Q: What does the Social Security Administration consider when a disability claim is filed?

A: The Social Security Administration will look at the following:

  • type of disability;
  • claimant’s medical records;
  • claimant’s work record;
  • claimants’ educational history;
  • claimant’s age;
  • claimant’s financial need (for SSI); and
  • Any other information that may be relevant to the claim.

Q: Are you disabled according to the rules and regulations of the Social Security Administration (SSA)?

A: Many people apply for disability benefits but not all claimants understand the criteria used by SSA to determine eligibility. SSA, defines disability as: Inability to engage in any substantial gainful activity due to a medically determinable impairment (physical or mental) or combination of impairments expected to result in death or has lasted or will be expected to last for a continuous period of at least 12 months.

If you have a medical condition, you may be considered disabled if:

  • You can no longer perform the work you performed in your old job;
  • You cannot adjust to new work because of your medical condition; and
  • Your disability lasts or is expected to last for a year or more or will result in death.

Disability benefits are more difficult to win for younger claimants, under the age of 50. Based on the Social Security disability guidelines anyone under 50 must prove they cannot perform any job in the national economy eight hours per day, five days per week, and 52 weeks a year.
Just because you are unable to locate a job and actually be hired for work does not mean you will be entitled to a medical finding of disability by SSA.
SSA will also not limit the scope of review as to whether an individual can return to the type of work performed in the past or whether or not the person can obtain employment at the same level of compensation of any past work. SSA will consider all jobs available in the local and national economies and determine whether or not claimant can actually mentally and physically perform the job duties of any of those jobs as well as the claimant’s ability to maintain and sustain employment over time.
An older claimant will benefit from the rules changing slightly for those between 50 and 54 and more significantly once a claimant reaches age 55. With advanced age, SSA will be more inclined, based on the rules and regulations; to consider whether or not past work can be performed, whether or not work can be performed with the same exceptional requirements as past work, whether or not claimant has transferable skills to other types of work, and whether or not claimant has education and skills to perform any work available in the local and national economies.

Q: Does Social Security provide short-term or temporary disability benefits?

A: No. Social Security only provides benefits for medical conditions lasting for one year or more. Claimant does not have to be out of work for a year or more in order to apply for benefits. A person can apply for benefits immediately after all full time work activity ends as long as the medical impairment is the cause of why the claimant to stopped working and the resulting conditions will persist preventing the claimant from returning to work for a year or more.

Q: What is Social Security Disability Insurance Benefit (SSDI)?

A: SSDI is one of two benefit programs available through SSA based on disability pursuant to SSA’s requisite medical criteria. Payments under this plan are based upon prior work reported to the Social Security Administration. A claimant must earn substantial credits based on taxable work in order to qualify for SSDI. The amount of payment is based directly on the claimant’s earnings record. Benefits will be paid to claimants who have earned enough credits and who are unable to work as a result of a disability that has lasted or will last for at least 13 months or end in death.

Q: How are credits earned and how do they dictate eligibility for Social Security Disability Insurance Benefits?

A: One credit is earned for approximately every $1,000 a worker earns. Workers cannot earn more than four credits per year. In order to qualify for SSDI, a claimant needs to have earned 20 credits over a 10 year period. If a claimant is under age 24, he or she needs to have earned six credits over a three year period, and if the claimant is between the ages of 24 and 31, he or she needs to have credits for half of the time between age 21 and the age at which he or she becomes disabled.

Q: What is Supplemental Security Income (SSI)?

A: SSI is the other of the two benefits programs available to claimants based on disability status. SSI benefits are payable if a claimant meets the financial needs requirements instead of the prior work of the claimant. Children and adults may be eligible to receive SSI benefits based on limited income and resources, living arrangements, and medical disability criteria.

Q: What does a disabled individual need to do in order to apply for Social Security Disability benefits?

A: The individual can either visit his or her local Social Security Office or apply online at the Social Security Administration’s website.

Q: How long does it take to receive a response from the Social Security Administration once a disability claim is filed?

A: It typically takes three to six months to receive an initial decision in a disability case but may take longer.

Q: What if the disability claim is denied?

A: If claimant maintains disability and has evidence to support a claim the next step is to file a request for reconsideration within 60 days of the denial date. If claimant fails to appeal the initial decision within 60 days, claimant must file a new application unless claimant can show good cause for late filing.

Q: How long does it take to receive a response to the request for reconsideration from SSA

A: It takes approximately four to six months to receive a response to the request for reconsideration.

Q: What option does claimant have if the request for reconsideration appeal is also denied?

A: Claimant can continue the appeals process by filing a request for hearing before an administrative law judge within 60 days of the denial. If claimant fails to appeal the decision within 60 days, claimant must file a new application unless the claimant can show good cause for untimely filing.

Q: How long does it typically take to receive a hearing date?

A: Waiting times can vary. On average, claimant should expect to wait anywhere from 12 to 18 months between date of hearing request and date the hearing is scheduled. This is an average wait time and is can vary depending on the office location handling the claim.

Q: How long does it typically take to receive a decision after the administrative hearing?

A: It usually takes anywhere between 30 to 90 days. Again this is an average and can be shorter or longer.

Q: What if the claim is denied at the hearing level?

A: The claimant has 60 days to file an appeal to the Appeals Council. Claimant must submit a request for review of the hearing decision to the Appeals Council based on an error of law or fact in the Judge’s decision.

Q: Does a claimant have to be represented by an attorney in a disability case?

A: No. A claimant can represent himself or herself at all stages of the process. A claimant can also be represented by a non-attorney. Attorney and non-attorneys receive the same fees under Social Security guidelines and there are definite advantages to being represented by an attorney at the hearing level. The benefit of an attorney early on in your case can assist with development and presentation to SSA to assist in obtaining payments of benefits you are entitled to.

Q: What are the benefits of attorney representation in a disability case?

A: The attorney possesses the knowledge and familiarity with the process to help navigate the frustrations, paperwork and case preparation. Attorneys will also likely be familiar with the assigned Administrative Law judges in their area, individual practices, and demeanors. The attorney will assist with the completion and filing of appeals and work up the file with all necessary paperwork, request and submit all necessary records. Attorneys also prepare the client for the hearing and provides information as to what questions to expect from the Judge. An attorney will also submit a legal brief to the Administrative Law Judge identifying claimant’s impairments that preclude work as well as obtain and point to specific medical evidence to support the claim.

Q: Is there a waiting period for receiving Social Security benefits?

A: Yes. Social Security disability insurance benefits (SSDI) will not be paid for the first five months of disability. If benefits are awarded, they begin to accrue during the six month of the disability. However, benefits will not accrue for more than twelve months before the claimant filed for Social Security. If the claimant became disabled more than twelve months before he or she applied for Social Security Disability, back benefits will only go back to the twelfth month before the filing date. Social Security benefits begin to accrue either five months after the onset of the disability or twelve months before the Social Security application is filed, whichever is later.
At the hearing level, depending on the specific evidence in the case, facts, and circumstances, the Administrative Law Judge (ALJ) can make a finding that the claimant became disabled sometime after the alleged date he or she became disabled.
If the ALJ finds the claimant became disabled at a later point, benefits will not be paid until the sixth month after the date that ALJ finds the claimant disabled. If the claim is for SSI only, benefits begin to accrue from the date of the application filing or from the date the ALJ finds that the claimant became disabled, whichever is later.

Q: How are monthly Social Security disability benefits calculated?

A: The calculation for SSDI involves Social Security Administration’s evaluation of earnings, FICA taxes pain, age of claimant, and date of disability. SSI benefits are calculated based on income, marital status, and living arrangement. SSA uses a complicated formula to calculate benefits and the amount is not exactly accurately predictable. Estimated calculations can be accessed on SSA website

Q: When does a disabled person become eligible for Medicare?

A: The disabled individual is considered Medicare eligible 24 months after the date of eligibility for Disability Insurance Benefit.

Q: When does a disabled individual become eligible for Medicaid?

A: If an individual qualifies for even $1 in SSI benefits, the individual will be eligible for Medicaid. Medicaid eligibility is retroactive to the date of the application.

Q: How do workers’ compensation or other public disability benefits affect disability benefits?

A: Receipt of workers’ compensation and/or other public disability benefits may reduce your Social Security disability benefits. A disabled individual cannot earn more than 80% of claimant’s average current earnings before becoming disabled, once workers’ compensation benefits or other public disability payment, and social security disability benefits are combined.