Frequently Asked Social Security Disability Questions & Answers
If you are disabled and unable to work, you likely have a lot of questions. You may be wondering whether your medical or mental condition qualifies you for Social Security Disability Insurance or Supplemental Security Income benefits. If you have already applied for benefits you likely are wondering what to expect with the Social Security Disability application and appeals process. If you have been denied benefits, you are not alone. Most people who apply for Social Security Disability or Supplemental Security Income benefits are denied at the initial application and reconsideration benefits. At the Law Office of Katherine, we are here to answer your questions and guide you through the process.
Social Security considers you disabled if:
- You cannot do work that you did before;
- You cannot adjust to other work because of your medical condition(s) – meaning you can’t do any other jobs even if it’s not a job you have done in the past; and
- Your disability has lasted or is expected to last for at least one year or to result in death.
The Five-Step Process
Social Security uses a five-step process in order to determine whether you meet the disability criteria described above.
- Are you working? For 2016, if you are currently working and earning over $1,130 per month, generally you are not disabled.
- Is your condition “severe” ? Your medical condition(s) must interfere with work-related activities.
- Is your medical condition on Social Security’s list of disabling conditions? Also known as “listings”, Social Security has a list of medical conditions that are so severe you are automatically found to be disabled if you meet or equal a listing.
- Can you do your prior work? If you don’t meet a “listing” but your medical condition(s) is so severe that you aren’t able to do your last 10 years of jobs.
- If you can’t do your prior work, are there are jobs in the economy that you could do?
If you believe you are disabled and are unable to work you should apply for Social Security Disability benefits right away. In fact, you can apply for SSDI benefits at the same time you apply for California State Disability Insurance (SDI). The process for obtaining Social Security Disability benefits can take a long time, especially if you are denied once, twice or more times! Social Security estimates that it takes 90 – 120 days to process an initial application. However, the wait can be longer. For someone who must wait until the Administrative Law Judge (ALJ) hearing to be awarded benefits, the wait time from the initial application to ALJ decision can easily be two years!
If you cannot apply for benefits right away but know that you plan on filing you can contact Social Security to get a “protective filing date”. Essentially this means that you have notified Social Security that you intend to file for benefits within the next few weeks or months. This becomes your application date. An earlier date can make a difference in the amount of back pay you are owed. For more information see Protective Filing Date.
Applying for Social Security Disability Insurance (SSDI)
There are three options for applying for SSDI benefits.
- Apply online through the Social Security Administration website at www.ssa.gov/applyfordisability/
- Call Social Security at 800-772-1213 to set up an appointment to apply in person; or
- Walk into your local Social Security field office and apply in person without an appointment. Find your local field office by visiting https://secure.ssa.gov/ICON/main.jsp
Applying for Supplemental Security Income (SSI)
Currently most claimants applying for SSI are not able to do so online. You must visit your local field office and apply in person. You are eligible to apply for SSI benefits online if you meet the following requirements:
- Are between the ages of 18 and 65;
- Have never been married;
- Aren’t blind;
- Are a U.S. citizen residing in one of the fifty states, District of Columbia, or the Northern Mariana Islands;
- Haven’t applied for or received SSI benefits in the past; and
- Are applying for Social Security Disability Insurance at the same time as your SSI claim.
It can take a long time to receive Social Security Disability or Supplemental Security Income benefits if you aren’t approved on your initial application. In fact, if you have to appeal multiple times the process can take years. Here’s a break down of what you can expect at each level. Keep in mind that these are only estimates and you may receive a decision faster or slower depending on a number of factors including the complexity of your case, medical record collection and the hearing office location wait times. Average wait times can also change.
Initial Application: Once you apply for Social Security Disability or Supplemental Security Income you can expect to receive the Initial Determination in about 3 – 4 months. But you could receive a determination in as little as 30 days or as long as 6 months.
Reconsideration: If you are denied at the Initial Level you will have 60 days to appeal. The decision on Reconsideration takes about as long as the Initial Determination and you can expect to wait about 4 months.
Administrative Law Judge Hearing (ALJ): If you are denied at the Reconsideration level you will have 60 days to appeal. Wait times for a hearing before a judge greatly vary depending on your location. Each Office of Disability Adjudication and Review has different average wait times depending on the number of cases and judges. Currently the average wait time at Sacramento ODAR is 16 months. Once you have your hearing the judge will typically issue her decision in 60 days. However, this is not a hard deadline. It’s not unheard of for it to take 6 months to receive the judge’s decision.
Appeals Council: At this point, you may be 2 years from the point you applied for disability benefits! If you are denied at the ALJ hearing level, it is a good idea to talk to your attorney regarding whether you have the option of reapplying for benefits or if you should continue appealing. If you appeal the judge’s determination to the Appeals Council you can expect to wait another 12 – 18 months to receive their decision. In many cases the Appeals Council decides to remand (send back) the case to the Administrative Law Judge. The Appeals Council can also refuse to review the matter, in which case you will need to file in Federal District Court, or approve or deny the case.
Whether you are thinking of applying for Social Security Disability benefits for the first time or have been denied benefits it’s a good idea to consider hiring a local, Sacramento/Stockton Social Security Disability attorney.
- In 2014 Social Security received 2,485,077 applications for disability benefits.
- In 2014, Social Security approved 22.4% of all initial SSDI and SSI applications. https://www.ssa.gov/policy/docs/statcomps/di_asr/2011/sect04.html
- At the Sacramento Office of Adjudication and Review the approval rate at the Administrative Law Judge hearing level is 50%. The approval rate varies greatly by judge with approval rates ranging from 25% – 64%.
As you can see the Social Security Disability process is long and challenging. If you aren’t approved on your initial application you should appeal the decision. A good, local Social Security Disability attorney will help you prepare your case by collecting relevant medical evidence, meet with you to prepare for your hearing with the judge and represent your case to the judge in a clear, concise and compelling manner. Not only can an attorney help you to win your case but an experienced attorney can also help increase the amount of your back pay by arguing the earliest possible onset date.
- Trial Work Period (TWP): This allows you to “test” your ability to work for a period of nine months. During your TWP you will continue to receive your full SSDI benefits regardless of how much you earn so long as you report your work to Social Security and continue to have a disability. For 2017, a month is counted as toward your TWP if you earn over $840.00. For people who are self-employed, the calculation is a little different – the month counts toward your TWP if you earn more than $840 (after expenses) or work more than 80 hours in your own business. The TWP continues until you have worked 9 months within a 60-month period.
- Extended Period of Eligibility: After you have completed a Trial Work Period, you have 36 months during which you can work and still receive benefits for any month that your earnings aren’t “substantial”. For 2017, earnings over $1,170 ($1,950 for the blind) are considered to be “substantial”.
- Expedited Reinstatement: If your SSDI benefits stop because you have substantial earnings, you have five years to ask us to restart your benefits if you are unable to work because of your condition. You are not required to file a new application.
- Continued Medicare: If your Social Security Disability benefits stop because of your earnings but you are still disabled, your free Medicare Part A coverage will continue for at least 93 months after the 9-month work period. After that time you can still buy Medicare Part A coverage for a monthly premium. If you have Medicare Part B, you must continue to pay the coverage to keep it.
- Work expenses related to your disability: If you work and have to pay for certain items or services related to your disability (i.e. a car service instead of public transportation or counseling services) Social Security might deduct those expenses from your monthly earnings in determining your eligibility for benefits.
Disability Benefits for Work Related Injuries
Some disabilities are the result/or caused in part by work-related injuries. If you have suffered a work-related injury you may be entitled to workers’ compensation benefits, which are paid by your employer or your employer’s insurance carrier. In California, you can receive up to 2 years of workers’ compensation temporary disability benefits. This is in addition to any permanent disability benefits you may be entitled to. Permanent disability benefits typically start being paid once your temporary disability benefits have stopped. They are paid every two weeks. Once your case is settled, you will likely receive any remaining owed permanent disability benefits as a lump sum.
If you have a serious work related injury and your disability is expected to last for at least 12 months or death, you may also qualify for Social Security Disability benefits.
When Should You Apply for Social Security Disability Benefits?
You do not need to wait for your workers’ compensation benefits to stop to apply for Social Security Disability! In most cases, I recommend that my client apply for Social Security Disability right away. So, if you believe you are disabled and are unable to work, you should apply for Social Security Disability benefits even if you are still on workers’ compensation.
The same is true if you are on California State Disability Insurance. In fact, you can apply for SSDI benefits at the same time you apply for California State Disability Insurance (SDI). However, you cannot receive the full amount of Social Security Disability Benefits if you are also receiving workers’ compensation benefits or state disability. (I explain more about how your benefit amount is calculated in these situations below.) So, why would I recommend applying for Social Security Disability benefits if you are already receiving workers’ compensation or State Disability Insurance?
Why You Should Not Wait to Apply for Social Security Disability Insurance
Because, the process for obtaining Social Security Disability benefits can take a VERY long time, especially if you are denied once, twice or more times! Social Security estimates that it takes 90 – 120 days to process an initial application. However, the wait can be longer and it is not unheard of for applications to take six months to process. For someone who must wait until the Administrative Law Judge (ALJ) hearing to be awarded benefits, the wait time from the initial application to ALJ decision can easily be two years!
Social Security Disability Benefits Amount if You Receive Workers’ Compensation or State Disability Insurance
If you are approved for Social Security Disability benefits for the same time period that you receive another disability benefit (State Disability or Workers’ Compensation temporary or permanent disability), Social Security will off-set/reduce your Social Security disability benefit. The rule states that the combination of a person’s Social Security Disability benefits + State Disability Insurance + Workers’ Compensation benefits cannot exceed 80% of average monthly earnings. However, once the worker reaches age 62, only 25% of Social Security Disability benefits are used in this formula. Benefit off-sets can be complicated, so if you are receiving a combination of the above benefits it’s a good idea to discuss this with your workers’ compensation and/or Social Security Disability attorney.