Myths and Truths
Myths and Truths of
Social Security Disability (SSD) and Supplemental Security Income (SSI)
Social Security Disability and Supplemental Security Income are a confusing pair of programs run by the Federal Government. These programs exist throughout the United States and Puerto Rico.
The questions are always the same: who should file and what program should they file for?
This is a brief overview of the Social Security Administration's two major Federal programs for people under the age of 65. Included is SSI which is a "need based" program in place for non-workers or workers who earned very little while working, or for those who are no longer insured for SSD benefits. SSD is for those who worked enough to "insure" themselves for disability insurance and retirement through work and paying into FICA. A limited number of people with low earnings, before they became totally disabled, may file and collect both SSD and SSI. SSI is a Federal welfare program: SSD is a Federal insurance program. An individual may be eligible for Federal adult SSI if they would otherwise be welfare eligible and cannot work at any job. For SSD, if an individual is not working for six months and is insured, the only question is whether they could work. The assets of the individual or any of their household is not involved. There is also another special program for severely disabled children called "Child's SSI".
The basic medical definition of disability applies to both programs:
20 CFR Section 404.1505: "The law defines disability as the inability to do any substantial gainful activity (ability to perform any work and make $700.00 per month) 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 continuos period of not less than 12 continuous months." To meet this definition, you must have a severe impairment which makes you unable to do your previous work or any other work which existed in the national economy.
Each program is a multistep process. First is the initial application. If denied, a person has 60 days to file for a Hearing before an Administrative Law Judge. The whole process usually takes anywhere from 1.5 to 2 years. The majority of individuals who apply for either or both programs are not successful at the first two levels. However, the odds of being successful change one the individual has filed for a hearing and has their matter heard by an Administrative Law Judge particularly if they have a representative knowledgeable about the system and how it works.
Things to remember when filing for one or both programs would include:
Be sure to include all impairments as well as subjective complaints such as pain, fatigue, swelling, stiffness, depression, side-effects to medications, etc. as well as restrictions sustained sitting, standing, walking, lifting and carrying and any restrictions in daily activities of living;
All information given to Social Security must be verified by your doctors; and your doctors must place physical and/or mental restrictions on your ability to work, daily activities, and must also provide diagnosis with supporting tests and examination reports;
Everyone who files has a right to representation, however a representative is not required;
If a person does want representation, a representative may only charge a fee if you win and then only up to 25% of past due benefits (for you and your family) with a total maximum fee of $5,300.00 which is subject to approval from the Social Security Administration.
Remember, the ultimate question is whether an individual could, based on objective medical evidence, theoretically do a full-time, sitting job, not only whether you can do the job(s) you used to do.
By Anne L. Lang and Karen Dimmick, Paralegals of the Law Office of Lawrence I. Heller.