The Social Security Administration (SSA) offers two programs for people who suffer from a debilitating condition such as cancer or diabetes mellitus and can no longer work. These programs are the Social Security Disability Insurance program (SSDI) and the Supplemental Security Income disability program (SSI). SSDI is available to people who have a disability and who have worked for a certain number of years prior to becoming disabled. 20 C.F.R. § 404.315. SSI disability is available to people who have a disability, who have low incomes and few assets, and who have a sufficient work history. Benefits include monthly payments and medical care. Neither program offers benefits for those who are only partially disabled, or if who have a short-term disability. If you are suffering from a debilitating condition so that you can no longer work, contact an experienced Brooklyn Social Security Disability Lawyer who can help you through the claims process so that you receive the benefits to which you are entitled.
In addition to being disabled as defined by the SSA, to be eligible for SSDI you must have worked enough prior to being disabled that you have earned enough Social Security "work credits." When you work, you and your employer pay into the Social Security fund through FICA taxes. This is how you earn work credits and how the SSA keeps track of your eligibility. Generally speaking, you must have worked at least five of the last ten years before you became disabled. This means that if you only have worked for 6 months in the past 30 years, you will not be eligible for SSDI even if you have a condition that renders you disabled according to the SSA's definition of disability. However, if you are only 28 when you became disabled, you would have needed to work about 1.5 years. Currently, over 7 million people are receiving SSDI benefits.
You can earn up to four work credits each year. Each year the SSA changes the amount needed to earn a credit. For example, in 2013 you had to earn $1,160 in wages to earn a work credit, while in 2014 you must earn $1,200. So for 2014, once you have earned $4,800 for the year, you would have earned 4 credits. The number of work credits that you will need to be eligible depends on your age and the year became disabled. The older you are the more credits you will need to be eligible for Social Security benefits.
If you meet all of the requirements to receive SSDI, the amount of your monthly benefit will depend on your earnings history. On average, SSDI payments range from $800 to $1,400 per month. In addition, if you are receiving other governmental benefits, the amount of SSDI that you receive may be offset by that amount. After two years of receiving SSDI, you will then become eligible for Medicare.
In addition, certain family members may also be eligible for SSDI based on your work record. For example, your spouse who is at least 62 years old, your unmarried child who is under 18 or under 19 if in secondary school, your unmarried child who is over 18 and has a disability that started prior to the age of 22, your spouse or former spouse who is taking care of your child full-time who is under the age of 16 or who is disabled, or your unmarried former spouse who was married to you for at least 10 years, may be eligible for benefits.
Supplemental Security Income Disability (SSI)SSI disability is a program offered by the Social Security Administration in conjunction with the local government. Therefore, the eligibility requirements and the amount of monthly benefits that you receive are impacted by New York law. However, the federal requirements include:
If you meet all 4 of these requirements, plus any state requirements you will be eligible to receive monthly benefits payments. For 2014 the amount is $721 per month for an individual and $1,082 for a couple. This amount is adjusted each year based on the cost of living. In addition, New York may supplement this amount.
The SSA Definition of DisabilityEven if you meet the other requirements for either SSDI or SSI disability, including having paid into the Social Security fund through FICA payments, if you do not meet the Social Security Administration's strict definition of "disabled" you will not be approved for disability benefits. To determine if you are eligible, the SSA will conduct the following 5-step analysis:
Are you engaged in substantial gainful activity? The SSA will want to know if you are earning at least $1070 per month (for 2014). If so, then the SSA will likely decide that you are not so disabled so that you cannot work and will deny your application for benefits. This does mean that you can work and earn some money each month and still be considered disabled. You just cannot earn much money. 20 C.F.R. § 404.1572
Is your condition severe? Your disease or injury must be so severe that it is incapacitating. This means that your physical or mental activities are severely limited due to your condition. It is possible to have a serious medical condition that does not limit your activities enough to prevent you from working.
Is you condition on the Listing of Impairments? The SSA maintains a Listing of Impairments that includes conditions that have been determined by the SSA to be so debilitating that a person suffering from that impairment is deemed disabled. 20 C.F.R. § 404.1525. However, it is not enough to have a diagnosis of a condition that is on the Listing of Impairments. You also must me the requirements of the listing that indicate the degree of severity of the condition.
Are you able to perform your prior job? If your condition is not on the Listing of Impairments or you do not meet the requirements of the Listing, then the SSA will seek to determine if given your condition, you can still perform your prior job.
Are you able to perform any other job? If the SSA concludes that you cannot perform your prior job and that you also cannot perform any other job given your condition, skills and education, then it will conclude that you are disabled and eligible for benefits.
The majority of claims for Social Security disability benefits are initially denied. Often the reason for denial is something that can be easily fixed. However, it is important to make sure that you understand why your application was denied. Common reasons for claim denial include insufficient medical records, incomplete application, and lack of the requisite number of work credits. There are four stages of appeal for a disability claim, including: Reconsideration, Administrative Hearing, Appeals Council Review, and lawsuit in federal court.
If your claim was denied after the initial application, you have 60 days to file a "Request for Reconsideration." Your application will then be reviewed by a different reviewer in the Disability Determination Services office. If you are again denied, you have another 60 days to file a request for an Administrative Hearing before an Administrative Law Judge (ALJ). At the hearing you will have the opportunity to present your case. The ALJ will ask you questions to evaluate your claim. After the hearing, it typically takes the ALJ two months to render his or her decision.
If your claim is denied at the administrative hearing stage, you have another 60 days to request that the Appeals Council review your case. The Appeals Council can refuse to review your claim, ask you for additional information, request a reevaluation by the ALJ, or approve your claim. The final appeal step is to file a lawsuit in federal court.
When Social Security Disability Benefits Will EndYour disability benefits will end if you begin substantial gainful activity. While you are permitted to earn some money while you are legally disabled under the rules of the SSA, if you earn too much the SSA will determine that you are not disabled and your benefits will cease. Typically, the SSA bases whether or not you are performing SGA on the amount of money you earn. For 2014, if you earn at least $1070, the SSA will end your eligibility for disability benefits. You are required to report to the SSA any income that you receive while you are receiving disability benefits, even if it is below the threshold for SGA.
The SSA will also terminate your benefits if your condition has improved to the extent that you are no longer disabled. The SSA has a procedure known as Continuing Disability Review (CDR). During the CDR process the SSA will check the status of your condition to determine if you are still disabled. Generally, CDRs will take place every 3-7 years. However, if you have a condition that typically improves sooner, then the SSA may schedule a CDR prior to 3 years. Similarly, if you have a condition that is not expected to improve, then the SSA may wait 7 or more years before conducting at CDR.
Sometimes events may occur that trigger the SSA to perform a CDR. In some cases a third party reports to the SSA that a SSDI recipient is no longer disabled. In other cases, medical records may show that a condition has improved. Your benefits may also be terminated if the SSA finds that you have committed fraud related to your disability case. In addition, your benefits may also be terminated if you do not cooperate with your Continuing Disability Review , if you fail to follow the course of treatment that your doctor prescribes, or if the SSA is unable to locate you.
The chances of you being successful with your initial application or with your appeal increase if you are represented by an experienced Brooklyn Social Security Disability Lawyer who understands the Social Security disability claims process. The staff at Stephen Bilkis and Associates understands the complexities of the claims process and will work with your doctors to make sure you have all of the necessary documentation to support your claim for Social Security disability benefits. We have experience working with SSDI and SSI applicants with serious conditions such as carpal tunnel syndrome, back injuries and diseases, neurological disorders, sleep disorders, fibromyalgia disability, headaches, hepatitis disability, kidney failure disability, and blood disorders. Contact us at 800.696.9529 to schedule a free, no obligation consultation regarding your case.