined on the basis of
financial need. The medical requirements and
determination process are the same for both programs.
Both programs define a 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 last for a continuous period of not less than 12
months or result in death." In simple language, your illness
makes you incapable of working enough to earn anything
significant. The Social Security Administration (SSA) defines
a medically determinable impairment as "an impairment that
results from anatomical, physiological, or psychological
abnormalities which can be shown by medically acceptable
clinical and laboratory diagnostic techniques."
Who is Eligible for SSDI?
Basically, you are eligible if:
You have contributed to a Social Security account while
working for a specified period of time, usually 5 out of the
last ten years of work;
You meet the SSA's definition of disabled;
You are currently not working, or you are working, but
earning less than the amount considered to be the
substantial gainful activity level ($900 in 2007).
Family members of SSDI recipients may also be eligible for
benefits. Eligible family members include:
Any unmarried children under 18 or age 19 if they are in
high school full time. (This includes adopted children, and,
in some cases, stepchildren or grandchildren);
Unmarried children, 18 or older, may qualify if they have a
disability that started before the age of 22 and if they meet
the adult definition of disability;
A spouse who is age 62 or older, or any age if he or she is
caring for a child of the recipient who is under age 16, or
disabled and also receiving checks;
A disabled widow or widower age 50 or older. The disability
must have started before, or within seven years after, the
spouse's death. (Widows or widowers who receive Social
Security benefits because they are caring for a recipient's
children are eligible if they become disabled before, or
within seven years after, those payments end.)
Who Is Eligible for SSI?
In order to receive SSI, or Supplemental Security Income,
you must be age 65 or older, disabled or blind, and not
exceed eligibility limits for income and assets. SSI also pays
disability benefits to disabled or blind children who are
under 18 years old, whose families have limited income and
resources. People who get SSI can usually qualify for other
assistance programs, such as food stamps and Medicaid.
Am I Considered Disabled?
Once you have determined that you fall into an eligible
category, to receive benefits you must demonstrate that
you are "disabled" by the Act's standards. Basically,
'disabled' means that you suffer from a physical or mental
health problem (or a combination of problems) that makes
you unable to do any kind of work. In addition, your
disability is expected to last for at least a year or to result in
death. The Social Security Administration uses five
sequential questions to determine whether someone
qualifies as disabled:
Are you working?
If you have earnings averaging more than $900 a month in
2007, you generally are not considered disabled.
Is your condition severe?
Do you have a diagnosed condition that is severe enough
to prevent you from performing basic work-related tasks?
Is your condition found in the list of disabling impairments?
The Social Security Administration's Handbook for
Physicians contains a "Listing of Impairments" for each of
the major body systems. It catalogs impairments that are
considered severe enough to prevent a person from
performing any gainful activity (or in the case of children
under age 18 applying for SSI, cause marked and severe
functional limitations). Most of these impairments are
permanent or are expected to result in death, or have a
specific duration. For the others, the impairment must have
lasted or be expected to last for a continuous period of at
least 12 months. The criteria in the Listing of Impairments
are applicable to evaluation of claims under both the Social
Security disability insurance and SSI programs. If your
condition is on the list, you are automatically approved for
benefits. If it is not on the list, the SSA determines whether
your condition "meets the listing," i.e., is as severe as an
impairment on the list. If it is, your claim is approved. If not,
your claim is further scrutinized under the next requirement.
Can you do the work you did previously?
If your condition is severe, but not of the same or equal
severity as an impairment on the list, then the SSA
determines whether your medical documentation shows
that you cannot reasonably be expected to do the work you
have done in the last 15 years. If it does not, your claim will
be denied. If it does, your claim will be considered further.
Can you do any other type of work?
If you cannot do the work you did in the last 15 years, then it
will be determined whether you can do any other type of
work. Taking into consideration your age, education, past
work experience, and transferable skills, the SSA will
review the job demands of any other job which "exists in
significant numbers" in the national economy, as
determined by the Department of Labor. If you cannot do
any other kind of work, your claim will be approved. If you
can, your claim will be denied.
How Do I Apply?
You can apply for Security Disability Insurance (SSDI)
benefits online, by phone, mail or by visiting the nearest
office as soon as you become disabled.
You may apply online or by phone, toll-free at
1-800-772-1213 from 7 a.m. to 7 p.m., Monday through
Friday. Representatives will give you an appointment for
your application to be taken over the telephone. For people
who are deaf or hard of hearing, the SSA provides a
toll-free "TTY" number: 1-800-325-0778. You can also apply
at any Social Security office. You can find the name and
address of the closest Social Security office with the
SSA office locator
The SSA estimates that the initial claims process for
disability benefits generally takes from 90 to 120 days.
However, being prepared with the necessary documents
and medical evidence can help shorten the process.
What Information Will I Need to Provide?
The SSA requires original documents (or copies certified by
the issuing agency) of:
Your birth certificate or other proof of birth;
Your Citizenship or Naturalization papers (if applicable).
The SSA will accept copies of:
Your U.S. Military Service discharge paper(s) if you have
served in the military;
Your W-2 Form (Wage and Tax Statement), or if you are
self-employed, your federal tax return for the past year.
In addition, you will need to supply:
Your Social Security number;
A summary of where you worked in the past 15 years and
the kind of work you did;
The names and addresses of each employer for this year
and last year;
The amount you earned last year and the amount you
expect to earn this year (between September and
December, you may also be asked to estimate how much
you expect to earn next year);
Names, addresses, phone numbers and dates of treatment
for doctors, hospitals, clinics, and institutions that provided
treatment for the disabling condition;
Medical records from your doctors, therapists, hospitals,
clinics, and caseworkers, including the names of all
medications you are taking, and all laboratory and test
The beginning and ending dates for any period of U.S.
military service you may have served;
If your spouse and/or children are applying for benefits, you
will need their birth certificates and Social Security
If you have ever been married, the name, Social Security
number, and date of birth of your current and/or any prior
spouse, the date and place of each marriage and, if
applicable, the date and place the marriage ended;
Your bank account number and your bank or financial
institution's routing transit number, so your benefits can be
deposited electronically into your account.
If you are applying for Supplemental Security Income
benefits you will also need to provide:
Financial records, such as payroll slips, bank books,
insurance policies, car registration, burial fund records,
and other information about your income and the things you
Information about your home, such as your mortgage or
your lease and landlord's name.
When Will My Benefits Start?
If your SSDI claim is approved, you will receive benefits
beginning with the sixth full month after the date that it is
determined your disability began.
For Supplemental Security Income (SSI), benefits are paid
for the first full month after the date you filed your claim, or
the date you become eligible for SSI, if that is later.
How Much Will My Benefit Be?
The amount of your monthly disability benefit is based on
your lifetime average earnings covered by Social Security.
The Social Security Administration provides a statement
that will tell you the amount of the benefit you have
accrued. Request a statement.
How Long Will the Benefits Last?
Benefits usually continue until you are able to work again
on a regular basis. There are also a number of special rules,
called "work incentives," that provide continued benefits
and health care coverage to help you make the transition
back to work. Information about work incentives can be
found on the Social Security web site at:
SSA Publication 10095
In addition, there are a number of circumstances that could
cause SSA to discontinue your benefits. These are detailed
on the Social Security web site at: Circumstances which can
If you are receiving Social Security disability benefits when
you reach age 65, your disability benefits automatically
convert to retirement benefits, but the amount remains the
vast majority of
Disability (aka SSD
and SSI claims are
denied at the
Initial Claim and
For this reason,
most SSD and SSI
claims will need to
be heard by an
before a claimant
can hope to
It is at the level of
an ALJ hearing
that one should
accompanied by a
While a disability
guarantee that a
claimant will be
or SSI benefits, a
guarantee that a
case will be
developed prior to
a hearing date.
The simple fact of
the matter is this:
the vast majority
of SSD and SSI
claimants will have
no idea how to
disability case for
attorney or non
can apply a certain
level of familiarity
and expertise with
the goal of
on a case. And, in
many cases, an
attorney will have
several years of
and SSI claim
lend to a
Can a claimant
who is not
represented by an
attorney or non
attorney still win
an SSD or SSI
disability claim at
an ALJ hearing?
Yes. And, in fact,
odds of winning a
disability or SSI
claim before an
decreased when a
claimant does not
services of an
therefore, a social
should weigh the
risk of going
a hearing when
literally at stake---
it takes so long to
get to a disability
hearing in the first
claimants who are
win their claims
may not obtain the
onset date for the
The date of onset
and the date of
much a claimant
will receive in
able to prove the
onset is of
importance for a
disability or SSI
do a great many
things to ensure
that a social
or SSI claim will
have the best
chance of winning.
statements from a
physicians, and, at
the time of the
to the disability
Hiring an attorney
is never required
in a disability claim
attend a hearing
before a judge
assistance of a
is unwise and may
result in a lost
opportunity to win
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