Social Security Disability FAQ's
What is the definition of disability used by Social Security?
Under the Social Security Act, "disability" means "inability to engage in any substantial gainful activity because of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months." As a practical matter, this means you are unable to perform any full-time job (not just your past occupation) for at least 12 continuous months. There are special rules for people over 50 - in some situations, a person over 50 may be found disabled even if there are some jobs he or she could perform.
How many different types of Social Security Disability Benefits are there?
There are five major types of Social Security Disability Benefits.
Disability Insurance Benefits is the most important type of Social Security Disability Benefits. It goes to individuals who have worked in recent years (five out of the last ten years in most cases) and paid into Social Security, who is now disabled. The amount paid is based on the individual’s Social Security earnings record.
Disabled Widow's and Widower's Benefits are paid to individuals who are at least 50 and become disabled within a certain amount of time after the death of their husband or wife. The late husband or wife must have worked enough under Social Security to be insured.
Disabled Adult Child Benefits go to the children of persons who are deceased or who are drawing Social Security Disability or Retirement Benefits. The child must have become disabled before age 22.
Supplemental Security Income (SSI) benefits are paid to individuals who are poor and who are disabled. It does not matter for SSI whether an individual has worked in the past or not.
SSI Child's Disability Benefits are a variety of SSI benefits paid to children under the age of 18 who are disabled. The way in which disability is determined is a bit different for children than adults.
How do I apply for Social Security Disability Benefits?
The best, surest way to file a Social Security Disability claim is to go to the nearest Social Security office in person and wait to see someone to file the claim in person. Always make sure and get a copy of the application you submitted. In the alternative, a person may contact Social Security by telephone and arrange for a telephone interview to file the claim or file a claim for disability via the internet.
I am disabled, but I have money in the bank. Do I have to wait until this money is gone before I apply for Social Security Disability Benefits?
No. If you have worked in recent years or if you are applying for Disabled Widow's or Widower's benefits or Disabled Adult Child benefits, it does not matter how much money you have in the bank. There is no reason to wait to file the claim. However, if you are applying for Supplemental Security Income (SSI) Benefits, the general rule is you cannot have more than $2000 in assets.
I used to work, but lately, I have been staying home taking care of the kids. I have now become sick. Can I get Social Security Disability Benefits?
Possibly. If you have worked five out of the ten years under Social Security before becoming disabled, you will have enough earnings to qualify for Social Security Disability Benefits potentially. For individuals 31 or less, the requirements are a little different, since such individuals have not had such a long time to work. Unless a person has been staying home and taking care of their children for many years, however, they may qualify for Social Security disability benefits based upon their own earnings. Also, a homemaker, if poor enough, can be eligible for Supplemental Security Income (SSI) whether he or she has worked in the past or not.
How long do I have to wait after becoming disabled before I can file for Social Security Disability Benefits?
You don’t have to wait at all. You can file for Social Security Disability Benefits on the very same day that you become disabled. Many individuals make the mistake of waiting months and even years after becoming disabled before filing a Social Security Disability Claim. There is no reason to file a Social Security Disability Claim if one has only a minor illness or one which is unlikely to last a year or more. However, an individual who suffers serious illness or injury and expects to be out of work for a year or more should not delay in filing a claim for Social Security Disability Benefits. Don’t wait! The approval process can take many months or even years, so the sooner you apply, the better.
I am still on sick leave from my employer. Can I file for Social Security Disability now, or do I have to wait until the sick leave is exhausted?
No, you do not have to wait until the sick leave is exhausted. You should file for Social Security Disability Benefits now if you believe that you will be out of work for a year or more. We also recommend that you file if you are unsure if your disability will last 12 months.
I got hurt on the job and am receiving Worker’s Compensation Benefits and State Disability Insurance Benefits. Can I file a claim for Social Security Disability Benefits now or should I wait until the Worker’s Compensation or State Disability payments end?
You do not have to wait until the Worker's Compensation or State Disability ends, and you should not wait that long. An individual can file a claim for Social Security Disability Benefits while receiving Worker's Compensation Benefits and State Disability Insurance Benefits. It is best to file the Social Security Disability claim as soon as possible because otherwise there may be a gap between the time the Worker's Compensation or State Disability Benefits end and the Social Security Disability Benefits begin.
Can I get both Worker's Compensation and Social Security Disability Benefits?
Yes. There is an offset, which reduces Social Security Disability Benefits because of worker's compensation benefits paid. However, in virtually all cases, there are still some Social Security Disability Benefits to be paid.
Can you receive Social Security Disability Benefits for _________________ (insert the name of any disease or medical impairment)?
In almost every case, no matter what the disease is, the answer is the same - "Maybe, it just depends upon how badly you are affected by the disease." One example might be cancer. The word "cancer" is scary to anyone, but there are many cancers that can be treated and cured very quickly, with little or no lasting effect. On the other hand, of course, some cancers cause great suffering and, ultimately, death. The question in each individual case is, "How sick is this particular individual with cancer, and how long is this person going to remain sick?" Skin diseases are another example. The vast majority of skin diseases, while annoying, would not be considered to be disabling.
On the other hand, there are some uncommon, very severe skin problems that are clearly disabling. In extreme cases, psoriasis, which is not rare, may be disabling. Thus, almost without exception, the mere fact that an individual has a disease with a specific name does not guarantee that the individual either will or will not be found disabled. It all depends upon how sick the person is.
Do you have to be permanently disabled to get Social Security Disability Benefits?
No. You have to have been disabled for at least a year or be expected to be disabled for at least a year or have a condition that can be expected to result in death within a year.
I have several health problems, but no one of them disables me. It is the combination that disables me. Can I get Social Security Disability Benefits?
Social Security is required to consider the combination of impairments that an individual suffers in determining disability. Many claimants for Social Security Disability Benefits have more than one health problem, and the combined effects of all of the health problems must be considered. Therefore, when filing for benefits, it is essential to let Social Security know about all of your medical impairments that contribute to your inability to work.
I got hurt in an automobile accident. I am disabled now, but I expect that I will be able to return to work after I recover. Should I file for Social Security Disability Benefits?
If you expect to be out of work for a year or more on account of illness or injury, you should file for Social Security Disability Benefits. You may also consider filing if you aren’t sure whether your disability will last for a year. Experience demonstrates that many individuals do not recover as fast as anticipated by their physicians.
How does Social Security determine if I am disabled?
Social Security is supposed to gather your medical records and carefully consider all of your health problems, as well as your age, education, and work experience. If your medical records establish specific criteria contained in the Listing of Impairments, you will be found disabled. In most cases, an individual’s condition will not meet all of these criteria, and Social Security will then decide whether you can do your past work. If Social Security decides that you are unable to do your previous work, they are supposed to consider whether there is any other work that you can do considering your health problems and your age, education, and work experience. In general, if Social Security determines that one or more occupations are existing in significant numbers in the national economy, which can be performed with your limitations, your disability claim will be denied. There are special rules which are applied for people over 50, and other situations.
Who decides if I am disabled?
After an individual files a Social Security Disability Claim, the case is sent to a disability examiner at the Disability Determination agency in your state. This individual, working with a doctor, makes the initial decision on the claim. If the claim is denied and the individual requests reconsideration, the case is then sent to another disability examiner at the Disability Determination agency, where it goes through much the same process. In many cases, however, the reconsideration level is simply a “rubber stamp” of the initial denial, and less than 20% of cases are approved at this level. If a claim is denied at reconsideration, the claimant may then request a hearing. At this point, the case is sent to an Administrative Law Judge who works for Social Security. The Administrative Law Judge makes an independent decision upon the claim. This is the only level at which the claimant and the decision maker get to see each other.
Why does Social Security consider my age in determining whether I am disabled?
Social Security has to consider age because that is what the Social Security Act requires. As people get older, they become less adaptable, less able to switch to different jobs to cope with health problems. A severe foot injury which might cause a 30-year-old to change to a career in which he or she can sit down most of the time might disable a 60-year-old person who could not adjust a different type of work.
What can I do to improve my chances of winning my Social Security Disability Claim?
Be honest and complete in giving information to Social Security about what is disabling you. Many claimants, for instance, fail to mention their psychiatric problems to Social Security because they are embarrassed about them. In almost all cases, individuals who were slow learners in school fail to mention this fact to Social Security, even though it can have a good deal to do with whether or not the Social Security disability claim is approved. Beyond being honest and complete with Social Security, the most important thing that you can do is keep appealing and hire an experienced person to represent you. It is important to appeal because most claims are denied at the initial level, but are approved at higher levels of review. It is essential to hire an experienced attorney to represent you because you do not understand the way Social Security works. Statistically, claimants who employ an attorney to represent them are much more likely to win than those who go unrepresented.
I am approved for Social Security Disability Benefits, how much will I get?
For Disability Insurance Benefits, it all depends upon how much you have worked and earned in the past. For disabled widow's or widower's benefits, it depends upon how much the late husband or wife worked and made. For disabled adult child benefits, it all depends upon how much the parent worked and earned. For all types of SSI benefits, there is a base amount that an individual with no other income receives. Other income that an individual has reduces the amount of SSI which an individual can receive.
If I get Social Security Disability Benefits, will I get Medicare?
If you are approved for any Social Security disability benefit other than SSI, you will get Medicare after you have been entitled to Social Security Disability Benefits for two years.
How far back will they pay benefits if I am found disabled?
For Disability Insurance Benefits and Disabled Widow's and Widower's Benefits, you are not paid for the first five months of your disability, so the benefit payments begin five months after you become disabled. Also, benefits cannot be paid more than one year before the date the claim was filed. For a Disabled Adult Child, there is no five-month waiting period before benefits begin, but benefits cannot be paid more than six months prior to the date of the claim filing. SSI benefits cannot be paid prior to the start of the month following the date of the claim filing.
What do I do if Social Security denies my claim for Social Security Disability Benefits?
First, do not be surprised. Only about 40% of Social Security Disability Claims are approved at the initial level. If you are denied at the initial level, unless you have already returned to work or expect to return to work in the near future, you should appeal, by filing a request for reconsideration. You should also consider employing an attorney to represent you. You are likely to be denied again at the reconsideration level, so you need to appeal again and request a hearing before an Administrative Law Judge. If you have not yet hired an attorney, you should strongly consider doing so, as the hearing will involve complicated legal and medical issues. Remember, the fact that your claim gets denied does not mean you will not ultimately be approved for benefits. Most people that are on Social Security Disability have gone through the process of going to a hearing. Unfortunately, it can take several years to get approved in many cases. Don’t give up!
What is Social Security hearing like?
The hearings are relatively informal. The only people likely to be there are the judge, a secretary operating a tape recorder, the claimant, the claimant's attorney, and anyone else the claimant has brought with him or her. In some cases, the Administrative Law Judge has a medical doctor or vocational expert present to testify at the hearing. There is no jury, nor are there any spectators at the hearing. There is no attorney at the hearing representing Social Security trying to get the judge to deny the Disability Claim.
If the Administrative Law Judge denies my claim, can I appeal any more?
Yes. You can appeal to the Appeals Council, which is still within Social Security.
What is the Appeals Council?
The Appeals Council exists to review Administrative Law Judge decisions. The Appeals Council is located in Falls Church, Virginia, and neither the claimant nor the attorney sees the people at the Appeals Council who are working on the case.
Can I appeal a case beyond Social Security to the Federal Courts?
Yes. After being denied by the Appeals Council, it is possible to file a civil action in the United States District Court, requesting a review of Social Security's decision. A Social Security Disability Claim can go all the way to the Supreme Court. Perhaps once every year or two years, the United States Supreme Court hears an appeal about a Social Security Disability case.
If I get on Social Security Disability Benefits and get to feeling better and want to return to work, can I return to work?
Yes, you can return to work. Social Security wants individuals drawing Disability Benefits to return to work and gives them every encouragement to do so. For persons receiving Disability Insurance Benefits, Disabled Widow's and Widower's Benefits, and Disabled Adult Child Benefits, full benefits may continue for a year after an individual return to work. Even after that, an individual who has to stop work in the following three years can get back on Social Security Disability Benefits immediately without having to file a new claim. In SSI cases, things work differently, but there is still a strong encouragement to return to work.
Can alcoholics and drug addicts get Social Security Disability Benefits?
Not anymore. There never were all that many people getting Social Security Disability Benefits on account of alcoholism or drug addiction. Still, Congress has now prohibited Social Security from paying disability benefits based on alcoholism or drug addiction. However, alcoholics and drug addicts have heart attacks, get cancer, or get sick in other ways just like everyone else. Alcoholics and drug addicts who become disabled apart from their alcoholism or drug addiction can become eligible for Social Security Disability Benefits.
I am disabled, but I have never worked. Can I get Social Security Disability Benefits?
If you are poor enough, that is, you don’t have assets of over $2000, you can qualify for Supplemental Security Income (SSI) if you are disabled, even if you have never worked in the past. It is also possible to be eligible for Disabled Adult Child Benefits on account of a parent if you became disabled before age 22 or for disabled widow's or widower's benefits on account of a late husband or wife.
I am a widow. I have not worked in public work in many years. I am disabled. Can I get Social Security Disability Benefits?
If you are over 50 and became disabled within seven years after your husband or wife died or within seven years after you last drew mother's or father's benefits from Social Security, you can get Disabled Widow's or Widower's Benefits. Perhaps more important, if you are poor, you can draw Supplemental Security Income benefits no matter what age you are or when you became disabled.
I have a daughter who has been disabled by cerebral palsy since birth and has never been able to work. Can she get Disability Benefits from Social Security?
Very possibly. If the child is under 18, and you are poor enough, the child may be able to qualify for SSI Child's Disability Benefits. If the child is over 18, she may be able to be eligible for SSI Disability Benefits without regard to the income of her parents. If her father or mother is drawing Social Security Benefits of some type or is deceased, the child may be eligible for disabled adult child benefits.
I am already on Social Security Disability Benefits, but I am worried that my benefits will be stopped in the future. What are the chances of this happening?
Social Security is not supposed to cut off Disability Benefits for an individual unless his or her medical condition has improved. When Social Security reviews a case of someone already on Social Security Disability Benefits, they continue benefits in the vast majority of cases.
If Social Security tries to cut off my Disability Benefits, what can I do?
You should appeal immediately. If you appeal within ten days after being notified that your disability benefits are being ceased, you can ask that your Disability Benefits continue while you appeal the decision cutting off your benefits. You may also want to talk with an attorney about representation in your case, but you should file the appeal immediately.
My doctor says I am disabled, so why is Social Security denying my Social Security Disability Claim?
Social Security's position is that it is not up to your doctor to determine whether or not you are disabled. It is up to them, and they will make their own decision regardless of what your doctor thinks.
VA says I am disabled, so why is Social Security denying my Social Security Disability Claim?
It is Social Security's position that VA decisions are not binding upon them. Social Security and VA have very different standards for approving Disability Claims.
I am 60% disabled. Do I get 60% of my Social Security Disability Benefits?
No. There are no percentages of disability in Social Security disability determination. For purposes of Social Security Disability Benefits, you are either disabled or not disabled. There are no percentages of disability, nor any percentages of Disability Benefits.
I am disabled by mental illness. Can mental illness serve as the basis for a Social Security Disability Claim?
Yes. Mental illness is a frequent basis for awarding Social Security Disability Benefits.
What is the difference between Medicare and Medicaid?
The short answer is that Medicaid is a poverty program, and Medicare isn't. Many disabled people who get Medicaid get it because they are on Supplemental Security Income (SSI). This is called “categorical” Medicaid eligibility. To get SSI and thereby get Medicaid, you have to be poor and disabled. Medicaid pays doctors at very low rates. People who have only Medicaid can have a hard time finding doctors willing to take them on as patients. Medicaid does pay for prescription medications. Medicaid can go back up to three months before the date of a Medicaid claim. Note that it is possible to apply for Medicaid directly - through a local Medicaid office - without having a companion claim for SSI.
For Medicare, it does not matter whether you are rich or poor. If you have been on Disability Insurance Benefits, Disabled Widows or Widowers Benefits or Disabled Adult Child Benefits for 24 months, you qualify for Medicare. The good thing about Medicare is that it pays doctors at a higher rate than Medicaid. Almost all doctors are happy to take Medicare patients. The bad things about Medicare are that it does not begin until after a person has been on cash disability benefits for two years and that it generally does not pay for prescription medications.
If I get Social Security Disability Benefits, will I get Medicaid?
If you are approved for SSI, you will get Medicaid. It is possible to get both Medicare and Medicaid if you are entitled to SSI and some other type of Social Security Disability Benefit. Also, see #56, above Frequently Asked Questions.
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