What is Social Security Disability?

D. Frequently Asked Questions About Social Security Disability

Following are some frequently asked questions about SSDI and SSI.

1. How is the disability determination made?

The SSA disability evaluation is made under a procedure known as the sequential evaluation process. For adults, this process requires step-by-step review of your current work activity, the severity of your impairment, your remaining physical and mental abilities, your past work, and your 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, and an assessment of whether the impairment results in marked and severe functional limitations. (The sequential evaluation process is discussed in Chapter 7.)

2. When do disability benefits start?

SSDI claimants may be entitled to retroactive (past) benefits, if the SS A finds they were disabled before their application date. Actual payments, however, cannot be made until five months after the date of the onset of disability. Cash benefit payments cannot be paid retroactively to cover more than 12 months before the application date— no matter how severe your disability.

There are exceptions to the five month waiting period requirement. These exceptions, along with more detailed information about onset, can be found in Chapter 10.

Under SSI, disability payments may begin as early as the first day of the month after an individual files an application, but no earlier. In addition, under the SSI program, you may be found "presumptively disabled" and receive cash payments for up to six months while the formal disability determination is made. The presumptive payment is designed to allow a needy person to meet his or her basic living expenses during the time it takes to process the application. If a claimant is denied SSI benefits, he or she is not required to refund the payments.

3. What if I disagree with the determination?

If you disagree with the initial determination, you can appeal. Under the old rules, the first appeal of a denial was called a reconsideration, which was generally a review of your case by a DDS team that was not involved in the original determination. Under the new Disability Service Improvement Process (DSIP ) that the SSA is implementing, your first appeal would be to a Federal Reviewing Official (FRO). If your case is denied by the FRO, you can request a hearing before an administrative law judge. If you are dissatisfied with that decision and wish to continue pursuing the case, you can file a civil lawsuit in federal district court and eventually appeal all the way to the U.S. Supreme Court. (Appeals are covered in Chapter 12.)

4. Can I receive disability benefits or payments while getting Medicare or Medicaid coverage?

Yes. Medicaid and Medicare are our country’s two major government-run health insurance programs. Generally, people on SSI and other people with low incomes qualify for Medicaid, while Medicare coverage is earned by working in jobs covered by Social Security, the Railroad Retirement Act, or for the federal government. Many people qualify for both. If you receive Medicare or Medicaid along with your disability benefits, you do not have to do anything special or additional to obtain such coverage once you have qualified for disability. You don’t have to write any letters or fill out any more forms. If and when you qualify for such coverage, the federal government will send you what you need.

SSDI claimants granted disability benefits qualify for Medicare coverage. The coverage doesn’t start for two years from the onset of disability—and that means two years starting after the initial five-month waiting period. Therefore, you may be left without medical insurance coverage for several years if you don’t have some other type of coverage or are not poor enough to qualify for SSI Medicaid coverage. There are three exceptions to the two-year rule:

• If you have end-stage renal disease with kidney failure and you require dialysis or a kidney transplant, coverage by Medicare can begin the third month after the month in which dialysis began.
• If you are terminally ill with a life expectancy of six months or less and receive hospice care, coverage by Medicare can begin immediately.
• Individuals with amyotrophic lateral sclerosis (ALS) qualify for Medicare as soon as they qualify for benefits.

If you get Medicare and have low income and few resources, your state may pay your Medicare premiums and, in some cases, other out-of-pocket Medicare expenses such as deductibles and coinsurance. Only your state can decide if you qualify. Contact your local welfare office or Medicaid agency. For more general information about Medicare, contact a local SSA office or look for Medicare Savings for Qualified Beneficiaries on the SSA’s website, www.ssa.gov.

SSI claimants granted disability qualify for Medicaid coverage in most states. Where available, Medicaid coverage starts immediately. Only 16 states have no medically needy programs for their aged, blind and disabled. The 16 states are Alabama, Alaska, Arizona, Colorado, Delaware, Idaho, Indiana, Mississippi, Missouri, Nevada, New Mexico, Ohio, South Carolina, South Dakota, Texas, and Wyoming.

5. Can I work and still receive disability benefits?

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 are called work incentives. The rules are different for SSDI and SSI , but under both programs, you can receive:

• continued cash benefits
• continued help with medical bills
• help with work expenses, or
• vocational training.

For more information about work incentives, contact a local SSA office or look for A Summary Guide to Social Security and Supplemental Security Income Work Incentives for People With Disabilities on the SSA’s website, www.ssa.gov. (Work incentives are discussed in Chapter 13.)

6. How can I receive vocational training services?

Claimants for SSDI or SSI may be referred to a state vocational rehabilitation agency for rehabilitation services. The referral may be made by the DDS (see Chapter 6), the SSA, a treating source, or personal request. The services may be medical or nonmedical and may include counseling, teaching of new employment skills, training in the use of prostheses, and job placement. In determining whether vocational rehabilitation services would benefit you in returning to work, medical evidence from your treating source may be very important.

7. I understand that to get disability benefits, my disability must be expected to last at least a year. Does this mean that I must wait a year before I can get benefits?

You do not have to wait a year after the onset of the disability before you can get benefits. File as soon as you can after becoming disabled.

8. I have been receiving Social Security disability benefits for the past four years and my condition has not improved. Is there a time limit on Social Security disability benefits?

No. You will continue to receive a disability benefit as long as your condition keeps you from working. But, your case will be reviewed periodically to see if there has been any improvement in your condition and whether you are still eligible for benefits (see Chapter 14). If you are still eligible when you reach 65, your disability benefits will be automatically converted to retirement benefits.

9. I had a serious back injury four years ago and received disability benefits for about 18 months, until I could return to work. Unfortunately, my back problems have recurred and I don’t know how much longer I will continue working. When I initially applied for benefits, I waited several months before I received my first check. If I reapply for benefits, will my wait be as long as it was the first time?

Maybe not. It depends on what the new medical reports say and whether additional evidence is required. A worker who becomes disabled a second time within five years after benefits stop can have his or her checks start again, beginning with the first full month of disability if the new claim is approved.

10. My brother had an accident at work last year and is now receiving SSDI disability benefits for himself, his wife and daughter. Before his accident, he helped support another daughter by a woman to whom he has never been married. Is the second child entitled to some benefits as well?

Yes. Even though your brother was not married to the second child’s mother, Social Security pays benefits to all of his children. Each child is entitled to equal benefits.

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