Frequently Asked Questions
- When do I apply?
- How do I apply?
- What do I need?
- How does Social Security determine disability?
- How does Social Security define disability?
- What kinds of benefits are there?
- Is it hard to apply for Social Security disability benefits?
- When can I file for Social Security disability benefits?
- Is it necessary to hire a representative to represent me in my Social Security disability claim?
- How do representatives who help Social Security disability claimants get paid?
- Can I get Social Security disability benefits if I expect to get better and return to work?
- I got hurt on the job. I am drawing worker’s compensation benefits. Can I file a claim for Social Security disability benefits now or should I wait until the worker’s compensation ends?
- I have several health problems, but no one of them disables me. It is the combination that disables me. Can I get Social Security disability benefits?
- My doctor says I am disabled so why is Social Security denying my Social Security disability claim?
- If I am approved for Social Security disability benefits, how much will I get?
- VA says I am disabled, so why is Social Security denying my Social Security disability claim?
- If I am found disabled how far back will Social Security pay benefits?
- What is the difference between Medicare and Medicaid?
- If Social Security tries to cut off my disability benefits, what can I do?
You should apply for disability benefits as soon as you become disabled. It can take a long time to process an application for disability benefits (three to five months). If you apply for
- Social Security, disability benefits will not begin until the sixth full month of disability. The Social Security disability waiting period begins with the first full month after the date it is decided that your disability began.
- In Supplemental Security Income (SSI), SSI disability benefits are paid for the first full month after the date you filed your claim, or, if later, the date you become eligible for SSI.
To apply for disability benefits, you will need to complete an application for Social Security Benefits and the Disability Report. You can complete the Disability Report at www.socialsecurity.gov/disability/3368. You can also print the Disability Report, complete it and return it to your local Social Security office. Social Security may be able to process your application faster if you help them by getting any other information they need.
You can also apply by calling the toll-free number, 1-800-772-1213. Representatives there can make an appointment for your application to be taken over the telephone or at any convenient Social Security office.
People who are deaf or hard of hearing may call toll-free “TTY” number, 1-800-325-0778, between 7 a.m. and 7 p.m. on Monday through Friday.
The claims process for disability benefits is generally longer than for other types of Social Security benefits. It can take up to six months at each of the disability application and appeal levels. The wait for a hearing has grown as the backlog of cases grows – in many cities it is well over a year.
To complete the application, you should gather the following information:
- Your Social Security number;
- Your birth certificate or other evidence of your date of birth (if you do not have a birth certificate, you may request one from the State where you were born);
- Your military discharge papers, if you were in the military service;
- Your spouse’s birth certificate and Social Security number if he or she is applying for benefits;
- Your children’s birth certificates and Social Security numbers if they are applying for benefits;
- Your checking or savings account information, so your benefits can be directly deposited;
- Names, addresses, and phone numbers of doctors, hospitals, clinics, and institutions that treated you and dates of treatment;
- Names of all medications you are taking;
- Medical records from your doctors, therapists, hospitals, clinics, and caseworkers;
- Laboratory and test results;
- A summary of where you worked in the past 15 years and the kind of work you did;
- A copy of your W-2 Form (Wage and Tax Statement), or if you are self-employed, your federal tax return for the past year;
- Dates of prior marriages if your spouse is applying.
The documents presented as evidence must be either originals or copies certified by the issuing agency. SSA cannot accept uncertified or notarized photocopies as evidence since they cannot verify their authenticity. Do not delay filing for benefits just because you do not have all of the information you need. The Social Security office will be glad to help you.
If you are applying for Supplemental Security Income benefits you also need the following:
- information about the home where you live, such as your mortgage or your lease and landlord’s name;
- payroll slips;
- bank books;
- insurance policies;
- car registration;
- burial fund records;
- and other information about your income and the things you own.
They use a five-step process to decide if you are disabled. Here are the questions Social Security asks:
- Are you working?
If you are working and your earnings average more than a certain amount each month, you generally will not be considered disabled. The amount you can earn changes each year, for the current figure across all the programs, see: http://www.socialsecurity.gov/pubs/10003.pdf. If you are not working, or your monthly earnings average the current amount or less, the state agency then looks at your medical condition.
- Is your medical condition “severe”?
For the state agency to decide that you are disabled, your medical condition must significantly limit your ability to do basic work activities—such as walking, sitting and remembering—for at least one year. If your medical condition is not that severe, the state agency will not consider you disabled. If your condition is that severe, the state agency goes on to step three.
- Is your medical condition on the List of Impairments?
The state agency has a List of Impairments that describes medical conditions that are considered so severe that they automatically mean that you are disabled as defined by law. If your condition (or combination of medical conditions) is not on this list, the state agency looks to see if your condition is as severe as a condition that is on the list. If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide that you are disabled. If it does not, the state agency goes on to step four.
- Can you do the work you did before?
At this step, the state agency decides if your medical condition prevents you from being able to do the work you did before. If it does not, the state agency will decide that you are not disabled. If it does, the state agency goes on to step five.
- Can you do any other type of work?
If you cannot do the work you did in the past, the state agency looks to see if you would be able to do other work. It evaluates your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work. If you cannot do other work, the state agency will decide that you are disabled. If you can do other work, the state agency will decide that you are not disabled.
Social Security defines “disability” as the “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.”
There are several kinds of disability benefits for which a person can be eligible. Depending on the facts, you may be entitled to one of these benefits, or you may be entitled to more than one. The medical rules are the same for all categories, you must be just as disabled to qualify for one as for another. The non-medical requirements are different for each category.
Disability Insurance Benefits (DIB) –
You are only eligible for these benefits if you have paid a certain amount of Social Security tax over a period of time, enough to have disability insurance coverage in force. In general, you must have paid at least a certain amount of Social Security tax (the FICA deduction on your paycheck, or your Social Security tax if you’re self-employed) in at least twenty calendar quarters during the forty calendar quarters before your total disability began. In other words, you must have worked and paid Social Security tax for about five out of the last ten years before you became totally disabled.
There is a different, easier rule for people whose disability began before age 30. Everyone must prove the disability began while disability insurance coverage was in force or they are not entitled to benefits, no matter how serious the medical condition is now. If your DIB claim is approved, the monthly payment you will receive is set by your earnings (and Social Security tax payments) during your working career. There is no minimum rate, and the rate a person can receive at this time can be calculated here: http://ssa.gov/planners/calculators.htm There is a cost-of-living raise in the monthly payment at the start of most years. In many cases, your spouse and dependent children will also get benefits in addition to your own.
Supplemental Security Income (SSI) –
SSI can be paid whether or not a person has paid in enough Social Security tax to get disability insurance benefits. You must be disabled under the same rules as for disability insurance, or be blind, or be over 65. You 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 in the household you live in, not just your own, and also the value of any support (like free room and board) you may get from others, to determine whether you are financially eligible for SSI. Social Security does this in addition to deciding if you are disabled. Also, some children 18 or younger with a severe disability can get a monthly benefit if their family income is low enough.
Disability Widow/Widower Benefits (DWB) –
This is a special disability benefit for certain widows and widowers, based on the Social Security tax paid by his or her deceased spouse. In order to qualify, you must be between ages of 50 and 60, and have been married for at least 10 years to the person who was covered under Social Security at the time of his or her death. Also, you must have proof that your disability was severe enough to meet these rules within seven years of your spouse’s death, with some exceptions for those already receiving other kinds of Social Security benefits. If you are awarded DWB benefits, your monthly rate is determined by your spouse’s income and Social Security tax payments. However, a surviving spouse’s pension can usually be paid at the age of 60, regardless of any disability.
Disabled Adult Child Benefits (DAC) –
In order to be eligible, you must be a child of a person already receiving Disability Insurance Benefits or Retirement Benefits, or who died while covered for Social Security. You must be at least 19 years old, and you must prove your total disability began before the month you turned age 22, and is continuing. The monthly benefit rate is based on a percentage of your parent’s rate. Therefore, it is different in each particular case.
No. There are several ways to apply for a Social Security disability claim. The first is to go to the Social Security District Office and file the claim in person. Now applications can also be made online at www.ssa.gov. Another way is to call Social Security at 1-800-772-1213. They will make an appointment for a telephone interview for you. Once the interview is finished they will send necessary forms for you to fill out. All the basic information will have been collected during the phone interview.
You can file for Social Security disability benefits on the day that you become disabled if you believe that you will be out of work for one year or more. Sometimes hospital social workers can help you and your family make the initial contact with Social Security.
No. Any claimant can represent himself in all phases of the Social Security disability process. Claimants with representation win their cases more often than those who are not represented.
Cases are generally handled on a contingency basis. That means the representative receives a fee only if you win your case. Normally the fee is 25% of your back benefits and must be approved by Social Security. This fee is set by federal law.
If you do not win your case there is no fee. There are also costs in each case for which you may be responsible. These costs are charges paid to doctors for medical records.
You have to have been disabled for at least one year or be expected to be disabled for at least one year. So, if you expect to be out of work for one year or more on account of illness or injury, you should file for Social Security disability benefits.
I got hurt on the job. I am drawing worker’s compensation benefits. Can I file a claim for Social Security disability benefits now or should I wait until the worker’s compensation ends?
You do not have to wait until the worker’s compensation ends and you should not wait that long. An individual can file a claim for Social Security disability benefits while receiving worker’s compensation benefits.
I have several health problems, but no one of them disables me. It is the combination that disables me. Can I get Social Security disability benefits?
Social Security is supposed to consider the combination of impairments that an individual suffers from in determining disability. Many, perhaps most claimants for Social Security disability benefits have more than one health problem and the combined effects of all of the health problems must be considered.
Social Security’s position is that it is not up to your doctor to determine whether or not you are disabled. It is up to them and they will make their own decision regardless of what your doctor thinks.
For disability insurance benefits, it all depends upon how much you have worked and earned in the past. For disabled widow’s or widower’s benefits, it depends upon how much the late husband or wife worked and earned. For disabled adult child benefits, it all depends upon how much the parent worked and earned. For all types of SSI benefits, there is a base amount that an individual with no other income receives. Other income that an individual has reduces the amount of SSI which an individual can receive. Each year we all receive a report from Social Security about our retirement benefits. This report also has the dollar figure you’d receive if you were disabled. A spouse and children are also eligible in most cases.
It is Social Security’s position that VA decisions are not binding upon them. Social Security and VA have similar standards for approving disability claims, but the VA has many partial disability programs. For Social Security disability, one must be totally disabled from any kind of work.
For Disability Benefits and for Disabled Widow’s and Widower’s Benefit, the benefits begin five months after the person becomes disabled. Benefits can be paid for up to one year prior to the date of the claim, if the medical records support this. For a Disabled Adult Child, benefits begin as of the onset date, but benefits cannot be paid more than six months prior to the date of the claim.
SSI benefits begin at the start of the month following the date of the claim.
The short answer is that Medicaid is a program for people with limited resources, and Medicare isn’t. Many disabled people who get Medicaid get it because they are on Supplemental Security Income (SSI). To get SSI and thereby get Medicaid you have to be poor and disabled. Medicaid does pay for prescription medications. Medicaid can go back up to three months prior to the date of a Medicaid claim. For Medicare, it does not matter whether you are rich or poor. If you have been on Disability Insurance Benefits, Disabled Widows or Widowers Benefit or Disabled Adult child Benefits for 24 months you qualify for Medicare. The good thing about Medicare is that it pays doctors at a higher rate than Medicaid. Almost all doctors are happy to take Medicare patients. Medicare does not begin until after a person has been on disability benefits for two years, and it only pays for prescriptions through Medicare Part D.
You should appeal immediately. If you appeal within 10 days after being notified that your disability benefits are being ceased, you can ask that your disability benefits continue while you appeal the decision cutting off your benefits. You may also want to talk with an attorney about representation on your case, but you should file the appeal immediately.