What Does Social Security Mean By ‘Totally Disabled’?
Social Security Disability benefits are often available to people who are suffering from medical problems that produce symptoms so severe that they cannot sustain any type of work. The Social Security Act requires that the medical proof document the inability to work for a period that has lasted, or is expected to last, at least 12 months, or result in death. This is the basic requirement for the two disability programs — SSDI and SSI.
What Is SSDI?
Social Security Disability Insurance (SSDI) benefits are available for those people who have worked and paid FICA taxes for a sufficient number of quarters, and who are suffering from medical impairments that make it impossible to sustain any type of work activity. Basically for SSDI you must have paid FICA taxes while working for 10 years in your life, and for five of the 10 years prior to the date that you became totally disabled. The requirements are adjusted for people who are less than 28 years old.
SSDI benefits may also be available for disabled widows/widowers who are more than 50 years old and who became totally disabled within seven years of their spouse’s death; and for persons who can prove that they became totally disabled before age 22 and who have a parent on SSDI or on the SS retirement program.
What Is SSI?
Supplemental Security Income (SSI) benefits are available for people who are totally disabled and who are “indigent.” “Indigent” is based upon your assets and income and essentially means that you have no money coming into the household other than child support or TANF benefits for children, and for a single person, less than $3,000 in assets not counting your house and one car. The base SSI grant is reduced if you are living with someone who is paying the rent for you.
What Diseases Qualify For SSDI Or SSI?
Any “medically determinable impairment” that makes it impossible for you to work for at least 12 months can qualify for disability benefits. At Jeffrey A. Rabin & Associates, we have successfully represented people with many different medical problems including chronic fatigue syndrome, fibromyalgia, lupus, reflex sympathetic dystrophy, multiple sclerosis, ankylosing spondylitis, chronic headaches, depression, hepatitis C, PTSD, bipolar disorder, multiple chemical sensitivities, congestive heart failure, asthma, emphysema, diabetes, cancer, Huntington’s disease, rheumatoid arthritis and other chronic pain disorders.
How Do I Apply?
There are a number of ways to start a Social Security Disability claim. You can contact our law firm for a free brochure describing the application process. If your claim is only for SSDI, you can file on Social Security’s website at www.ssa.gov. If your claim is for both SSDI and SSI, or for SSI only, you must either go to your local Social Security District Office, or call SSA at 800-772-1213.
Our lawyers prefer to be retained as soon as you have filed your application. Statistics show that people with quality representation have a greater chance of having their application approved. Our experience shows that the earlier in the process we get involved, the stronger the claim.
Why Was My Application Denied?
Most claims are denied because the medical proof is not sufficient to prove that you are totally disabled. This could be because you are not seeing the proper specialists, because of inadequate medical records, because the doctor does not understand the legal requirements, or because Social Security’s reviewers misinterpreted the medical records. Social Security rarely denies that you have a medical diagnosis, or that you are impaired, but does deny that you proved the legal requirement of being “totally disabled.” Our lawyers and staff work with our clients’ medical providers to make certain that the medical proof is as strong as possible.
How Long Will This Take?
The backlogs are serious at all levels of the application and review process. The severity of the backlog varies nationwide. While SSA is working on this problem, it can easily take as long as 18 months to go from initial application to an administrative law judge hearing.
How Much Will I Get?
The amount you receive on SSDI is based upon multiple factors including your work earnings, your FICA taxes and the number of quarters you worked. It is a fairly complex formula. You should have received a Personal Earnings Statement in the last year that confirmed your yearly earnings and told you how much you would receive for retirement benefits and for disability benefits. If you have not received a PES, you should contact Social Security and order one. You can do this at www.ssa.gov. When you receive it, check it carefully to make sure that the earnings are correct.
How Do I Get Medicare?
Medicare is the federal government’s health insurance program and is available to people on retirement or on SSDI. If you are on SSDI, you will become Medicare eligible on the 30th month after your onset date, that is, the date that Social Security says you became totally disabled.
How Do I Get Medicaid?
Medicaid is the joint federal-state health insurance program that covers certain categories of people. One of those categories is the “totally disabled” so that when your SSI claim is approved you will be Medicaid eligible. SSDI beneficiaries may also be Medicaid eligible, however, Medicaid is based upon total family income and assets so you will need to check your state’s guidelines.
Are Social Security Disability Benefits Taxable?
SSDI benefits may be taxable depending on your total family taxable income. For example, a person filing as an “individual” with a combined income between $25,000 and $34,000 would have to pay income taxes on 50 percent of the SSDI benefits. If the combined income is more than $34,000 then 85 percent of the SSDI benefit is taxable. You should consult with an experienced tax expert when your claim is approved to make certain that you plan for any tax liabilities.
What Does A Lawyer Do For Me?
This question comes up frequently on the Internet boards that we monitor and provide general legal information. Here was my answer:
“Don’t you think Jeff that if you have all you facts straight you can do just as well with out a lawyer. Especially at 25% of you back pay. after all you do all the leg work yourself. Am I wrong in my thinking? What can a lawyer do that you haven’t did yourself. Every lawyer says after you 2nd denial I will take over after the work is done. I feel so bad all the time anyway the stress of getting info together.”
Hi C –
Well, since I’ve been representing Social Security Claimants as an attorney for more than 22 years, and almost exclusively for the last 15 years, I can not agree. The statistics show that far more claims are awarded when there is experienced representation and almost every ALJ will tell you that they prefer Claimants to be represented.
Getting the medical records together is one part of the job, but the most menial and not usually the most important. Let me just ask some questions that can guide you to deciding whether getting the records together adequately prepares your claim.
While your claim is pending, are you seeing the right doctors? Do you know if they are the right doctors? Are you communicating to them? Are you communicating to them about the issues that matter most to Social Security?
What are the issues that matter to Social Security in your particular claim? Are there issues to emphasize? Are there other issues which will make a difference that may not be in the medical records? Is there only one severe impairment? Two? More? Are they all being developed? Does SSA know?
Is there a Listing that applies to your claim? Are there two? Is there a Ruling that applies? There are likely several Rulings that will govern the adjudication of your case – does the Judge know of them? Will she consider them? Do you know which to bring to her attention? Do you want to take the chance that she will take the time to find them for you? Are there Regulations which will help your claim – what about some of the prefatory language in the Listings?
Are there onset date issues – are you even certain? Date last insured issues? Are there earlier application which can be reopened? Which regulations apply to those issues?
What about the doctor whose notes are ambiguous? Will you review them ahead of time? Will you try to get that ambiguity worked out in your favor? Will you be able to? Will you even recognize the ambiguity?
Do the Grids apply to your claim? Which section? What about transferability of work skills – can that be used with your age as a favorable factor? Will it hurt your claim? Will the ALJ only consider skills, or will she also consider traits which is improper?
Is there going to be a medical advisor at your hearing? Who will cross-examine him? Last week I was at a hearing where the orthopedic doctor testified that my client’s fibromyalgia was nothing more than “change of life” and that she should take hormones and get over it. When I was finished, the ALJ threw out all of his testimony.
Will there be a vocational expert at your hearing? Who will cross examine him when he testifies that you can be security monitor? Will you be prepared to discuss the relevant SVP of that job in the Dictionary of Occupational Titles?
Who will review and outline and be prepared to present the most important details from the medical evidence to the ALJ?
Did you already complete the Activities of Daily Living Questionnaire? We call that the “killer form” in my office and is one of the primary reasons I want to get hired as soon as an application is filed. Did you prepare the answers so that they can not be twisted by an adjudicator or reviewing DDS physician?
What happens if you want to try to return to work before a year has elapsed? What about after a year? What about after your decision?
Yes, the program is set up so that you do not need a representative. The ALJ ultimately is supposed to help unrepresented Claimants. Will yours? Are you willing to take that chance? That’s your call and sometimes it works out just fine – often it does not and the hearing is the only time you get to fully develop the record and testify – that record controls at all subsequent reviews. Some ALJs are very diligent in their obligation to assist a Claimant, however, in Region V in the Midwest the average ALJ has a caseload varying from 550 to more than 1000 cases – just how much work is he/she doing for any single Claimant? If the ALJ misses an issue, or some way to help you, you will never know.
Attorney fees in this line of work are regulated, capped, reviewed and subject to a specific “administrative fee” (e.g., tax) which only SS lawyers pay. We only get paid when we win, we get nothing for our time and expertise when we lose a claim. In this area of law I feel very comfortable that experienced representatives play a decisive role for many of their clients and earn their fees.
I’ve read and revised this a couple of times which is unusual for me on the Internet. This list of issues is NOT inclusive – there are others – but an experienced representative will look at every one of these questions in almost every single case.
How Do You Get Paid?
We work on a contingency fee basis — that means no money up front, no hourly fees. In most cases, our fee is limited to the lesser 25 percent of your back benefits up to a maximum of $5,300 in 2004. Our fees must be approved by Social Security, and we file our fee agreement with SSA in every case.
How Can I Get More Information?
Call, email or write to us. There is no fee for an initial phone consultation — our office telephone number is 847-299-0008; our toll free number is 888-529-0600. You can email to us from this website.