Frequently asked questions.

1. What is the difference between Social Security Disability Insurance Benefits and Supplemental Security Income?

Disability Insurance Benefits (DIB) are granted if an individual establishes that he or she is disabled and has had sufficient earnings over the last 10 years to qualify for these insurance benefits. The claimant has the opportunity to prove that he or she had more income during the ten year period to establish that he had sufficient earnings. In some cases, a person can amend his/her tax returns to show additional income and give him/her the necessary quarters to be insured and qualify for DIB. Thus, our attorneys can be of assistance in this area.

Supplemental Security Income (SSI) is a need basis or poverty program which requires the same manner of proof to establish disability, but is only given to individuals whose assets and income are under certain levels. A review of one’s income and assets is necessary to determine whether he or she can qualify.

Many claimant’s can qualify for both DIB and SSI. Therefore, when making an application each claimant should apply for both types of benefits.

2. How long do I have to wait after becoming disabled before I can file for Social Security disability benefits or SSI?

You can file for Social Security disability benefits on the day that you become disabled. Many individuals make the mistake of waiting months and even years after their injury or illness causes them to be 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.  If that person is denied at the initial and reconsideration stage, then the hearing before an Administrative Law Judge will probably be held close to one year after the application was filed.  Thus, it important to start the process as early as possible.

3. What must I prove to be found disabled?

To establish disability for SSI or DIB, the following five step test was established called the “Sequential Evaluation.”

1. Are you engaged in substantial gainful work activity (SGA)? SGA is defined as work which generates more than $500.00 per month income and is work that would normally be sufficient to warrant that amount of pay. If you are working and the work you are doing is considered to be SGA, the Social Security Administration will find that you are not disabled regardless of your medical condition or your age, education, and work experience.
2. Do you have a severe impairment? An impairment is severe if it significantly limits your physical or mental abilities to do basic work activities. You can be found not to be disabled at this step if it is determined that you do not have a severe impairment.
3. Does your impairment(s) meet or equal a listed impairment? Most major diseases and medical conditions are listed in an appendix to the Social Security regulations. Each listing sets out how severe an impairment must be to meet that listing.  If your medical condition or impairment meets or equals one of these listed impairments, you are entitled to DIB or SSI at this point and do not need to move to step 4 or 5.
4. Can you do the kind of work that you have done in the past? You must prove that you cannot perform any of the types of jobs you have held in the past 15 years. If this cannot be established, then a decision that you are not disabled will be entered.  If you prove that you cannot do your past work, then the process goes to the final step.
5. Can you do any other work considering your age, education and previous work experience? Most claimants can easily prove that they are not working (step 1), that they have a severe impairment (step 2) and that they cannot perform their past work (step 4).  However, showing that they cannot do any other work (step 5) is very difficult in most cases. In making this determination, the Administrative Law Judge must consider your age, your past work experience and your education.
   

4. How do I get started?

If you believe you are disabled, then you must first file an application for DIB, SSI or both with the local district office for the Social Security Administration or complete the application online at http://ssa.gov.

The state disability determination agency (state agency) will make a determination and send you notice of its decision by mail. If that determination is unfavorable and your claim is denied, then you have 60 days to appeal asking the state agency to reconsider its decision. Do not become discouraged because you lose your claim at the state agency level since over 75% of all claims are denied at this level.

If you are denied again, you have another 60 days to appeal by requesting a hearing before an Administrative Law Judge (ALJ). Although there are other appeals available after the hearing, the best chance to win is at the hearing, and the later appeals will use the testimony and evidence presented at the hearing in making a decision.  We make every effort to make sure that we put on the best case possible for you at the hearing since this is the most important step in the entire process.

5. What happens if I let my 60 day appeal time expire?

Unless you have an acceptable explanation of why you failed to appeal within the 60 days, you must file again. Fortunately, the regulations allow you to ask that your original application to be reopened under two circumstances if your claim is a claim for DIB. (1) If you refile within one year of the initial denial, and (2) if you refile within four years of the initial denial and can show good cause for reopening. One example of good cause is that new and material evidence is furnished.  If your claim is for SSI, then the only difference is under option (2) and that difference is the new claim must be filed within two years of the initial denial.

6. Can I receive partial 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. Thus, there are no percentages of disability, nor any percentages of disability benefits.  If found disabled, the claimant will receive the amount to which he or she is entitled based upon the average yearly earnings.

7. If I win, can I get Medicaid or Medicare for help with my medical bills?

If you are determined to be disabled and qualify for SSI, you will also be entitled to Medicaid, including retroactive Medicaid since the first month that you would have received SSI benefits.  If you are determined to be disabled and qualify for Social Security disability insurance benefits, you will be entitled to Medicare 24 months after the first month for which you received your disability insurance benefits.

8. What is the difference between Medicare and Medicaid?

The short answer is that Medicaid like SSI is a poverty program or need basis program and Medicare like Social Security disability insurance (DIB) is not .

Most disabled people who are eligible for Medicaid are eligible because they are receiving Supplemental Security Income (SSI).   Medicaid pays doctors at very low rates. As a result, people who have only Medicaid can have a hard time finding doctors willing to take them on as patients. However, medicaid does pay for some prescription medications.  In years past, Medicare did not pay for any prescription medications, but some prescription drug coverage was added in the Bush administration.

If you win your SSI claim, you will be entitled to retroactive Medicaid benefits.  Thus, you should keep up with your medical bills while waiting on a final favorable decision in your case.

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, then you qualify for Medicare. The good thing about Medicare is that it pays doctors at a higher rate than Medicaid, and most doctors will take Medicare patients. Unfortunately, Medicare does not begin until after a person has entitled to cash disability benefits for two years.

9. Should I Be Represented by an Attorney?

The National Organization for Social Security Claimant’s Representatives (NOSSCR) recently determined after study that claimant’s, represented by an attorney, win almost twice as often as non-represented Claimant’s. Some of the reasons for having competent representation are stated below:

Many people believe because their doctor has written a letter stating that the claimant is permanently and totally disabled, that the Administrative Law Judge (ALJ) will have to rule favorably. However, the doctors opinion as to disability is not important to the judge. A doctor is trained in medicine, not in the vocational factors necessary to determine whether or not someone is disabled. Thus, what the ALJ needs from a treating doctor is what limitations the claimant has. For example, our office uses a form prepared by the Social Security Administration and explains to the doctor what information is necessary to assist our client.

At the hearing, the ALJ will question the claimant and his or her witnesses. A lawyer, can assist the claimant in preparing for this hearing and insure that all the information helpful to the claimant is presented to the ALJ. In many cases a vocational expert (VE) is called to testify. Without the proper training and understanding of the purpose of the use of a VE, a claimant will not understand how to question the VE or attack his or her findings, if necessary.

As mentioned above, if a claimant loses at the ALJ hearing level, the later appeals use the testimony and evidence presented at the hearing to make the decision. Thus, retaining a lawyer after the hearing may be too late. Remember the old saying, “A person who represents himself has a fool for a lawyer and a fool for a client.”

Our firm and almost all lawyers charge fees in Social Security Disability Claims based upon a percentage of the back benefits received by the claimant. Thus, there is no fee unless your case is won. back to the list of FAQ