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Social Security Disability & SSI Claims

Social Security Disability (also known as SSDI or Social Security Disability Insurance) and SSI (Supplemental Security Income) are two separate disability programs that operate under the control of the Social Security Administration. Social Security Disability provides benefits to disabled individuals and, in some cases, their disabled adult children, on the basis of insured coverage that has been earned via work credits. SSI, on the other hand, provides benefits to disabled minor children as well as individuals who were previously insured for SSDI, but whose coverage for Social Security Disability Insurance has lapsed.

Additional differences between SSDI and SSI include the fact that eligibility for SSI is means-tested (you cannot have assets exceeding $2000 and a spouse’s income will also be used — the exact term is “deemed” — to determine basic eligibility). Additionally, SSI carries Medicaid benefits while Social Security Disability recipients are eligible for Medicare two years after their date of entitlement has been established.

However, aside from these differences, Social Security Disability and SSI are essentially the same. And, in fact, when it comes to the medical evaluation of a disability case, there is absolutely no difference between the programs. That is, claims for the Social Security Disability and SSI are processed in exactly the same way. Individuals, of course, who are disabled, should immediately contact the local social security office for the purpose of initiating a claim for disability benefits.

The disability can be the result of an injury from an automobile accident, motorcycle accident, truck accident, bus accident, pedestrian accident, slip & fall accident or any accident causing disabling injury. The disability may also be as the result of an illness or both an injury and illness. The injury or illness may be of physical or psychological nature.

Social Security Disability Process

  1. Applicant must be out of work more than six months to qualify for benefits.
  2. Social Security Office will obtain medical records of your surgery or illness.
  3. Social Security Office may often request a medical examination by a physician other than the patient’s treating physician.
  4. An administrative panel employed by the Social Security Agency will make an initial determination.
  5. The applicant is informed of the decision and then has 60 days to request reconsideration
  6. An appeal may be taken.
  7. The application will be transferred to a different administrative panel using the same criteria of eligibility.
  8. If the appeal process continues, it proceeds to the next level: the Administrative Law Judge. The applicant may be represented by counsel and may also present additional evidence concerning disabilities.
  9. If the applicant’s appeal is rejected at the Administrative-Law-Judge-level, the process can continue through appeals to the Social Security Appeals Council and, ultimately, to the Federal District Court system.
  10. NOTE: Pain plays only a minor role in the Social Security disability process. Under the Social Security system pain is not a sufficient condition to award disability benefits. There must be objective and documented evidence to support disability payments. In the government handbook, DISABILITY EVALUATION UNDER SOCIAL SECURITY, the following criteria set forth permanent disability resulting from pain:
    1. Pain must persist for at least six months, despite prescribed therapy; and, additionally, the pain must be expected to last twelve months.
    2. Pain, muscle spasm and significant limitation of motion of the spine must be present
    3. There must be evidence of radicular distribution or significant motor loss coupled with muscle weakness and sensory and reflex loss.

Qualification for Benefits

  1. The applicant must be able to meet the handbook’s definition of disability and impairment:
    1. Disability: “Inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment or impairments which can be expected to result in death which have lasted, or can be expected to last, for a continuous period of not less than twelve months.”
    2. Impairment: “A physical or mental impairment that results from anatomical, physiological or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques.”
     
  2. According to the Social Security Administration (SSA), a person qualifies for SSDI if they:
    1. Have a physical or mental condition that prevents them from engaging in any “substantial gainful activity” (“SGA”), and
    2. The condition is expected to last at least 12 months or result in death, and
    3. They are under the age of 65, and
    4. Generally, have worked 5 out of the last 10 years as of the determined date of onset of disability
    5.  
  3. The work requirement is waived for applicants who can prove that they became disabled at or before the age of 22, as these individuals may be allowed to collect on their parent’s or parents’ work credits. The parent(s) experience no loss of benefits.
  4.  
  5. There must be medical evidence that demonstrates the applicant’s inability to work. If their condition does not meet requirements of a listing, their residual functional capacity is considered, along with their age, past relevant work, and education, in determining their ability to perform either their past work, or other work generally available in the national economy.
  6.  
  7. Determination of a residual functional capacity often constitutes the bulk of the SSDI application and appeal process. A residual functional capacity is assessed in accordance with Title 20 of the Code of Federal Regulations, part 404, section 1545 by a disability determination service (DDS) or, an appeal, by an administrative law judge (ALJ), and is generally based upon the opinions of treating and examining physicians, if available. The DDS or ALJ may also require the applicant to visit a third-party physician for a medical opinion.
  8.  
  9. Residual functional capacity is classified according to the five exertional levels of work defined in the Dictionary of Occupational Titles, which are: Sedentary, Light, Medium, Heavy, and Very Heavy. A person is generally not considered disabled if they are found to retain the capacity for work at or above the sedentary level, but persons over 49 or who cannot read or speak English may be found disabled at the light or medium exertional level.

Time for Applications

The amount of time it takes for an application to be approved or denied varies, depending on the level of the process at which the award is made. In 2006, there were 2,532,264 applications for SSDI. As of March 31, 2007, the number of pending applications (or “backlog”) was 1,463,153. Experts have asserted that this backlog is being caused by the increase in applicants, the increase in retiring SSA workers, the inability of the SSA to replace the retiring workers and budget limitations.

The Social Security Administration estimates that the initial benefits application will take 90-120 days, but in practice filings can take up to eight months to complete. The appeals process for denied filings can likewise take 90 days to well over a year to get a hearing, depending on caseloads.

Where and How to Apply

Most Social Security offices do claims-related business by appointment. You can apply (“file”) for benefits in person or by mail or by phone.

You can apply for Social Security Disability online by filling out the Social Security Benefit Application.

There is also an Adult Disability and Work History report you can fill out online.

If you prefer not to apply over the Internet you can apply over the phone by calling the toll-free number, 1-800-772-1213, Monday through Friday 7 a.m. to 7 p.m. EST.

You can also apply in person at your local Social Security Administration office.

If you have questions concerning a Social Security Disability Claim, contact Moore·Faust Injury Law Group for a free confidential consultation.


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