Social Security disability laws provide assistance to individuals with disabilities. Benefits provided under these laws include insurance that will pay benefits to both the disabled individual and their family as long as you have paid enough in social security through work. Supplemental security income is provided based on financial needs.
An attorney is not allowed to charge you a fee unless it has been approved by Social Security. Social Security Disability Insurance benefits are only paid to individuals who are totally disabled, as that term is defined by Social Security.
Social Security disability law consists of the rules used to decide who will qualify for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits, and how much money they will receive. Because these are federal programs, state and local laws do not apply. The rules can be found in the Social Security Act as it appears in Title 42 of the United States Code, as well as in the published regulations and rulings of the Social Security Administration (SSA).
SSDI benefits are meant for adults who become disabled and unable to work for at least one year. Benefits are only available to those who have paid a sufficient amount into the system (through payroll taxes), and have not yet reached retirement age. Dependents of people receiving SSDI may qualify for benefits as well. SSI serves a different purpose. It is designed for disabled people with little or no income, regardless of whether they have paid anything into the system.
Requirements for Disability Benefits
Eligibility requirements for SSDI and SSI are very specific. For SSDI, the threshold qualification involves the number of “work credits” the applicant has accumulated prior to becoming disabled. Work credits are based on the applicant’s earnings. Each time the applicant earns a certain amount of wages or self-employment income, he or she receives one work credit (as of 2013, it takes $1,160 of earnings to receive one work credit).
A maximum of four work credits can be earned in any given calendar year. To be eligible for SSDI benefits, the applicant must have a total of 40 credits, and 20 of these must have been earned in the 10-year period leading up to the application date.
To receive SSDI, the applicant must also be “disabled.” SSA considers people to be disabled if they cannot work in their field or adjust to another field of employment, due to a severe medical impairment. An applicant may qualify based on a single impairment, or a combination. Either way, the inability to work must be complete, and long-term.
For SSI, eligibility is based on income level, not work credits. An applicant must have an income level below a certain amount known as the federal benefit rate, or “FBR” (as of 2013, the FBR is $710 per month). Calculating the FBR is complex. For example, only a portion of income earned by working will be used in the calculation. At the same time, FBR will include the value of any in-kind services the applicant receives, such as free rent or meals.
How to File a Claim
Disability applications can be started online, by phone, or in-person at the nearest social security office. A great deal of personal information is required to complete the application, most of which deals with the applicant’s medical condition and work history. Applicants should be ready to provide a description of their doctors and other care providers, medications, and lab results. SSA will also ask about previous jobs, and request copies of the applicant’s W-2s and tax returns.
Appealing an Unfavorable Decision
On average, SSA only approves about 30% of initial claims for disability benefits. For those who persevere, however, the odds improve significantly. Applicants who are denied benefits can appeal the decision through multiple stages of administrative review. During the appeal process, applicants are permitted to submit additional medical records, thereby strengthening their case, and giving SSA a reason to reverse its decision.
The first level of review is called a “reconsideration.” A relatively small number of cases are won at this level, and in some states the reconsideration stage has been done away with altogether. Following the reconsideration, if there is one, the case will be submitted to an administrative law judge (ALJ).The ALJ will hold a short, informal hearing during which the applicant can present testimony and other evidence. Hearings are not adversarial in nature, although a vocational expert may appear on behalf of the SSA.
Approximately 60% of previously denied claims are granted by the ALJ. But if this does not occur, the applicant can continue on in the appeals process. The next stage is to submit the case to the Appeals Council. Applicants do not appear in front of the Appeals Council. Rather, this consists of a final review of the file by members of the SSA, from their offices in Falls Church, Virginia. If a claim is still not granted, the applicant can file an appeal in federal court.