A Guide to Social Security Disability

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Social Security Disability is an entitlement program that allows disabled individuals to receive paid benefits from the Federal government, specifically the Social Security Administration (SSA).

All Americans with a work history are entitled to Social Security Disability Insurance (SSDI) benefits because they have paid into the system.

A percentage is taken out through FICA (Federal Insurance Contributions Act) and put into the Social Security system for workers’ protection, and that of their family members, should a disability occur.

Social Security taxes provide benefits, but those who have never worked can apply for the welfare program, Supplemental Security Income (SSI). Some individuals qualify for both programs.

The disability benefits process, whether qualifying through SSI or SSDI, is the same.

As an applicant, it isn’t necessary to know whether you qualify for SSDI or SSI at the time of filing.

Whether you choose to apply on your own or with a disability lawyer, your local SSA office will determine which program or programs apply to you.

What Are Social Security Disability Benefits?

Disability programs include employer-based and private disability insurance, but Social Security Disability is backed by the federal government.

If a disability claim is allowed it leads directly to a monthly check, and those who qualify prior to retirement age also receive health insurance through Medicaid or Medicare.

Some applicants will receive a lump sum prior to getting their monthly benefits if their disabling condition began a number of years prior to approval.

The monthly benefits are not enough for most people to live on, but the combination of a monthly check and health insurance provides substantial financial security through a guaranteed income.

What Is Social Security Disability Insurance?

In addition to a monthly check issued by the Federal government, SSDI provides health insurance. This means you will receive medical care as long as you have benefits.

This is guaranteed health coverage through the existing Medicaid or Medicare systems, and you cannot be denied coverage or medical treatment.

For most individuals facing health challenges or recovering from injuries, the health insurance portion of benefits is as important as the monthly cash support.

How Much Income Does SSDI Provide?

The SSDI program is designed to help with income, but it doesn’t lead a life of luxury. Disability payments depend on which program, SSI or SSDI, the applicant qualifies under.

The most common allowance is for SSDI benefits, and SSA statistics show that $1,234 (monthly) is the average 2019 benefits check.

The level of income, however, ranges and the actual amount is dependent on eligibility under Title 2 (SSDI benefits), Title 16 (SSI benefits), or both disability programs.

How Do You Qualify for SSDI?

About 9 million recipients currently meet the definition of disability and receive social security benefits. Since SSDI is an entitlement program, all workers qualify but not all who apply will be approved.

Once an application is filed, the information is sent electronically to a separate office where medical eligibility is determined.

Facts such as medical records, work history, and income are all reviewed by Disability Examiners, and the claim is also reviewed by one or more medical consultants.

What Is Supplemental Security Income?

SSI is a program developed to help disabled individuals who do not work. The reason for this is simple: if disabled due to a medical condition or injury, finding employment may be impossible.

Because of this, SSI is considered a welfare program that is designed to care for vulnerable people without work credits who need assistance supporting themselves with a basic income. Like SSDI, the SSI program provides both a check and health insurance.

SSA’s definition of disability does not change whether the claimant qualifies under SSI or SSDI.

What Is the Social Security Administration’s Definition of “Disabled”?

Disability is defined by SSA in its simplest terms as the inability to work. The technical definition is “the inability to engage in ‘substantial gainful activity’ (SGA)”.

For practical purposes, SGA means full-time work – either usual employment or having the capacity to adjust to new, different employment.

This straightforward definition does not mean the process of getting approved is simple or quick, however.

Determining whether SGA is possible takes a team of specialists and doctors to review the disability application, and sometimes schedule additional medical appointments.

Past work has a big impact on allowance or denial, and a law firm that offers a free evaluation of work history can be helpful.

What Is the Listing of Impairments?

A disabling condition is termed an “impairment” and it refers to any medical condition, whether physical or psychological. Impairments include injuries or chronic illnesses and are categorized by a listing number; the shorthand at the disability office is “listings.”

If an impairment “meets” a listing, quick approval follows.

Most impairments, however, do not meet a listing and require assessment based and the ability to engage in SGA. Common medical problems, such as back pain and depression, usually result in longer wait times.

Conditions that are less cut-and-dry, such as Fibromyalgia, or impairments that range in recovery time, like cerebral vascular accidents (CVA, or strokes), will usually take longer to adjudicate.

How Do You Apply for Disability Benefits?

Before applying, it’s wise to decide if you want help. The best way to get help is through an experienced disability lawyer working at an established law firm.

These professionals have years of experience with claims, understand how this complex system operates, and offer a free evaluation.

They know the listings and can give applicants a realistic sense of how long the application process may take. Non-attorney representatives are also available to assist with the application.

If you decide to apply on your own, the SSA eligibility screening uses a website with an electronic portal, and you can begin the application process on the SSA website.

For those who lack computer access, the local Social Security office is the place to go. The office that processes these claims is the same place where social security retirement benefits are processed, and all offices have a phone number to call to schedule an appointment.

What You Need to Apply for Benefits

The process of applying begins online, by working with a disability lawyer, or by visiting a local office. (Disability evaluation, however, takes place at a separate office where medical records are reviewed).

Before taking any action, applicants should make a complete list of all medical facilities where they have received medical treatment.

It isn’t necessary to have exact addresses, but the names of hospitals, doctors, treatment facilities, rehabilitation facilities, workman’s compensation, and even prison or jail are important.

If this process is too difficult, a law firm or representative can help. In addition, the applicant should be prepared to fill out a form – either alone, or with help – that describes work history for the last fifteen years.

Having this information on hand makes applying less stressful.

What If Your Application is Denied?

The Social Security disability process isn’t swift, even with the help of a disability lawyer. For most applicants, there are multiple phases because the SSA process allows only for total disability.

Unlike other government programs, such as Workman’s Compensation or Veteran’s Administration (VA) benefits that provide partial disability, SSA benefits are all-or-nothing.

About one in three claimants (33%) is approved on the initial (first) application for total disability. This means most individuals will be denied the first time.The next step is called “reconsideration” and it involves resubmitting the claim with any new medical information for review by a different Disability Examiner. The reconsideration (“Recon”) process takes about as long as the initial claim.

Claimants who file at Recon level are usually denied; about 14% of these cases are allowed.

The Administrative Law Judge (ALJ) is the next level, where three out of four (75%) claims are approved in federal court.

By the time the claim reaches the ALJ, most claimants have waited close to a year, but overall forty percent of all disability applications are finally approved for social security benefits.

Compassionate Allowance Conditions

Some conditions are so severe that a special category has been created called Compassionate Allowance.

Applicants in this category still go through the same process at the local Social Security office (or online), with or without the help of a law firm, but once their case file is developed, a “CAL” label is added to expedite the claim at the office where medical decisions are made.

CAL cases are typically processed, and almost always approved, within one month from the time of initial application.