Social Security Law
Total disability from earning a living can be a frightening and powerless situation. Fortunately, there may be help available through the Social Security Administration's Disability Insurance Benefit (DIB or SSDI) or Supplemental Security Income (SSI) programs. As with any government program, there are layers of forms, complex office procedures, regulations, statutes, administrative law decisions and court decisions to contend with. However, if you think you qualify, it is well worth the effort to apply; and the benefits often mean the difference between staying afloat and not making it.
Generally speaking, to qualify for either SSDI or SSI disability benefits, an individual must be disabled seriously enough to be unable to work for a period of twelve consecutive months. There are regulations defining what disabling conditions constitute "severe impairments". Sometimes, however, it is necessary to explain that the disability is either equivalent to a defined "severe impairment", or there are a combination of conditions that are the equivalent. Also, it can be argued that brief, unsuccessful work attempts do not defeat the 12 consecutive month requirement. A legal representative with a good understanding of medical conditions, and a good relationship with the medical community can assist in obtaining medical reports needed to win your case. If the disability is not severe enough in itself to meet the impairment regulations, then vocational factors are looked at including level of education, employment background and transferability of employment skills. Again, the assistance of legal counsel with a good understanding of vocational issues (Administrative Law Judges often engage Vocational Rehabilitation counselors to testify as expert witnesses) may be an important factor in obtaining a successful result.
The claim process is started for both types of benefits at your local Social Security office; and appeals of unfavorable agency decisions follow the same administrative and court appeal process. There are various pilot procedures that are being tested that expedite the process, but also eliminate the second and fourth chances to win your case. The bottom line is that no one in the agency is going to be as motivated to present your case in the best light possible as you and your advocate will be. Because of these pilot programs, the stakes are higher than ever.
SSDI
SSDI operates very much like a private long term disability insurance policy. The "premiums" in SSDI take the form of payroll taxes. Your monthly benefit depends upon whether or not you paid enough "premiums", and how much was deducted from your paychecks for Social Security. Consequently, an initial hurdle you have to clear is the "insured" criteria; and after being out of work for five years (and therefore not paying "premiums"), the right to make an SSDI claim is lost. Retroactive benefits are limited to a 12 month period from when the application was filed. Because of these time limitations on benefits, it is important not to delay if you think you qualify, and to seek advice if you have questions.
Just like private disability insurance (and unlike SSI benefits), SSDI is not a need-based benefit. That means that SSDI benefits may piggyback nicely with money from other disability related claims like a personal injury or a workers compensation case. Where the issue of the medical cause of a disability may be a hotly contested issue in a personal injury or workers compensation case, causation is not a concern in an SSDI case (or an SSI case). Therefore, you may be able to collect money for total disability from the Social Security Administration because of a combination of accidental and non-accidental disabilities, even though you can only make a claim for partial disability in your accident case. Also, after 2 years Medicare benefits are available to SSDI recipients. This health insurance coverage can be extremely valuable. If you have a personal injury or a workers compensation case, Medicare benefits and the extra money from SSDI can be a big help, before and after a settlement.
On the subject of private long term disability insurance, disability insurance companies often require an insured to file an application for SSDI benefits (because it reduces or eliminates their obligation to pay). It may appear tempting just to go through the motions since on the surface, the insurance company appears to benefit the most. Looks can be deceiving. Depending on earning history, SSDI benefits may be higher, SSDI entitlement includes dependent and Medicare benefits and the appeal process for an SSDI claim is before an administrative law judge, and sometimes a federal court judge, not in a cubicle in an insurance company.
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SSI
SSI is a need-based benefit administered by the Social Security Administration. The procedures for obtaining benefits and the disability criteria are similar to SSDI claims. Historically, SSI benefits replaced state public assistance programs; and now the amount of the benefit is set by Congress each year. Because it is a need-based as well as a disability benefit, there are income and asset restrictions. Many assets are exempt from consideration up to a certain value. Therefore, in addition to assisting with the impairment and vocational issues discussed above, an attorney can help you qualify with asset planning. While SSDI benefits may be awarded retroactively up to 12 months before an application is filed, SSI benefits are not retroactive. Therefore, it is very important not to delay in beginning the process. If you think you qualify and have questions, make sure you seek out advice.
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