Disability Advocacy Center SSDI/SSI 101

The number of people grappling with a disability in the U.S. is approximately 57 million – or 1 in every 5 people, according to the U.S. Census Bureau.

The agency uses a very broad definition of “disability,” but both the number and percentage of people with severe disabilities has risen substantially in recent years. That has meant the number of people needing assistance has increased as well. New research has shown the average 20-year-old worker today has a 1-in-4 chance of becoming disabled before reaching full retirement age.

At Jeffrey Glassman Injury Lawyers, our dedicated Boston disability lawyers are committed to assisting clients in obtaining the benefits to which they are entitled. Although 41 percent of disabled persons between the ages of 21 and 64 are gainfully employed, there are still higher rates of unemployment and poverty within this group as compared to their non-disabled peers.

From the federal government, the two key programs that can help provide assistance to disabled persons prior to retirement age are:

• Social Security Disability Insurance (SSDI)
• Supplemental Security Income (SSI)

There are some key differences between these two programs, though both are administered by the Social Security Administration. There is much that is misunderstood about these programs – both by applicants and the general public.

With this Disability Advocacy Center, our SSDI attorneys and SSI lawyers seek to provide in-depth information that can provide insight and assistance.

Despite a presumption that disability benefits are relatively easy to obtain, the reality, according to the Social Security Administration (SSA), is that just 45 percent of claims filed from 2001 to 2010 had a final award rate. And that final award rate is only after a significant fight. The percentage of applicants awarded benefits at the initial claims level averaged 28 percent over that 10-year timeframe.

This is not to say obtaining benefits is impossible. However, successful applicants almost always have an experienced disability attorney at their side.

Social Security Disability Insurance is a type of federal benefits program provided by the SSA to individuals who become disabled after paying into the system through taxes out of their previous wages.

So in order to determine Who Is Eligible for SSDI, one must ask whether claimant:

• Has worked in jobs covered by Social Security;
• Has a condition that meets the SSA’s definition of disability.

Usually, that definition includes being unable to work for a year or more due to disability.

In order to qualify, a person must have earned enough work “credits.” When a person works and pays Social Security taxes, he or she can earn up to four credits for each year. Credits are based on total wages and self-employment income in a single year. The amount it takes to qualify each year changes. As of 2015, a person had to make $1,220 in covered earnings to get one Medicare or Social Security work credit, and $4,880 to obtain the maximum four credits.

Unless a person is disabled due to blindness, he or she typically must earn at least 20 credits in the decade immediately prior to becoming disabled in order to qualify for SSDI benefits. The exact amount of credits needed depends on the person’s age at the time he or she became disabled.

The question of whether a disability is covered under the program can usually be answered by reviewing the SSA’s Listing of Impairments, which covers everything from musculoskeletal system dysfunction to special senses and speech programs to mental disorders.

Supplemental Security Income (SSI) is a federal income supplement program that is paid for with general tax revenue, as opposed to Social Security taxes. That means claimants need not have necessarily paid into the program by working in order to obtain it.

So Who is Eligible for SSI?

It is essentially designed to provide those who are aging, blind, disabled and have little or no income with:

• Food
• Clothing
• Shelter
• Other basic needs

Both children and adults may qualify for SSI benefits.

Children under 18 may be considered disabled if they have a physical, mental or emotional impairment or learning problem that severely limits their functional ability, is expected to result in death or has lasted for at least a year.

Adults over 18 may be considered disabled if impairment results in the inability to do any kind of gainful activity, is expected to result in death or lasts for at least a year.

Both income and resources will be considered. This will include money earned from work, as well as what is received from sources like workers’ compensation, unemployment, Veterans’ Affairs, friends and relatives and any resources or assets that could be converted to cash for food or shelter.

The purposes served by SSDI and SSI are similar, but the Differences Between SSDI and SSI are distinct. While both serve impoverished, disabled populations, SSDI is available to those with a work history who have accumulated sufficient work credits, while SSI is available to anyone who is disabled and has a financial need.

They are paid for by different sources. SSDI is covered by taxes, paid into by recipients, while SSI is covered by funds from the U.S. treasury.

Medical eligibility is generally determined in the same manner for both programs. However, while spouses and other dependents may receive benefits under SSDI, the same is not true for dependents or spouses of SSI recipients.

In short: Yes.

In cases where an individual meets the qualifications for both SSDI and SSI, claimants can get both. This is called a concurrent claim. Usually, this happens when a person qualifies for SSDI, but only receives a low monthly payment, typically the result of either earning low wages or not having worked much in recent years.

The SSI program is based on the federal benefit rate, which as of 2015 was $733. So if you qualify for SSDI benefits, but receive less than this amount, you may qualify for SSI benefits too.

Keep in mind, however, that these benefits do not “stack.” That is, you won’t receive the entire amount you may qualify for each program and add them together. Rather, your SSI payment will be reduced by the amount of your SSDI payment in order to meet the maximum SSI payment amount.

A disabling condition can be extremely distressing in terms of anxiety over finances. With so many people living paycheck-to-paycheck, even missing a couple weeks of work can be crippling to some households.

There may be benefits available to those affected through both short-term disability and long-term disability, but the source will depend on a number of factors. There are many key differences when comparing Long-Term vs. Short-Term Disability.

Short-term disability claims are typically available through either a private insurance company or programs like workers’ compensation. Neither the SSI or SSDI programs provide benefits for those with short-term conditions. In most cases, individuals eligible for these programs need to suffer either a terminal illness or a condition expected to last at least a year.

There may also be unemployment benefits available, depending on the individual’s situation.

Most short-term policies provide coverage for up to six months’ off work, though workers’ compensation benefits may be paid on a longer-term basis, and sometimes for life.

SSDI and SSI benefits are usually available until one reaches retirement age, at which point recipients usually apply for social security benefits for the elderly.

Although securing benefits through SSDI and SSI can be a challenge, the SSA has made an effort in recent years to hasten the process for those with certain medical conditions that are so serious, they obviously meet the disability requirements.

The ways to achieve Expedited Claims include:

• Quick Disability Determination (QDD)
• Compassionate Allowances (CAL)
• Terminal Illness Cases (TERI)

With Compassionate Allowances, the goal is to swiftly identify certain diseases and other medical conditions that are going to qualify under SSA’s List of Impairments, even when considering minimal objective information.

So while some disorders or illnesses may require extensive consideration by the SSA to determine whether a condition qualifies, a simple diagnosis of a condition on the Compassionate Allowances list may be sufficient to obtain benefits.

QDD claims are flagged internally for the fast-track. In TERI cases, a determination for such designation can be made either directly by claimant or indirectly according to the description of the condition.

This does not mean people with those conditions don’t need an experienced Massachusetts disability lawyer. There’s always a chance there could be complication, and it’s usually in a patient’s best interest to secure benefits as quickly and seamlessly as possible. We can help.

Figuring out How Benefits Are Determined depends on whether you are applying for SSDI or SSI or both.

Both programs base eligibility on the condition that claimant suffers total disability, which is generally defined in both programs as a physical, mental, emotional or learning impairment that substantially limits one’s ability to function or engage in gainful activity.

If a person is applying for SSDI, benefits will be determined on a point-system that analyzes previous “work credits.” Simply put, the longer a person previously worked and the more income he or she made, the higher the benefits will be, subject to a statutory cap.

The Social Security Administration does a good job of explaining How You Earn Credits through working in a job and paying Social Security taxes.

Meanwhile, SSI applicants will receive benefits on the basis of financial need. So benefits can range from $1 to $733 (as of 2016), or up to $1,100 for a couple. In some cases, supplemental payments may be available through the state. The Massachusetts State Supplement Program (SSP) provides for certain recipients who are over 65, blind or disabled.

In some cases, a person may have income that is too high for a federal SSI payment, but could still qualify for an SSP payment.

Figuring out What Type of Benefits Can Be Received will depend on a myriad of factors. SSI and SSDI are available to provide financial aid to those who are disabled. SSI is based solely on an income-and-asset basis, while SSDI is calculated based on one’s work history.

These benefits may be paid in addition to any unemployment benefits, workers’ compensation claim or personal injury lawsuit. These benefits may help claimants:

• Pay the bills
• Visit the doctor
• Fill prescriptions
• Provide for their families

In general, there are not varying degrees of disability with SSI and SSDI, the way there are with workers’ compensation. Only those with qualifying total disabilities (terminal illnesses or conditions lasting a year or more) are eligible.

Disabled worker and auxiliary benefits may cover:

• Disabled worker
• Spouse of disabled worker
• Child of disabled worker

SSDI is calculated based on age, income, number of years worked and anticipated date of retirement. On average, SSDI covers 40 percent of one’s pre-retirement income.

For SSI, the maximum monthly amount that can be received (as of 2016) is $733 for eligible individual and $1,100 for an eligible individual with an eligible spouse. Married couples have a number of options when applying, assuming they are both eligible.

Payments may be reduced by subtracting monthly countable income, but could alternately be increased under the Massachusetts State Supplement Program (SSP).

If you are preparing to file for SSDI or SSI benefits, understand that your chances of being DENIED – especially in the initial application process, are high. Even the final award rate, per the SSA, is only 45 percent.

Your chances of success greatly improve when you retain the services of an experienced Boston disability lawyer. This is why when we are asked, “Do I Need An Attorney?” the answer is usually yes.

This is especially true considering reason for the claim has to do with a person’s inability to function or engage in meaningful gainful activity.

Although there is no legal requirement to hire an attorney, one’s ability to competently navigate the process could be detrimental to the claim. A knowledgeable disability lawyer can help quickly gather necessary medical evidence to prove severity of claimant’s ailment and other eligibility requirements. This can save substantial time and money.

It should be said that it is possible to win a claim without a lawyer. However, the chances of success markedly decrease without legal help.

It’s important when filing a claim for disability benefits – whether through SSI or SSDI – to seek legal help early on in the process. This can help claimants avoid any major missteps.

There are generally two types of representatives who can help with these claims: Organizations and attorneys. The benefit of working with a law firm is that claimants will have someone with legal knowledge and backing both through the administrative and court process.

Experience does matter in these cases. Some relevant questions to ask when Choosing an Attorney include:

• How long have you been in business?
• What is your success rate?
• How many people will work on my file?
• Will you attend appointments and hearings with me?
• Is there a limit to the number of times I can call with questions?
• How often will you check on my claim?
• Will I receive regular status reports?
• How many cases does the attorney handle on average?
• How long will the process take?

You want an attorney who will be professional, courteous and competent.

The perceived cost of Paying An Attorney is one thing that usually drives many people away from legal consultation. However, it’s important to understand that first of all, most attorneys accept these cases on a contingency fee basis. That means claimants don’t pay anything unless they win the case.

Federal law typically limits the fee charged by SSDI and SSI lawyers to 25 percent of one’s back pay or $6,000 – whichever is less. Back payments are those benefits that accrued while one was waiting for a claim to be approved.

In preparing to initiate a claim, we are often asked, “How Long Does it Take?” The answer is anywhere from 3 to 6 months to get an initial decision from the Social Security Administration regarding SSI or SSDI benefits.

However, if a claim is denied and must go through the process of reconsideration and hearing before an Administrative Law Judge, it can take up to 2 years to have a judge assigned to the claim. For the Boston field office, the average wait time for a hearing is 12 months.

Many variables can play into the ultimately timeline, including:

• The stage of the claim
• The state where you live
• The responsiveness of doctors to provide necessary records
• Whether the case is singled out for quality review
• Whether the case can be expedited

Having an experienced Massachusetts disability lawyer can significantly reduce the amount of time a case might drag on due to insufficiency of certain records or evidence. Knowing what’s needed upfront can help streamline the process.

Social Security disability claims are processed through local field offices of the Social Security Administration, formally referred to as Disability Determination Services (DDS).

So What Is the Claims Process? Typically, a claim will proceed like this:

• Initiated via phone application, in-person interview at a Social Security Administration office or online.
• Completed applications sent to the DDS and assigned to examiners who make eligibility decisions.
• Checking in periodically with the DDS can sometimes help speed up the process.
• If a claim is denied, one can ask for reconsideration, which is a complete review of the claim by someone who didn’t take part in the first consideration.
• If the reconsideration still results in a denial, one can request a hearing conducted by an administrative law judge.
• If the hearing still results in a denial, claimant can request a review by the Social Security Appeals Council. The council can reject review, but if it accepts, it may issue its own decision or remand to the administrative law judge for further consideration.
• If claimant disagrees with the Appeals Council’s decision (or if the Council declines to review the case), it may be appealed to the federal district court.