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Saturday, May 3, 2014

Social Security and Disability | Q & A

the information below was posted in 2011, we have updated as we can. Please always verify any info at the Social Security website ....

Of course, all of the programs of the Social Security Administration (SSA) are available to people who have disabilities and people who do not have disabilities. There are two main benefit programs for people with disabilities – Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). There is also the Ticket to Work program that helps people who are getting SSI or SSDI to attempt to return to work with supports that protect benefits and gradually transition people to self-sufficiency.

What is SSI?

SSI stands for Supplemental Security Income. It’s a federal income supplement program funded by general tax revenues – not Social Security taxes. It’s designed to help people who are elderly, blind, or have a disability (as defined by SSA, but we will get to that later), and who also have very limited or no income or assets. It provides cash assistance to meet very basic needs for food and shelter. Even if you have never worked or paid Social Security taxes, you may be eligible for SSI. But remember that one of the requirements for SSI is that you have very limited or no income, and few financial assets or resources.

What is SSDI?

SSDI stands for Social Security Disability Insurance. It pays benefits to a person who has a disability (as defined by SSA, but again, we will get to that later), and sometimes even to family members of the person with a disability, if the person worked long enough and paid Social Security taxes.

How do I apply for SSI or SSDI?

You may apply by calling 1.800.772.1213 and they will make an appointment to take your application by phone or in person at a Social Security office. You can also just go to a Social Security office without an appointment, but you will probably have to wait a long time.

The easiest way is to do as much as possible of the application process online. For SSDI, you can complete both the application and the Adult Disability and Work History Report online at www.socialsecurity.gov. For SSI, you can complete the online Adult Disability and Work History Report online, but then you will have to call 1.800.772.1213 in order to complete the application process.

Be sure to keep a copy of any paperwork you send to SSA.

How long will it take for Social Security to make a decision about whether I’ll get benefits?

Usually it takes about 3-5 months to get the initial decision.

Who makes the decision?

The Social Security Administration sends your application to a state agency that makes disability decisions. The state has medical and vocational experts who contact your healthcare providers to get information and records. The state agency might ask you to have a medical exam or tests. You do not have to pay for this. If the state does notify you that it is requesting that you be at a certain healthcare office or facility for an exam or test, be sure to keep that appointment.

I heard that most people get turned down when they apply. Is that true?

Yes, that’s true. Most people will be denied when they first apply. What’s most important, though, is to read that denial letter because it will tell you about your right to appeal.

What do I do if I get turned down at first?

You appeal that decision. The letter you get will tell you how to do that. When you appeal that initial denial, that is called reconsideration. You may be able to appeal for reconsideration online. Or you can complete paper forms and submit them. But either way, you must request reconsideration within 60 days. Even on reconsideration, though, most people are still denied benefits. Reconsideration generally takes another 3-5 months.

Is there another appeal if I get turned down on reconsideration?

Yes. You can appeal for a hearing by filing a Request for Hearing by an Administrative Law Judge and an Appeal Disability Report. Both can be submitted online or on paper. Again, this appeal must be filed within 60 days.

Will I have to wait another 3-5 months for the hearing with the judge?

Actually, you will probably have to wait a lot longer than that to get to the hearing. In some places, the wait for a hearing is longer than a year. It is impossible to say how long your wait will be, but your lawyer can probably give you an idea of the wait you can expect in your area.

What happens at the hearing?

That is a little difficult to answer because each hearing is a little different, but they do have some things in common. The people in the room will usually be the Administrative Law Judge (ALJ), the judge’s clerk who will record (either digitally or on tape) the hearing, and you, along with your representative, if you have one. There might also be a doctor (not anyone who has ever treated you, but just someone who can read and interpret the medical records and give an opinion about your ability to perform work-related activities), a psychologist or psychiatrist (if you have claimed to have a mental disability), and/or a vocational expert who will give an opinion about whether there are jobs that you could do, even with the limitations you have. In the hearing, you will have a chance to explain to the judge why you believe that you should get benefits.

After the hearing, the judge will notify you in writing of his/her decision.

If I lose there, is that the end of the line for appeals?

No. You may appeal to the Appeals Council by filing a Request for Review of Decision/Order of Administrative Law Judge. You cannot do this online at this time. It must be filed on paper. The form is available online or you can call 1.800.772.1213 and request that the form be mailed to you. Your request will go to the Office of Disability Adjudication and Review. Someone there will review your medical records and notify you in writing about the decision on your case. If you do not prevail in your appeal to the Appeals Council, you can file suit in federal court. You must have a lawyer to do this. The case will be filed on your behalf against the Social Security Administration. A federal district court judge will hear the case and notify you in writing of the decision in your case.

Should I get a lawyer to help me apply for SSI or SSDI?

You are not required to have a lawyer unless you appeal to federal court. However, it might be a good idea to have a lawyer help you, especially if you are going to have a hearing before a Social Security Administrative Law Judge. The reason it’s helpful to have a lawyer with you at that point is that a lawyer will know what kind of evidence to gather, how to best present the evidence, what to ask the witnesses that the judge will ask to testify, whether to seek additional witnesses, how to prepare you for the questions you will face, and how to put on the best case possible. Also, a lawyer will help to ease some of the fear and nervousness that most people feel when they go into a courtroom setting.

What should I do if I can’t afford a lawyer?

Social Security law sets out how lawyers get paid and no lawyer is allowed to charge you more than that. The way it works is that you do not have to pay the lawyer anything in advance for his/her fee. There might be a very small expense deposit to cover the costs of mailing and copies and those kinds of out-of-pocket expenses. But you do not pay the lawyer a fee for his/her time. The lawyer will be paid 25 percent of your past due benefits, or $5300, whichever is less. And the lawyer is paid only if you get benefits. If you do not prevail in your case, then the lawyer does not get a fee and cannot ask you to pay a fee.

What is the Social Security definition of disability?

It’s important to remember that the definition of disability is a legal definition and not a medical definition. Therefore, there are almost as many definitions of disability as there are disability laws. Social Security pays only for total disability. No benefits are paid for partial disability or for short-term disability under SSI or SSDI.

Social Security law defines disability as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

Disability, under Social Security law, is based on your inability to work. You will meet the Social Security definition of disability if SSA finds that you cannot do the work you did before; you cannot adjust to other work because of your medical condition(s); and your disability has lasted or is expected to last for at least one year or result in death. This is a strict definition of disability.

What is a “medically determinable impairment?”

It is an impairment that can be shown by medically acceptable clinical and/or laboratory diagnostic techniques. The impairment must be established by medical evidence consisting of signs, symptoms, and lab findings – and not simply by a person listing the symptoms.

Lots of times, people will bring a letter from a doctor that says that they have a disability. Often it says the person has a “total and permanent disability.” They don’t understand why, if their doctor says it, that Social Security disagrees. This goes back to the definition of disability being legal rather than medical. Your doctor, probably, is not a lawyer. So SSA is not that interested in the legal opinion of your doctor. What SSA wants from your doctor is evidence in the form of clinical notes and diagnostic tests and lab findings. SSA wants to know what treatments have been tried and how they have, or have not, worked. SSA wants to know about side effects of treatments and medications. SSA wants to know how your condition affects your ability to function and do work-related activities.

I heard that Social Security has a list of disabilities. How can I find out if my condition is on that list?

Social Security does not have a list of disabilities. What it has is a Listing of Impairments. The Listing of Impairments describes impairments that are considered severe enough to prevent a person from gainful work-related activities. But this isn't the kind of list where you can just look for your condition, find it, and know you’ll get benefits. It goes into detail about the criteria under which each condition is considered. Just because your condition is in the Listing of Impairments, that does not mean that you will automatically get benefits.

What kind of medical benefits do I get if I am on SSI or SSDI?

If you get SSDI, you can get Medicare coverage. Medicare helps pay hospital and doctor bills and it will go into effect after you have gotten benefits for at least 24 months, unless you have ALS or need long-term dialysis for chronic kidney disease or need a kidney transplant. Medicare pays roughly 80 percent of reasonable charges.

If you get SSI, you will get Medicaid (the name varies in some states). Medicaid covers all of the approved charges of the patient.

Can someone work and still get disability benefits from Social Security?

Social Security rules make it possible for people to test their ability to work without losing their benefits. These rules are called “work incentives.” The rules are different for SSI and SSDI, but under both programs, the program may provide continued cash benefits, continued help with medical bills, help with work-related expenses, and vocational training. For more information about work incentives, ask any Social Security office for the publication called “The Red Book – A Guide to Work Incentives

What is the Ticket To Work program?

Ticket to Work gives most people who are getting Social Security benefits more choices for getting employment services. SSA issues the “tickets” to eligible people who, in turn, may choose to assign those tickets to an Employment Network (EN) of their choice to get employment services, vocational rehabilitation (VR) services, or other support services they need to achieve a work goal. The EN, if it accepts the ticket, will help the person find and maintain employment. You can get more specific information about the Ticket to Work by contacting the SSA at 1.800.772.1213 or visiting the website at www.socialsecurity.gov

# For the Social Security Administration, visit:  http://www.ssa.gov/
   or you can call 1-800-772-1213

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