Frequently Asked Social Security Disability Questions

Was your Social Security disability application denied? You’re not alone. Most people are denied initially – about 70% of those who apply are denied. That’s why we’re here to assist you through the process.

Our attorneys will help you with the reconsideration process. Once that step is complete, we will request a judicial hearing and accompany you before the judge to advocate on your behalf. The majority of appeals will receive the judge’s approval, but some do not. If you disagree with the judge’s decision, we submit an appeal to the Appeals Council. If denied once again, we will request a case review by a Federal District Court.

Filing for SSD or SSI can be a long, difficult process, but we will make it as smooth as possible for you.

Both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are disability programs administered by the Social Security Administration (SSA).

What is Social Security Disability Insurance?

SSDI 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. It is benefit for those who had a relatively steady work history for a period of time prior to becoming disabled. According to the SSA, a person qualifies for Social Security Disability Insurance (SSDI) if:

• They have a physical or mental condition that prevents them from engaging in any “substantial gainful activity,” AND
• The condition is expected to last at least 12 months or result in death, AND
• They are under the age of 65, 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 parent’s or parents’ work credits. The parent(s) experience(s) no loss of benefits.

What is Supplemental Security Income?

Unlike SSDI, SSI is not based on an individual’s work history. Instead, it’s based solely on an individual’s financial need. SSI is a benefit for those who may have only worked for a brief period of time, or not worked at all, prior to becoming disabled. It is designed to help aged, blind, and disabled people, who have little or no income, and it provides cash to meet basic needs for food, clothing, and shelter.

To be eligible for SSI, you must meet financial guidelines for Public Assistance. In order to be eligible to receive SSI benefits, individuals must prove the following:

• They are blind or disabled, AND
• They legally reside in one of the 50 states, or are the child of military parent(s) assigned to permanent duty outside of the US, or are a temporarily abroad student AND
• They have income and resources within certain limits

While many people don’t distinguish between SSI and SSDI, they are two completely different governmental programs. Both programs are overseen and managed by the Social Security Administration; however, there are distinct differences between the two.

The main difference between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) is the fact that SSDI is available to workers who have accumulated a sufficient number of work credits, while SSI disability benefits are available to low-income individuals who have either never worked or who haven’t earned enough work credits to qualify for SSDI.

Learn more about the difference between the two by speaking with a Social Security disability lawyer today. Our SSDI attorneys can evaluate your case and, if you do qualify for SSDI or SSI, can help you through the entire process, including filing for benefits as well as handling application or judge denials.

To qualify for SSDI benefits, you must first have worked in jobs in which Social Security taxes were taken from your paycheck. Next, you must have a medical condition that meets SSA’s definition of “disability.”

Benefits usually continue until you are able to work again on a regular basis. There are also a number of special rules, called “work incentives,” that provide continued benefits and healthcare coverage to help you make the transition back to work.

If you are receiving SSDI benefits when you reach full retirement age, your disability benefits automatically convert to retirement benefits. The amount always remains the same.

In general, you are eligible for SSDI if you:

• Suffer from an injury or illness that prevents you from working for at least 12 months
• Have worked for the past 5 of 10 years
• Are unable to perform any regular job or work-like activity
• Are under 66 years old
• Have paid taxes
• Have a diagnosis from a doctor that supports your claim

The Social Security Administration’s impairment listing manual (called the Blue Book) includes a number of impairments, both physical and mental, that will automatically qualify an individual for (SSDI) or  (SSI), provided the individual’s condition meets, or is equivalent to, the specified criteria for a listing.

Does a medical condition have to match the Blue Book listing?

An individual filing for SSDI benefits does not necessarily have to satisfy the exact listing requirements for a particular illness or condition (such as rheumatoid arthritis) to be awarded disability benefits based on this condition. You can also be awarded disability benefits if Social Security Administration considers aspects of your condition medically equivalent to the criteria in the listing or a related listing.

You can also be eligible for disability benefits if you don’t meet or equal the criteria for the Blue Book listing for your condition if your condition limits your functioning so much that you can’t work. The SSA will consider the effect of your condition on your capacity to perform routine daily activities and work and will then determine whether there is any kind of job you can safely be expected to do.

Other qualifications for eligibility:

• You are not working.
• You earn less than $1,350 a month if you are working.
• Your condition must be so severe that it prevents you from performing your job.
• Your condition meets the Social Security Administration’s requirements, which are found here.
• You are unable to do the work you did before you were disabled.
• You are not able to perform other types of work that your background prepared you to do.

SSI is a disability program designed for those with a demonstrated financial need and a disability that prevents them from substantial gainful activity. In some cases, those over 65 years old may qualify for SSI even if they are not completely disabled according to the Social Security Administration (SSA)’s definition of total disability.

For those under 65 years of age, you must establish that you are both completely disabled and that you do not have adequate other means of support to qualify for SSI benefits. This means proving that your disability makes it impossible for you to perform any work, including both work that you have done before and any work that you could otherwise be trained to do.

To qualify financially for SSI, you cannot own more than $2,000 worth of total countable assets (if you are married, you may jointly own up to $3,000 in assets). These assets are basically anything of value that you own except for the home in which you live in plus one vehicle. Your assets include such things as money in savings and checking accounts, IRAs and other retirement accounts, vehicles (other than one vehicle for transportation), and virtually anything else of significant value.

If you are both disabled, according to the definition by the SSA, and can demonstrate your financial need (insufficient or no income and less than $2,000 in assets), you may qualify for SSI.

If you have worked during the past 10 years, you should look into applying for SSDI while you are applying for SSI, as some people qualify for both.

Children with certain disabilities may also qualify for SSI. If you suspect your child may qualify for SSI, check with the SSA concerning the current list of accepted conditions. The list of accepted conditions does change periodically, but once a child is medically qualified for SSI, they will continue to collect SSI (generally paid to a representative payee such as a parent or other guardian) even if their condition is taken off the list of accepted disabilities.

If your initial Supplemental Security Income claim is denied, you should consider having a disability lawyer represent you. Disability advocates deal with the SSA on a regular basis and represent your best chance of having your disability claim approved during the appeals process. While you certainly may represent yourself, a professional disability advocate can help the process go much smoother, and the representation won’t cost you anything unless you are approved for disability benefits.

If you qualify for SSI benefits, you also qualify for Medicaid.

The Social Security Administration definition of disability is based on your inability to work at all for a long period of time. When you apply for SSDI benefits, the Social Security Administration wants to know whether your medical disorder is severe enough for you to qualify for benefits.

You are considered disabled and eligible for SSDI benefits if you meet these conditions:

• You are unable to work or earn less than $1,350 per month
• Your condition must be so severe that it interferes with work-related activities you must perform to do your job
• You are unable to do the work you did before you were disabled
• You are not able to perform other types of work that your background may have prepared you to do

It is important to understand that this explanation does not take into account special situations that may make you eligible for disability benefits even if you have not fulfilled all the above conditions. Disability attorneys can advise you regarding your eligibility and help you apply for benefits.

You are eligible for benefits as soon as you stop being able to do substantial work. In most cases, Social Security Administration defines substantial work as making $1,350 per month (but the rules are different for the self-employed).

When can you apply?

You can apply for disability as soon as you are not working or are earning less than $1,350 per month because of your medical condition — or when you realize you are disabled and can’t go back to work. That said, the expectation must be that you wont be able to work for at least 12 months (or have an illness that is likely to result in your death) to qualify for SSDI or SSI benefits (this is called the durational requirement). You should apply right away because there are delays between applying and actually receiving benefits. There are certain requirements regarding the expected length of disability and certain waiting periods during which benefits are not payable. Our attorneys can help explain these to you.

What’s the difference between the two?

Most of the time, workers’ compensation is designed to be temporary, affording employees who have been hurt on the job a period of continuing income while they heal or wait for acceptance for SSDI benefits. Receiving workers’ compensation does not disqualify you for SSDI, nor does it negatively affect your chances of having your disability claim accepted.

In some cases, there are offsets (reductions) against your SSDI benefits because of workers’ compensation benefits you may have received during the same period of disability.

The Social Security Administration has a very different definition of disability than workers’ compensation. To qualify for SSDI, you must demonstrate that you are unable to perform any work that you have ever performed or could be trained to perform for any employer. Additionally, your disabling condition must be expected to last over 12 months or be expected to result in death.

Calculating average current earnings

Social Security Administration calculates your average current earnings in one of three ways:

• The Average Monthly Wage Formula: The Social Security Administration uses your average monthly wages to calculate your disability benefit amount.
• The High-Five Formula: The Social Security Administration uses the average monthly wages from your five highest-paid consecutive calendar years.
• High-One Formula: The Social Security Administration uses the average monthly wages from your single highest-paid calendar year during the previous five years.

The High-One Formula is used in the vast majority of cases, although the Social Security Administration will use whichever method is most favorable to you. However your average earnings are calculated, if your SSDI monthly benefit and your monthly workers’ compensation benefit combined is higher than 80 percent of your average current earnings, an offset will apply.

Offsets are something that must be reviewed on a case-by-case basis. Our attorneys can advise you on whether or not you will see an offset in benefits. Generally, Veterans Administration benefits and private pension benefits do not offset (reduce) SSA’s disability benefits.

If you plan on receiving both workers’ compensation and SSDI, you would be well advised to seek the advice of a lawyer who is experienced working with both workers’ compensation and SSDI claims. In addition to advising you, they can also help structure your claims for both programs in a way that is most likely to be accepted.

Disability benefits lawyers work on a contingency basis, which means if you do not win your claim, we do not receive any payment. This is a requirement from the federal government and is enforced by the Social Security Administration.

If your claim is approved, your disability attorney will receive a one-time 25 percent payment from your retroactive benefits, not to exceed $7,200 — whichever is less. This means that you will never pay out of pocket for an attorney’s help.

Statistically, having a SSDI lawyer represent you will improve your chances no matter where you are in the claims and appeals process.

There are many people on disability and many more that should be receiving benefits. Numerous times, people who deserve disability benefits do not receive them. One of the things that improves your chances as you go through the process of applying for disability benefits is to have the help of an experienced SSDI lawyer.

There are also many people who would love to have the assistance of a SSDI lawyer, but believe they can not afford it. Many times, these individuals are not working and have little or no income, and it would normally be very difficult to hire a lawyer in these circumstances.

Under new U.S. Department of Education guidelines, those who have borrowed federal loans may be eligible to have their Title IV federal loans forgiven. There are several circumstances, such as the following:

• The borrower is suffering from a permanent total disability. If you have suffered a medical condition that prevents you from working for an indefinite period of time, you may be eligible to cancel any student loans you have. To qualify for this cancellation, you must not have had this permanent total disability before you applied for your student loan, or your situation must have deteriorated significantly since that time. To prove this, you will need to supply a letter from your doctor, most likely on a form that your loan holder will provide.
• The borrower is suffering from a temporary total disability. If you have a student loan that you took out before July 1, 1993, you may be able to defer loan payments for up to three years if you can show that you, your spouse or a dependent has suffered from a temporary total disability. If you are claiming you have the disability, you must be able to show that you are unable to attend school or work a job for at least 60 days. If it is your spouse or dependent that suffered the disability, you must be able to show that the disabled person needs you to care for them for at least three months.
• The borrower is enrolled in a rehabilitation program for their disability. If you are currently enrolled in a rehabilitation program for a disability you suffered, you may be able to defer your loan payments for the length of the program and an additional six months after the program ends.

Learn more about loan forgiveness and SSDI.

The first thing to remember is that a trial work period applies only if you receive SSDI. Anyone who only receives SSI, for example, does not have to worry about the meaning of a trial work period. However, if you receive SSDI (which is based on your work history), you need to be aware of the impact of completing a trial work period.

The Social Security Administration allows you nine trial work months during any five-year period. Generally, you will not be entitled to another trial work period once you have used these nine months. However, if your disability benefits end due to working and you later qualify for benefits again by submitting a new application or through expedited reinstatement, you may be allotted an additional trial work period. If you become eligible for benefits due to a granted application for expedited reinstatement, you will qualify for a new trial work period 24 months after the reinstatement of your benefits.

Further, if five years or more have passed since a given trial month, that trial month is no longer counted. As a result, your entitlement to a nine-month trial period may start over, and you may actually receive more than nine trial work months.

The trial work period can be difficult to understand because, as is often the case with the Social Security Administration, it often is a lengthy process that has various exceptions. Knowing what the trial work period really means and what rights you have after the end of your trial work period can help you to protect yourself from significant difficulties later on.

The process of obtaining disability benefits from the SSA can be a long, confusing and tedious process. It typically takes anywhere from 18 to 24 months to get an award of benefits. At Pond Lehocky Disability, we can guide you through the process as quickly and effectively as possible. The Social Security Administration has adopted fast-track processing for certain disabilities. Our objective is to assist you in obtaining the benefits that you deserve as quickly as possible.