Frequently Asked Questions About
Social Security Disability Law

1. How does Social Security define disability?

   Social Security defines "disability" as the "inability to engage in any substantial gainful activity by reason 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 continuous period of not less than 12 months."

2. What kinds of benefits are there?

   There are several kinds of disability benefits for which a person can be eligible. Depending on the facts, you may be entitled to one of these benefits, or you may be entitled to more than one. The medical rules are the same for all categories, you must be just as disabled to qualify for one as for another. The non-medical requirements are different for each category.

   • Disability Insurance Benefits (DIB) - You are only eligible for these benefits if you have paid a certain amount of Social Security tax over a period of time, enough to have disability insurance coverage in force. In general, you must have paid at least a certain amount of Social Security tax in at least twenty calendar quarters during the forty calendar quarters before your total disability began. In other words, you must have worked and paid Social Security tax for about five out of the last ten years before you became totally disabled. There is a different, easier rule for people whose disability began before age 30. Everyone must prove that he or she became disabled while disability insurance coverage was in force or they are not entitled to benefits, no matter how serious the medical condition is now. If your DIB claim is approved, the monthly payment you will receive is set by your earnings (and Social Security tax payments) during your working career. There is no minimum rate, and the maximum a person can receive at this time is over $1,300 per month. There is a cost-of-living raise in the monthly payment at the start of most years. In many cases, your dependent children will also get benefits in addition to your own.
   • Supplemental Security Income (SSI) - SSI can be paid whether or not a person has paid in enough Social Security tax to get disability insurance benefits. You must be disabled under the same rules as for disability insurance, or be blind, or be over 65. You must also have very little income or property, because this benefit is based on financial need. Social Security looks at all other income and property in the household you live in, not just your own, and also the value of any support (like free room and board) you may get from others, to determine whether you are financially eligible for SSI. Social Security does this in addition to deciding if you are disabled. Also, some children 18 or younger with a severe disability can get a monthly benefit if their family income is low enough.
   • Disability Widow/Widower Benefits (DWB) - This is a special disability benefit for certain widows and widowers, based on the Social Security tax paid by his or her deceased spouse. In order to qualify, you must be between ages of 50 and 60, and have been married for at least 10 years to the person who was covered under Social Security at the time of his or her death. Also, you must have proof that your disability was severe enough to meet these rules within seven years of your spouse's death, with some exceptions for those already receiving other kinds of Social Security benefits. If you are awarded DWB benefits, your monthly rate is determined by your spouse's income and Social Security tax payments. However, a surviving spouse's pension can usually be paid at the age of 60, regardless of any disability.
   • Disabled Adult Child Benefits (DAC) - In order to be eligible, you must be a child of a person already receiving Disability Insurance Benefits or Retirement Benefits, or who died while covered for Social Security. You must be at least 19 years old, and you must prove your total disability began before the month you turned age 22, and is continuing. The monthly benefit rate is based on a percentage of your parent's rate. Therefore, it is different in each particular case.

3. Is it hard to apply for Social Security disability benefits?

   No. There are 2 ways to apply for a Social Security disability claim. The first is to go to the Social Security District Office and file the claim in person. The second way is to call Social Security at 1-800-772-1213. They will arrange for a telephone interview for you. Once the interview is finished they will send necessary forms for you to fill out. All the basic information will have been collected during the phone interview.

4. When can I file for Social Security disability benefits?

   You can file for Social Security disability benefits on the day that you become disabled if you believe that you will be out of work for one year or more. Sometimes hospital social workers can help you and your family make the initial contact with Social Security.

5. Is it necessary to hire a representative to represent me in my Social Security disability claim?

   No. Any claimant can represent himself in all phases of the Social Security disability process. Claimants with representation win their cases more often than those who are not represented.

6. How do representatives who help Social Security disability claimants get paid?

   Cases are generally handled on a contingency basis. That means the representative receives a fee only if you win your case. Normally the fee is 25% of your back benefits and must be approved by Social Security. If you do not win your case there is no fee. There are also costs in each case for which you will be responsible. These costs are generally fees paid to doctors for medical records.

7. Can I get Social Security disability benefits if I expect to get better and return to work?

   You have to have been disabled for at least one year or be expected to be disabled for at least one year. So, if you expect to be out of work for one year or more on account of illness or injury, you should file for Social Security disability benefits.

8. I got hurt on the job. I am drawing worker's compensation benefits. Can I file a claim for Social Security disability benefits now or should I wait until the worker's compensation ends?

   You do not have to wait until the worker's compensation 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.

9. 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 supposed to consider the combination of impairments that an individual suffers in determining disability. Many, perhaps most 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.

10. 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.

11. If 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 earned. 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.

12. 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.

13. If I am found disabled how far back will Social Security pay benefits?

    For Disability Benefits and for Disabled Widow's and Widower's Benefit, the benefits begin five months after the person becomes disabled. But, benefits cannot be paid more than one year prior to the date of the claim.
    
    For a Disabled Adult Child benefits begin as of the onset date, but benefits cannot be paid more than six months prior to the date of the claim.
    
    SSI benefits begin at the start of the month following the date of the claim.

14. What is the difference between Medicare and Medicaid?

    The short answer is that Medicaid is a poverty program and Medicare isn't. Most disabled people who get Medicaid get it because they are on Supplemental Security Income (SSI). 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 prior to the date of a Medicaid claim. For Medicare it does not matter whether you are rich or poor. If you have been on Disability Insurance Benefits, Disabled Widows or Widowers Benefit 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.

15. If Social Security tries to cut off my disability benefits, what can I do?

    You should appeal immediately. If you appeal within 10 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 on your case, but you should file the appeal immediately.