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SOCIAL SECURITY FAQ's

1.   What type of claims are there?

Social Security Disability is a part of the Federal Social Security Act. It includes several programs that provide disability payments and other benefits to disabled workers and their families.

Supplemental Security Income may pay benefits to people who have never worked, or who have not worked long enough, and/or to disabled children.

2.  Who is eligable for the benefits?

You may be eligible for Social Security Disability or Supplemental Security Income benefits if you can answer “yes” to any of the following questions:

Do you have a severe physical and/or mental impairment that prevents you from working?
Do you have a disability that prohibits you from working in any capacity - not just in the job you held previously?
Has your disability lasted - or is it expected to last - for at least one year?
Is the disability life threatening?
 

To receive Social Security Disability benefits, a disabled worker must be “insured”. Insured means that the worker must have an earnings record. In other words, you must have worked long enough – and recently enough – and you must have paid into the Social Security system to qualify for Disability benefits.

In some circumstances, a third party may also make a claim on the disabled worker’s earnings record. For example, when a person dies, certain members of the family may be eligible for survivors benefits if the deceased worked, paid Social Security taxes, and earned enough credits.

To receive Supplemental Security Income benefits, a disabled person may qualify as long as their income and assets are below a certain level. This level is determined by the Social Security Administration. To find out if you qualify for these benefits under Social Security regulations, you can contact the Social Security Administration.

Determining Disability
"Disability", as determined by the Social Security Administration, is based on your inability to work. The Social Security Administration considers you to be disabled under Social Security rules if you:

cannot do work that you did before and the Social Security Administration decides that you cannot adjust to other work because of your medical condition(s).
Your disability must also last, or be expected to last, for at least one year or to result in death.
To determine your level of disability, the Social Security Administration reviews medical reports and records provided by your treating physician(s) and/or other medical providers.

Other areas of evaluation include:

Your own average monthly earnings. You can work part-time and still qualify for Social Security Disability or Supplemental Security Income benefits; however, your own gross monthly income can not exceed approximately $810. (as of January 2004)
The severity of your condition. Your impairment(s) must interfere with basic work-related activities for your claim to be considered.
Your vocational background. A variety of areas that pertain to the type of work you have done during the last 15 years are looked at to see if you are able to perform any other type of job.
Other factors can include your age and education.
The Social Security Administration evaluates this information and applies it to their criteria in order to make a determination as to whether you are considered to be disabled.

 

1.  How Do I contact SSA?

To contact the Social Security Administration, you can:

Call toll-free at 1-800-772-1213  and ask to set an appointment at your local Social Security District Office.

You may also want to visit the  Social Security Administration's web site for forms and information.
 

5.   How does the claim process work?

The claims process in a Social Security Disability or Supplemental Security Income case can be very confusing and complex.

In the year 2001, the average processing time for a Social Security Disability claim - not counting appeals - was 106 days. The actual time it takes to process your claim may be more or less based on:

the state in which you live
the nature of your disability
how quickly Social Security can obtain medical evidence from your doctor or other medical source
whether it is necessary to send you for a medical examination
To help disabled people understand the claims process better, Edgar Snyder & Associates, LLC, has provided this general outline of how the claims process works. (Click on a specific topic below or scroll down the page to read all topics consecutively.)

Diagnosis of a Medically Determinable Impairment
Initial Application
Reconsideration (for cases in Ohio & West Virginia only)
Hearing
Appeals Council
Federal Court Review
Diagnosis of a Medically Determinable Impairment
A medically determinable physical or mental impairment that results from anatomical, physiological or psychological abnormalities, which can be shown by medically acceptable clinical and laboratory diagnostic techniques. A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings- not only by the individual's statement of symptoms.


Initial Application
If you are disabled and cannot work, you can apply for Social Security Disability or Supplemental Security Income benefits as soon as you become disabled. You can apply for benefits by contacting the Social Security Administration.

Certain qualifications exist for each type of Social Security benefit program. You must check with the Social Security Administration to see if you qualify to receive these benefits. For an overview of eligibility requirements, click here.


Approval of Benefits
If you apply for Social Security Disability benefits and are approved, benefits will not begin until the sixth full month of disability. This waiting period begins with the first full month after the date the Social Security Administration decides your disability began.

If you apply for Supplemental Security Income (SSI) benefits and are approved, the benefits are paid for the first full month after the date you filed your claim or the date you become eligible for SSI (whichever is later).


Denial of Benefits
If you are not approved for Social Security benefits and believe you are disabled, there are several levels of determination for Social Security Disability benefits. You have 60 days to appeal a denial to reach the next level of determination.

If you fail to appeal a denial within the allotted time frame, you may reapply for Social Security Disability benefits or Supplemental Security Income. Please note: ‘appealing’ and ‘reapplying’ are not the same thing. Reapplying will mean that you have to start the process over again.



Hearing

The average scheduling time for a hearing is 6 to 12 months. If you have obtained legal representation, you will meet prior to the hearing to discuss specific details of your case and to go over questions typically asked at the hearing. You will have an opportunity during this time to ask any questions that you may have about the hearing process.

The individual and/or their representative may come to the hearing and present their case in person.

To read about how to dress for your hearing, click here.
The hearing will be conducted by an Administrative Law Judge (ALJ). During the hearing, you will be asked basic background information regarding your education, work experience and your current medical treatment. You will also be asked to explain the symptoms and limitations you have because of your medical conditions, and how they keep you from working. This information will be the basis of your hearing and should be the only information on which you should focus.

In order for an Administrative Law Judge to determine whether you are disabled, a five-step evaluation must be preformed.

Click here to read these five steps.
You may have been told that a Vocational Expert will testify at your hearing. A Vocational Expert is asked by the Judge to testify about your work history and how your medical problems could keep you from working. The Vocational Expert is there only to give their opinion; they do not make the decision in your case.

The Judge will not issue a decision on the day of the hearing. The Judge will issue the decision after evaluating all the evidence on record, plus any additional evidence brought to the hearing. You will not learn the outcome of your case until a long, written decision - a "Notice of Decision" - is issued to you and your representative at the same time. Your legal counsel will not know the outcome of your case any sooner than you will.

In addition, your legal counsel cannot predict how the Judge will rule. Typically, it takes the Judge two to six months to issue a decision. These long waits occur mostly because of the tremendous backlog of cases pending at the Hearing Office.

If you disagree with the hearing decision, you can choose to go to the next level - the Appeals Council.

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Appeals Council
The average processing time for the Appeals Council is 18 to 24 months. The Appeals Council can choose to do any of the following:

review the claim and render a decision
choose not to review the claim
remand it to the Administrative Law Judge for further consideration
The appellant, or the person filing the appeal, will receive a copy of the Appeals Council decision or a copy of the Order sending it back to the ALJ for further consideration.

If the disabled person disagrees with the Appeals Council, or if the Appeals Council refuses to review the case, the disabled person can pursue their case in Federal Court.

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Federal Court Review
If a disabled person exhausts all administrative appeals, but wishes to continue pursuing the case, he or she may file a civil suit in Federal District Court and eventually appeal all the way to the United States Supreme Court.

4.  What is Reconsideration?
Reconsideration in Ohio & West Virginia only:
In Ohio & West Virginia, if a claim for Social Security Disability is denied, the case is reviewed under Reconsideration. A reconsideration is a complete review of the claim by someone other than the individual who made the original decision. All evidence, plus any additional evidence submitted, will be re-evaluated and a new decision will be rendered (the average processing time is 3 to 4 months). If an individual disagrees with the reconsidered decision, they can choose to go to the next level of the appeals process
 

10.  Do I Need a Lawyer?

If you are permanently disabled and can no longer work, you may be entitled to collect either Social Security Disability benefits or Supplemental Security Income. Unfortunately, the laws dealing with disability are complex and many times people who apply for these benefits are turned down, even though they have completed the proper forms.   Although representation by a lawyer is not required to pursue a Social Security Disability or Supplemental Security Income claim, you may need an attorney to cut through the red tape and help you fight for the benefits you may deserve.

An attorney can help you to:

Gather medical records and reports.
Gather evidence particular to your claim.
Gather documents from your Social Security file.
Determine the best course of action for your claim based on Social Security regulations.
Confer with your physician regarding your condition and the regulations under Social Security.
Suggest a “second opinion” on your condition by having the Social Security Administration send you to a doctor.
Review prior actions taken by the Social Security Administration.
Provide helpful advice to you on how to prepare for your Social Security hearing.
Provide legal counsel at the hearing to ensure a fair and proper procedure.
Review, object to, or make changes to the written questions being sent to a doctor by the Administrative Law Judge overseeing your hearing who may request an additional medical opinion.
Make sure the Social Security Administration gives you your correct benefit payment, if your claim is approved.
Request a review of the hearing decision by the Social Security Administration Appeals Council, if your claim is denied at the hearing level. This request must be made within a certain time frame.
Request a review of the Social Security Administration Appeals Council decision by the Federal District Court if your claim was denied at the Appeals Council level. This request must be made within a certain time frame
Hiring an experienced law firm as your advocate during the appeals process could mean the difference in whether you ultimately collect Social Security Disability benefits or not.

7.   Types of SSD Benefits?

Social Security Disability includes several programs that provide disability payments and other benefits to disabled workers and their families.

Social Security Disability benefits may consist of cash payments and medical coverage. Benefits depend on your financial situation and whether you qualify under the appropriate Social Security Administration regulations.

Widow's Benefits
A disabled widow or widower can get benefits at 50 if they are found to meet Social Security Disability requirements. This disability must have started before the death or within seven years after the death of the wage earner.

Survivor's Benefits
Survivor's Benefits can be paid to certain members of the family if the deceased worker, paid Social Security taxes, and earned enough credits.

A widow/widower full benefits at full retirement age (currently age 65), or reduced benefits as early as age 60. A disabled widow/widower may receive benefits as early as age 50.
A widow/widower may receive benefits at any age if he or she takes care of the deceased's child under the age 16 or disabled who receives Social Security benefits.
Unmarried children under 18, or up to age 19 if they are attending elementary or secondary school full-time. A child can receive benefits at any age if he or she was disabled before age 22 and remains disabled. Under certain circumstances, benefits can also be paid to stepchildren, grandchildren or adopted children.
Dependent parents at 62 or older.
Former spouse can receive benefits under the same circumstances if the marriage lasted 10 years or more. In general, a widow/widower cannot receive benefits if they remarry before the age of 60 (50 if disabled) unless the latter marriage ends, whether by death, divorce or annulment. However, remarriage after age 60 (50 if disabled) will not prevent payments on a former spouse's record
 

8.  Types of SSI benefits?

Supplemental Security Income may provide benefits for:

disabled people with low incomes and limited assets who have never worked or who have not worked long enough
blind people with low incomes and limited assets
disabled people who are age 65 or older with low incomes and limited assets
disabled children
Supplemental Security Income benefits may consist of cash payments and medical coverage. Benefits depend on your financial situation and whether you qualify under the appropriate Social Security Administration regulations.

Child's Supplemental Security Income
A child under the age of 18 will be considered disabled if he or she has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.

These benefits are payable to disabled children who have limited income and resources, or who come from homes with limited income and resources



9. Can They Terminate my benefits?

Once a disabled person receives approval for Social Security Disability or Supplemental Security Income, the benefits are usually considered to be lifelong and permanent.

There are, however, a few circumstances where benefits could be terminated. These include:

If you engage in “Substantial Gainful Activity” (SGA). The Social Security Administration uses this term to determine if any activity – including working or attending school full-time – is substantial enough to make a person ineligible for benefits. Examples of activities that may disqualify you for benefits are:
You go back to work full-time.
You go back to work part-time and earn over approximately $810 gross per month. (as of January 2004)
You attend college or business/trade school full-time.
If the Social Security Administration reviews your case and feels your condition has improved, they may terminate your benefits. Periodically , the Social Security Administration will review cases. When your case is reviewed, they check to make sure you still have disabling impairments, are still in treatment, and are compliant with treatment and medication.
If medical improvement is "expected", your case will normally be reviewed within 6 to 18 months.
If medical improvement is "possible", your case will normally be reviewed no sooner than 3 years.
If medical improvement is "not expected", your case will normally be reviewed no sooner than 7 years.
If you become incarcerated or institutionalized against your will for over 30 days, you are ineligible for benefits during this time period.
Reinstatement of Terminated Benefits
If your benefits have been terminated, and you would like to have them reinstated, you have the right to file an appeal within 60 days.

If you want to continue to receive your checks while the appeal is pending, you must file an appeal requesting this continuation within 10 days of having your benefits terminated. Please note: If you are unsuccessful with your appeal, and you continued to receive checks while the case was pending, you will be required to pay back the money you received while the case was pending.