ALAN JOHN CLARK, PAHIGHLY EXPERIENCED PERSONAL INJURY & CIVIL TRIAL LAWYER
Frequently Asked Questions
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Q. Who can get disability benefits under Social Security?
A. Under the Social Security disability insurance program (title II of the Act), there are three basic categories of individuals who can qualify for benefits on the basis of disability:
- A disabled insured worker under full retirement age.
- An individual disabled since childhood (before age 22) who is a dependent of a parent entitled to title II disability or retirement benefits or was a dependent of a deceased insured parent.
- Disabled widow or widower, age 50-60 if the deceased spouse was insured under Social Security.
Under title XVI, or SSI, there are two basic categories under which a financially needy person can get payments based on disability:
- An adult age 18 or over who is disabled.
- Child (under age 18) who is disabled.
Q. How is the disability determination made?
A. SSAs regulations provide for disability evaluation under a procedure known as the “sequential evaluation process.” For adults, this process requires sequential review of the claimant’s current work activity, the severity of his or her impairment(s), a determination of whether his or her impairment(s) meets or medically equals a listing (see Part III of this guide), the claimant’s residual functional capacity, his or her past work, and his or her age, education, and work experience. For children applying for SSI, the process requires sequential review of the child’s current work activity (if any), the severity of his or her impairment(s), and an assessment of whether his or her impairment(s) results in marked and severe functional limitations. If an adult or child is found disabled or not disabled at any point in the evaluation, the evaluation does not continue.
Q. When do disability benefits start?
A. Disability benefits for workers and widows usually cannot begin for 5 months after the established onset of the disability. Therefore, Social Security disability benefits will be paid for the sixth full month after the date the disability began. The 5-month waiting period does not apply to individuals filing as children of workers. Under SSI, disability payments may begin as early as the first full month after the individual applied or became eligible for SSI.
In addition, under the SSI disability program, an applicant may be found “presumptively disabled or blind,” and receive cash payments for up to 6 months while the formal disability determination is made. The presumptive payment is designed to allow a needy individual to meet his or her basic living expenses during the time it takes to process the application. If it is finally determined that the individual is not disabled, he or she is not required to refund the payments. There is no provision for a finding of presumptive disability or blindness under the Title II program.
Q. What can an individual do if he or she disagrees with the determination?
A. If an individual disagrees with the initial determination in the case, he or she may appeal it. The first administrative appeal is a reconsideration, which is generally a case review at the State level by an adjudicative team that was not involved in the original determination. If dissatisfied with the reconsideration determination, the individual may request a hearing before an administrative law judge. If he or she is dissatisfied with the hearing decision, the final administrative appeal is for review by the Appeals Council. In general, a claimant has 60 days to appeal an unfavorable determination or decision. Appeals must be filed in writing and may be submitted by mail or in person to any Social Security office.
If the individual exhausts all administrative appeals, but wishes to continue pursuing the case, he or she may file a civil suit in Federal District Court and eventually appeal all the way to the United States Supreme Court.
Q. Can individuals receiving disability benefits or payments get Medicare or Medicaid coverage?
A.Medicare helps pay hospital and doctor bills of disabled or retired people who have worked long enough under Social Security to be insured for Social Security benefits. It generally covers people who are 65 and over; people who have been determined to be disabled and have been receiving benefits for at least 24 months or have amyotrophic lateral sclerosis; and people who need long‑term dialysis treatment for chronic kidney disease or require a kidney transplant. In general, Medicare pays 80 percent of reasonable charges.
In most States, individuals who qualify for SSI disability payments also qualify for Medicaid. The Medicaid program is referred to by different names depending on the State. The program covers all of the approved charges of the Medicaid patient. Medicaid is financed by Federal and State matching funds, but eligibility rules may vary from State to State.
Q. Can someone work and still receive disability benefits?
A. Social Security rules make it possible for people to test their ability to work without losing their rights to cash benefits and Medicare or Medicaid. These rules are called “work incentives.” The rules are different for title II and title XVI, but under both programs they may provide:
- continued cash benefits;
- continued help with medical bills;
- help with work expenses or;
- vocational training.
For more information about work incentives, ask any Social Security Office for the a publication entitled the “Red Book,” A Summary Guide to Employment Support for Individuals with Disabilities under the Social Security Disability Insurance and Supplemental Security Income Programs. You can access the Red Book online at: http://www.socialsecurity.gov/redbook/index.html
For more information on the Social Security Disability Process – use this helpful link from the Social Security Administration below:
No Fee Unless We Obtain Benefits for You
Free No Obligation Consultation
The Law Offices of Alan John Clark, PA. will go over your Social Security Disability Claim with you.