Social Security Disability Claims

SOCIAL SECURITY DISABILITY (SSD) &
SUPPLEMENTAL SECURITY INCOME (SSI)

Seniors and persons with disabilities may be eligible for benefits through SSI (Supplemental Security Income) or SSDI (Social Security Disability Insurance). SSI is a needs-based program that provides financial assistance to older adults and persons with disabilities who have very limited income and resources. SSDI is a program that provides assistance to individuals based on their work/income history, whether it be through their own employment or that of a family member, specifically a spouse or parent. While both programs require the individual to suffer from a disability and be unable to engage in what the Social Security Administration calls Substantial Gainful Activity (SGA is defined as earning $1,310 or more a month from working, or $2,190 for blind people), SSI is based upon the limited resources of the individual, while SSDI is based on the work credits an individual has earned. It is important to note that an individual can be employed and still be considered disabled if they are unable to work or earn enough so that their income elevates to the level of Substantial Gainful Activity.

SSD & SSI: Application & Appeal

Both SSI and SSDI require an applicant to complete an application for benefits detailing what conditions and limitations they experience and the reason they are unable to find or maintain gainful employment. It is not uncommon for many individuals to be denied on this application initially. The process requires an individual to appeal this denial within sixty (60) days of receiving the denial. If denied on appeal from the initial application, they may then make an appeal request (also within sixty (60) days of the denial) consisting of a request for hearing in front of an Administrative Law Judge (ALJ). Many individuals who have success on their claims do so at the hearing level, and it is important to find adequate representation to develop your case and present your claim to the ALJ at this hearing.

SSD & SSI: Medicaid & Medicare

In addition to financial assistance, SSI recipients will automatically qualify for health care coverage through Medicaid, while SSDI recipients will automatically qualify for Medicare after 24 months of receiving disability payments (individuals with amyotrophic lateral sclerosis [ALS] are eligible for Medicare immediately). It is important to note that this does not mean SSDI recipients will have to be disabled for two years after being deemed disabled before becoming eligible to receive insurance benefits. This is because of ‘backpay.’

SSD & SSI: Backpay

When an individual applies for disability benefits, they can allege a disability going back 12 months before the date of their application in the case of SSDI applications and may go back to the date of the application on SSI applications. Because it can take months to receive a determination on the disability claim, individuals can receive backpay benefits for the months between the date the disability began (the Social Security Administration will make a finding concerning whether the individual is disabled and a determination as to what date they became disabled) and the date they received the decision. This is called ‘backpay.’ For example, an applicant files for disability in January and receives a decision that they are disabled in July. That decision states that the applicant is disabled and has been disabled since the date of their January application. In this situation the applicant could receive payment of benefits for the six months preceding the decision in July, which would be considered their backpay. The reception of benefits could be on a continued basis, or it is also possible to receive what is referred to as a “closed” period of disability, wherein an individual is unable to work for a specified time, which must exceed twelve (12) months. An example of a closed period would be an individual who is injured and unable to work for twelve or more months, but after that time is able to return to work and engage in Substantial Gainful Activity. In this situation the individual could apply for and receive disability benefits during the period in which they were unable to work.

SSD & SSI: Hiring an Attorney

If you seek legal counsel to assist you with your application and claim for benefits, the representation is based on a contingency fee form of payment. This means that the attorney only gets paid if you win, and in that event the attorney will only receive 25% of your ‘backpay,’ up to $6,000.00, which is the current fee limit. There are exceptions and caveats to these general principles or rules, and any individual seeking disability benefits should consult with an attorney to determine their rights and potential for success. It is also best to consult with an attorney about building and establishing your claim for disability. The Social Security administration uses a complicated sequential evaluation process involving the grouping of conditions into ‘listings’ and/or an evaluation method known as ‘the grids’, which takes into account the individuals age, past relevant work, and education in order to determine disability. Understanding this process and the evaluation methods can be complicated and seeking an experienced Social Security Disability attorney can greatly increase any applicant’s chances for success.

The best way to ensure a successful claim is to have documented medical treatment that can substantiate and verify the conditions an individual has and help establish the severity and/or extent of those conditions and limitations, as any disability finding must be founded upon documented medical treatment that establishes what conditions or limitations render the applicant disabled and when that disability began.

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