Social Security Disability Frequently Asked Questions

 
People who become unable to work due to injuries or illnesses need quick access to their Social Security Disability Insurance (“SSDI”) benefits.  However, many applicants suffer painful delays, and other fail to get disability benefits because they do not understand their role in the process of providing disability.  Here we address questions frequently asked by people who call or write.
 
 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 by “FICA” tax withheld from workers’ pay and by employer contributions, and pays qu alifying 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 onset of their disability typically are covered by SSDI.  Younger workers can qualify with fewer years of work.  You can apply for SSDI 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.
 
Is “SSDI” the same as “SSI?”
 
The definitions of “disability” are identical in the two programs, but “SSI” (Supplemental Security Income) and “SSDI; (Social Security Disability Insurance) are different in their financial qualifications and benefits.  For example:
Benefit Amounts.  The SSDI 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 $494 for an individual (in 1998).  (Exception: Even though the SSI benefit is fixed, individual checks may vary because of deductions required by law.)  Some states pay a supplemental to SSI recipients.
 
 Healthcare Benefits.  Recipients of SSDI qualify for Medicare benefits 24 months after their first monthly check.  SSI recipients get Medicaid benefits immediately, without a waiting period.
 
 Other People’s Income and Resources.  Benefits of SSDI 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 SSDI benefits.  But benefits of SSI recipients may fluctuate (or end) because of 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 the other.  Get the free booklets “Social Security Disability Benefits,” SSA Publication No. 05-10029; and “Supplemental Security Income,” SSA Publication No. 05-11000.
 
Why might I need SSDI?
People who become disabled typically have a large drop in income, which SSDI can partially replace.  This helps pay living expenses, and it 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 SSDI after age 65?
SSDI benefits cut off at age 65, and ordinary Social Security retirement and Medicare benefits take over.  See the Social Security Handbook, 1997, section 501, available in many public libraries.
 
If I have been self-employed, can I get SSDI if I become disabled?
Self-employed people who become disabled can get SSDI if they have paid the government enough self-employment tax and/or FICA tax to qualify for SSDI 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. 5-10022.
 
Will my spouse’s income affect my SSDI?
Your Spouse’s income will not affect your SSDI benefits.  SSA considers your work capacity – not the income or resources of your spouse.  Your savings and investment s 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 SSDI; 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 SSDI differ from worker’s 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 SSDI does not require a casual connection between your medical condition and your work.  You may receive workers’ compensation benefits for partial incapacity; but SSDI requires that you be totally incapacitated from substantial gainful work.  Workers’ compensation may pay benefits for periods of disability shorter than a year; but SSDI requires that your disability persist at least a year.
 
State Disability Insurance
Five states and the Commonwealth of Puerto Rico 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 SSDI benefits become payable.  State benefits generally are short term, while Social Security Disability Insurance benefits are long term (SSDI benefits may continue indefinitely, until Social Security retirement benefits become payable at age 65.) State benefits continue a maximum of 26 weeks in Hawaii, New Jersey, New York, and Puerto Rico; 30 weeks in Rhode Island; and 52 weeks in California. 
 
For more information contact the appropriate state agencies.  (CALIFORNIA:  Employment Development Department, 916-654-8198; HAWAII: Disability Compensation Division for TDI, 805-586-9188; NEW JERSEY: Temporary Disability Insurance information, 609-292-7060; NEW YORK:  Toll-free information in NY, 800-887-7695 or Workers Compensation Board, Albany District, 518-474-6681; PUERTO RICO: Insurance Fund 787-793-5959; RHODE ISLAND: Temporary Disability Insurance, 401-222-3625.) 
 
Private Disability Insurance
Many people purchase private disability insurance policies to assure that they continue to have income in the event of disability.  Private policies often start paying more quickly than SSDI.  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 SSDI benefits.  Some private policies have definitions of “disability” more lenient that 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.) This definition is found in Section 223(d) (1) (A) of the Social Security Act, and applicants must supply SSA the evidence that proves their condition meets these criteria.  “Substantial gainful activity” is defined as working on a regular and continuing basis and earning at least $500 a month.  If you are working and earning $500 a month or more, SSA will be reluctant to accept your claim because they see you doing substantial gainful activity. This should not be a problem if you are on sick leave or leave of absence, because then you are not actively working. 
 
How do I apply for SSDI benefits?
You can apply for SSDI 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 one.  SSA typically sends out an initial claim decision  in 60 to 120 days, and approves about one-third of claims in the initial decision.  Unsuccessful claims can be appealed within 60 days after you receive the notice of decision, and SSA reverses many unfavorable decisions and awards benefits when claimants appeal. 
 
What information do I submit with my SSDI claim?
Furnish the information listed in the booklet “Social Security Disabled Benefits,” SSA Publication No. 05-10029. (See the extract below.)  Also provide at least one doctor’s report based on a recent examination that; (1) established 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.   Doctors can get complete information on disability reports from the PDS booklet, Disability Evaluation in a Nutshell. For complete information on filing and managing a claim for benefits, see the Disability Workbook for Social Security Applicants available from Physicians Disability Services. 
 
The booklet “Social Security Disability Benefits,” SSA Publication No. 05-10029, says (at page 8) , “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:
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.
Also, give SSA a certified copy of  your birth certificate.
 
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 a full set of evaluation criteria to treating doctors.  However, SSA evaluates their reports as if treating doctors knew the criteria.  Treating doctors typically fill out an SSA form that has 10 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.  To assure that doctors can write thorough reports to SSA, Physician Disability Services publishes the 14 page booklet, Disability Evaluation in a Nutshell: A Three Minute Guide to Effective Medical Reports. 
 
What does SSA do after I file my claim?
 
Applying for Benefits
You apply for SSDI Benefits at an SSA office, or by telephone and mail.  A claims representative interviews you and identifies sources of medical evidence.  The representative also confirms that you need the SSDI 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 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.
 
Requesting a Hearing. If SSA reconsiders the claim and denies it again, you request a hearing before an administrative law judge (AALJ) within 60 day 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 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 revise 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.
 
Applicants appeal more than one-half of unfavorable SSA initial claim decisions, and more than three-fourths of unfavorable reconsideration decisions.  Many appeals result in benefit awards.  About one-fourth of all the disability awards made by SSA are made by ALJs, when applicants appeal unfavorable lower level decisions.
 
Are there recent changes in SSDI procedures that I should know about?
SSA recently gave stat disability examiners more latitude to approve meritorious claims in the initial claim decision, which is good for applicants.  This information was reported by the U.S. General Accounting Office.  On the other hand, SSA is trying to restrain ALJs because the agency thinks they make too many decisions favorable to applicants.
These changes mean applicants must 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 Physicians Disability Services publications, Disability Workbook and Disability Evaluation in a Nutshell show that 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
 
Q:  Where can I get more help with my disability claim?
For information about legal representation, contact the National Organization of Social Security Claimant’s Representative (“NOSSCR), telephone 800-431-2804.  For information about SSA office locations and publications, contact the Social Security Administration, 800-772-1213.