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You are listening to the Disability Law Lowdown Podcast Show #27 with your host, Jacquie Brennan.

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Jacquie Brennan: Today’s podcast is going to be one of our Frequently Asked Questions podcasts and the questions this time are going to center on Social Security. SO here we go.

Q: What kinds of programs does Social Security have that are specifically for people with disabilities?

A: Well, you know all programs of the Social Security Administration are available for people who have disabilities as well as people who don’t have disabilities, but there are two main benefit programs for people with disabilities. There’s SSI and SSDI. There’s also the Ticket to Work program that helps people who are either getting either SSI or SSDI to attempt to return to work with supports that protect the benefits and the goal is to gradually transition people to self-sufficiency.

Q: So, I’m guessing that the very next question there would be well, what is SSI and what is SSDI?

A: So let me explain the difference because there’s a lot of confusion about that. SSI stands for Supplemental Security Income. This is a federal income supplement program and one of the differences, and there are a lot, but this is a big one, is that SSI is funded by general tax revenues, It is not funded by Social Security taxes. So people who get SSI are not taking money from the Social Security system to get that. It’s designed especially to help people who are elderly, blind or have another disability as defined by Social Security, and we’ll get to that later, and who also have very limited or no income or assets. It provides cash assistance each month to meet very basic needs for food and shelter.

Even if you’ve never worked or paid Social Security taxes, you might still be eligible for SSI, but remember that SSI is a needs based program and, for that reason, one of the requirements is that you have very limited or no income.

Now, SSDI stands to Social Security Disability Insurance and it pays benefits to people who have disabilities, again as defined by Social Security and we’ll get to that part about the definition in a little bit. It will also sometimes even pay to family members of the person with the disability as long as the person worked long enough and paid Social Security taxes.

Now remember that SSDI stands of Social Security Disability Insurance, so this comes from the payroll taxes that people pay when they work, that Social Security tax that you pay. It’s sort of like an insurance payment that you make for this Social Security Disability Insurance. When you pay those premiums, you’re covered and you have to pay the premiums for a certain amount of time before you are covered and when you stop paying the premiums, you’re still covered for the disability piece of it for the next five years. So, for the first five years after you stop paying into the program, if you become disabled under Social Security’s rules, during that time you may also be eligible for benefits.

Now, SSDI doesn’t care one way or the other about how much you make. For example, a millionaire could qualify for SSDI if the person had worked enough quarters and had paid into the system regardless of how much money they may have.

So, when we’re looking at the differences between SSI and SSDI, those are some of the big differences, how they are funded and that SSI is needs- based and SSDI isn’t, but with SSDI you have to have worked.

Now, if you’re in your fifties when you apply for SSDI, you have to have worked forty quarters, that’s basically ten years. They have a mathematical formula depending on how much you’ve earned in each quarter, but for most people you have to have worked ten years for SSDI. And you can’t have worked ten years and then taken off the last thirty years. You have to have worked, you know, ten years and it can’t have been more than five years since you last paid in, but you have to have that many quarters.

Now, of course they don’t expect people who are twenty-one to have worked ten years and so they have a pro-rated scheduled on that, for how long you have to have worked. If you have a need for more information about any of this, please visit Social Security’s website at www.ssa.gov and that ssa is Social Security Administration or you can use www.socialsecurity.gov and you can get information there. It’s a very user-friendly website.

Q: So, another question: how do I apply for SSI or SSDI?

A: You may apply by phone by calling 1-800-772-1213 and they will make an appointment to take your application by phone or in person at a Social Security office. You can also just go to a Social Security office, but if you don’t have an appointment, you will probably end up waiting a really long time. The easiest way is to do as much of the application process as possible on-line.

For SSDI, you can complete both the application and the Adult Disability and Work History Report which is another piece of paper they make you fill out. You can do that on-line at www.SocialSecurity.gov.

For SSI, you can complete the Adult Disability and Work History Report, but then you’ll have to call 1-800-772-1213 in order to complete the application process.

Be sure to keep a copy of any paperwork that you send into Social Security.

Q: How long will it take for Social Security to make a decision about whether I’ll get benefits?

A: Usually it takes three to five months to get that initial decision.

Q: Who makes the decision?

A: Social Security will send your application to a state agencies which makes the decision. The state has medical and vocational experts who contact your health care providers to get information and records. The state agency might ask you to have a medical exam or tests. You do not have to pay for this. If the state does notify you that it is requesting that you be at a certain health care office or facility for an exam or test, make sure to keep that appointment.

Q: I hear that most people get turned down when they apply. Is that true?

A: Yes, that’s true. Most people will be denied when they first apply. What’s most important, though, is to read that denial letter that you get because it will tell you about your right to appeal. When you appeal that initial denial, that’s called reconsideration. You may be able to appeal for reconsideration on-line or you can complete paper forms and submit them. Either way, you must request reconsideration within sixty days. Even on reconsideration, though, most people are still denied benefits. Reconsideration generally takes another three to five months.

Q: Is there another appeal if I get turned down on reconsideration?

A: Yes. You can appeal for a hearing by filing a Request for Hearing By an Administrative Law Judge and an Appeal Disability Report. Both of these can be submitted on-line or on paper. Again, this appeal has to be filed within sixty days.

Q: Will I have to wait another three to five months for a hearing with a judge?

A: Actually, you will probably have to wait a lot longer than that to get to the hearing. In some places the wait for a hearing is longer than a year. It does vary by location, so you should check with a lawyer if you retain one, more about that in a minute, to see how long the general wait is in your area.

Q: So what happens at the hearing?

A: That’s a little difficult to answer because each hearing is a little different, but they do have some things in common. The people in the room will usually be the administrative law judge, the judge’s clerk who will record either digitally or on tape the hearing, you along with your representative, if you have one. There might also be a doctor, but not anyone who has ever treated you, just someone who can read and interpret the medical records and give an opinion about your ability to perform what they call work-related activities. There might be a psychiatrist or a psychologist if you’ve claimed to have a mental disability or a vocational expert who will give an opinion about whether there are jobs you could do even with the limitations you have.

In the hearing, you will have a chance to explain to the judge why you believe you should get benefits.

Q: If I lose there, is that the end of the line for appeals?

A: No. You can appeal to the Appeals Council by filing a Request for Review of Decision/ Order of Administrative Law Judge. You cannot do this on-line at this time, although that may change later, but right now it has to be filed on paper. The form is available on-line, though, so you can get the form or you can call 1-800-772-1213 and request that the form be mailed to you.

Your form will go to the Office of Disability Adjudication and Review. Someone there will review your medical records and notify you in writing about the decision on your case.

If you do not prevail in your appeal to the Appeals Council, you can file suit in federal court. You have to have a lawyer to do that, though. The case will be filed on your behalf against the Social Security Administration and a federal judge will hear the case and notify you in writing of the decision in your case.

Q: So that brings us to this question which is: should I get a lawyer to help me apply for SSI or SSDI?

A: You are not required to have a lawyer unless you appeal to federal court, however,it might be a good idea to have a lawyer help you, especially if you’re going to have a hearing before an administrative law judge for Social Security. The reason it’s helpful to have a lawyer with you at that point is that a lawyer will know what kind of evidence to gather, how best to present the evidence, what to ask the witnesses that the judge will ask to testify, whether to seek additional witnesses, how to prepare you for the questions that you’re going to face ad how to put on the best case possible. Also, a lawyer will help to ease some of the fear and nervousness that most people feel when they go into a courtroom setting.

Q: What should I do if I can’t afford a lawyer?

A: Social Security law sets out how lawyers get paid and no lawyer is allowed to charge you more than what it says. The way it works is, you do not have to pay the lawyer anything in advance for his or her fee. There might be a very small expense deposit to cover the cost of mailing and copies and those kinds of out-of-pocket expenses, but you do not have to pay the lawyer for his or her time. The lawyer will be paid twenty-five percent of your past-due benefits or five thousand three hundred dollars, whichever is less and the lawyer is paid only if you get benefits. If you do not prevail in your case then the lawyer does not get a fee and cannot ask you to pay a fee.

Q: What is the Social Security definition of disability?

A: See. I told you we’d get to this. It’s important to remember that the definition of disability is a legal definition and not a medical definition. Because of that, there are almost as many definitions of disability as there are disability laws. Social Security pays only for total disability and no benefits are paid for partial disability or short-term disability under SSI or SSDI.

Social Security law defines disability as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to either result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months.

Disability, under Social Security law, is based on your inability to work. You will meet the Social Security definition of disability if the Social Security Administration finds that you cannot do the work you did before, you cannot adjust to other work because of your medical condition and your disability has lasted or is expected to last at least one year or result in death. This is a strict definition of disability.

Q: What is a medically determinable impairment?

A: A medically determinable impairment is an impairment that can be shown by medically acceptable clinical and or laboratory diagnostic techniques. The impairment must be established by medical evidence that consists of signs, symptoms, and lab findings and not by someone just listing the symptoms they have.

Lots of times people will bring a letter from a doctor that says they have a disability. They don’t understand why, if their doctor says it, that Social Security disagrees. This goes back to the definition of disability being legal rather than medical. Your doctor, probably, is not a lawyer so Social Security is not that interested in what amounts to the legal opinion of your doctor. What Social Security wants from your doctor is evidence in the form of clinical notes, diagnostic tests and lab findings. Social Security wants to know what treatments have been tried and how they have or haven’t worked. Social Security wants to know about the side effects of treatments and medications. Social Security wants to know how your condition effects your ability to function and do work-related activities.

Social Security does not have a list of disabilities. What it has is a listing of impairments. The listing of impairments describes impairments that are considered severe enough to prevent a person from gainful work-related activities, but this isn’t the kind of list where you can look for your condition, find it and know you’ll get benefits. It goes into detail about the criteria under which each condition is considered. Just because your condition is in the listing of impairments, that does not mean you’ll automatically get benefits.

Q: What kind of medical benefits do I get if I’m on SSI or SSDI?

A: If you get SSDI, you get Medicare coverage. Medicare helps pay hospital and doctor bills and it will go into effect once you have gotten benefits for at least twenty-four months unless you have ALS or you need long-term dialysis for chronic kidney disease or need a kidney transplant. Medicare pays roughly eighty percent of reasonable charges.

But if you get SSI, you’ll get Medicaid. It’s called that in most states, although in some states its name varies. Medicaid covers all of the approved charges of the patient.

Q: Can someone work and still get disability benefits from Social Security?

A: Yes. Social Security rules make it possible for people to test their ability to work without losing their benefits. These rules are called Work Incentives. The rules are different for SSI and SSDI, but under both programs, the rule may provide continued cash benefits, continued help with medical bills, help with work related expenses and vocational training.

For more information about work incentives, you can go to any Social Security office and ask for the publication called The Red Book, a Guide to Work Incentives. That’s also available online.

Q: What is the Ticket to Work program?

A: Ticket to Work gives most people who are getting Social Security benefits more choices for getting employment services. Social Security issues the tickets to eligible people who in turn can choose to assign those tickets to what is called an employment network or their choice to get employment services. They can also get vocational rehabilitation services, VR services, or other services they need to achieve a work goal. The employment network, if it accepts the ticket from an individual, will help that person to find and maintain employment.

Now, you can get more specific information about the Ticket to Work or any other Social Security questions by calling Social Security at 1-800-772-1213 or visiting the website at socialsecurity.gov.

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The Disability Law Lowdown is brought to you by the Disability Business Technical Assistance Centers which are a network of ADA centers that provide training, technical assistance and materials on the ADA and other disability related laws. Funding for the centers is provided by a grant from NIDRR, the National Institute on Disability and Rehabilitation Research. You can subscribe to the Disability Law Lowdown at our website at disabilitylawlowdown.com or on iTunes.





The Southwest and Rocky Mountain ADA Centers are part of a program of Independent Living Research Utilization at TIRR - Memorial Hermann in Houston, Texas, and is funded by the National Institute on Disability and Rehabilitation Research. If you have questions about disability law or would like to request materials or training, please call 1-800-949-4232. This podcast is protected by the Creative Commons Attribution Non-Commercial No-Derivative-Works 2.5 License. For more information and transcripts, visit www.ada-podcast.com.