More Frequently-Asked Questions about Social Security Disability Benefits
What do all the abbreviations and initials mean?
ALJ is an Administrative Law Judge. They are involved in the appeals process.
CE is a Consultative Examination. You may be asked to take one, to confirm the extent of your disability.
CSRS is the Civil Service Retirement System, which covered federal government workers up until 1983. It was replaced with the Federal Employees Retirement System (FERS) in 1984.
DDS is Disability Determination Services. After the SSA accepts your application, they send it to your state’s DDS office to review your disability report, to determine whether your disability meets their strict criteria.
DRB is the Decision Review Board, which reviews most ALJ decisions regarding SSD claims.
DSI is Disability Service Improvement. The SSA is rolling out DSI across the states to improve the speed with which applications are reviewed, accepted or denied, and appealed. Some states have not adopted the improvements as yet. As of this writing, DSI is being used in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.
FedRo stands for Federal Reviewing Official. They are involved in SSD determinations.
FERS is the Federal Employees Retirement System, which started in 1984. It replaced the Civil Service Retirement System (CSRS).
SGA is Substantial Gainful Activity. This is income from your work. If your income exceeds the SSA’s limit (which may change every year), you will not meet their criteria for receiving SSD.
SSA is the Social Security Administration. It’s the U.S.’s department that controls and manages the distribution of Social Security funds.
SSD is Social Security Disability. This is short for SSDI (see below) and usually applies to Social Security Disability benefits.
SSDI is Social Security Disability Insurance. SSD is not welfare. It is an insurance policy, and if you’ve been working and paying taxes and FICA, you have contributed to paying for this insurance. You will need to meet the minimum contributions required by SSA for your specific circumstances.
SSI is Supplemental Security Income. The SSI program makes payments to eligible people with low income who are age 65 or older, or are blind, or have some other qualifying disability. The Social Security Administration manages the SSI program. Even so, SSI is not paid for by Social Security taxes. It’s paid for by U.S. Treasury general funds, not the Social Security trust funds. Disabled or blind children also can receive SSI. The basic SSI amount is the same nationwide. However, many states add money to the basic benefit.
How does the SSA define “disability”?
The SSA has strict requirements for eligibility. Benefits are paid to adults with a physical or mental disability that is severe enough to keep them from working for at least 12 months, or is expected to result in death. Social Security does not pay short-term or partial disability benefits, because their rules assume (correctly or not) that working families have access to other resources to provide support during this period, such as workers’ compensation, disability insurance, savings, or investments.
My doctor says I’m disabled. Is that enough to qualify me for Social Security disability benefits?
No. First, you will need to complete an application for Social Security Disability Benefits and the Disability Report (available online or at an SSA local office). To process your application, the SSA requires the following data (among others):
- Your name and complete address
- Your Social Security number
- Your birth certificate or baptismal certificate
- The names, addresses, and phone numbers of the doctors, caseworkers, hospitals and clinics that took care of you, and the dates of your visits
- Medical records from your doctors, therapists, hospitals, clinics and caseworkers that you have in your possession
- Names and dosages of all the medicine you take
- Laboratory and test results
- A summary of where you worked and the kind of work you did
- A copy of your most recent W-2 Form (Wage and Tax Statement) or, if you are self-employed, your federal tax return for the past year. You will need to fill out and submit other forms, too. One form collects information about your medical condition and how it affects your ability to work. Other forms give doctors and other health care providers who have treated you permission to send the SSA information about your medical condition. Do not delay applying for benefits if you cannot get all of this data together quickly; the SSA can help you get it.
What happens when the SSA receives my application?
The SSA reviews your application to make sure you meet some basic requirements for disability benefits. They check whether you worked enough years (and reported your earnings) to qualify. Also, they evaluate any current work activities. If you meet these requirements, they send your application to the Disability Determination Services (DDS) office in your state.
What does the DDS office do?
This state agency completes the disability decision for the SSA. Their doctors and other disability specialists ask your doctors for information about your condition, and then consider all the facts in your case. They will use the medical evidence from your health care providers and will ask your doctors: What your medical condition is • When it began • How it limits your activities • What the medical tests have shown • What treatment you have received • How your condition limits your ability to do work-related activities, such as walking, sitting, lifting, carrying, and remembering instructions. Your doctors are not asked to decide if you are disabled. The DDS may ask for more medical information and/or ask you to go for a special examination (which the SSA would pay for).
How does the SSA make a decision in regard to my claim of disability?
It’s a five-step process, and requires the appropriate answers to these questions:
- Are you working? If you are, and your earnings average more than a certain amount each month, the SSA will generally not consider you disabled. The amount changes each year. The 2018 figure is $1,970 per month if blind, and $1,180 per month if not blind. If you are not working, or your average monthly earnings are the same or less than this figure, the DDS then looks at your medical condition.
- Is your medical condition “severe”? Does it significantly limit your ability to do basic work activities for at least one year? If not, the DDS will not consider you disabled. Otherwise, they proceed to step three.
- Is your medical condition on the official “List of Impairments”? This list describes medical conditions that are considered so severe—e.g., you have terminal cancer, are on a waiting list for a heart transplant, have lost the use of either legs, or other obvious disabilities—that they automatically mean that you are disabled as defined by law. It also lists severe impairments pertaining to the various parts of the body: musculoskeletal system, respiratory system, cardiovascular system, digestive system, endocrine system, neurological system, mental disorders, special senses and speech, skin disorders, etc. If your condition is not on this list, the DDS looks to see if your condition is as severe as a condition that is on the list. If so, they may decide that you are disabled. If not, they go on to step four.
- Can you do the work you did before? If you can, they will decide you are not disabled. But if your condition prevents you from doing that kind of work, they go on to step five.
- Can you do any other kind of work? The DDS evaluates your medical condition, age, education, work experience, and any skills you may have that could be used to do other work. If you cannot do other work, they will decide that you are disabled. If you can do other work, they will decide that you are not disabled. (There are special rules for the blind, explained in SSA Publication #05-10052.)
What happens when the DDS reaches a decision on my case?
When the state agency reaches a decision on your case, the SSA will send you a letter. If your claim is approved, the letter will show the amount of your disability benefit and when your payments will start. If your claim is not approved, the letter will explain why not and tell you how to appeal the decision if you do not agree with it.
How long does it take to get a decision?
Usually, it takes from three to five months. It depends, to some extent, on how long it takes to get your medical records and any other evidence needed to make a decision. It can also depend on the DDS’s workload at the time you initially apply (i.e., file a claim) for SSD benefits. However, if you’re in a state where the new Disability Service Improvement (DSI) process has been introduced, and the medical evidence provided shows you are obviously disabled, a favorable determination can be made in as little as 20 days after the DDS receives your claim.
What if my claim is denied and I disagree with the decision?
Over 70% of all first time claims are denied through the system. If your claim is denied, you may request reconsideration (if offered in your state). Then, if the second examiner also denies your claim, you may request a hearing before a federal administrative law judge, but you must do so within 60 days of receiving the Appeals Council’s notice of denial or revised decision. Last year, the average amount of time needed to process a hearing request was over 17 months! The SSA is working hard to reduce the wait, beginning with DSI.
Under DSI, a Federal Reviewing Official (FedRo) reviews initial determinations (denials, in almost all cases) upon request for review from the claimant. The FedRo makes a decision based on all of the evidence. This written decision explains in clear and understandable language the specific reason(s) for the decision, including an explanation as to why the FedRo agrees or disagrees with the initial determination.
If it’s a denial and you don’t agree with the FedRo’s decision, you can request a hearing by an Administrative Law Judge (ALJ). After the hearing is held, the ALJ will explain why he or she agrees or disagrees with the decision of the FedRo. Then your case record is closed, unless you can establish a “good cause” exception.
In order to continually improve the process, the Decision Review Board (DRB) identifies issues in both favorable and unfavorable decisions that may impede consistent adjudication at all levels of the process, in all geographic areas of the U.S. The DRB reviews of most ALJ decisions are discretionary and are not a level of appeal requested by the claimant. However, if you are denied benefits and file a further appeal, but the ALJ does not reopen your claim, you may be able to appeal to the DRB (depending on your particular claim).
If I appeal a negative decision on my claim, what happens next?
Your claim file, request for review, and any additional evidence and comments you submitted are assembled into a case folder by the SSA. Then a hearings and appeals analyst (who is a paralegal specialist) reviews the case folder and prepares a written analysis of your claim and a recommendation. He or she also prepares a notice, order, or decision for the administrative appeals judge or appeals officer’s signature. This official considers the evidence, the hearing decision, the analysis, and the recommendation. If the official agrees with the recommended action, he or she will sign the notice, order, or decision. Otherwise, he or she will make appropriate changes or will return the case folder to the analyst for a different action. Ultimately, the judge or officer issues the Appeal Council’s action. The support staff then dates and mails it to you and sends a copy to your representative, if you have one.
The entire process can, and usually does, take many months — up to a year — unless you’re in a U.S. state where the new DSI process has been introduced. In that case, as noted in the answer above, a favorable determination can take as little as 20 days after the DDS receives your appeal. But no matter where you live, and whether or not there’s DSI, lengthy delays due to errors or omissions can often be avoided by having an SSD attorney handle your case.
Do I need a lawyer to represent me?
The federal government does not require applicants to have legal representation — but it’s a good idea to have one. The SSA admits that claimants who have attorneys have a better chance of a successful result and, they state, “A representative who is familiar with the Social Security system may provide valuable service to you.” Attorneys who specialize in disability claims know exactly what is required and can have it ready to present to the examiner or judge. Our legal team has this expertise and can help you from the beginning of the process to the end. If you’ve tried it on your own and your application has been denied, we can file your appeal.
How do disability lawyers get paid?
Attorney’s fees are paid on a contingency basis. If your claim is successful, the attorney receives one-fourth of back benefits (not to exceed a total of $5,900) and you receive the other three-fourths. Going forward, you get 100% of your benefits. If your claim is denied, the attorney receives no fee at all. Any fees paid will not affect your future monthly benefit.
What about benefits for disabled children?
If you have a disabled child under the age of 18, and your family meets federal income requirements, the child could qualify for Supplementary Security Income. A child may also be entitled to disability benefits on the earnings record of a parent, if that parent is deceased or disabled and the child becomes disabled before age 22. A child may be considered disabled if he or she:
- Is not working at a job considered by the SSA to be substantial work, and
- Has a physical and/or mental condition that results in “marked and severe functional limitations” that seriously limit activities, and
- The condition has lasted, or is expected to last, at least one year or is expected to result in death.
Who pays these disability benefits?
The government’s disability benefits come from two sources:
- The Social Security Disability Insurance (SSDI) program, which is for insured workers (i.e., those covered by Social Security), their disabled surviving spouses, and children (if disabled before age 22) of disabled, retired or deceased workers. (A disabled worker may sometimes also collect benefits from workers’ compensation insurance; if so, the amount Social Security pays may be reduced accordingly.)
- The Supplemental Security Income (SSI) program, for people with little or no income or other financial resources.
If approved, when will my disability benefits begin?
You first benefit will be paid for the sixth full month after the date your disability began (as determined by the SSA). For example, if your disability began on June 15, 2016, your first benefit would be paid for the month of December, 2016, and arrive in January, 2017. Your payments would arrive in the month following the month for which they’re due.
Why would it take so long for the Appeals Council to act on my case?
The Appeals Council is understaffed to handle the number of cases to be reviewed. It is made up of about 68 administrative appeals judges and 42 appeals officers, who must review and sign each final action. Each year, the Council receives about 176,000 requests for review. The average waiting time is 364 days (one year), down from a high of 505 days back in 2000.
What is the earliest age that an individual can receive disability benefits?
There is no minimum age as long as the strict Social Security definition of disability is met. But to qualify for SSD benefits, you (or a parent if you’re a child and are not working) must have worked long enough and recently enough under Social Security to earn the required number of work credits. An individual can earn up to a maximum of four work credits each year. The amount of earnings required for a credit increases each year as general wage levels rise. For 2014, it’s $1,200. (If the SSD requirements can’t be met, you may qualify for SSI or other benefit programs.)
Once I start receiving disability benefits, how long will I keep receiving them?
Benefits usually continue until you are able to work again on a regular basis (if that’s possible). There are also a number of special rules, called “work incentives,” that provide continued benefits and health care coverage to help you make the transition back to work. If you are receiving Social Security disability benefits when you reach full retirement age (as defined by the SSA, it ranges from 65 and two months to 67, depending on your date of birth), your disability benefits automatically convert to retirement benefits, but the amount remains the same.
I am receiving Social Security disability benefits. Will my benefits be affected if I work and earn money?
The SSA has special rules called “work incentives” that help you keep your cash benefits and Medicare while you test your ability to work. For example, there is a trial work period during which you can receive full benefits regardless of how much you earn—as long as you report your work activity and continue to have a disabling impairment. This trial work period continues until you accumulate nine months (they need not be consecutive) of what the SSA calls “services” within a rolling 60-month period. The SSA considers your work to be “services” if you earn more than $1,170 a month (the limit for 2017). After the trial work period ends, your benefits will stop for the months your earnings are at a level the SSA considers “substantial”; the monthly amount is $1,170 in 2017. Different amounts ($1,950 in 2017) apply to the blind. Then, for an additional 36 months after completing the trial work period, your benefits can start again if your earnings fall below the then-current “substantial” level and you continue to have a disabling impairment.
Are there special rules for the blind or those who have low vision?
Yes. The SSA considers a person to be legally blind if his/her vision cannot be corrected to better than 20/200 in the better eye (if there is one), or if the visual field is 20 degrees or less, even with a corrective lens. Many people who meet the legal definition of blindness still have some sight, and may be able to read large print and get around without a cane or guide dog. If you do not meet the legal definition of blindness, you may still qualify for disability benefits if your vision problems alone or combined with other health problems prevent you from working. There are a number of special rules for people who are blind that recognize the severe impact of blindness on a person’s ability to work. For example, the monthly earnings limit (in order to qualify for disability benefits) for people who are blind is generally higher than that for non-blind disabled workers. In 2017 the limit is $1,950.
For Social Security disability payments, you must have worked long enough in a job where you paid Social Security taxes. Or you may be able to get benefits based on the earnings of one of your parents or your spouse. For SSI payments based on disability and blindness, you need not have worked, but your income and resources must be under certain dollar limits.
If I receive disability benefits, can members of my family receive benefits, too?
Perhaps. Benefits may also be paid to your spouse, your divorced spouse, your children, and/or your disabled child if they qualify. Each family member may be eligible for a monthly benefit of up to 50 percent of your disability rate. However, there is a limit to the total amount of money that can be paid to a family on your Social Security record. The limit varies, but it is usually between 150 and 180 percent of your benefit.
I worked for the federal government some years ago. Was I covered by Social Security and will my earnings help qualify me for their disability benefits?
It depends when you worked. Up until 1984, employment by the federal government was covered under the Civil Service Retirement System (CSRS) and not by Social Security. If you worked for a federal agency during those years, you did not pay Social Security tax on your earnings and those earnings are not shown on your record. In 1984, a second retirement system—the Federal Employees Retirement System (FERS)—was introduced. People who began working for the federal government after 1983 are covered by FERS instead of CSRS. Also, some workers who had been covered by the CSRS program chose to switch to the FERS program when it became available. Work under FERS is covered by Social Security. If you stayed under the CSRS program after 1983, you still are not covered by Social Security, but you are covered under the Medicare program and you pay Medicare taxes on your federal earnings.
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