Frequently Asked Questions
- What are the different types of benefits and medical assistance for the disabled?
Social Security Disability Insurance (SSDI) benefits can be paid to you monthly at any age if you have worked for five out of the last ten years and you have a severe physical or mental impairment that prevents you from working for a year or more, or if you have a medical condition that is expected to result in your death. Medicare is available to persons who have received SSDI benefits for two years.
Supplemental Security Income (SSI) benefits are payable to low income disabled persons regardless of work history. To get SSI you must be blind, disabled or 65 years of age or older. The federal government pays a basic benefit which may be increased by the state where you live. Medicaid is available to pay for medical care and prescription expense for SSI recipients.
- 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.”
- How do I apply for Social Security disability benefits?
The best way to file a Social Security disability claim is to contact us or go to the nearest Social Security office in person.
- Do you have to be permanently disabled to get Social Security disability benefits?
No. A person only has to have a severe impairment that lasts for 1 year and prevents them from doing their usual occupation.
- Why does the Social Security Administration consider my age in determining whether I am disabled?
The Social Security Administration 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 back 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.
- How will my Social Security Disability representative get paid?
The representative receives 25% of the back benefits if the claimant wins and no fee if the claimant loses. The Social Security Administration must approve the representative’s fees in every case. The representative receives no fee from future benefits.
- I am disabled, but I have little or no prior work. Can I get Social Security disability benefits?
If you have few assets 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 deceased husband or wife.
- I have a child who has a severe impairment. Can she get disability benefits from Social Security?
Yes. If the child is under 18 and you have few assets, 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 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.
- My doctor says I am disabled so why is Social Security denying my Social Security disability claim?
Social Security will consider the opinion of your treating physican, however the Social Security Administration will make its own decision on your claim.
- I receive Veterans Benefits, so why is Social Security denying my Social Security disability claim?
The Social Security Administration must give consideration to VA Rating Decisions, but VA Rating Decisions are not binding on the Social Security Administration. These federal agencies have very different standards for approving disability claims.
- I have been rated 60% disabled by a workers compensation examiner. Do I get 60% of my Social Security disability benefits?
No. There are no percentages of disability in Social Security disability determinations. 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.
- I am disabled by mental illness. Can mental illness serve as the basis for a Social Security disability claim?
Yes. Mental illness is a basis for awarding Social Security disability benefits. You must have marked impairment in activities of daily living, social functioning, and concentration.
- 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.
- SSDI/SSI Information
According to the Social Security Administration (SSA), a person qualifies for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) if:
- he or she has a physical or mental condition that prevents him or her from engaging in any “substantial gainful activity” (“SGA”), and
- the condition is expected to last at least 12 months or result in death, and
- the claimant is under full retirement age, and
- generally, they have accumulated 20 social security credits in the last 10 years prior to the onset of disability (normally four credits per full or partial year); one additional credit is required for every year by which the worker’s age exceeds 42.[
The work requirement is waived for applicants who can prove that they became disabled at or before the age of 22, as these individuals may be allowed to collect on their parents’ work credits. The parent(s) experience no loss of benefits.
Medical evidence consists of signs, symptoms and laboratory findings and is required to document the claim. Symptoms, such as pain, are considered but must be reasonably expected to come from a medically determinable impairment which the claimant is diagnosed to have. The decision is based on a sequential evaluation of medical evidence. The sequence for adults is:
1. Is the claimant performing a substantial gainful activity? If yes, the claim is denied.
2. Is the claimant’s impairment severe? If no, the claim is denied.
3. Does the impairment meet or equal the severity of impairments in the Listing of Impairments?If yes, allow the claim. If no, continue to next sequence.
4. Is the claimant able to perform past work? If yes, deny. If no continue to next sequence.
5. Is the claimant able to perform any work in the economy? If yes, deny. If no allow the claim.
Medical evidence that demonstrates the applicant’s inability to work is required. The DDS or ALJ (Administrative Law Judge) may also require the applicant to visit a third-party physician for medical documentation, often to supplement the evidence treating sources do not supply. The applicant may meet a SSA medical listing for their condition. If their condition does not meet the requirements of a listing, their residual functional capacity is considered, along with their age, past relevant work, and education, in determining their ability to perform either their past work, or other work generally available in the national economy.
Determination of a residual functional capacity—made in the fourth step in the sequential evaluation process—often constitutes the majority of the SSDI and/or SSI application and appeal process. A residual functional capacity is assessed in accordance with Title 20 of the Code of Federal Regulations, part 404, section 1545 by a disability determination service (DDS) in your state or, on appeal, by an administrative law judge (ALJ).
Residual functional capacity (RFC) is classified according to the five exertion levels of work defined in the Dictionary of Occupational Titles, which are: Sedentary, Light, Medium, Heavy, and Very Heavy. If the residual functional capacity of an individual equals the previous work performed, the claim is denied on the basis that the individual can return to former work. If the residual functional capacity is less than former work then the RFC is applied against a vocational grid that considers the individual’s age, education and transferability of work skills. The vocational grid directs an allowance or denial of benefits. The grids are not applicable when the claimant alleges psychological impairments.