Social Security Disability Benefits Guide

You've just left the doctor's office and the diagnosis isn't good. You know your ability to work has been affected and you're worried about how you're going to get by. What are your options? Should you keep working through the pain or is there another way? Sixty-two years ago you might have found yourself in a significantly more difficult position but as of July 1956, after spending twenty years bouncing around Congress, the Social Security Disability Insurance program was put into effect. Social Security Disability Insurance or SSDI as it's commonly called, helps hundreds of thousands of people every year. This article will explain the program in depth and aims to help you decide whether or not SSDI may be the right path for you.

What Is SSDI and What Are Its Various Components?

Social Security Disability Insurance simply defined is a program designed to assist workers who are considered disabled and their dependents. It's overseen by the Social Security Administration and is funded through taxes withdrawn from a worker's earnings. What constitutes as a disability is very strictly defined by the Social Security Act, setting it apart from both private disability plans and other government programs like workers' compensation. It is, however, a part of the Social Security Retirement Insurance program and as such receives its benefits from that same fund. Additional components of SSDI include understanding that the benefits it provides are generally only enough to cover basic living expenses and that the program also requires a return-to-work program be in place. Only people with significant work histories, i.e. those who have paid into the program, are eligible.

As part of the above mentioned components, the program guidelines state that a recipient's monthly benefits will equal their projected retirement benefit only if it can be determined that they'll either not be able to work for at least a year or if there's a possibility of death within a year. In keeping with these strict regulations, a recipient's medical records will be reviewed every 5-7 years however their financial records will be reviewed annually.

How is SSDI Different than SSI?

Although very different programs, people frequently confuse Social Security Disability Insurance and Supplemental Security Income. Despite both programs being governed by the Social Security Administration, they receive their funding from different sources and are eligible to different groups of people. SSDI funding comes from Social Security and FICA taxes in the form of payroll deductions. SSI receives funds generated by general tax revenue. As far as who's eligible, SSDI is meant solely for people with severe disabilities that impede their ability to work with the additional condition that the applicant has an actual work history. SSI, on the other hand, is an income-based program that provides cash assistance and health care coverage to people with limited assets who are either aged 65 or older, blind, or disabled.

Who Can Apply and When is it Necessary to Apply for Disability Benefits?

Anyone who is at least 18 years of age can apply for SSDI. Applicants must not already be receiving other forms of social security benefits and cannot have had an application deniedwithin the last 60 days. Necessity depends on the applicant, however anyone facing a severe mental or physical disability should apply as soon as they are able. Often this will be immediately after their last day of work or after their earnings for the month total less than $1070. If you expect to be unable to work for at least a year or more, a speedy application is advisable as the process to get approved can be a lengthy one. The average approval time is around 90 days but it may take longer before recipients receive their first benefit check. Application for SSDI also qualifies a person to be eligible for SSI application, subject to additional conditions.

What Disabilities are Listed in the Impairment Listing Manual and is the List All-Inclusive?

To determine what qualifies as a disability, the Social Security Administration created the Impairment Listing Manual, also known as the Blue Book. Most of the impairments listed in the Blue Book will automatically qualify an individual for SSDI. Those impairments include:

  • musculoskeletal problems, such as back injuries
  • cardiovascular conditions, such as heart failure or coronary artery disease
  • senses and speech issues, such as vision and hearing loss
  • respiratory illnesses, such as COPD or asthma
  • neurological disorders, such as multiple sclerosis, cerebral palsy, Parkinson's disease, and epilepsy
  • mental disorders, such as depression, anxiety, schizophrenia, autism, or retardation
  • immune system disorders, such as HIV/AIDS, lupus, and rheumatoid arthritis
  • various syndromes, such as Sjogren's Syndrome and Marfan Syndrome
  • skin disorders, such as dermatitis
  • digestive tract problems, such as liver disease or IBD
  • kidney disease and genitourinary problems, and cancer
  • hematological disorders, such as hemolytic anemias and disorders of bone marrow failure

This list is not all-inclusive however. It is possible to have a disability not listed in explicit terms that can ‘equal' the criteria of a Blue Book listing. Furthermore, the SSA will take into consideration to what extent your disability, if not listed, affects your ability to work and make a ruling based on that. In fact, several of the more common disabilities aren't listed such as carpal tunnel syndrome, migraines, and fibromyalgia, among others. Although some conditions are more likely to be approved than others, at the end of the day what matters is whether or not it's a medical determinable impairment and how much it reduces a person's ability to perform their work duties.

What Percentage of the Population has a Disability and How Many People Apply for Benefits Each Year?

The amount of Americans living with a disability is a rather sobering figure. As many as 56 million people or 20% of the population falls within this category. An additional 38 million are labeled as being severely disabled. Unfortunately disabilities are unpredictable and can affect the young as well as the old. With such a high rate of disability occurring, it can be expected that the number of annual applications is proportionately high. That number has steadily increased from year to year resulting in the number of applications nearly doubling from 1990 to 2017 - in which year 2.18 million applications were submitted.

How to Apply for Disability Benefits and What Information is Needed to Apply?

  • Identification - a social security number, birth certificate, passport, or other proof of legal status.
  • Name of current or prior spouse (if applicable) including dates of marriage/divorce and place of marriage.
  • Names and birthdates of your minor children.
  • Military ID/Documents including discharge papers if released prior to 1968.
  • Completion of the Adult Disability Report (form found on the SSA website)
  • All medical information including the names and addresses of all doctors seen, the dates of all exams and tests as well as who ordered them, any prescriptions you are/were taking, and any other medical records you might have. Additional medical history documents can include records of previous workers' compensation claims, public welfare, and vocational rehabilitation information, to name a few.
  • The name, address, and phone number of a contact who can verify your medical condition and assist with the claim.
  • Tax returns and/or W-2s.
  • Employment information for the last two years including employer's name and address, start and end dates, and total earnings. If self-employed, business type should also be stated.
  • A copy of your Social Security Statement, found on the SSA's website.
  • Information about your Education and training such as highest grade completed and any job training classes or certifications courses completed.
  • Bank account information so benefits can be direct deposited.

How is a Decision Made on a Claim and Who Makes it?

A decision is made based on the information and documents provided by the applicant. The SSA has professionally trained claims examiners and physicians who work as part of the Disability Determination Services team and who are trained to make determinations on claims. A DDS worker will review any information submitted in accordance with all guidelines, laws, and regulations regarding SSDI to decide whether the claim is approved, denied, or if more information is needed.

How to Appeal a Claims Decision

If your claim is initially denied, and most are, there is an appeals process that you can follow. An applicant typically has 60 days to file for an appeal after receiving their denial letter. There are four different levels of appeal that an applicant may face, the first being a Request for Reconsideration. This is essentially a review of your claim by a different claims examiner. Should they also deny your claim, the next level of appeal is a hearing with an administrative law judge. After that, you can request a review with the Appeals Council and finally, a Federal Court Review. The denial letter you receive will explain which level of appeal you should choose as well as how to file for the appeal. Keep in mind that throughout this process, you do have the right to appoint a representative to handle your case. If you have trouble finding or affording a representative, your Social Security office can provide a list of organizations that can help. You may even qualify for free legal assistance. With or without the aid of a representative, the easiest way to begin your appeal is online, however you can also call their toll free number or contact your local Social Security office.

When is a Claim Approved and Who Can Receive Benefits from that Claim?

A claim is approved when it's been determined that the applicant meets all the SSA's criteria for being disabled. When this happens, there is a 5 month waiting period before your benefits start even if your application is approved right away. However, once the wait period is over and you become eligible, you will receive back pay for those months after which the payments will be deposited monthly. If your household income is over a certain amount, those benefits will be taxed.

Family members can also receive benefits depending on several factors but it's limited to current/divorced spouse, children, disabled children, and adult children that became disabled prior to the age of 22. Additional documentation will be needed if requesting benefits for any of the above-listed persons. Each approved family member is eligible to receive up to 50 percent of your benefit amount but keep in mind that there is an overall household limit. The benefits awarded to family members will not affect what you as the primary applicant will receive.

How Common is SSDI Fraud?

Thanks to the strict guidelines put in place by the SSA regarding disability, the occurrence of fraud is incredibly low. By adhering to the agency's zero tolerance policy, fraud accounts for less than 1 percent of all claims submitted. Furthermore, through use of their Cooperative Disability Investigations program, the SSA is able to investigate suspicious claims prior to benefits being awarded, effectively stopping fraud before it happens. "In fiscal year 2017, with the help of state and local law enforcement, the program reported $228 million in projected savings for the disability programs."

How is SSDI Related to Medicare?

Medicare is a federal healthcare program generally reserved for those aged 65 and older. It can also be available to those with disabilities. If you have been receiving disability benefits for at least 2 years, on your 25th month you become eligible for Medicare parts A and B. Part A covers all hospital expenses while Part B is your standard health insurance coverage.

Is it Possible to Work while on SSDI and How Does that Affect Benefits?

One of the biggest questions applicants have is not only if it's possible to work while receiving benefits, but how working will affect their benefits. The answer to the first part is yes, it is certainly possible to work while receiving benefits, though how it affects them is dependent on several factors. One factor is how much a recipient is actually capable of working. If a person is unable to return to full time work or Substantial Gainful Activity, they can earn up to $1170 a month without losing any of their benefits. Alternately, Social Security offers different programs to make transitioning back to work easier for recipients. An example of one such program is the Ticket to Work Program. This allows you to receive employment support services and work incentives in order to explore how much work you can handle all while still maintaining your benefits. Should it be decided however that you can return to SGA full time, your benefits will be discontinued.

The Social Security Disability Insurance program has helped millions of Americans since its inception. By offering benefits to those unable to continue working, people have been able to meet their basic needs without fear of what might happen to them or their family.

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