Filing For Social Security Disability Benefits

A guide to the Social Security disability program and tips to help you get the income and Medicare and Medicaid benefits you're entitled to.

When most people think of Social Security, they think of retirement benefits. However, the Social Security Administration also handles the national disability benefit program. There are two separate, but similar, programs that provide cash assistance and health coverage for certain people with disabilities who cannot work. According to Social Security, the disability insurance program pays an average benefit of $722 to 4.7 million people with disabilities.

The first program is Social Security Disability Insurance (SSDI). To be eligible for SSDI, you must have worked at a job where you paid Social Security taxes for at least twenty of the last forty quarters -- that is to say, five out of the last ten years. (For younger workers, this number is reduced on a sliding scale.) Your benefit is based on the amount of Social Security taxes you've paid. You may also recieve a retroactive benefit starting from the day you first became disabled. After two years of receiving SSDI benefits, you'll be eligible to apply for Medicare.

The second program is Supplemental Security Income (SSI). There's no work requirement to receive SSI; in fact, many SSI recipients -- about 1.5 million -- are children. However, the SSI program has important eligibility limitations. You cannot have resources of more than $2,000, or $3,000 for couples (excluding your homestead, for one). You cannot have a monthly income that exceeds $700. However, once you're on SSI, you can receive Medicaid retroactive to three months before the date you became disabled. It is possible to be on both SSI and SSDI at the same time, although you'll receive just one check.

Both the SSI and SSDI programs require that you meet the Social Security definition of disability. Social Security defines "disability" as a medical condition that's so severe that you can't do any kind of work at all for at least one year, taking into account your education and work history. Temporary disabilities do not qualify you for Social Security disability benefits.

When Social Security receives your application for SSI/SSDI, it's automatically transferred to your state's vocational rehabilitation (VR) agency. The VR agency makes its decisions based on your medical records. If there's any question about your disability status, the VR agency will pay for a doctor to examine you. This process takes approximately sixty days.

Not all disabilities are treated equally by the Social Security system. Social Security uses a long, complex set of regulations to determine whether an individual has a qualifying disability or not. The regulations are more stringent for some disabilities than others. It is generally more difficult to get SSI/SSDI benefits if you have a back injury, a knee injury, a mental illness, or a chronic disease like chronic fatigue syndrome or fibromyalgia.

If the VR agency determines that you're medically eligible for SSI/SSDI, your file is sent back to Social Security so that they can determine whether you're financially eligible for SSI or how much your SSDI benefit is. However, if the VR agency denies your application -- and it happens more than you might think -- you must request a "reconsideration" and allow the VR agency another sixty days to review your file again.

If the VR agency turns you down at the reconsideration level, you have the right to file an appeal with Social Security. Social Security will assign your appeal to an "administrative law judge" at the Social Security Office of Hearings and Appeals. Despite what Social Security may tell you, this is a complex and lengthy process that can take 18 months to three years. There is generally a very long waiting list just to get a hearing with a Social Security judge.

If you lose at the hearing stage, you have the right to appeal the judge's ruling at the Social Security Appeals Council in Virginia. If you lose at the Appeals Council stage, you have the right to sue Social Security in federal court.

There are some steps you can take to help yourself to get the benefits to which you're entitled.

1. Work with your doctor. It's vitally important that you provide all your medical records to the VR agency. If your medical condition worsens, make sure that your doctor gives that information to the VR agency. Also, it's helpful if your doctor knows the Social Security regulations and provides exactly the information that the VR agency needs to evaluate your disability.

2. Hire a lawyer. Social Security limits the amount of compensation that an attorney can receive to 25% of any retroactive award, and a lawyer won't get any money unless you get your disability check. If you have to file an appeal, having a lawyer is almost a necessity. If you can, deal with a lawyer who specializes in Social Security law; they'll likely have a good relationship with the judge.

3. Write your Congressman. Your Congressman and Senators can't get your disability for you, but they can contact Social Security and ask them to speed up the process. If you're faced with the loss of your home, or some other emergency, your Congressman can help get your claim expidited quickly. However, even with your Congressman on your side, processing a disability application still takes a long time.

There are other resources open to you as well. If you were injured on the job, you may be entitled to workers' compensation. Your company may have short or long-term disability benefits, or you may have disability benefits through private insurance. Your state may also provide financial assistance.

Additionally, your local employment agency and your VR agency can provide training and other assistance that may help you get back to work. A new federal law, the Ticket-to-Work Act, may allow you to work while retaining Medicare or Medicaid benefits. Ask Social Security if this new law can help you.

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