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Individuals who are unable to work or are expected to be out of work for the next 12 months because of a medical condition may be entitled to receive Social Security Disability Insurance (SSDI) benefits. However, applying for benefits requires providing proof of income, assets, work history, and medical conditions. The Social Security Administration (SSA) denies many applications for technical reasons that are unrelated to the worker’s medical condition. In order to navigate the SSDI process, applicants should seek an attorney’s help. The legal team at Galfand Berger LLP provides caring and experienced guidance to help individuals receive all the benefits for which they are eligible.
What is the Difference Between SSDI and SSI?
The SSA administers two distinct benefit programs for individuals who are disabled: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). The primary difference between SSDI and SSI is that SSDI requires applicants to have a documented work history, whereas SSI does not. The following paragraphs describe the differences in more detail:
- Social Security Disability Insurance (SSDI). Individuals who are disabled because of an illness or medical condition that prevents them from performing most jobs in the work force may be able to receive SSDI benefits. To be eligible, individuals must have a work history, during which they have been paying Federal Insurance Contributions Act (FICA) taxes.
- Supplemental Security Income (SSI). To be eligible to receive SSI, an adult individual must be found unable to work just as with SSDI, but instead of a work history, the individual must meet certain financial and residency eligibility requirements.
Both programs assist working-age adults who have a mental or physical disability that prevents them from engaging in substantial gainful employer. SSI benefits are also available to eligible children, whereas SSDI benefits are not.
How Do I Submit an SSDI Application?
The first step in submitting an SSDI application is to collect all necessary documents showing income, assets, work history, and proof of disability. For disabled workers, this task can be overwhelming. To ensure the best possible outcome, individuals should contact a Social Security disability lawyer for assistance. Once the lawyer submits the application, the SSA will notify the individual whether the application is eligible to be reviewed for medical reasons.
How Does the Federal Government Define Disability?
The federal government defines and regulates the meaning of disability. The SSA has defined the term disability as the: Inability to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of no less than 12 months. Individuals must provide enough evidence to prove that their impairment is significant enough to prevent them from working for at least 12 months.
It is important to note that individuals who cannot perform their regular work at the time of the injury are not automatically eligible to receive SSDI benefits. They must be able to show that they have been unable to do any other types of work for at least 12 months because of their medical condition, and that they expect to be out of work for the next year at least.
What Medical Conditions Qualify as an SSDI Disability?
Medical conditions that qualify as an SSDI disability may include but not are not limited to the following:
- Kidney diseases
- Heart conditions
- Certain types of cancer
- Clinical depression and other mental illness
- Immune system disorders
- Severe asthma
- Musculoskeletal disorders
- Chronic obstructive pulmonary disease (COPD)
It is important to note that the criteria for SSDI disability are not necessarily the same as for Workers’ Compensation, which provides benefits for temporary and partial disability. To receive SSDI benefits, a claimant must suffer from a severe medical condition that has lasted, or is expected to last, at least one year or result in death. And, this medical condition prevents a person from doing work that they did in the past and from adjusting to other work.
What Type of Medical Evidence is Sufficient to Prove Disability?
The Disability Determination Services (DDS) are responsible for reviewing an applicant’s medical evidence and making the initial determination on whether a claimant is disabled or blind under the law.
In some cases, medical records provided by the applicant may be sufficient evidence to prove disability. Information provided by applicants should include the following:
- Contact details for all persons and institutions where they have obtained treatment, including doctors, hospitals, surgical centers, and clinics
- Dates of treatment
- Names and dates of laboratory tests and the health care providers who requested the tests
- Names of all prescriptions and the health care providers who prescribed the medicines
If the evidence provided by the application is unavailable or insufficient, the DDS will arrange a consultative examination (CE) to obtain the additional information needed. This examination may be conducted by the applicant’s own physicians or by an independent health care provider.
If the DDS determines the individual is disabled, the SSA will compute the benefit amount and authorize the payment of benefits. It may take a few months before the disabled individual begins receiving benefits.
Many times, the SSA will deny benefits to individuals who submit applications without the help of an experienced attorney. Many applications are rejected for technical reasons before a medical review is even conducted. Technical reasons include lack of documentation of work history, income, or assets. A Social Security disability lawyer can assist disabled individuals with the process of collecting and submitting technical and medical evidence to prove disability.
What Should I Do If My SSDI Application is Denied?
Claimants who receive an initial denial for SSDI or SSI must request “reconsideration” review. They must do so within 60 days of the initial denial. Because of these timelines and required documentation, we recommend applicants have an experienced attorney guide them through this process.
If the SSA still denies the reconsideration, an applicant may appeal within 60 days to an administrative law judge (ALJ).
After filing the appeal, the SSA will schedule a hearing, during which the disabled individual will be asked to testify. However, disabled individuals also have the right to have a lawyer represent them at hearings. A qualified Social Security disability lawyer brings legal skill and experience to bear in presenting testimony and cross-examining the vocational expert who, in all probability, will be present at the hearing.
It may take several months or more to obtain a Social Security disability hearing before an administrative law judge. However, with the help of a qualified Social Security disability lawyer, outcomes are generally positive. Having an experienced lawyer on the disabled person’s side increases the chances of getting a positive outcome.
How Much Will I Get Paid in SSDI Benefits?
The amount of money that individuals get paid in SSDI benefits depends on how much they have contributed in FICA taxes over the years..
One reason why the SSDI application process requires detailed information about income history is because there is a direct relationship between future benefit amounts and past FICA taxes paid by the individual. Detailed work history includes not only the amount of money earned in the past, but also the names and addresses of employers over the years, as well as the dates of employment at each job.
Monthly benefits may also be reduced if individuals are receiving, or have received, compensation from other sources, including but not limited to the following:
- Workers’ Compensation
- Longshore Workers’ Compensation
- Civil Service disability pensions
- Black lung benefits
- Federal employee retirement benefits
- Disability insurance benefits from state or local governments
Department of Veterans Affairs (VA) benefits that are not disability based will not reduce the amount of SSDI benefits.
Are SSDI Benefits Permanent?
The SSA periodically reviews the medical impairment of individuals on SSDI to determine whether they still have a disabling condition. The law requires the SSA to perform a continuing disability review (CDR) at least once every three years unless it has been determined that the medical condition will never improve, such as amputation or permanent blindness. In that instance, the SSA may still review the individual’s case once every five to seven years.
Examples of information requested for a CDR include but are not limited to the following:
- Doctor’s visits in the past year
- Hospitalizations
- Laboratory tests
- Updated medical records
The review will cover the previous year, although the SSA has the option of requesting information dating back to the point when the individual was initially granted benefits. It is important for disabled individuals receiving SSDI to schedule appointments with a doctor on a regular basis to document that the disability is still preventing them from seeking gainful employment.
The SSA will also inquire about whether the individual has been working. They will also request information about the individual’s income, assets, and living arrangements to determine whether these factors still meet the technical or non-medical requirements for SSDI.
Can I Receive SSI Benefits After I Retire?
Unlike SSDI, Supplemental Security Income (SSI) benefits can be made to individuals 65 years and older if they meet certain financial limits. SSI provides monthly payments to both children and adults who meet income and medical disability criteria. However, where a person lives can affect the monthly benefit amount. Payments may be reduced up to one-third for individuals who do not pay all their own food and shelter costs. According to the SSA, residents of nursing homes are eligible only for $30 per month in benefits, although some states do offer supplements.
How Many Americans Receive SSDI Benefits?
Nearly 11 million Americans currently receive SSDI benefits. At any given time, millions of disabled workers have SSDI applications pending, and more than half of those applications will be denied. More than 25 percent of all adults will become disabled before they retire. Social Security disability lawyers understand that SSDI benefits can be a critical lifeline of financial support for these individuals who have spent many years getting up each day and going to work to support their families.
How Have Galfand Berger Lawyers Helped Disabled Workers?
Galfand Berger lawyers have helped many disabled workers obtain the funds they need to pay the bills by guiding them through the complicated process of collecting evidence about their medical condition and proof needed to show they are no longer able to participate in the workforce. In addition to representing individuals, our legal team also won a landmark decision in a federal court case regarding disabled steelworkers’ rights to appeal denials of disability income benefits.
Philadelphia Social Security Disability Lawyers at Galfand Berger LLP Help Disabled Individuals Obtain SSDI Benefits
The process of applying for SSDI benefits is complicated, requiring applicants to submit extensive proof of work history and employment dates. Most applicants are initially denied benefits, often owing to technical reasons that have nothing to do with their medical condition. The Philadelphia Social Security disability lawyers at Galfand Berger LLP help disabled individuals obtain SSDI benefits by collecting the evidence they need to obtain a favorable decision. We also represent workers who have been denied and need to file an appeal. If you or a loved one has been denied SSDI benefits, we will be happy to answer your questions and review your case. To schedule a free and confidential consultation, call us at 800-222-USWA (8792) or contact us online. From our offices in Philadelphia, Bethlehem, Lancaster, and Reading, Pennsylvania, we proudly serve clients throughout Pennsylvania and New Jersey, including Allentown and Harrisburg.