While many are familiar with collecting Social Security benefits due to retirement or age, Social Security also provides benefits to injured individuals who are unable to work and meet the stringent disability requirements. Under the Social Security Act (hereinafter “the Act”) the Social Security Administration provides two programs for those who have become disabled before retirement age: (1) Social Security Disability Insurance (“SSDI”) and (2) Supplemental Security Income (“SSI”). Social Security has both medical and non-medical rules an individual must meet in order to qualify.
What is the Difference between SSDI and SSI?
While there are several differences between the two disability programs, the following will provide a general overview of both. To be eligible for SSDI, a disabled individual must meet the “insured” status requirements under the Act—this means that they must have worked long enough—and recently enough—in order to qualify for the program. In other words, SSDI recipients are “insured” because they have worked for a certain number of years while making contributions to the Social Security trust fund in the form of FICA Social Security taxes.
If the individual does not meet the insured status, they will not qualify for the SSDI program. However, it is anticipated that a disabled individual may still need benefits if they have either never worked or do not meet the insured status as required by SSDI—these particular individuals may apply for SSI. Since SSI is considered a needs-based program, one of the many requirements to qualify is that an individual cannot have more than $2,000 in countable resources and if married, the couple may not have more than $3,000 in countable resources. Under Social Security standards, countable resources include but are not limited to, cash, bank accounts, stocks, U.S. savings bonds, land, life insurance, personal property, vehicles, et cetera. Countable resources do not include the home you live in and the land it is on, one vehicle, household goods, et cetera. For an exhaustive list of what is considered countable resources for SSI purposes, click here. While there are differences between these two programs, the Social Security Administration manages both programs and the medical eligibility for disability is determined in the same manner.
Who is “Disabled” Under the Act?
Under the Act, “disabled” is a term of art and has a specific meaning. An individual cannot rely on common sense to tell who is or who is or is not “disabled” under the Act. Congress has defined the term “disability” for both SSDI and SSI as an inability “to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which can be expected to last for a continuous period of not less than 12 months.” 42 U.S.C. §§ 423(d)(1(A) and 1382c(a)(3)(A). The individual applying for disability benefits must be unable to work for a minimum of 12 months and Social Security uses a strict set of standards to determine whether the individual is in fact disabled according to their rules.
What are the Benefits?
Overall, Social Security provides three main benefits: (1) back pay for lost time during which the individual was unable to work; (2) monthly benefits for the present inability to work; and (3) medical care. While many are quick to ask, “How much will my benefits be?” there is no one size fits all answer. An individual’s benefits will depend on whether they are receiving SSDI or SSI. If they are receiving SSDI, then the monthly amount will depend on their earnings and if receiving SSI, it will depend on any assets or income the individual may have. SSDI medical benefits are provided through Medicare and SSI medical benefits are provided through Medicaid.
How do I Apply?
First, the claimant will file an initial application with the Social Security Administration. A large majority of claims are initially denied. Specifically, about 70% of initial claims are denied by the Social Security Administration. The initial denial will trigger a 60-day deadline to appeal the initial decision or benefits may be lost. This first level of appeal is the request for reconsideration. If that appeal is denied, then another 60-day deadline is triggered and the claimant will have an opportunity to testify in front of an Administrative Law Judge at a hearing. While a claim may take over a year or two to complete, a favorable outcome provides substantial benefits to the primary beneficiary and any secondary recipients
Mastagni Holstedt Can Help
Please be advised this article did not provide all factors that Social Security will take into consideration when determining whether an individual is disabled. This is simply a brief overview of the Social Security process. If you or a loved one are considering applying for Social Security disability benefits, or even if you have already initiated the process, and would like some assistance, contact Mastagni Holstedt today. The Social Security process can be difficult and at times intimidating. Communicating with the Social Security Administration can be challenging, especially at the more advanced levels of appeal. Please know that you and your loved ones do not have to undergo this stressful process alone. Mastagni Holstedt has an experienced team of lawyers and paralegals ready to help you. Contact Mastagni Holstedt for a free consultation.