Social Security Disability in a Nutshell Series Blog 1

canstockphoto10669314What is Social Security Disability? I can tell you that it is not a welfare program  and is certainly NOT handed out to just anyone.  If this were true I would be driving a Rolls and not a Jeep Patriot.

My name is April Roberts and I am a professional disability advocate. I represent individuals that are applying for Social Security Disability and Medicare benefits. I have had the privilege of representing claimants around the country. I have traveled to over 50  SSA (Social Security Administration) hearing offices in 16 states to argue hearings in front of Administrative Law Judges.  I have learned that many Americans do not understand the Social Security Programs and how they work.  This lack of understanding is used by the media and other special interests to play on public fears.

In truth it is not easy to get approved for Social Security Disability and there are inconsistencies in how the rules are applied by the administration, itself. In fact over 70% of all applications are denied upon initial review. This is not because SSA ‘has’ to deny claimants the first time. There are many reasons for this unfortunate percentage which I will address in future blogs.

There are great people who work at SSA and most are just like anyone else trying to do a job.Like any organization there are problems and mistakes are made. There are times when a claimant does not need a representative or attorney to help them. Most of the time claimants can benefit from having someone advocate for them.  Some representatives and attorneys are great.  Some representatives and attorneys are not.

With that said, my intentions are to educate people on these things and hopefully publish a simple book to help people better understand the disability process and rights to those benefits. Since I have never written a book I am hoping all of you can help me.  By that I mean commenting on each blog I publish with your thoughts and questions. Hopefully your input can help me direct my writing to cover all the areas where people have questions . So, with no further adieu…

What is Social Security Disability?

Simply put, Social Security Disability (otherwise known as SSDI) is a disability insurance program. Most working Americans pay into this insurance program via income tax withholding. Once a person has achieved a required minimum of earnings and time worked, she will become eligible for disability income should she become disabled. There is much more to this and I will address it in a later blog. But here are some basics.

The ONLY ways someone is eligible to receive benefits through the SSDI program are:

  1. Be disabled per Social Security’s rules and meet the minimum work and earnings requirements or;
  2. Be the dependant of a person who is receiving SSDI benefits or;
  3. Be the Substitution of Party (ie surviving family member or appointed person) of a deceased person to whom SSA still owes benefits to

Since this is a program you have to pay into to become eligible, this program is NOT a welfare program.  SSDI can be compared to the Social Security Retirement benefits in that a person has to work and pay into the program. SSDI is too often mistaken for SSI or Supplemental Security Income which IS a welfare  or “needs based” program.

What is SSI?

SSI is a needs based disability program through Social Security. SSI rules for medical eligibility are the same as SSI. SSI recipients must be very low income and have limited assets. He may not have the requisite earnings and time worked to have earned any SSDI benefits. A person who is eligible for an SSDI benefit that is below a certian threshhold may qualify for SSI in addition to his SSDI benefit. A disabled child whose parents’ income and assets fall below a certain threshold may be eligible for SSI. The thing to remember with SSI is that the medical rules are the same as SSDI but is based on the needs of the indigent claimant.

SSA keeps tabs on recipients of SSI to make sure that at no time does a claimant rise above the minimum income or assets to continue recieving SSI. If a person does rise above the threshold, SSA can stop the benefits and sometimes even demand return of any over-payments that may have been received by the claimant.

Who is eligible to receive Disability Benefits?

This is where things begin to get more complicated but I promise to keep it simple and break these issues down over the course of time.

Once a person becomes unable to perform “SGA” or Substantial Gainful Activity due to health problems she becomes medically eligible to receive disability through Social Security. I will focus on adult disability for now.

SSA has a five step sequential process in how it must determine if an adult claimant meets the medical requirements for eligibility. There are many thing that affects these steps but the basic breakdown is as follows.

1. Is the person working at “SGA” levels since he alleged his disability began? For 2016 a person earning more than $1130/mo is working at SGA levels and will likely be found not disabled right off the bat. SGA also refers also to how much a claimant works and working alot of hours may cause a person to be found not disabled. There are many variables that can be considered regarding these factors but for the most part if someone is working less than 30 hours and earning less than $1130/month due to an inability to work any more than this, he may still be found disabled despite the fact he is working. If a person has worked since his disability started and the work is under the monthly SGA amount or he has not worked at all, then SSA proceeds to step 2. (Yikes I can work while getting disability? Yes! I am saving that for another blog)

2. Does the claimant suffer from  a severe impairment? The claimant must suffer from a mental and/or physical condition that is so severe that it will be expected to prevent her from working at SGA  levels for twelve months; or result in death. Of course these conditions must be diagnosed by a medical doctor. If SSA finds there is a severe medical condition at this step the process moves to step 3.

3. Do the claimant’s  impairments meet or equal the criteria under certain medical conditions set forth by SSA? These lists of criteria are referred to as listings or body systems. In other words if your diagnoses, symptoms, and prognosis fit under certain specific disease listings then SSA may have to find you disabled. If SSA does not find that the claimant’s conditions fit into one or more of these listings then process moves to step 4.

4. Can the claimant return to his past relevant work? Past Relevant Work is work that a claimant has performed in the past for a period long enough to have learned each job. If SSA finds the person cannot perform any work he has done before then the process moves to step 5.

5. Can the claimant perform other work? What SSA means by ‘other’ work is any other type of work that is performed in the general national economy that the claimant might be able to perform.  SSA considers the claimant’s age, level of education completed, residual functional capacity (ie what can the claimant do now), and transfer-ability of job skills from past  work that could be used in other jobs.

If the claimant cannot perform any of his past work and any other work he may be approved for SSDI and/or SSI.

This I hope gives a clear basic picture of the Social Security Disability process. Please leave comments and questions here on the blog site, Facebook, or Twitter for me. I am open to your input and happy to answer questions.

Next up, “Why do so many people who should not get disability get approved for it?”

©2016 April L. Roberts and Aaria Consulting, LLC. All Rights Reserved.


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Filed under Basics of Social Security Disability, Disability Advocates, Medicare & Medicaid, Spouse's Benefits, SSDI, SSI, Uncategorized

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