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SSI/SSDI FAQ

SSI/SSDI FAQ – WV Law Firm Jan Dils Firm Attorneys

SSI FAQ

General

Q: What is the definition of disability?

A: Disability is defined as the inability to engage in substantial gainful activity due to a medically determinable impairment that has lasted or is expected to last a minimum of 12 months or result in death.

Q:  If I am approved for SSI, how much will my monthly benefit amount be?

A:  Each year the Social Security Administration will publish the Federal Benefit Rate which is the highest amount payable for SSI recipients. This amount changes year to year based on a cost-of-living adjustment. There are several items that may affect the amount you receive each month such as income in your household or your living arrangements. For a more detailed list of the items that may affect your payment visit www.ssa.gov or contact our firm and one of our staff members will be happy to assist you

Q: I have been denied disability benefits. How and when should I file an appeal?

A: The Social Security Administration allows 60 days for an appeal to be filed. The appeal can be filed online by visiting SSA’s website or you can appeal the decision at your local SSA office. It is also acceptable to file an appeal via mail, however; it is imperative that you confirm your appeal was received and we suggest the appeal be mailed certified. Of course, if you are a client of our firm, an appeal will be filed on your behalf. s.

Q: How many steps are there in the Social Security disability claims process?

A:  There are five levels in the disability claims process. Upon filing an application for benefits, you are at the initial level. If you receive a denial you have the right to appeal. The appeal is called a Request for Reconsideration and this is the second level. If you are denied after filing your request you also have the right to appeal again. This will begin the third level, the Request for Hearing with an Administration Law Judge. This is often referred to as the hearing level. It is at this level that your claim will be heard by an Administrative Law Judge (ALJ). If you receive a less than favorable decision from the ALJ, you may choose to file an appeal for a review by the Appeals Council entering the fourth level of the claims process. Lastly, upon a less than favorable Appeals Council decision you may also choose to enter the fifth level by filing an appeal to Federal District Court.

Q: What can I do to strengthen my case?

A: The most essential piece of evidence in a Social Security disability claim is consistent medical treatment. Treating regularly with your doctor(s) and fully expressing all symptoms you are experiencing is the best way to strengthen your case. It may also be beneficial for your doctor(s) to complete a medical assessment and/or write an opinion letter regarding the severity of your medical conditions.

Q: How much does representation cost?

A: There are no upfront costs for representation. If the outcome of your claim is favorable Jan Dils office is entitled to 25% of any retroactive benefits awarded to you up to $6,000 whichever is lowest. However, if your claim continues passed the administrative level to the Appeals Council and Federal District Court, a higher amount may be paid in representative fees. Also, any expenses for reports requested from medical providers or other establishments paid for by the firm will be passed to you as a client.

Q: What should I expect at my hearing?

A: As a general rule of thumb, you should arrive at the Social Security hearings office a half hour prior to the time of your hearing.  We will meet you in the waiting room and most often, if you have any questions we will have a few minutes to go over your case with you prior to going into the hearing room.  Social Security hearings are rather informal proceedings. At the start of your hearing you will be asked to take an oath. Next, most judges will start with an explanation about procedural matters of the hearing.  The hearing will then proceed most often with an opening statement from your representative and then the Judge and/or your representative will ask you questions. Others present at the hearing will include but are not limited to a hearing reporter, a vocational expert and in some cases medical experts. The hearing will conclude once all questioning and expert statements are complete. Typically, the Judge will not announce what his/her decision is at the hearing. You will be notified via mail of the decision

Q: If I receive both SSI and SSDI am I eligible for both Medicaid and Medicare? 

A: Yes. As a beneficiary of SSI and SSDI you will be entitled to both Medicaid and Medicare.

Q: Will Social Security schedule an appointment with a doctor for me?

A: In most cases, yes. Social Security will schedule a Consultative Examination to assess your physical and/or mental impairment(s). The examination will be paid for by Social Security and it is very important that you attend all appointments.

SSI or Supplemental Security Income

Q: What are the requirements for Supplemental Security Income (SSI)?

A:  In order to receive SSI you must be found disabled in accordance to Social Security regulations and have limited income and resources. (SSI).

Q: When should I apply for Supplemental Security Income (SSI) benefits?

A: You should apply for Supplemental Security Income (SSI) benefits as soon as you become disabled.

Q: How do I apply for my benefits?

A:You may apply for benefits online at www.ssa.gov, in person at your local Social Security office or you may contact our firm and one of our staff members will be happy to assist you.

Q: Will I get health insurance if I am approved for SSI?

A: Supplemental Security Income recipients are eligible to receive Medicaid.

Q: Is there an age requirement to be eligible for SSI?

A: There is not an age requirement to receive SSI. However; at age 65 you may receive benefits without a disability as long as you meet the financial requirements.

Q: Can I work and receive SSI benefits?

A: You can receive SSI benefits while working, however; your income will affect your monthly benefit amount. Also, any work performed while receiving any type of disability benefit will be evaluated by Social Security and could affect whether or not you meet the definition of disability in order to receive ongoing benefits.

Q: Can someone get approved for Supplemental Security Income and not get approved for Social Security Disability Insurance?

A: Yes. The main difference between these two disability programs is the eligibility requirements. In short, in order to receive SSDI you must have worked long enough and paid taxes to be “insured”. Depending on how long it has been since you last worked the date in which you were last insured may be in the past. If so, you must meet the requirements to be found disabled prior to this date, which is referred to as your Date Last Insured (DLI). The SSI program does not have a DLI, therefore; if you are found disabled after your DLI but are eligible for the SSI program you would receive monthly benefits from SSI but not SSDI. For more information on DLIs, see “What is my Date Last Insured?”.

Q:  How much money will I receive if I am awarded both SSDI and SSI benefits?

A: There is no set amount on how much you will receive if you are eligible for both programs. Your monthly benefits for SSDI are dependent upon your earnings history and your SSI benefits will be offset by your SSDI benefits and any other income. The amount varies for each individual; however, if you are awarded both SSI and SSDI benefits you will receive notifications detailing your monthly benefit amounts.

SSDI or Social Security Disability Insurance

Q: What is my Date Last Insured?

A: Eligibility for the Social Security Disability Insurance program is based on your work history. When you work and pay taxes you are building “work credits”. Depending on your age, you must have a certain amount of work credits to be considered “insured”. Much like private medical insurance, once you stop paying a premium (taxes in this case) your insured status will eventually end. For SSDI purposes, the last date in which you are insured under the SSDI program is referred to as your Date Last Insured (DLI). In order to receive benefits from SSDI program, you must meet the disability requirements prior to your DLI. Your DLI will be one of four dates, March 31st, June 30th, September 30th or December 31st. These dates fall on the last day of each quarter.

Q:  What are the eligibility requirements to apply for Social Security Disability Insurance (SSDI)?

A:  In addition to having a medically determinable impairment that keeps you from engaging in substantial gainful activity for a minimum of 12 months or result in death, you must have also worked long enough paying Social Security taxes. Paying taxes allows you to build “work credits”. Depending on your age, you must have a certain amount of work credits in order to be eligible for SSDI. The table below demonstrates the number of work credits you must earn as it relates to your age.

Before Age 24 6 credits earned in a 3 year period
Age 24-31 You must have one credit for every two quarters worked between the age of 21 and the age you become disabled.
31 and older The following boxes reflect the number of credits you must have. You must earn at least 20 of these credits in the 10 years immediately before you become disabled.
31 through 42  20
44 22
46 24
48 26
50 28
52 30
54 32
56 34
58 36
60 38
62 or older 40

You can also find this information by visiting www.ssa.gov

Q: When should I apply for Social Security Disability Insurance?

A: You should apply for SSDI benefits as soon as you become disabled.

Q: Will I get health insurance if I get SSDI?

A: Individuals who receive SSDI benefits are eligible to receive Medicare. Your Medicare benefits will begin 24 months after you are date of entitlement for benefits. Your date of entitlement is the first month in which you are eligible to receive a cash benefit.

Q: Can I work while I am applying for SSDI benefits?

A:  Yes. You can work while you are applying for SSDI benefits; however, the amount of work you are performing and your rate of pay may cause you to be denied. In short, if you are working above the allowable limit (Substantial Gainful Activity) as defined by SSA while you are applying for benefits, you will not be eligible to receive disability. If you are working while you’re applying, make certain that the Social Security Administration is aware of your monthly earnings.

Q: If I am currently receiving SSDI benefits, what happens to my benefits if I return to work? 

A: : If you are awarded benefits and decide to return to work, your earnings may trigger what is called a Trial Work Period (TWP). The amount that triggers the TWP changes year to year but it allows an individual to return to work for a period of time without their current SSDI benefits being affected. The TWP continues until you have accumulated nine months (it does not have to be consecutive) in a rolling 60 month period. Work after the TWP could be indication that you are no longer disabled and will be evaluated by Social Security. If you do return to work, make certain that you report your earnings directly to Social Security and keep in mind that proof that a disabling impairment(s) is still necessary to continue your benefits.

Q: Is there an age requirement to receive Social Security Disability Insurance benefits?

A: An individual 18 or older may be eligible to receive SSDI benefits.

Q: How long will I receive SSDI benefits?

A: You will receive benefits until you reach full retirement age, or until your condition improves to the point where you are able to work on a full time basis for over nine months. Social Security has instituted a number of provisions to encourage individuals to try to return to work without jeopardizing their disability payments. If you worked for a short period of time after the onset of your disability, you may still be entitled to a full period of disability. Keep in mind, the Social Security Administration conducts regular reviews to make certain beneficiaries continue to meet disability requirements.

Q: Will other income affect my SSDI?

A: If you receive Social Security Disability (SSD), there is no limit to the amount of other income you can receive, as long as it is not from work activity. For example, money from dividends or a piece of land that you sell will have no affect your benefits.

Q: Can I receive both Workers’ Compensation and SSDI?

A: You can receive payments from both programs; however, that is dependent on the amount of benefits you receive. If the total of your workers’ compensation, Social Security benefits (including those payable to your dependents) and any other public disability benefits exceed the higher of 80% of your average current earnings prior to your disability or your family’s total Social Security benefit, you will see a reduction in your SSDI benefits.

Q: Will my benefits increase when I reach full retirement age? 

A: No. Your benefits will not increase once you reach full retirement age; however, you will see a difference in the title of your benefits. The title of your benefits will change from Social Security Disability Insurance to Social Security Retirement.

Q: Can I apply for both early retirement benefits and SSDI? 

A: You can apply for both programs but you will not receive payments from both. If you apply for early retirement you will receive retirement benefit payments at a reduced amount. If you are then awarded SSDI, the most significant change you will see is a slight increase in your monthly benefits. Any retroactive SSDI benefits payable will also be offset during any months that you received early retirement benefits. In other words, your retroactive benefits for any month you received early retirement will equal the difference between those benefits and your SSDI benefit amount.

Most of this information comes directly from SSA and can be found on their website.