No Longer Meeting The Definition Of Disabled
The SSA has a very strict and narrow definition of what it means to be disabled. You have to prove you meet all these criteria when you apply for benefits:
- Your condition must have lasted at least 12 months, be expected to last at least 12 months, or be terminal.
- Your condition must have a significant impact on your ability to do basic work activities such as sitting, walking, or remembering information.
- Your condition must prevent you from doing any work you did before.
- Your condition must be on the SSA’s Listing of Impairments or must be medically equivalent in severity to a listed condition. The Listing of Impairments is a long list of medical problems, including musculoskeletal issues, neurological disorders, and more. Conditions on the list, which is also called the Blue Book, can usually qualify you for benefits provided you exhibit specific required symptoms for your listed ailment.
The SSA periodically conducts Continuing Disability Reviews to make sure you’re still entitled to benefits. The frequency with which SSA reviews your medical history depends on your condition:
- If medical improvement is expected, you may have your case reviewed every six to 18 months.
- If improvement is possible but not expected, your case may be reviewed every three years.
- If improvement isn’t anticipated, you may go as long as five to seven years without a review.
Social Security Benefits Vs Ssi Benefits
The Supplemental Security Income program can help make ends meet but, as you can see, qualifying beneficiaries may need to identify other programs to add extra stretch to the monthly budget. If youre considering SSI and believe you meet the needs-based standards, ask about the SNAP! Program if you dont already receive food stamps.
Many states also offer supplemental income programs . If you qualify, its possible to receive state supplemental income and SSI. A short list of states dont offer state supplemental income programs to residents. If you dont live in Arizona, West Virginia, Arkansas, Texas, Oregon, Mississippi, and Tennessee , its challenging to determine the amount of SSI income you may qualify for. Your living situation may also affect how much money you receive in SSI benefits.
Contact Social Security at 1-800-772-1213 to discuss your SSI application questions or make an appointment with the SSA office nearest you. If you already receive Social Security benefits, including Social Security disability, its possible to qualify for SSI in some situations.
Social Security Disability Insurance Eligibility
In order to be eligible for disability benefits under SSDI, you must have paid into the Social Security system through income tax deductions and also have a qualifying medical condition as determined by the Social Security Administration . Unfortunately, many applications are initially denied for a variety of reasons. By engaging the services of an experienced disability benefits attorney, your chances of obtaining benefits greatly improves.
At Peña & Bromberg, PLC we have a proven track of successfully fighting for the disabled throughout Central Valley, California and across the United States. Over our many years of practice, we have helped individuals who are suffering from a wide range of medical conditions obtain the disability benefits they deserve.
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Extended Period Of Eligibility
Following your trial work period, you will enter a 36-month extended period of eligibility. It is in this period that you can work and still receive benefits only as long as your earnings are less than what Social Security considers substantial. Social Security deducts what they consider work expenses that are a direct result of your disability from your total monthly earnings. These work expenses can range from prescription drug copays, transportation to and from work, and specialized work equipment.
How Does The Ssa Define Disability
According to the SSA, a person is disabled if she or he suffers from a physical impairment or mental impairment that has lasted or is expected to last 12 months or more or result in death. The claimant must also be unable of performing any substantial gainful activity . In particular, the SSA considers an individual disabled if a claimant cannot perform the work he or she did before and cannot adjust to other work because of his or her medical condition.
Additionally, there are number of impairments that are included in the SSAs listing of qualifying medical conditions, including but not limited to:
- Degenerative disc disease
- Intellectual disability
- Personality disorder
It is important to note that you may still be eligible for benefits if you have a condition that is not included in the listing but medically equal to one of these impairments. Moreover, the SSAs definition of disability is different than other programs such as private long-term disability insurance. Social Security pays only for total disability and benefits are not available for partial disability or for short-term disability.
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How Many People Currently Receive Social Security Disability Benefits And What Is The Value Of The Benefits They Receive
About 8.8 million workers with disabilities currently receive Disability Insurance. The amount of Disability Insurance benefits that a disabled worker receives is based on his or her earnings before becoming disabled. As Table 1 shows, Disability Insurance benefits typically replace less than half of a disabled workers previous earnings.
As of March 2013, the average monthly benefit for a disabled worker was about $1,129, with male workers receiving $1,255 per month and female workers receiving $993 per month on average. About 1.9 million children of disabled workers and 160,000 spouses of disabled workers also receive supplemental benefits from Social Securityroughly $300 a month on average.
For most beneficiaries of Disability Insurance and Supplemental Security, disability benefits make up most or all of their income. For the vast majority of Disability Insurance beneficiariesabout 71 percenthalf or more of their income comes from Disability Insurance. And for nearly half of beneficiaries, 90 percent or more of their income comes from Disability Insurance. Given the modest extent to which benefits replace lost earnings and the limited sources of other income upon which they can depend, people who receive Disability Insurance are rarely able to maintain the same standard of living they had before becoming disabled. Disability Insurance provides a floor, however, that moderates the decline in their living standards.
Job Hopping Between Public And Private Sectors Requires More Math
If you follow these steps you should have a secure retirement. But what happens if you switch to the private sector before you qualify for your full pension?
If you work for a state or local government, it all depends upon the vesting requirements of the pension plan. Once you are vested, you will be entitled to benefits, or a rollover of the plan assets. Youll have to check with your pension plan administrator to determine what the rules are.
For an example, OSU employees are entitled to pension benefits once theyve worked for the university for five years. Their monthly benefit, of course, would be much smaller than one received by an employee who completed the full 25-year term. But they would still receive it. If not vested, they can take their contributions , and roll them over into an IRA or a new employers 401.
For federal employees, there are specific rules under the FERS program. You are vested in the plan after five years, after which you have the choice to either take a refund of your contributions, plus interest, or leave the money in the plan, and sign up for a deferred annuity when you get close to retirement.
If you are not vested in the plan, you can either take a refund of your contributions, plus interest, or you can leave the money in the plan if you believe you may return to federal government employment. You can also request a refund at a later date if you do not return to the federal government.
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When Doesmedicare Or Medicaid Start
SSDI recipients aren’t eligible to receive Medicare benefitsuntil two years after their date of entitlement to SSDI . Because it oftentakes a year or two to be approved for disability benefits, however, SSDIrecipients often become eligible for Medicare soon after they get their awardletter from Social Security.
In the states where Medicaid eligibility is automatic for SSIrecipients, there is no waiting period for SSI recipients to receive Medicaid.In other states, you need to apply separately for Medicaid, but there is nowaiting period.
Consultation And Filing Assistance For Social Security Disability Insurance
At DECO Recovery Management, we work with patients to ensure that your healthcare establishment gets compensated for the care it provides. In many cases, if a patient is uninsured or underinsured, their medical bills go unpaid, resulting in a loss of revenue and service ability for your organization. We get into the middle of that process to help patients find ways to pay for their care and determine their eligibility for government healthcare coverage programs.
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Policy Basics: Social Security Disability Insurance
Social Security Disability Insurance provides earned benefits for workers who can no longer support themselves through work due to severe impairments.
Social Security Disability Insurance is an integral part of Social Security. Workers contribute to SSDI and earn its protection in case they can no longer support themselves due to a severe and long-lasting disability. The Social Security Administration administers SSDI.
In June 2020, 8.3 million people received disabled-worker benefits from Social Security. Payments also went to some of their family members: 110,000 spouses and 1.4 million children.
SSDI benefits are financed primarily by Social Security payroll tax contributions and totaled about $145 billion in 2019. Thats less than 4 percent of the federal budget and less than 1 percent of gross domestic product. SSDIs share of the payroll tax is now 0.9 percent of earnings up to Social Securitys taxable maximum, currently $137,700. Benefits are paid from the SSDI trust fund, which is legally separate from the much larger retirement and survivors trust fund. The most recent projections estimate that the SSDI trust fund will need replenishment in 2065.
Musculoskeletal System And Connective Tissue
The SSA reports that the largest category of diagnoses among disabled workers receiving disability benefits was diseases of the musculoskeletal system and connective tissue. These disabilities, which represented 32.3 percent of the diagnoses, involve damage to ones nerves, muscles, tendons or ligaments. Examples of this type of disorder include:
- ArthritisAn individual with rheumatoid arthritis, a disorder of the immune system, must experience significant limits on his or her ability to work to qualify for benefits under this medical diagnosis. Rheumatoid arthritis is sometimes referred to as a connective tissue disorder.
- Back pain Abnormal curvature of the spine may affect an individuals ability to walk as well as the function of other body systems. The intensity of back pain and the limitations on an individuals ability to function are considered in a disability diagnosis related to back pain.
- FibromyalgiaFibromyalgia is a complex syndrome in which a person has widespread pain in the joints, tendons, muscles and soft tissues that lasts for more than three months. Claims reviewers will try to assess whether there is adequate evidence to show that the condition limits a persons ability to perform any type of gainful work.
- Reflex Sympathetic Dystrophy RSD describes a range of symptoms that may occur from injury, diseases or surgery. RSD is characterized by intense burning or aching pain typically caused by trauma to a single extremity.
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Who Pays For Disability Insurance Benefits
Workers and employers pay for the DI program with part of their Social Security taxes. Workers and employers each pay a Social Security tax that is 6.2 percent of workers earnings up to a cap of $127,200 in 2017. The cap is adjusted each year to keep pace with average wages. Of the 6.2 percent, 5.015 percent goes to pay for Social Security retirement and survivor benefits and 1.185 percent pays for disability insurance. The combined tax paid by workers and employers for disability insurance is 2.37 percent of wages, while the combined tax for retirement and survivor benefits is 10.03 percent, for a total of 12.4 percent.
Seeking Out The Right Disability Attorney For Your Situation
If you need to file a claim or already have a denial of your private disability insurance benefits, you need the right law firm on your side. At DarrasLaw, we can assist with these disability claims in many different ways:
- Individual policy analysis
- ERISA and group coverage plans
- Private individual plans
- Business overhead expense policies
It is never too early or too late in the claim process to obtain terrific legal representation. Some people believe they should file a disability insurance claim and start receiving benefit payments shortly thereafter. However, this rarely happens, and many private disability insurance companies give claimants the runaround to try to reduce benefits or avoid payment altogether.
Never hesitate to seek legal help at the start of the claim process. Doing so can have many benefits, including speeding up your claim and getting your benefits without unnecessary delays or denials. This is highly beneficial if you are losing monthly income because you cannot perform your occupational duties due to a disability.
If you did not have legal help with your initial claim and you now face delays or denials, you want to contact our private disability insurance attorneys as soon as possible. There are deadlines for appealing benefit denials, and you want us to get started building your appeal case right away.
When you need help with a private disability insurance claim, you want the nations top disability lawyers on your side.
What Information Do I Need To Apply For Benefits
Applicants will need thefollowing information to apply for Social Security Disability:
- Your date and place of birth, as well as your Social Security number
- The name, date of birth, and Social Security number of your current spouse and any former spouses, as well as the dates and places of marriage and dates of divorce or death
- Names and dates of birth of any minor children
- Your bank account and routing numbers if you wish to have Social Security electronically deposit your benefits
- Detailed information about your injuries or illnesses, including contact information for all doctors, hospitals, and clinics that have provided treatment to you
- Names of any medicines you are prescribed and names of any medical tests you are ordered to undergo, as well as the name of the physicians who ordered these medications or tests
- The amount of money you have earned this year and last year
- A copy of your Social Security statement
- The beginning and ending dates of any military service you had before 1968
- A list of up to five jobs you had in the 15 years before you became unable to work and the dates you held those jobs
- Information on any additional benefits, such as workers compensation that you plan to apply for
Social Security may also require you to show documentation to prove your eligibility for benefits, including:
How Much Is The Disability Benefit
The disability benefit is linked through a formula to a workers earnings before he or she became disabled. The following figures show how the disability insurance benefits compare to prior earnings for a worker who became eligible for benefits in 2014 at age 55.
|Earnings Before Disability||Annual DI Benefit|
*Average indexed earnings
The average benefit paid to disabled workers in June 2017 was $1,172 a month or about $14,064 a year.
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What Are Social Security Retirement Benefits
Over 70% of the people receiving Social Security benefits are receiving retirement benefits. The retirement benefit is only available for those who are at least 62 years of age. Eligibility for retirement benefits requires that the recipient has earned at least 40 work credits, with four credits available for each year worked. In 2015, the method of calculating eligibility for work credits changed, assigning one work credit for every $1,220 in earnings as opposed to the amount of time worked.
Social Security retirement benefits can be affected by your age, when you begin to draw benefits, and the average of your 35 highest-earning working years. Theres also a cap on how much can be received as a retirement benefit. Partial benefits can be paid at age 62, with full benefits available at age 65 to 67, depending on your birth year. In most cases, retirees benefit most from waiting until they can receive a full benefit at age 70 because the amount of the benefit increases by up to 8% each year between age 62 and age 70. However, there can be exceptions to this rule and households with retirees who retire at different times should research their options carefully. The difference can mean tens or even hundreds of thousands of dollars in Social Security benefits that you may or may not receive as a household, depending on your choice.
Workers who become disabled later in life may also have the option of filing for disability benefits as opposed to retirement benefits.
Please Answer A Few Questions To Help Us Determine Your Eligibility
Disabled people who are approved for Social Security disability insurance benefits will receive Medicare, and those who are approved for Supplemental Security Income will receive Medicaid. However, SSDI recipients aren’t eligible to receive Medicare benefits until two years after their date of entitlement. For more information on calculating how this is calculated, see our article on when you’ll receive Medicare benefits. There is no waiting period for SSI recipients to receive Medicaid.
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How To Apply For Ssdi
To apply for Social Security disability insurance, you can go online, call a toll-free telephone service at 1-800-772-1213, or visit your local Social Security office.
Before applying, you must fill out the SSAâs Disability Report for adults. This form is lengthy because it goes into deep detail about you and your family, your disability, your employment history, and your general health and treatments youâre undergoing. Youâll also need the following documents, as applicable:
Identification: Birth certificate, proof of U.S. citizenship, lawful alien status, U.S. military discharge papers
Employment history: Tax returns, W-2 forms, or pay stubs
Benefit documents: Anything related to receiving temporary or permanent workersâ compensation or similar benefits, including award letters and settlement agreements
The SSA will ask you many questions, some of which you may have already answered on your Disability Report submission. These may include: