Frequently Asked Questions about Social Security Benefits for Adults
What are Social Security Disability (SSD) benefits?
Social Security disability benefits (also called Social Security Disability Insurance) are a part of the Federal Social Security Act. It includes several programs that provide disability payments and other benefits to disabled workers and their families. Benefits are often referred to as Social Security disability benefits, or SSD benefits. SSD benefits may consist of cash payments and medical coverage. Benefits depend on your financial situation and whether you qualify under the appropriate Social Security Administration regulations.
What is Supplemental Security Income (SSI)?
People who have never worked, or who have not paid into the Social Security system for the past five years, may qualify for Supplementary Security Income (SSI) benefits. Disabled children also may qualify for SSI benefits. SSI benefits may consist of cash payments and medical coverage. Benefits depend on your financial situation and whether you qualify under the appropriate Social Security Administration regulations.
Who can apply for these benefits? Am I eligible for SSD or SSI benefits?
You can apply for benefits if you are disabled and cannot work full-time; if your disability or medical condition has lasted, or is expected to last, for at least one year; and if you have a life-threatening disability or medical condition. However, certain qualifications exist for each type of Social Security benefit program. You must check to see if you qualify.
You can help your chances of being approved for SSD benefits by having an official diagnosis by a physician or specialist. You should be undergoing treatment and see your specialist regularly. Symptoms alone are not enough.
What physical disabilities qualify for SSD or SSI benefits?
There are many types of physical disabilities that are accepted by the Social Security Administration, but you must check to see if you qualify under the appropriate Social Security Administration regulations.
What mental disabilities qualify for SSD or SSI benefits?
There are many types of mental disabilities that may make you eligible for SSD or SSI benefits, but you must check with the Social Security Administration to see if you qualify.
How does the Social Security Administration determine whether I am disabled?
Disability, as determined by the Social Security Administration (SSA), is based on your inability to work. The SSA considers you to be disabled under Social Security rules if you cannot do work that you did before and if the SSA determines that you cannot adjust to other work because of your medical condition(s). Your disability must also last, or be expected to last, for at least one year or be expected to result in death.
The SSA reviews medical reports and records provided by your treating physician(s) and/or other medical providers. Other areas of evaluation include:
- Your own average monthly earnings (you can work part-time and still qualify for SSD or SSI benefits, but your individual gross monthly income cannot exceed $1,070)
- The severity of your condition (your impairments must interfere with basic work-related activities for your claim to be considered)
- Your vocational background
- Your age
- Your education
- If you're receiving other types of benefits, such as unemployment or workers' compensation
The Social Security Administration evaluates this information and applies it to their criteria in order to determine whether you are considered to be disabled.
What is the definition of a disability?
The definition of disability under Social Security is different than other programs. Social Security pays only for total disability. No benefits are payable for partial disability or for short-term disability.
"Disability" under Social Security is based on your inability to work. We consider you disabled under Social Security rules if:
- You cannot do work that you did before;
- We decide that 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 to result in death.
This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers' compensation, insurance, savings and investments.
Where can I find the list of disability impairments used for the determination of benefits?
http://www.ssa.gov/disability/professionals/bluebook/listing-impairments.htm
How long can I receive SSD benefits? Can my benefits be terminated?
If you are approved for Social Security disability benefits, they are seen as a permanent life-long benefit. However, there are a few circumstances where your benefits could be terminated. These circumstances may include:
- Engaging in "Substantial Gainful Activity" (the Social Security Administration uses this term to determine if any activity - including working or attending school full-time - is substantial enough to make a person ineligible for benefits); examples of activities that may disqualify you for benefits include going back to work full-time, going back to work part-time and earning over $1,040 gross per month, and attending college or business/trade school full-time
- If the Social Security Administration reviews your case and feels your condition has improved, they may terminate your benefits. Periodically (perhaps every 5 years), the Social Security Administration will review cases. When your case is reviewed, they check to make sure that you still have disabling impairments; are still in treatment; and are compliant with treatment and medication.
- Becoming incarcerated or institutionalized against your will for over 30 days -- during this time, you are ineligible for benefits
If your benefits are terminated, you have the right to file an appeal within 60 days. You have 10 days in which to appeal in order to continue receiving your checks while the appeal is pending. If you are unsuccessful with your appeal but received checks while the case was pending, you will be required to pay back the money you received while the case was pending.
Can I receive benefits from both workers' compensation and SSD or SSI?
Generally, you can receive benefits from both workers' compensation and SSD. However, if you are receiving workers' compensation, the payments you receive for SSD benefits will be reduced, so that the combined amount of the SSD benefits you receive do not exceed 80 percent of your average current earnings. If your workers' compensation payment stops, your SSD benefits will usually increase. If you are receiving workers' compensation, you probably won't be eligible to receive SSI benefits. However, the only way to find out if you qualify is to contact the Social Security Administration.
Can I receive benefits from both unemployment compensation and SSD or SSI?
If you receive unemployment compensation while your claim for SSD or SSI benefits is pending, and your claim is approved, your retroactive SSD or SSI benefits will be reduced for the period of time you were collecting unemployment compensation. Typically, unemployment means that you're capable of working – you just can't find a job. In order to be successful in your claim to receive SSD or SSI benefits, you must have a disability or condition that prevents you from working at all and that you are not currently seeking employment. There may be exceptions, and you should contact the Social Security Administration to learn if you're eligible to apply for SSD or SSI benefits.
Can I receive benefits from Long-Term Disability Insurance and SSD?
If you are receiving Long-Term Disability payments from your employer and you are approved for SSD benefits, your Long-Term Disability payments may be reduced. As insurance policies tend to vary, you should contact your Long-Term Disability insurance carrier for more information about your policy.
Can I receive benefits from both private insurance, like a pension plan, and SSD?
Yes, you can receive payments from both private insurance and SSD benefits. Your eligibility is not affected by any private insurance you may have, including company pension or 401K plans.
Can I receive benefits from assistance programs and SSD at the same time?
Yes, but only while your claim for SSD benefits is pending. You can receive benefits from an assistance program while your claim is pending, but if you are approved for SSD benefits, your benefits from the assistance program will stop. You should contact the Social Security Administration for more information.
Can I receive benefits from a Public Disability plan and SSD?
Public disability payments that may affect your SSD benefits are those paid under a federal, state, or local government law or plan that pays for conditions not job-related. For example, civil service disability benefits, state temporary benefits, and state or local government retirement benefits may affect your SSD benefits. Your Social Security disability benefits would be reduced so that the combined amount of the SSD benefits, plus the public disability payment received, do not exceed 80 percent of your average current earnings.
Can I continue to receive SSD or SSI when I start collecting Social Security retirement benefits?
If you were receiving SSD benefits and you now qualify for Social Security retirement benefits, your benefits should be switched over to the retirement benefits. In some instances, you can receive an SSI check in addition to your retirement check. To find out if you're eligible, you should contact the Social Security Administration.
How do I apply for Social Security disability benefits?
To apply for SSD or SSI benefits, you can contact the Social Security Administration at 1-800-772-1213, or visit the SSA website at www.ssa.gov to file online.
You also can make an appointment at your local Social Security District Office.
What documentation do I need to apply for benefits?
You can help by being ready to:
- Provide any needed documents; and
- Answer the questions listed below.
Documents you may need to provide
We may ask you to provide documents to show that you are eligible, such as:
- Birth certificate or other proof of birth;
- Proof of U.S. citizenship or lawful alien status if you were not born in the United States;
- U.S. military discharge paper(s) if you had military service before 1968;
- W-2 forms(s) and/or self-employment tax returns for last year;
- An Adult Disability Report that collects more details about your illnesses, injuries or conditions, and your work history. You can complete this report online;
- Medical evidence already in your possession. This includes medical records, doctors' reports, and recent test results; and
- Award letters, pay stubs, settlement agreements or other proof of any temporary or permanent workers' compensation-type benefits you received
What questions will they ask me?
- Your name, gender and Social Security number;
- Your name at birth (if different);
- Your date of birth and place of birth (State or foreign country);
- Whether a public or religious record was made of your birth before age 5;
- Your citizenship status;
- Whether you or anyone else has ever filed for Social Security benefits, Medicare or Supplemental Security Income on your behalf (if so, we will also ask for information on whose Social Security record you applied);
- Whether you have used any other Social Security number;
- Whether you were ever in the active military service before 1968 and, if so, the dates of service and whether you have ever been eligible to receive a monthly benefit from a military or Federal civilian agency;
- Whether you or your spouse have ever worked for the railroad industry;
- Whether you have earned Social Security credits under another country's Social Security system;
- Whether you qualified for or expect to receive a pension or annuity based on your own employment with the Federal government of the United States or one of its States or local subdivisions;
- Whether you are currently married and, if so, your spouse's name, date of birth (or age) and Social Security number (if known);
- The names, dates of birth (or age) and Social Security numbers (if known) of any former spouses;
- The dates and places of each of your marriages and, for marriages that have ended, how and when they ended;
- The names of any unmarried children under 18, 18-19 and in secondary school or disabled before age 22;
- Whether you have or had a child under age 3 living with you during a calendar year when you had no earnings;
- Whether you have a parent who was dependent on the worker for 1/2 of his or her support at the time you became disabled;
- Whether you had earnings in all years since 1978;
- The name(s) of your employer(s) or information about your self-employment and the amount of your earnings for this year and last year;
- Whether you received or expect to receive any money from an employer since the date you became unable to work;
- Whether you have any unsatisfied felony warrants for your arrest or unsatisfied Federal or State warrants for your arrest for any violations of the conditions of your parole or probation;
- The date you became unable to work because of illnesses, injuries or conditions and if you are still unable to work; and
- Information about any workers' compensation, black lung, and/or similar benefits you filed, or intend to file for. These benefits can:
- Be temporary or permanent in nature;
- Include annuities and lump sum payments that you received in the past; and
- Be paid by your employer or your employer's insurance carrier, private agencies, or Federal, State or other government or public agencies.
- Some examples include:
- Workers' Compensation
- Black Lung Benefits
- Longshore and Harbor Workers' Compensation
- Civil Service Retirement
- Federal Employees' Retirement
- Federal Employees' Compensation
- State Disability Insurance benefits
- Military retirement pensions based on disability
Note: You also should bring along your checkbook or other papers that show your account number at a bank, credit union or other financial institution so you can sign up for Direct Deposit, and avoid worries about lost or stolen checks and mail delays.
Where can I find a local Social Security Administration office in Pennsylvania?
Social Security Offices in Pennsylvania
You can now find your local Social Security Office by calling the Social Security Administration toll free number, 1-800-772-1213, or by searching on-line at the Social Security Office Locator. Just enter your zip code to find the address, phone number, directions to the office and even a street map to help you find the office.
What can I do if my claim was denied?
If your claim was denied and you believe you qualify for SSD benefits, don't worry. You can file an appeal. There are several levels of determination for Social Security Disability benefits. You have 60 days to appeal a denial to reach the next level of determination. If you fail to appeal a denial, you may reapply for Social Security disability or Supplemental Security Income. Please keep in mind that 'appealing' and 'reapplying' are not the same thing. Reapplying will mean that you have to start the process over again.
What's the process for filing an appeal?
If your initial application was denied, and you believe you qualify, you have 60 days to file an appeal to reach the next level of determination. First, you can hire a lawyer and have him or her schedule a hearing. Your lawyer should meet with you before the hearing to discuss what will happen and go over questions that are normally asked at the hearing. The hearing will be conducted by an Administrative Law Judge and will follow a five-step evaluation. The judge will not issue a decision on the day of the hearing; a "Notice of Decision" will be issued to you and your attorney at the same time, which can take anywhere from two to six months.
Second, you can move on to an Appeals Council. The average processing time for the Appeals Council is 18 to 24 months. The council can review your claim and render a decision, choose not to review the claim, or remand your claim back to the Administrative Law Judge for reconsideration.
Finally, you can appeal to the Federal Court if all else fails. You can file a civil suit in a Federal District Court and appeal ultimately to the United States Supreme Court.
How long do I have to file an appeal?
Time is critical if your claim was denied. You only have 60 days to appeal. Otherwise you have to start the process all over again.
If your benefits were terminated, you have the right to file an appeal within 60 days. But, you only have 10 days to appeal in order to continue receiving your checks while the appeal is pending. If you appeal but are unsuccessful, and you continued receiving checks while the case was pending, you will have to pay back the money you received while the case was pending.
Do I need a lawyer to represent me in my SSD claim?
You do not have to hire a lawyer to pursue a Social Security Disability or Supplemental Security Income claim. However, because of the various deadlines and other technical requirements for the application and appeals process, a lawyer can be very helpful.
When or why might I need to hire an attorney?
If your claim was denied or your benefits were terminated, you may want to hire an attorney. Hiring an attorney is not required to file an appeal, but doing so could mean the difference between winning your appeal or not. Our attorneys at Edgar Snyder & Associates can help with your SSD benefits appeal by:
- Gathering medical records and reports
- Gathering evidence particular to your claim
- Gathering documents from your Social Security file
- Determining the best course of action for your claim based on Social Security regulations
- Talking with your physician about your condition(s)
- Suggesting a "second opinion" on your condition by having the Social Security Administration send you to a doctor
- Reviewing prior actions taken by the Social Security Administration
- Providing helpful advice to you on how to prepare for your Social Security hearing.
- Providing legal counsel at the hearing to ensure a fair and proper procedure
- Reviewing, objecting to, or making changes to the written questions being sent to a doctor by the Administrative Law Judge
- Making sure the Social Security Administration gives you your correct benefit payment, if your claim is approved
- Requesting a review of the hearing decision by the Social Security Administration Appeals Council
- Requesting a review of the Social Security Administration Appeals Council decision by the Federal District Court
Resources and Acknowledgments:
Office of Social Security http://www.ssa.gov/disability/
Checklist for Social Security Benefits Interview for children: http://www.ssa.gov/disability/Documents/Checklist%20-%20Child.pdf
Medical and school worksheet – Child The worksheet can help you to prepare for the disability interview or complete the Child Disability Report on the Internet