Social Security Disability Overview

Social Security disability is an insurance program for the severely disabled.

Eligibility. To qualify for Social Security disability benefits, you must have worked long enough and recently enough under the rules. Generally, you must have worked at least 5 years in the last 10 years, ending with the year of disability. However, younger workers may qualify with fewer work credits. The rules for younger workers are as follows:

Before age 24 - you may qualify if you have worked at least 18 months in the 3 year period ending when your disability starts.

Age 24 to 31 - you may qualify if you have worked half the time between age 21 and the time you became disabled.

Who can get Social Security disability benefits? You can receive Social Security disability benefits at any age. Generally speaking, however, it is more difficult for younger individuals to be found disabled than claimants of more advanced age. If you are receiving disability benefits at age 65, they will become retirement benefits, although the amount remains the same. Certain members of your family may also qualify for benefits on your record. They include:

• Your unmarried son or daughter, including a step-child, adopted child, or in some cases, a grandchild. The child must be under 18, or under 19 if in high school full time.
• Your unmarried son or daughter, 18 or older, if he or she has a disability that started before 22.
• Your spouse who is 62 or older, or any age if he or she is caring for a child of yours who is under 16 or disabled and also receiving checks.

Certain family members may qualify for disability benefits if you should die. They include:

• Your disabled widow or widower, 50 or older. this disability must have started before your death or within 7 years after your death.
• Your disabled ex-wife or ex-husband who is 50 or older if the marriage lasted 10 years or longer..

DEFINITION OF "DISABILITY." Disability under Social Security is based on an inability to work. Social Security will only consider you disabled if you are unable to do any kind of work for which you are suited and your disability is expected to last for at least 1 year or to result in death. Social Security does not pay for partial disability or for short-term disability.

Social Security utilizes a step-by-step process involving 5 questions to determine if you are disabled. They are:

1. Are you working? If you are and your earnings average more than $500 a month, you generally cannot be considered disabled.
2. Is your condition "severe?" Your impairments must interfere with basic work-related activities for your claim to be considered.
3. Is your condition found in a list of disabling impairments? Social Security maintains a list of impairments for each of the major body systems that are so severe they automatically mean you are disabled. If your condition is not on that list, Social Security has to decide if it is of equal severity to an impairment on the list. If it is, your claim is approved. If it is not, Social Security goes to the next step.
4. Can you do the work you did previously? If your condition is severe, but not at the same or equal severity as an impairment on the list, then Social Security must determine if it interferes with your ability to do the work you did in the last 15 years. If it does not, your claim will be denied. If it does, your claim will be considered further.
5. Can you do any other type of work? If you cannot do the work you did in the last 15 years, Social Security then looks to see if you can do any other type of work. Social Security considers your age, education, past work experience, and transferable skills, and it reviews the job demands of occupations as determined by the Department of Labor. If you cannot do any other kind of work, your claim will be approved. If you can, your claim will be denied.

RULES FOR BLIND PERSONS. You are considered blind under Social Security rules if your vision cannot be corrected to better than 20/200 in your better eye, or if your visual field is 20 degrees or less, even with a corrective lens.

There are a number of special rules for persons who are blind. The rules recognize the severe impact of blindness on a person's ability to work. For example, the earnings limit for people who are blind is generally higher than the $500 limit that applies to non-blind disabled workers. This figure changes annually.

HOW TO APPLY FOR DISABILITY BENEFITS. You should apply at any Social Security office as soon as you become disabled. You may file by phone, mail, or by visiting the nearest office. However, if your claim is approved, Social Security disability benefits will not begin until the 6th full month of disability. This "waiting period" begins with the first full month after the date Social Security decides your disability began.

The initial claims process for disability benefits is generally longer than for other types of Social Security benefits -usually from 60 to 90 days. It takes longer to obtain medical information and to assess the nature of the disability in terms of your ability to work. It would be helpful to bring certain documents with you when you apply. These include:

• Social Security number and proof of age for each person applying for benefits. This includes your spouse and children, if they are applying for benefits.
• Names, addresses, and phone numbers of doctors, hospitals, clinics, therapists, and institutions that treated you and dates of treatment.
• A summary of where you worked in the past 15 years and the kind of work you did.
• A copy of your W-2 form and federal income tax return for the past year.
• Dates of prior marriages if your spouse if applying.

When you apply, the Social Security Administration will require you to sign medical "releases" so that copies of your medical records can be obtained. Additional medical information may also be needed before Social Security can decide your case. Furthermore, you may be asked to take a special medical examination called a "consultative examination". Social Security will pay for this examination and for certain travel expenses related to it.

Once a decision on your claim is reached, you will receive a written notice from the Social Security Administration. If your claim is approved, the notice will show the amount of your benefit and when payments start. If it is not approved, the notice will explain why.

IF YOUR CLAIM IS DENIED. If your claim is denied or you disagree with any other decision Social Security makes, you may appeal the decision. There are four levels of appeal:

1. Reconsideration. One has 60 days to request reconsideration of a decision of denial. Additional information may be supplied to Social Security with the request for reconsideration.
2. Administrative law judge. Within 60 days of denial of reconsideration, you can request a hearing before an administrative law judge. If you fail to request a hearing within 60 days, the appeal process stops unless you have a very good reason for not filing it within 60 days. It is a good idea to ask a lawyer for assistance in requesting a hearing and in the hearing process.
3. Appeals Council review. A denial by the administrative law judge can be appealed by filing a request for review of the hearing record with the Appeals Council. A review may be granted for an abuse of discretion by the administrative law judge, for an error of law, or if the judge's findings were not supported by substantial evidence.
4. Federal Court. If the Appeal Council's review (or request for review) is denied, a complaint may be filed in federal district court within 60 days of the denial of the appeal by the Appeals Council.

It is important to note that many, many legitimate disability claims are denied initially and at the reconsideration level. Oftentimes, benefits are not granted until an administrative law judge hears the case following the initial denial and reconsideration denial.

LEGAL FEES. All legal fees must be approved by the Social Security Administration. Generally speaking, if you hire a lawyer on a contingent fee basis, the legal fee is limited to 25% of past due benefits up to a maximum of $4,000. Social Security will usually withhold up to 25% of past due benefits to pay your lawyer. In the event of a successful appeal to federal court, the federal government, not you, may be responsible for paying the successful lawyer at a reasonable hourly rate.

This article provides a very general overview of the Social Security disability program. The information it contains is not intended to cover all provisions of the law. For specific information about your case, contact Social Security or an attorney.