When you think of “Social Security,” it’s likely that retirement benefits come to mind. But there’s more to it than that. The Social Security Administration (SSA) has two disability benefit plans that were set up under the Social Security Act, a law that commits the federal government to financially assist those persons who are unable to provide for themselves.
The two plans administered by the SSA are Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). Although the initials are similar, the programs are not. Here is a brief overview of the two disability programs administered by the SSA:
SSI is a needs-based program, meaning that the individual with a disability (or family, if the individual is a minor) must have little or no income and resources. In other words, certain income criteria must be met, whether it is earned through a job or unearned through unemployment benefits or other benefit programs. Assets must be less than $2,000. This includes money in checking, savings and retirement accounts, stocks, bonds, mutual funds and other investments including real estate (other than the home in which the person with a disability is living).
In addition to income criteria, the individual must meet SSA criteria for a disability. This includes physical or mental conditions that severely affect a person’s ability to function and have lasted or are expected to last for more than a year. Although this sounds simple, in certain cases it may not be.
“The SSA does, indeed, make it very complicated,” says Tracy Miller, special needs coordinator for Protected Tomorrows, Inc. “Their definitions of what constitutes a disability are sometimes vague and subject to interpretation.”
If disability and income criteria are met, SSI payments are made on a monthly basis. An SSI award, says Miller, is based on income. The maximum award amount for 2006 is $603 per month (this amount will increase to $623 in 2007).
In most states, those receiving SSI are automatically provided health insurance through Medicaid. However, in a few states, this must be applied for through a separate process. Some states also provide SSI recipients with an additional stipend to be used for food and shelter. Those receiving SSI may work; however the monthly SSI payment will be reduced according to the amount of income earned.
SSDI is a benefit individuals are entitled to based on their work history. The SSA takes money from each paycheck through Social Security taxes to insure a worker in the event that he or she becomes disabled before retirement age (and eligibility for Social Security retirement benefits). A person must have worked a sufficient amount of time (depending on age) before becoming disabled to meet eligibility criteria for SSDI. An individual is eligible for SSDI regardless of assets or any unearned income, such as disability payments, through a prior job.
“[SSDI] is about a claimant’s work capacity more so than about his medical condition,” says Jonathan Ginsberg, a disability attorney from Atlanta, Ga. “SSA is trying to determine whether a claimant has the capacity to perform any type of work.”
To be eligible for SSDI, a person must not only be unable to work in the job he or she worked at prior to the disability, but the individual must be deemed unable to adjust to another type of work due to a medical condition that has lasted for at least one year or is expected to result in death. Medical conditions qualifying an applicant for disability are the same as those used by the SSA for SSI applicants.
Monthly SSDI benefits will not be paid until five calendar months after SSDI eligibility begins. Payment amounts are based on an individual’s lifetime average earnings and the age at which the disability occurred. SSDI recipients may apply for health insurance through Medicare 24 months after becoming SSDI eligible and, in some cases, may qualify for Medicaid, too.
You can begin the disability application process by calling the SSA at (800) 772-1213 for an appointment, which will be held at the Social Security office nearest your home. You will be sent application materials to fill out prior to your appointment. You may also apply online at www.ssa.gov.
It’s important to be prepared for the disability interview. The SSA will send you a “Disability Starter Kit” either for a disabled child or an adult (these are also available online). Some of the information you will be requested to bring with you to the interview includes:
- Identification for the claimant (birth certificate and Social Security number) and all household members if the person with a disability is a minor
- Medical records for the individual with a disability, including names of all doctors, therapists, hospitals and clinics that have provided care in the past year
- A list of medications the individual is taking
- A list of social services that are providing resources to the individual
- School records, if the claimant is a child
- Employer information, if the individual with a disability is working
- Proof of income (for the entire family if the family member who has a disability is a minor)
- Proof of assets, including bank statements and any other savings account or investment
During the SSA interview, the claims representative will ask you for all documentation needed to support the disability claim. If medical records are not sufficient to support a disability, the individual with a disability may be requested to have a “consultative exam,” which is an examination by an independent source such as a physician or a psychologist.
It may take up to several months for the SSA to make a decision regarding your disability benefit claim. According to Miller, as many as 65 to 70 percent of self-initiated disability claims are denied.
“Remember, it is the job of the SSA to minimize the amount of money they pay out,” she says. “[However], it is your responsibility to acquire and maintain all of the benefits for which you or your family member is entitled.”
You may dispute the SSA decision by filing a Request for Reconsideration, which must be done within 60 days of receiving a disability claim denial. In most states, this requires that you provide additional information to the SSA so that they may review your case again. In some states, you must request reconsideration by filing an appeal for a hearing of your case before a judge.
Miller advises the help of a special needs planner in negotiating the maze of Social Security disability benefits. This person can help you understand the SSA rules and process and help you file a claim for disability benefits and assist with the appeal process, if necessary.