Understanding Social Security Disability (SSDI) and SSI (Supplemental Security Income) Claims

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are two distinct disability programs managed by the Social Security Administration. While both provide financial assistance to individuals with disabilities, they differ in eligibility criteria and coverage.

• SSDI offers benefits to disabled workers (and in some cases, their disabled adult children) who have earned enough work credits through their employment history.
• SSI, on the other hand, assists disabled individuals who have limited financial resources and may include benefits for disabled children, as well as adults who were once insured for SSDI but whose coverage has lapsed.

Key Differences Between SSDI and SSI:

1. Eligibility:
   
   
   • SSDI eligibility is based on work credits earned through employment, whereas SSI is means-tested, meaning your financial assets must be below $2,000 (for individuals) or $3,000 (for couples), and your spouse’s income is also considered.
2. Healthcare:
   
   
   • SSI recipients qualify for Medicaid, while SSDI recipients become eligible for Medicare two years after their disability entitlement date.
3. Medical Evaluation:
   
   
   • Both SSDI and SSI disability claims undergo the same medical evaluation process to determine eligibility.

Disability Coverage: A disability can result from various causes, including:

• Accidents (auto, motorcycle, truck, pedestrian, etc.)
• Illnesses or a combination of both
• Physical or psychological conditions

Social Security Disability Claims Process:

1. Initial Application:
   • To qualify for benefits, applicants must be unable to work for at least six months.
   • Social Security will gather medical records related to your illness or injury and may request an additional examination by an independent doctor.
2. Decision & Reconsideration:
   • A panel of Social Security officials will make an initial decision.
   • If denied, you can request reconsideration within 60 days.
3. Appeals Process:
   • If reconsideration is unsuccessful, your case will be transferred to another panel.
   • Further appeals may lead to a hearing with an Administrative Law Judge (ALJ), where you may present additional evidence or legal representation.
4. Further Appeals:
   • If the ALJ denies your claim, you can appeal to the Social Security Appeals Council and, if needed, to the Federal District Court.

Pain and Disability: Under Social Security guidelines, pain alone is not sufficient to qualify for disability benefits. There must be medical evidence supporting the disability, and pain must meet specific criteria:

• Lasting for six months or longer
• Expected to last at least 12 months
• Accompanied by severe limitations in physical function (e.g., significant muscle weakness or loss of motion)

Eligibility for SSDI Benefits:

To qualify for SSDI, you must:

1. Have a disability that prevents you from working and is expected to last at least 12 months or result in death.
2. Be under 65 years of age.
3. Have worked 5 out of the last 10 years before the onset of your disability (unless you became disabled before age 22, in which case you may qualify using a parent’s work credits).

Medical documentation proving your inability to work is essential. If your condition doesn’t match the Social Security’s listed disabilities, the agency will assess your residual functional capacity (RFC), which measures your ability to perform work tasks despite your impairment.

Residency and Exertional Capacity: Your RFC will be evaluated based on your ability to perform work at various levels: sedentary, light, medium, heavy, or very heavy. If you can still perform work at the sedentary level or higher, your claim may be denied, though individuals over 49 or those with limited education may still qualify.

Timeframe for SSDI Applications: The approval or denial process can vary. While the Social Security Administration (SSA) estimates initial decisions take 90 to 120 days, applicants may face longer waiting times, especially during appeals. In 2007, there were over 1.4 million pending SSDI applications, contributing to delays.

How and Where to Apply: Applications for SSDI or SSI benefits can be filed online, by phone, or in person at your local Social Security office.

• Online: Visit the Social Security website to complete the application and Disability Report.
• Phone: Call 1-800-772-1213 (Monday-Friday, 7 a.m. to 7 p.m. EST).
• In-Person: Apply at your local Social Security office.

Contact Us for a Free Consultation

At Moore-Faust Injury Law Group, we offer a free consultation to help you navigate the SSDI and SSI claims process. Contact us today for expert assistance in securing the disability benefits you deserve.