Frequently Asked Questions

The following FAQ's were generated with great help from NOSSCR.ORG's FAQ section. www.nosscr.org/hallfaq.html#01

1. What do I do if Social Security denies my claim for Social Security disability benefits?

First, do not be surprised. Only about 40% of Social Security disability claims are approved at the initial level. (See diagram below) If you are denied at the initial level, unless you have already returned to work or expect to return to work in the near future, you should appeal, that is, file a request for reconsideration. You should also consider employing an attorney to represent you.

2. Do I really have to hire a lawyer to represent me in my Social Security disability claim?

No. You can go through all of the levels of review on your own, if you wish, but statistically claimants who are represented by an attorney win a good deal more often than those who are not represented. This is because your claim becomes very complex, and having an attorney with experience is vital.

3. What is the definition of disability used by Social Security?

Under the Social Security Act, "disability" means "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."

4. How do I apply for Social Security disability benefits?

The best, surest way to file a Social Security disability claim is to go to the nearest Social Security office in person and wait (often for a few hours) to see someone to file the claim in person. In the alternative, a person may contact Social Security by telephone and arrange for a telephone interview to file the claim.

5. How long do I have to wait after becoming disabled before I can file for Social Security disability benefits?

Not a single day. You can file for Social Security disability benefits on the very same day that you become disabled. Many individuals make the mistake of waiting months and even years after becoming disabled before filing a Social Security disability claim. There is no reason to file a Social Security disability claim if one has only a minor illness or one which is unlikely to last a year or more. However, an individual who suffers serious illness or injury and expects to be out of work for a year or more should not delay in filing a claim for Social Security disability benefits.

6. Can I get both worker's compensation and Social Security disability benefits?

Yes. There is an offset, which reduces Social Security disability benefits because of worker's compensation benefits paid, but in virtually all cases, there is still some Social Security disability benefits to be paid. In a few states the offset works the other way - - worker's compensation benefits are reduced because of Social Security disability benefits. So it is still to your benefit to file for Social Security disability.

7. Do you have to be permanently disabled to get Social Security disability benefits?

No. You have to have been disabled for at least a year or be expected to be disabled for at least a year or have a condition that can be expected to result in death within a year.

8. How does Social Security determine if I am disabled?

Social Security is supposed to gather your medical records and carefully consider all of your health problems, as well as your age, education, and work experience. In general, Social Security is supposed to decide whether you are able to do your past work. If Social Security decides that you are unable to do your past work, they are supposed to consider whether there is any other work which you can do considering your health problems and your age, education, and work experience.

9. Who decides if I am disabled?

See the following:

SOCIAL SECURITY LEVELS

Social Security Administration 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 last for 12 continuous months.

FIRST LEVEL

Initial Application

The initial claim my be made at your local District Office. The claim needs to be made on a prescribed form, filed with the correct office, and filed while the person who is eligible is still living.

Waiting Period: 3-4 months

SECOND LEVEL

Request for Reconsideration, Disability Report, 3 SSA authorizations

At this level a Request for Reconsideration must be filed at the local District Office. The reconsideration is an independent review of the case based on evidence submitted at the initial application, plus any additional evidence submitted at this level.

Waiting Period: 3-4 months

THIRD LEVEL

Request Hearing with an Administrative Law Judge, Claimant's Statement...

This is the level where the only face to face contact is made. The request for a hearing may be made by either the claimant or his/her representative at the local District Office. In approximately six to eight months, the claimant will receive notice of the hearing date and time at least 20 days prior to the set date. A decision is usually made within 3 to 14 months after the hearing, however, this can take longer. The following represents what is considered in the case:

1. Substantial Gainful Activity
2. Severe Impairment
3. Meeting/Equaling Listing
4. Past work History (last 15 years)
5. Ability to do any job in the National Economy

Waiting Period: 6-8 months for hearing date
1 week - 14 months for decision from judge

FOURTH LEVEL

Appeals Council

The Appeals Council will review case if:

1. There appears to be an abuse of discretion by the Administrative Law Judge.
2. There is an error of law.
3. The actions and findings are not supported by substantial evidence.
4. There is a broad policy or procedural issue that may affect the general public interest.

Waiting Period: 24-30 months
*The Appeals Council may remand case back to the Administrative Law Judge if they feel more evidence is needed.

FIFTH LEVEL

Untied States Federal District Court

The Federal Courts will hear all appeals. $150 filing fee required.

Waiting Period: 9-12 months

10. How far back will they pay benefits if I am found disabled?

For Disability Insurance Benefits and for Disabled Widow's and Widower's 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. For a Disabled Adult Child, there is no five-month waiting period before benefits begin, but benefits cannot be paid more than six months prior to the date of the claim. SSI benefits cannot be paid prior to the start of the month following the date of the claim.

11. I am disabled, but I have never worked at public work. Can I get Social Security disability benefits?

If you are poor enough, you can qualify for Supplemental Security Income (SSI) if you are disabled, even if you have never worked in the past. It is also possible to qualify for Disabled Adult Child Benefits on the account of a parent if you became disabled before age 22 or for disabled widow's or widower's benefits on the account of a late husband or wife.

12. How long does it take before Social Security makes a decision once I file a claim for Social Security disability benefits?

In most cases Social Security makes the first decision within four months.

13. How long does it take for Social Security to make a reconsideration determination on my Social Security disability claim?

In most case Social Security makes the reconsideration determination within four months.

14. How long does it take for Social Security to act upon a request for Appeals Council review?

About a year, maybe longer.

15. What is the difference between Medicare and Medicaid?

The short answer is that Medicaid is a poverty program and Medicare isn't. Many disabled people who get Medicaid get it because they are on Supplemental Security Income (SSI). This is called "categorical" Medicaid eligibility. To get SSI and thereby get Medicaid you have to be poor and disabled. Medicaid pays doctors at very low rates. People who have only Medicaid can have a hard time finding doctors willing to take them on as patients. Medicaid does pay for prescription medications. Medicaid can go back up to three months prior to the date of a Medicaid claim. Note that it is possible to apply for Medicaid directly - through a local Medicaid office - without having a companion claim for SSI.

For Medicare it does not matter whether you are rich or poor. If you have been on Disability Insurance Benefits, Disabled Widows or Widowers Benefits 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. The bad things about Medicare are that it does not begin until after a person has been on cash disability benefits for two years and that it generally does not pay for prescription medications.

16. If I get Social Security disability benefits will I get Medicare?

If you are approved for any kind of Social Security disability benefit other than SSI you will get Medicare after you have been entitled to Social Security disability benefits for two years.

17. If I get Social Security disability benefits will I get Medicaid?

If you are approved for SSI you will get Medicaid. It is possible to get both Medicare and Medicaid if you are entitled to SSI and some other type of Social Security disability benefit. Also see #15 above.