Frequently Asked Questions
- Who can qualify for Social Security Disability Insurance (SSDI) benefits?
- Who can qualify for Supplemental Security Income (SSI) benefits?
- What Does it Mean to be “Disabled” Under Social Security’s Rules in order to Qualify Medically for Benefits?
- When are SSDI Benefits Payable Should I be Approved for Benefits?
- When are SSI benefits payable should I be approved for benefits?
- When Should You Start an Application for Disability Benefits?
- Will I Still Qualify for Benefits if I am Still Working?
- How Should One Start an Application for Benefits?
- How Long Does it Take to Obtain a Decision?
- Who Makes the Decision in my Case?
- What Happens if I’m Denied?
Who can qualify for Social Security Disability Insurance (SSDI) benefits?
For those who have worked and paid sufficient Social Security taxes to acquire sufficient quarters of coverage so as to be insured under the Social Security Disability Insurance (SSDI) program, a monthly check is available and payable based on how much one has paid into the system through their payroll taxes, assuming they meet the definition of “disabled” under Social Security’s rules. Benefits may also be payable to spouses, and dependent children under this program under certain circumstances.
Who can qualify for Supplemental Security Income (SSI) benefits?
A separate program, called the Supplemental Security Income (SSI) program, pays federal welfare benefits to “disabled” children who reside in households deemed to fall within SSI’s welfare guideline and to those “disabled” adults who may not have paid sufficiently into the SSDI program but are deemed to meet the SSI’s welfare guidelines.
What Does it Mean to be “Disabled” Under Social Security’s Rules in order to Qualify Medically for Benefits?
In order to qualify medically for a Social Security disability benefits, whether it is SSI or SSDI, one needs to prove that they are suffering from a severe medical impairment that, despite prescribed treatment, has caused them to remain (or is likely to cause them to remain) totally disabled from all forms of gainful employment for which they are reasonably suited by age, education and experience for a year or longer or is likely to result in death. One may satisfy the eligibility requirements by either meeting one of the Social Security Administration’s (SSA’s) Listings of Medical Impairments, or by showing that their medical conditions result in such severe functional impairments that they would remain incapable of other past work or any other work that exists in significant numbers in the national economy or which they are reasonably suited by age, education and experience.
When are SSDI Benefits Payable Should I be Approved for Benefits?
Assuming one is found long term disabled under Social Security’s rules, SSDI benefits are payable as far back as 1 year prior to one’s application date, assuming as well that the first monthly check cannot be paid prior to meeting a standard 5 full month waiting period.
When are SSI benefits payable should I be approved for benefits?
Assuming you are found disabled as of your application date, SSI benefits are payable beginning the month after your application month, with benefits being payable based on welfare need (that is to say, with benefits being determined each month based on your household income and assets).
When Should You Start an Application for Disability Benefits?
Given the need to show that one will remain totally disabled from all forms of gainful employment for a year or longer, despite prescribed treatment, it is important to avoid filing for benefits too early. Assuming there are other sources of income in the household that would not allow for a potential SSI needs based benefit, which would begin the month after one applies, ordinarily one will want to wait at least 6 months or longer before applying for benefits. While the analysis for each case is different, consideration needs to be given to the fact that applying too early, indicating that one believes they will remain disabled from working for a year or longer, will be met with skepticism and a potential denial by the Social Security Administration (SSA) if were to apply at a point where the medical outcome at a year remains less than clear.
Will I Still Qualify for Benefits if I am Still Working?
SSA will look at the nature of the work being performed and determine whether the work is 1) “substantial” under Social Security’s rules and 2) being undertaken at a gainful level. Substantial gainful activity for 2016 is defined as the ability to earn $1130.00 per month on a regular and continuing basis. Simply earning less than $1130.00, does not in and of itself mean that the Social Security Administration will determine that one remains incapable of earning gainful wages: that is to say, working simply a few more hours.
How Should One Start an Application for Benefits?
While an application for Social Security disability benefits can be started right on line by going to secure.ssa.gov, it is advisable to seek the advice and assistance of a dedicated Social Security disability lawyer who can assist you with the forms and procedures that will be necessary so as to hopefully avoid the need to appeal the decision.
How Long Does it Take to Obtain a Decision?
The length of time it takes to reach a decision depends on a number of factors: how long it takes for SSA to obtain your medical records, whether your individual circumstances require SSA to obtain additional forms from you or others (such as regarding work that has been performed for the same time period you’re claiming disability, or, for example, regarding workers’ compensation benefits that you’ve received in the interim) and whether SSA needs to send you to one of their doctors for an evaluation. Likewise, Maine, Massachusetts and New Hampshire decisions may be picked up by the Boston Quality Review Team to determine the appropriateness of a recommended decision. Typically, a decision is rendered anywhere from 3 to 6 months following the receipt of your application, however this process can be delayed an additional 1 to 3 months if in fact it is picked up by Quality Review.
Who Makes the Decision in my Case?
Once the application has been received, the electronic case file is transferred to the state agency responsible for making the decision as to whether you are “disabled” under Social Security’s rules: Disability Determination Services (DDS). In Maine, the DDS office is located in Augusta, ME, in New Hampshire, there is a DDS office in Concord, NH, and in Massachusetts, there are offices located in Boston and Worcester.
What Happens if I’m Denied?
Assuming one receives an initial denial of their claim, one is provided with 60 days, with an additional 5 days for mailing, in which to appeal the decision. In Maine and Massachusetts, the next step in the process would be to appeal by requesting reconsideration within this 60 day period. Assuming one is denied yet again, one would then Request a Hearing Before an Administrative Law Judge within 60 days of being denied on Reconsideration. In New Hampshire, the reconsideration process has been dispensed with as part of a pilot project that has gone on for many years: an appeal of an initial denial would require that one undertake a Request for Hearing Before An Administrative Law Judge. As there is a very high rate of denial on reconsideration, assuming one needs to request reconsideration, the chances are high that one will need to Request a Hearing.