Social Security
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What is Social Security Disability Income (SSDI) and Supplemental Security Income (SSI)?
Requirements for qualification (SSDI):
SSDI (aka Title II benefits) is for individuals who have severe impairments that have kept them or will result in keeping them from being gainfully employed for at least 12 months. SSDI is virtually the same benefit amount as full retirement. It usually takes getting to a hearing before an Administrative Law Judge (ALJ) to get a Fully Favorable decision. 90% of cases are denied at the initial level. There are two levels of appeal after the first denial. These are 1) Request for Reconsideration and 2) Request for Hearing before an Administrative Law Judge.
In order to qualify for SSDI, you must be disabled for at least a 12 month period, and you must have also worked to earn enough “credits.” The normal requirement is a total of 40 credits, 20 of which must have been earned in the 10 years prior to the onset of disability. A “credit” is earned each quarter when FICA taxes are taken out of your paycheck. Normally, this means that a person must have a fairly consistent work history and have worked (and paid Social Security taxes) for a combined five of the ten years prior to becoming disabled.
Requirements for qualification (SSI):
SSI (aka Title XVI benefits) is a supplement that is given on an as needed basis to those who are found to be disabled. You can qualify for SSI even if you have not earned enough credits to qualify for SSDI. It is designed to help the elderly, blind, or disabled who have little or no income or work history.
A person seeking assistance through SSI for disability purposes still needs to prove disability in the same way as in SSDI. The added requirement under SSI is that you have to prove that you have limited income and assets.
The SSI limits for the value of assets (excluding assets such as your primary residence, wedding/engagement ring, and one automobile) are:Individual/Child
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$2,000
Couple
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$3,000
Who is eligible for Social Security Disability?
- results in marked and severe functional limitations; and
- can be expected to result in death; or
- has lasted or can be expected to last for a continuous period of not less than 12 months.
- results in the inability to do any substantial gainful activity; and
- can be expected to result in death; or
- has lasted or can be expected to last for a continuous period of not less than 12 months.
How does Social Security decide if I am disabled?
The SSA takes the following under consideration when determining your claim:
- What severe impairment prevents you from working? (This should be supported by medical evidence.)
- Your past relevant work history for the last 15 years.
- You age and education to determine whether you can be retrained to do a less demanding job.
For SSI the Social Security Administration will use the above as well as a look at your finances and assets for determining your claim.
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When should I/can I apply for Social Security?
You should apply for disability benefits as soon as you have determined that you can no longer participate in any substantial work activity. The disability application process is very long and can take up to 18 months for a final determination to be made. For this reason, it is important to apply for disability benefits the moment you realize that you can no longer work.
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How do I apply or submit a claim for Social Security disability benefits or SSI?
Initial Application can be filed in 1 of 3 ways:
- In person at your local SSA Office
- Over the phone by calling: 1-800-772-1213
- Or online at www.ssa.gov (Part I Disability Application; Part II: Disability Report)
If you are denied, the next step is an Appeal for Reconsideration. If denied again, you can appeal a second time and Request a Hearing before an Administrative Law Judge. The best chances of winning a social security disability claim are at the hearing level.
If you would like to also apply for SSI benefits, you need to call 1-800-277-1213 to file a separate claim.
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How much money will I receive if I am awarded Social Security Disability and/or SSI?
The amount of your SSDI benefit is determined by the Social Security Administration by looking at your earnings history in the past 15 years and determining an average using a special calculation. Since your benefit amount is based on your earnings history, every individual will have a different benefit amount.
You will receive SSDI back pay going back to the onset date of your disability. However, under no circumstances, will the back pay be retroactive for more than one year from your application date. That is why it is important to apply as soon as you recognize that you will be out of work for a year. There is also a five month waiting period before you start receiving SSDI benefits. For example, if you are found to be disabled as of June 1, 2008, your benefits would start November 1, 2008.
There is no five month waiting period for SSI. However, SSI is not retroactive from the date of the application. Meaning that your back pay only goes back as far as your application date, regardless of when the SSA finds you disabled.
The 2010 monthly maximum SSI payment is $674.00 for an individual and $1,011.00 for a couple. Depending on the individual’s living arrangements and other resources, this number might be reduced to take those circumstances into account. For instance, the value of room and board will be subtracted if you are living with a family member and not paying rent.
You also are eligible for Medicare 29 months from the onset date of your disability. Using the example above, if your onset date is June 1, 2008, then you would be eligible to participate in Medicare as of November 1, 2010.
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How long does it take to get notified of a decision about disability benefits?
An average claim will take up to 18 months from beginning to end. Each step has its own common time frame:
Initial Application: 3-5 months
Reconsideration: 3-5 months
Hearing Request: 6-12 months Can I apply for Social Security benefits if I am already receiving Workers' Comp?
Yes. If you are granted Social Security Disability Benefits while still receiving workers’ compensation benefits, your disability benefits will be offset by the total monthly workers’ compensation benefit amount.
If you receive a lump sum workers’ compensation settlement, then you need to make sure that there is language in the workers’ compensation settlement that prorates your settlement over the course of your life expectancy. The final monthly proration amount will be your new offset for your disability benefits until you reach your full retirement age. If you do not include this proration language, the SSA will continue to offset your disability checks by the full amount of your workers’ compensation benefits.
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Do I need to have an attorney to receive the benefits that I am entitled to?
No, you can file for disability benefits on your own. It is best to seek the assistance of an attorney to file the appeal once you have been denied. The disability process can be long, tedious and complicated. Most applicants prefer to have the assistance of an attorney when filing the Request for Reconsideration. An attorney is also helpful if there is a workers' compensation claim involved so the offset language can be properly included and benefits calculated.
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How much will a lawyer charge for handling my case?
The attorneys’ fee is a contingency fee arrangement, meaning that there is no money paid up front to an attorney. An attorney’s fee is based on 25% of the back pay awarded (including both SSDI and SSI). However, the attorney’s fee is also subject to a fee cap set by the SSA. Currently, the fee cap is $6,000.00, but this amount changes from time to time. In other words, the fee is 25% of the back pay but in no event more than $6,000.00. This does not include the costs that an attorney will advance on your behalf to obtain your medical records and other evidence. You are responsible for these costs in addition to the attorneys’ fee. If you do not win your case, or if you win and there is no back pay awarded, then the attorney typically does not charge a fee.
If you are awarded back pay after using the assistance of an attorney, then the SSA will send one check to you for 75% of your back pay, and a separate check to your attorney for 25% of your back pay. That way, you do not typically need to come out of pocket to pay your attorney. As mentioned above, however, you would still be responsible for the costs advanced in your case.
How can Pantazis Law Firm assist you with your case?
The case begins with a free initial consultation with Attorney Annemarie Pantazis and social security paralegal, Melissa Livoti. At that initial consultation, we will discuss your work history, the nature of your disability, your medical conditions, and the nature of your appeal. If our office decides to accept your case, our staff of dedicated social security case managers and paralegals will assist you with all aspects of your claim, from filing the appeal, to gathering medical records, to preparing your case for hearing. Prior to the hearing, you will have an appointment with Attorney Pantazis to review the hearing brief and review the questions that you may be asked at hearing. Attorney Pantazis will then appear with you at the SSA hearing and conduct it on your behalf. It is our mission to guide you through the process to what we hope and expect to be a successful outcome.
Children
Children can file a claim for SSI if they are found to be disabled.
An individual under age 18 is "disabled" if he or she has a medically determinable physical or mental impairment, which:
If the individual is age 18 or older, the adult definition of disability explained below applies.
Adults:
An individual age 18 and older is "disabled" if he or she has a medically determinable physical or mental impairment, which: