What is SSI and do I qualify?

This program is financed through general revenues from taxes, meaning benefits are not based on your prior work history.
  • In most states, beneficiaries will automatically be eligible for Medicaid.
  • SSI disability benefits are payable to:
    • individuals age 65 or older
    • adults who are disabled or blind
    • children who are disabled or blind
  • Eligibility requirements:
    • have limited income and resources meet the living arrangement requirements
    • a U.S. citizen or national, or in one of certain categories of aliens.
    • The monthly payment varies up to the maximum federal benefit rate, which may be supplemented by the state.

What is SSDI?

Social Security Disability Insurance pays benefits to you and certain members of your family if you are “insured,” meaning that you worked long enough and paid Social Security taxes.
This program is financed with Social Security taxes paid by workers, employers, and self-employed persons.
  • The worker will get Medicare coverage automatically after receiving disability benefits for two years.
  • To be eligible for a Social Security benefit, the worker must earn sufficient credits based on taxable work to be “insured” for Social Security purposes.
  • The amount of the monthly disability benefit is based on the Social Security earnings record of the insured worker.

What is an initial claim?

An initial claim is the ‘first claim’ within a 60 day time period, meaning you have not had an open claim within a 60 day period. This is where a claim is filed, assigned to a case worker and basic records are reviewed and a decision is made. This process can take anywhere from 3-12 months and sometimes longer. Of the initial claims, 2/3s are denied the first time.

What is a reconsideration?

A reconsideration, the second step, is an appeal (within the 60 day period) to the initial decision. Here, the social security office requests Consultative Exams (physician visits either by approved physicians or with your pcp or staff) and requests a more in depth review of your medical history. This can also take several months to a year or so. During this review period, the case worker, a mental health specialist and a physical health specialist will review your claim and make a decision. Of this, around 80% from the initial 2/3s get denied, regardless of diagnosis.

What is a request for hearing?

A request for hearing is the third step of the application process. This is where we go to court and appeal to a judge to make a decision. This is where most cases are won. During this process, all the previous requested records are updated, any new medical information is added, and we make a formal request to the judge and his staff to review over the case. It can take 60 days or more to schedule a hearing. After the hearing, it can take a few months or more to have a decision made.

What qualifies as a disability?

An applicant may potentially qualify to receive Social Security Disability benefits from the Social Security Administration if they can demonstrate any injury, condition, or illness that is serious enough to limit their ability to work. While not comprehensive, the SSA lists a broad range of potentially qualifying impairments for SSD benefits in their “Blue Book.”

Why does it take so long?

The process takes a long time due to several factors. Medical records requests are often delayed due to the cooperation of each individual facility. Many facilities have a delay in turnaround periods, which they process the records requests. It also depends on the individual case workers and physicians who review the cases on staff at the disability/social security offices.

How long must I be out of work before I can apply for Social Security Disability?

You can file for disability as soon as you stop working, as soon as your earnings drop, or if you are not engaged in “substantial gainful activity.” To qualify for Social Security Disability (SSD) benefits issued by the Social Security Administration (SSA), an applicant must demonstrate their “disability has lasted or is expected to last for at least one year or to result in death.”

The SSA issues no time requirements for potential applicants seeking to apply for SSD benefits. One commonly held misconception states an applicant must be completely out of work for six months to a year before applying for SSD benefits, but this is not true.

Disability Hearing Overview

  • First, do you know what type of hearing it is? Will you have a phone hearing, video hearing or in person hearing? While phone hearings are considered the general default, video or in person can be requested and may take longer than a phone hearing to schedule.
  • If you do a video or in person hearing, you do not need to dress up and can essentially wear your everyday clothes.
  • All hearings are generally 45 minutes long. An in-person hearing is not held in a courtroom. We will all sit at a table in a private, ordinary room with the doors closed. It will be you, your attorney, the judge, and a court reporter.
  • You do not need to “rest up” or do anything special in advance. We just want to see you on an average day with your current health troubles.
  • If you do an in-person hearing, you should have someone drive you to your hearing, if possible. You should bring your medications or at least make a list of them.

When filling out our paperwork:

  • When you fill out our forms, do not overstate what you do as part of your daily living activities.
  • When you apply for Social Security Disability/SSI, you will be asked to describe your past work history for the last 15 years. Do not overstate what your duties are or what is your title. Also, do not understate the physical demands of your jobs.
  • Do give us a list of all the doctors you have seen and/or hospitals you have been to. You will not have to give the exact dates; the approximate dates are sufficient.
  • Do make a list of all your medical problems whether they are big or small to you. Every bit of information can be beneficial.
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