How Does the Social Security Disability System Work?

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The Social Security Administration (SSA) provides disability benefits via the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs. The main difference between the two is that SSDI is available to employees who have acquired a certain amount of “working credits.” On the other hand, SSI benefits are provided to financially underprivileged individuals.Many people view SSDI and SSI as one in the same; however, they are two separate programs. On the other hand, the Social Security Administration manages both systems, and the programs use the same medical eligibility method. More generally, disability benefits are available under SSDI or SSI to disabled or blind individuals.

What is a disability?

To understand the systems, it is imperative to know what a “disability” actually is under the law. A person must be disabled to qualify for the programs.

For SSDI or SSI, to be deemed disabled, an applicant must have a condition – psychological, physical or mental – that keeps him or her from participating in “substantial gainful activity” (SGA). More specifically, the disability applicant must be unable to participate in significant employment. Generally, this means working and earning a specific income. There are several ways to evaluate one’s capacity to work and make a living.

Moreover, the person’s condition must have kept the applicant from SGA for 12 months (or more). If not, the condition must be expected to carryon and limit the person from SGA for at least one year. Moreover, if a condition is likely to result in death, the applicant may qualify.

How does the administration assess whether a person is disabled?

To decipher whether a person is disabled and whether he or she may qualify for the receipt of benefits, the SSA will forward a claim to the appropriate state agency after the person submits an application. The state agency that makes the determination is referred to as the Disability Determination Services in Illinois.

An applicant’s file arrives from the Social Security office and is assigned to a disability claims examiner. The inspector evaluates medical records and all the treatment information as documented by the applicant in his or her application. When the information is compounded, the examiner reviews the information and decides whether a person qualifies for disability. In this evaluation, the examiner might consider some of the following questions:

  • Is the person currently employed?
  • Can the applicant be engaged in substantial gainful employment of any type?
  • Is the applicant’s condition severe?
  • Is the condition an official disability?

Generally, the examiner will focus on the medical information that supplements the application. The agency will also look into the person’s employment history.

Some diagnosed conditions are automatically deemed a disability under the program, and in such cases, applicants can apply to one of the SSA’s fast-tracking programs, which ensure that a person receives benefits as soon as possible. This might be, for example, when a person is suffering from terminal cancer.

In most cases, if the applicant is assessed as totally “disabled” after the evaluation of paperwork by the claims investigator, he or she will receive “benefit receipt” status, which will send the paperwork back to the SSA for processing.

Social Security Disability Insurance

Again, there are two separate systems under the overall disability program. Social Security Disability Insurance is paid by employment taxes. Beneficiaries are considered “covered” under the system because they have been employed for a particular amount of years and have provided regular payments to Social Security via FICA Social Security taxes. To qualify, applicants must have collected a particular number of “work credits.” Through the program, a recipient’s wife, husband or children can potentially get partial benefits. Otherwise, only those over 18 may apply for the SSDI disability adult benefit.

Supplemental Security Income

Supplemental Security Income is a need-based system, and it is supported by general taxes. SSI has nothing to do with one’s employment history. Instead, the system looks at financial need. Generally, to qualify for benefits, a disabled or blind applicant must have less than $2,000 in assets (or $3,000 for a couple) and have a limited income. The amount an eligible person receives is dependent on where he or she lives and the amount of regular income taken in.

When should a person apply for disability benefits?

SSDI and SSI cases can take a long time. The SSA estimates that it takes approximately 90-120 days for an application to fully process; however, it can take much longer.

Given the fact that it is a complex and time-consuming process, applicants should begin the paperwork as soon as they are disabled and unable to work. It helps to have an attorney’s assistance. Assuming the condition is expected to last at least one year, most claimants are eligible the day after they stop employment or when earnings drop below the SGA level.

Many cases are initially denied, so it is especially helpful to have legal assistance within the process. It can take anywhere from 30 days to two years before a person has his or her benefits in the hand. A lawyer can help ensure that an application is equipped with important medical evidence. This can help one avoid the appeals process.

How should one prepare his or her application for benefits?

To qualify for disability benefits, the application must contain very detailed evidence of the physical or mental impairment. Medical evidence can come in several ways, including doctor examinations and notes, health records, blood work, MRIs and more. The materials should also document exactly how the condition prevents the person from SGA. In essence, medical information and records are very important.

The evidence must be up to date, too. It should not include old examinations. Yet, over all, medical tests are very helpful. For example, if a doctor writes down information that a person has a broken back, this will be better evinced with current x-rays.

The importance of legal assistance

If you are ready to prepare your application, speak with a qualified legal professional who specializes in Social Security laws. Again, many applications are initially denied, so it helps to have an expert by your side. Even if an application is rejected the first time, an experienced lawyer can help with the appeals process.

Suffering from a debilitating disability is far from easy. The good news is that an attorney versed in complex disability laws can help you get back on track.