How Does Social Security Define Disability?
In order to qualify for Social Security disability benefits through either the SSI or SSDI program, the individual applying for benefits must have a qualifying disability. The Social Security Administration uses a step-by-step process to determine whether someone is disabled under their definition.
This process looks at questions such as these:
- Are you able to work? If you are currently performing work, then your condition is not disabling to the point where you can qualify for SSDI/SSI benefits. If you are not currently working, then the process will continue to step two.
- Do you have a condition that’s severe? In order to meet the definition of a “severe” condition, your condition must prevent you from doing any basic work, like walking, standing, or remembering, for at least 12 months or result in death. If your condition isn’t severe – meaning that it doesn’t interfere with basic work activities – then you are not considered disabled in the eyes of the SSA.
- Has the SSA included your condition in its list of disabling conditions? The SSA maintains a list of disabling conditions in its blue book of adult listings of impairments. The conditions that are included in the listing are considered so severe by the SSA that a person who is suffering from one of the listed conditions is automatically considered disabled. If you have a condition that is not listed, this does not mean that you cannot qualify for benefits. Instead, your case will proceed to step four.
- Can you perform the work that you did prior to your disability? If you can perform the same type of work that you did before suffering a disability, then you will not be considered disabled. If you cannot, then your case will proceed to step five.
- Can you perform other work? Finally, in order to be considered disabled in the eyes of the SSA, a person’s condition must be so severe that they are prevented from doing any other type of work.
The criteria for those who are blind or have low vision are slightly different. If you are filing for disability benefits based on blindness or low vision, be sure to consult with an attorney.
What Is the Difference Between SSDI & SSI?
The SSA maintains two separate and distinct types of disability programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). It is very important that you understand the differences between these two programs and which one is most appropriate for your situation.
Here’s an overview of the basics of each:
Social Security Disability Insurance – SSDI
SSDI benefits are for people who are not only disabled, but who are also insured by virtue of paying into the Social Security insurance system during their working years. A person who has not worked in the past or who has not earned enough work credits may not qualify for SSDI benefits. However, dependents can be eligible for benefits based on earnings from another’s record.
The number of work credits that a person needs to qualify for SSDI changes every year. However, in general, a person will need about 40 credits – four per year for the 10 years immediately preceding their disability.
If a person is approved for SSDI benefits, their monthly benefit amount will be based on their lifetime earnings. The more money a person made over the course of their working years, the greater their benefit amount will be. Benefits are paid beginning from the sixth full month from the date that the disability began. In addition, Medicare benefits will also start automatically after a person has been receiving disability benefits for two years.
Supplemental Security Income – SSI
Unlike SSDI benefits, a person who is applying for SSI benefits need not have earned work credits. In fact, they need not have worked at all. Even children can receive SSI benefits.
Instead of being for workers who have earned disability benefits by paying into insurance, so to speak, SSI benefits are for disabled, blind, and aged individuals who are of limited income and resources. Work history is not a factor for SSI.
Types of income that count for SSI purposes including paycheck/employment income, unearned income, such as benefits and pensions, food or shelter that is received for free, and the income of a spouse or parent with whom you live. If your countable income is over the income limit, you cannot receive SSI benefits.
When Should I Apply for Disability Benefits?
A person who suffers an accident or illness that renders them disabled is often tasked with dealing with insurance companies and medical bills, making accommodations at home, figuring out how they will provide for themselves, and generally adjusting to the changes brought about by the disability.
Applying for disability benefits may be the furthest thing from your mind. However, you should apply for disability benefits as soon as you become disabled, but not before you have proof of your disability. If you submit an application to the SSA that is incomplete or inaccurate, your claim will likely be delayed, if not denied altogether.
The earlier that you apply for SSDI or SSDI benefits, the better. It can take up to five months or longer for your claim to be approved, and very many initial applications are denied at first.
Steps for Applying for Disability Benefits
If you are thinking about applying for Social Security disability benefits, it’s important that you know what steps you need to take and how the process is organized. Consider these following steps, and reach out to our lawyers directly if you have more questions.
1. Gather necessary documents. There are a number of documents that you will need to submit to the SSA when you apply for disability benefits. Gathering all of these documents early on and ensuring that you are well-organized is important.
Documents you need include:
a. Proof of your age
b. Your Social Security number
c. Your most recent W-2 form (or other tax document that is used to report income)
d. Information about the last job you had prior to the injury and the type of work you performed at that job
e. All medical records, including your diagnosis, names of medications you’re taking, lab and test results, the name of your doctor, and any other medical evidence you have
2. Family member information. If you have qualifying family members, you’ll also need to collect their information, including each qualifying member’s Social Security number, proof of age, and proof of relation (marriage or dependent).
3. Fill out your application. You can apply for benefits online. The application is complex and may feel overwhelming. To guide you through the process, working with an experienced disability lawyer is strongly recommended.
After you submit your application online, the SSA will contact you to let you know that your application was received. Then the SSA will begin a review of your application, and contact you if it needs more information. The application will then be processed, and you will be informed via mail regarding whether your application has been accepted or denied. If denied, a reason for the denial will be stated.
How Long Does It Take to Receive Disability Benefits?
How long your claim will take to process depends on a number of factors, including whether your original application contains all of the information that the SSA needs to review your claim and make a decision. If it does not, then your claim processing will be delayed. If everything goes smoothly from the start, you could receive an answer from the SSA in as few as three months.
Of course, things don’t always happen this quickly. If your claim is complex or has missing information, things could take longer. If your claim is denied, you maintain the right to appeal the decision; however, this could mean that your claim will take at least another one to two months to process. If a secondary appeal is necessary, the process will be delayed by another one to two months, and so on.
The best thing that you can do to speed up your claim is to work with a skilled Social Security disability lawyer in Massachusetts who is well-versed in what the SSA is looking for and how to build a claim that is likely to get approved – and quickly.
What Should I Do If My SSD Application Was Denied?
It can be frustrating to hear back from the SSA after months of waiting for a claim decision only to learn that your claim for benefits has been denied. As aggravating as this may be, you do have the right to appeal the decision. However, you must do so within a specific amount of time and must follow the proper steps.
After receiving notice from the SSA that your claim has been denied, you generally have 60 days) from that date to file an appeal.
The first level of appeal is called “reconsideration.” You can request reconsideration online within the 60-day window. This is essentially a review of your claim by the SSA. The official who reviews your claim will be someone who did not take part in the original decision. In addition to having any old evidence reviewed, you can also submit new evidence at this point, too.
If reconsideration results in an upheld denial, the next step is to request a hearing by an Administrative Law Judge (ALJ). Like reconsideration, the ALJ assigned to your case will not have participated in making any previous decisions about your case. During the hearing, you can present new evidence, and will be given a chance to explain to the ALJ why you believe you should receive benefits.
If your hearing in front of an ALJ is also unsuccessful, your next step is to request review by the Appeals Council. While you have the right to request a review, the council can deny the request if a preliminary investigation determines that the ALJ made a decision about your case that was in accordance with SSA rules. If the council does decide to hear your case and your claim remains denied, your final opportunity for appeal is to file a request for a federal court review.
What Our Massachusetts Disability Lawyers Can Do for You
When you call our Massachusetts disability lawyers at Brooks Law, we will work hard for you to seek the full disability benefits that you deserve. We have years of experience, understand what the SSA looks at to approve or deny claims, and have the resources to dedicate to your claim.
Please contact us today for a free consultation and more information to get started. We are ready to serve you.