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Questions & Answers

Social Security Disability Questions and Answers

1.         What is the definition of disability used by Social Security?

Under the Social Security Act, “disability” means “the 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.”

2.         How many different types of Social Security disability benefits are there?

There are at least five major types of Social Security disability benefits. Disability Insurance Benefits go to individuals who have worked in recent years (five out of the last 10 years in most cases) who are now disabled. Disabled Widow’s and Widower’s Benefits are paid to individuals who are at least 50 years old and become disabled within a certain amount of time after the death of their husband or wife. The late husband or wife must have worked enough under Social Security to be insured. Disabled Adult Child Benefits go to the children of persons who are deceased or who are drawing Social Security disability or retirement benefits. The child must have become disabled before age 22. For Disability Insurance Benefits, Disabled Widow’s or Widower’s Benefits and Disabled Adult Child benefits, it does not matter whether the disabled individual is rich or poor. Benefits are paid based upon a Social Security earnings record. Supplemental Security Income (SSI) benefits, however, are paid to individuals who have little or no income and limited resources and who are disabled. It does not matter for SSI whether an individual has worked in the past or not. SSI child’s disability benefits are a variety of SSI benefits paid to children under the age of 18 who are disabled. The way in which disability is determined is a bit different for children.

3.         How do I apply for Social Security disability benefits?

The best, surest way to file a Social Security disability claim is to go to the nearest Social Security office in person and wait (often for a few hours) to see someone to file the claim in person. In the alternative, a person may contact Social Security by telephone and arrange for a telephone interview to file the claim.  Also, you may apply online at www.ssa.gov.

4.         I am disabled, but I have plenty of money in the bank. Do I have to wait until this money is gone before I apply for Social Security disability benefits?

No. If you have worked in recent years or if you are applying for Disabled Widow’s or Widower’s benefits or Disabled Adult Child benefits, it does not matter how much money you have in the bank. There is no reason to wait to file the claim.

5.         I used to work but lately I have been staying home taking care of the kids. I have now become sick. Can I get Social Security disability benefits?

Possibly. If you have worked roughly five out of the last 10 years under Social Security before becoming disabled, you will probably have enough earnings to qualify for Social Security disability benefits. For individuals 31-years-old or less, the requirements are a little different, since such individuals have not had as long to work. Unless a person has been staying home and taking care of their children for quite a long time, however, it is very possible that they will qualify for Social Security disability benefits based upon their own earnings.

6.         How long do I have to wait before I can file for Social Security disability benefits?

You can file for Social Security disability benefits on the same day that you become disabled. Many individuals make the mistake of waiting months or years after becoming disabled before filing a Social Security disability claim. There is no reason to file a Social Security disability claim if one has only a minor illness or one which is unlikely to last a year or more. However, an individual who suffers serious illness or injury and expects to be out of work for a year or more should not delay filing a claim for Social Security disability benefits.

7.         I am still on sick leave from my employer. Can I file for Social Security disability now or do I have to wait until the sick leave is exhausted?

You do not have to wait until the sick leave is exhausted. You should file for Social Security disability benefits now if you believe that you will be out of work for a year or more.

8.         I got hurt on the job. I am drawing worker’s compensation benefits. Can I file a claim for Social Security disability benefits now or should I wait until the worker’s compensation ends?

You do not have to wait until the worker’s compensation ends, and you should not wait that long. An individual can file a claim for Social Security disability benefits while receiving worker’s compensation benefits. It is best to file the Social Security disability claim as soon as possible.

9.         Can I get both worker’s compensation and Social Security disability benefits?

Yes. There is an offset which reduces Social Security disability benefits because of worker’s compensation benefits paid, but in virtually all cases, there are still some Social Security disability benefits to be paid. In a few states (though not in Indiana), the offset works the other way – worker’s compensation benefits are reduced because of Social Security disability benefits.

10.       How can I tell if I will be found disabled by Social Security?

Unless your disability is catastrophic (such as terminal cancer, a heart condition so bad that you are on a heart transplant waiting list, total paralysis of both legs, etc.), there is no easy way for you to tell whether you will be found disabled by Social Security. In the end, the decision of whether or not to apply for Social Security disability benefits should not be based upon whether or not you feel that Social Security will find you disabled. Attorneys familiar with Social Security disability can make predictions about who will win and who will lose, but even they can seldom be sure. You should make the decision about whether or not to file for Social Security disability based upon your own belief about your condition. If you feel that you are disabled and are not going to be able to return to work in the near future, you should file for Social Security disability benefits. If denied, you should consult with an attorney familiar with Social Security disability to get an opinion on the chances of success on appeal.

11.       Can I receive Social Security disability benefits for my condition?

In almost every case, no matter what the condition is, the answer is the same: “Maybe, it just depends upon how badly you are affected by the condition.” One example might be cancer. The word “cancer” is scary to anyone, but there are some cancers that can be treated relatively quickly, with little or no lasting effect. On the other hand, of course, there are cancers which cause great suffering and ultimately death. The question in each individual case is “How sick is this particular individual with cancer and how long is this person going to remain sick?” The mere fact that you have a disease with a certain name does not guarantee that you either will or will not be found disabled. It all depends upon how sick you are, and how long you will be too sick to work.

12.       Do you have to be permanently disabled to get Social Security disability benefits? 

No. You have to have been disabled for at least a year, or be expected to be disabled for at least a year, or have a condition that can be expected to result in death.

13.       I have several health problems, but no single condition disables me. It is the combination that disables me. Can I get Social Security disability benefits?

Social Security considers the combination of impairments that an individual suffers in determining disability. Many claimants for Social Security disability benefits have more than one health problem, and the combined effects of all of the health problems are considered.

14.       I got hurt in an automobile accident. I am disabled now, but I expect that I will be able to return to work after I recover. Should I file for Social Security disability benefits? 

If you expect to be out of work for a year or more on account of illness or injury, you should file for Social Security disability benefits.

15.       How does Social Security determine if I am disabled?

Social Security uses a five step analysis.

16.       Who decides if I am disabled?

After you file a Social Security disability claim, your case is sent to a disability examiner at the Disability Determination agency in your state. This individual, working with a doctor, makes the initial decision on the claim. If your claim is denied and you request reconsideration, the case is sent to another disability examiner at the Disability Determination agency, where it goes through the same process. If a claim is denied at reconsideration, you may then request a hearing. At this point, your case is sent to an Administrative Law Judge who works for Social Security. The Administrative Law Judge makes an independent decision upon the claim. This is the only level at which the claimant and the decision-maker get to see each other.

17.       Why does Social Security consider my age in determining whether I am disabled?

As people get older, they become less able to switch to different jobs.

18.       Is there a list of illnesses that Social Security considers disabling?

Most types of illness can vary from minor to severe, and there is no one simple list of illnesses which Social Security considers to be disabling. However, if an illness has reached a very severe level with certain medical findings, Social Security will award benefits on the basis of medical considerations alone.

19.       What can I do to improve my chances of winning my Social Security disability claim?

Be honest and complete in giving information to Social Security.

20.       If I am approved for Social Security disability benefits, how much will I get?

For Disability Insurance Benefits, it all depends upon your age and how much you have worked and earned in the past. For Disabled Widow’s or Widower’s Benefits, it depends upon your age and how much the late husband or wife worked and earned. For Disabled Adult Child Benefits, it depends upon how much the parent worked and earned. For all types of SSI benefits, there is a base amount that an individual with no other income receives. Other income that an individual has reduces the amount of SSI that an individual can receive.

21.       How far back will they pay benefits if I am found disabled?

For Disability Insurance Benefits and for Disabled Widow’s and Widower’s Benefits, the benefits cannot begin until five months have passed after the person becomes disabled. In addition, benefits cannot be paid more than one year prior to the date of the claim. For a Disabled Adult Child, there is no five-month waiting period before benefits begin, but benefits cannot be paid more than six months prior to the date of the claim. SSI benefits cannot be paid prior to the start of the month following the date of the claim.

22.       What do I do if Social Security denies my claim for Social Security disability benefits?

If you want to appeal, you have only 60 days to do so.  If you choose not to appeal but later decide to reapply, you may lose out on some back pay.

23.       Why does Social Security turn down so many claims for disability benefits?

There is no simple answer to this question. One reason is that there is no simple way to determine whether an individual is disabled. Most people who are disabled suffer from pain. There is no way of determining whether or not another individual is in pain, much less how much pain they are in.

24.       I only want to get back the money I put in to Social Security. Why do they make it so hard for me to get my own money back?

Actually, when you file a Social Security disability claim, you are not trying to just get “your own money” back. The money you paid in is an insurance premium, not a deposit into a savings account. The money that an individual has paid into Social Security over the years would usually not last very long if that was all that an individual could draw from Social Security.

25.       What is a “reconsideration”?

When a claim for Social Security disability benefits is denied at the initial level, the claimant may then request “reconsideration” of that decision.

26.       Who makes the reconsideration determination?

A disability examiner at the Disability Determination Section makes the reconsideration determination. Most of the time, the claimant does not see the disability examiner.

27.       What are my chances of winning at the reconsideration?

Statistically, only about 1 out of 10 claimants wins at the reconsideration level.

28.       Do I have to go through a reconsideration?

If you want to appeal a denial of Social Security disability benefits, you have to go through a reconsideration.

29.       What is the Social Security hearing like?

The hearings are fairly informal. The only people likely to be there are the judge, a court reporter operating a recording device, the claimant, the claimant’s attorney, and anyone else the claimant has brought with him or her. In some cases, the Administrative Law Judge has a medical doctor or vocational expert present to testify at the hearing. There is no jury, nor are there any spectators at the hearing. There is no attorney at the hearing who argues that the claim should be denied.

30.       What are my chances of winning at a hearing?

Statistically, slightly less than half of the claimants who have a Social Security disability hearing win.

31.       If the Administrative Law Judge denies my claim, can I appeal any more?

Yes. You can appeal to the Social Security Administration Appeals Council.

32.       What is the Appeals Council?

The Appeals Council exists to review Administrative Law Judge decisions. The Appeals Council is located in Falls Church, Virginia. Neither the claimant nor the attorney actually goes to Falls Church to argue the case.

33.       Can I appeal a case beyond Social Security to the Federal Courts?

Yes. After being denied by the Appeals Council, it is possible for a claimant to file a civil action in the United States District Court, requesting review of Social Security’s decision. A Social Security disability claim can go all the way to the Supreme Court. Perhaps once every few years, the United States Supreme Court actually hears an appeal about a Social Security disability case.

34.       If I get on Social Security disability benefits and get to feeling better and want to return to work, can I return to work?

Yes. Social Security wants individuals drawing disability benefits to return to work. For persons receiving Disability Insurance Benefits, Disabled Widow’s and Widower’s Benefits, and Disabled Adult Child Benefits, full benefits may continue for a year after an individual returns to work. Even thereafter, an individual who has to stop work in the following three years can get back on Social Security disability benefits immediately without having to file a new claim. In SSI cases, things work differently, but individuals receiving SSI are strongly encouraged to return to work.

35.       Do I really have to hire a lawyer to represent me in my Social Security disability claim?

No. You can go through all of the levels of review on your own, if you wish. Statistically, at least from the hearing level on, claimants who are represented by an attorney win more often than those who are not represented.

36.       How do lawyers who represent Social Security disability claimants get paid?

In almost all cases, the attorney receives one-fourth of the back benefits if the claimant wins and no fee if the claimant loses.

37.       Can alcoholics and drug addicts really get Social Security disability benefits?

Not for being alcoholic or addicted.  People who become disabled apart from their alcoholism or drug addiction can become eligible for Social Security disability benefits.

38.       I know someone who is on Social Security disability and he does not look disabled. Why do they let all of these people who don’t deserve it get on disability?

When it comes to disability, looks can be very deceiving. There are many people who look healthy but who are quite disabled.

39.       I am disabled, but I have never worked at public work. Can I get Social Security disability benefits?

If you have low income and limited resources, 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 late husband or wife.

40.       I am a widow. I have not worked in public work in many years. I am disabled. Can I get Social Security disability benefits?

If you are over 50 and became disabled within seven years after your husband or wife died or within seven years after you last drew mother’s or father’s benefits from Social Security, you can get Disabled Widow’s or Widower’s Benefits. If you have low income and limited resources, you can draw Supplemental Security Income benefits no matter what age you are when you became disabled.

41.       I have a daughter who has been disabled by cerebral palsy since birth and has never been able to work. Can she get disability benefits from Social Security?

Maybe. If the child is under 18 and you have low income and limited resources, 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 disability 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.

42.       I am already on Social Security disability benefits, but I am worried that my benefits will be stopped in the future. What are the chances of this happening?

Social Security reviews cases and discontinues disability benefits if the disabling condition has improved enough that the individual can work full-time.

43.       If Social Security tries to cut off my disability benefits, what can I do?

You can appeal. If you appeal within 10 days after being notified that your disability benefits are being ceased, you can ask that your disability benefits continue while you appeal the decision cutting off your benefits. You may also want to talk with an attorney about representation on your case, but you should file the appeal immediately.

44.       My doctor says I am disabled. Why is Social Security denying my Social Security disability claim?

It is not up to your doctor to determine whether or not you are disabled according to Social Security law. It is up to Social Security, and they will make their own decision.

45.       VA says I am disabled, so why is Social Security denying my Social Security disability claim?

VA decisions are not binding upon Social Security. Social Security and VA have different standards for approving disability claims.

46.       I am 60% disabled. 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.

47.       I am disabled by mental illness. Can mental illness serve as the basis for a Social Security disability claim?

Yes.

48.       Will it help if I ask my Congressional Representative to help me get Social Security disability benefits?

Many Social Security disability claimants become frustrated with claim delays and eventually ask their U.S. Representative or Senator to help. The local Congressional office typically will have staffers who are experienced with Social Security procedures and personnel. A “Congressional Inquiry,” as it is called at Social Security, may help to get a stalled process moving again. The inquiry will have no impact on how Social Security decides the case.