An individual is eligible for SSDI benefits only if he or she has paid a certain amount of Social Security tax over a period of time; enough to have disability insurance coverage in force. In general, a person must have worked and paid Social Security tax for about five out of the last ten years before the disability began. There is a different, easier rule for people whose disability started before age 30. Everyone must prove that he or she became disabled while disability insurance coverage was in force or they are not entitled to benefits, no matter how serious the medical condition is now.
SSI can be awarded whether or not a person has paid enough Social Security tax to get disability insurance benefits. You must be disabled under the same rules as for SSDI, or be blind, or be over 65. The individual must also have very little income or property, because this benefit is based on financial need. Social Security looks at all other income and property owned by a husband and wife, not just the applicant’s, and also the value of any support provided by others, to determine whether someone is financially eligible for SSI. People who receive SSI alone are not eligible for Medicare but they usually qualify for Medicaid.
There are several kinds of disability benefits for which a person can be eligible, and depending on the facts, an individual may be entitled to one or more categories of benefits. The medical requirements are the same for all categories in that an individual must be just as disabled to qualify for one as for the other, however the non-medical requirements are different for each category.
The best way to file a Social Security Disability claim is to go to the nearest Social Security office and wait to see someone to file your claim in person. If this is not possible, an individual may contact Social Security by telephone and arrange for a telephone interview to file their claim or simply apply online at http://www.ssa.gov/.
You should apply for disability benefits as soon as possible after becoming disabled. There is no need to wait and the Social Security Disability Process is lengthy.
To receive benefits under the Social Security Disability program, you must be found disabled. The law defines disability as “the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”
When evaluating your claim, Social Security takes into account the severity of your condition(s), your age, your education, your past work experience, any transferable skills you may have, and whether you are able to do any other substantial gainful activity.
To be successful in obtaining benefits, you must have a severe impairment that is supported by medically acceptable clinical and laboratory findings.
The claimant will need medical documentation and information regarding their past work. The claimant will also need information on all previous and current doctors' visits and hospitalizations, dates and places of lab reports, x-rays, and other clinical diagnostics that provide evidence of impairments, and a list of current medications and dosages.
The Social Security Administration will also need to know the name and location of previous employers for the last 15 years, the job description of the positions held at those jobs, and how long the claimant worked at each job. W-2 Forms will need to be submitted as well.
Additional documentation may include, but is not limited to:
Applying for Social Security Disability benefits is not a do-it-yourself process. The process is time-consuming and extremely complex. A minor mistake in the paperwork can cause your claim to be denied. The attorneys and representatives at Peterson & Associates, P.C. understand how to prepare a Social Security Disability claim and are here to assist you.
Make sure the information you provide is complete and accurate. A common mistake is failing to inform Social Security of psychiatric problems. This may stem from embarrassment but can also keep you from getting the coverage you need. Similarly, many people (if not most) who struggled academically do not tell Social Security about their learning disabilities, even though this can have a significant bearing on the success of their claim. The next - and most important - step is finding a lawyer to appeal your claim. Sometimes, you must appeal the claim multiple times. With the help of an experienced lawyer, your chances of submitting a successful claim are greater, statistics show. Without an attorney, your claim is more like to be unsuccessful.
Denials of claims at the initial and reconsideration stage are common and the Social Security appeals process can be lengthy, complicated and overwhelming. Having a qualified attorney or representative who specializes in Social Security Disability law can be extremely beneficial and will greatly increase the chances of a favorable decision for your claim. An experienced attorney or representative can help to collect and organize medical records and other documentation, file reconsideration and appeal requests in a correct and timely manner, and prepare both the claimant and witness before Administrative Law Judge hearings. According to the Social Security Administration’s statistics, individuals who are represented at their Administrative Law Judge hearings are more than four times more likely to win their case.
At Peterson & Associates, P.C., we work on a percentage basis for all Social Security Disability cases. All fees in Social Security Disability Insurance and Supplemental Security Income disability cases are set by Congress and must be approved by the Social Security Administration as part of the process when a case is won. Fees are 25% of any back benefit you receive. As of June 2009, the fee cap, or maximum is $6,000. That means that our attorneys and representatives will not get paid until you receive your disability benefits.
In addition to the attorney’s or representative’s fees, if we win your case, we will bill you for costs of medical records and office expenses we have incurred while preparing your case.
For Social Security Disability Insurance benefits, it all depends on how much you have worked and earned in the past. For all types of Supplemental Security Income benefits, there is a base amount that an individual with no other income receives. Other income that an individual has reduces the amount of Supplemental Security Income which an individual can receive.
For Social Security Disability Insurance benefits, the benefits cannot begin until five months have passed after the person becomes disabled. In addition, benefits cannot be paid more than one year prior to the date of the claim. Supplemental Security Income benefits cannot be paid prior to the start of the month following the date of the claim.
In most states, if you want to appeal a denial of Social Security Disability benefits, you have to go through reconsideration; there is no way to avoid it. In a few states, the Social Security Administration has abolished reconsideration and you can file an immediate request for a hearing before an Administrative Law Judge. The denial notice from Social Security will tell you what the next step is that you need to take. Nonetheless, you should strongly consider obtaining an attorney or representative to represent you.
Yes. You can appeal your denied claim to the Appeals Council. The council is still part of Social Security.
No, you do not have to wait until the sick leave is exhausted. You should file for Social Security Disability benefits now if you believe that you will be out of work for a year or more.
Yes. An individual can file a claim for Social Security Disability benefits while receiving worker’s compensation benefits. There is an offset however that reduces the amount of Social Security Disability benefits because of worker’s compensation benefits being paid. Yet, in virtually all cases there are still some Social Security Disability benefits to be paid. In a few states, the offset works the other way in that worker’s compensation benefits are reduced because of Social Security Disability benefits being paid.
If you expect to be out of work for a year or more on account of illness or injury, you should file for Social Security Disability benefits.
Not anymore. Congress has now prohibited Social Security from paying disability benefits on the basis of alcoholism or drug addiction. However, alcoholics and drug addicts have heart attacks, get cancer or get sick in other ways just like everyone else. Alcoholics and drug addicts who become disabled apart from their alcoholism or drug addictions can become eligible for Social Security Disability benefits.
Social Security is not supposed to cut off disability benefits for an individual unless his or her medical condition has improved. When Social Security reviews a case of an individual already on Social Security Disability benefits, they continue benefits in the vast majority of cases. In recent years, Social Security has been doing few reviews to determine whether or not individuals already on Social Security should continue to be. The vast majority of individuals who are reviewed will see their Social Security Disability benefits continued.
Social Security determines whether or not you are “disabled.” In other words, your doctor does not decide if you are legally disabled and should receive Social Security Disability. Regardless of what your doctor thinks, Social Security will make its own determination of your claim and eligibility.
According to Social Security, the Veterans Administration doesn’t make binding decisions about your disability and eligibility. Additionally, the Veterans Administration and Social Security have entirely different approval standards.
Receiving help with medical bills is usually tied up with receiving cash benefits; that is, you do not start receiving help with medical bills until after you start receiving the cash benefits. In order to receive help with medical bills, you have to keep pursuing the Social Security Disability claim.
The Social Security Administration does not provide a means for individuals to receive medical treatment. Because individuals need medical care and treatment as part of the disability application process, this is a difficult situation for many individuals to end up having to contend with.
First, each state has medical programs for its residents. Contacting your local state Medicaid or local health agency will connect you with available resources that can offer help in your particular situation.
Second, there are many clinics that offer services for low-income individuals and their families.
Third, there are individual doctors, physician groups and other health services that offer package and customized options just for patients who are applying for Social Security Disability. While these services are paid out of pocket, many offer discounts and even free services based on the type of program they offer.
Finally, most counties have community health centers, hospitals, and clinics that are funded by the state, and they offer medical services free of charge to patients without insurance or income to support their treatment on their own. Simply going to the hospital or clinic will reveal what options are available, and the range of services will also vary from community to community.
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