Social Security Benefits for Disabled Individuals

 
Social Security offers two main programs for adult, disabled individuals:  Social Security Disability and Supplemental Security Income (SSI).  Though not discussed here, there are also other auxiliary programs for people like dependents and survivors of disabled individuals.
 

What is the Difference Between Social Security Disability and SSI?

 
Social Security Disability (SSD) and SSI are both programs for those that meet the Social Security Administration’s definition of disability, but there are key differences:
 

  • Need for Work History: In order to qualify for SSD, one must have worked and paid sufficient social security taxes to be “covered” for benefits.  As a rule of thumb, someone that has worked 5 out of the last 10 years and paid social security taxes on their earnings is generally insured or covered for SSD benefits.  In contrast, one does not need to have an earnings history or have paid social security taxes to qualify for SSI.
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  • Asset Limits: Someone that qualifies for SSD will not be disqualified for having too many assets or “resources” such as too much money in their bank account or a second home.  The same is not true about SSI.  In order to qualify for SSI, one’s assets cannot be more than $2,000 for an individual or $3,000 for a couple.  There are things that do not count towards the asset limits, such as the value of the home one is living in or money put into special types of accounts used to pay expenses of the disabled person.  To understand the difference, one can look at SSD as being like a private insurance policy that one pays coverage for and SSI as welfare benefits or public assistance.
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  • Amount of Monthly Payment:  The amount of SSD benefit one receives is based on their earnings history.  The monthly SSI benefit is fixed for all recipients (though there may be some deductions in certain cases) and can be found at: https://www.ssa.gov/oact/cola/SSIamts.html.  In 2016, the maximum, base SSI monthly benefit one could receive was $733 per month.  Sometimes, a person can receive both SSI and SSD.  For example, if one’s earnings result in SSD benefits of less than $733 per month, one could receive SSI benefits sufficient to get their total monthly benefits to reach a maximum of $733.
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  • Source of Funds:  SSD funds come from the government trust fund for Retirement, Survivors and Disability Insurance benefits which is funded by money collected from payment of social security taxes by workers.  SSI benefits come from general federal funds.
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  • Retroactivity of Benefits: SSD payments may be received retroactive up to 12 months from the date that one applies for benefits.  However, SSD does have a 5-month waiting period – one is eligible for payments only after 5 months from the date that one is found disabled (i.e. you will not be paid SSD for the first 5 months that you are disabled).  For example if one is found disabled in January, their payments will begin in June of the same year (after 5 months of disability).  SSI benefits can only be received beginning from the date that one applies for them, but there is no 5-month waiting period.
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  • Immigration Status: Generally, legal permanent residents can receive SSD, but not SSI benefits, unless they fall into certain exceptions.
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How is Someone Determined to be Disabled by Social Security?

 
For both SSD and SSI cases, the social security administration will use the same definition of “disability” and the same criteria to determine disability in adult individuals.
 
Normally, social security follows a 5 step sequential evaluation process, except in special circumstances in which specific rules govern a finding of disability without needing to follow the 5 steps.
 

  • Step 1: At the first step, social security asks whether an applicant is engaging in “Substantial Gainful Activity.”  In short, they are looking to see whether one is working in a real job (not just one with little responsibilities that an employer accommodated the claimant with) and whether they are earning the threshold amount chosen by social security each year (which can be found at https://www.ssa.gov/oact/cola/sga.html). If one has earnings above this threshold amount, they are deemed to be not disabled, but if their earnings are below this level, the reviewer moves to step 2.
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  • Step 2:  At this second step, social security determines whether one has a “severe physical impairment” that is expected to result in death or last 12 months or more.  Social security is looking for a diagnosis of a medically acceptable condition that is expected to cause the symptoms alleged by the applicant.
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  • Step 3: This step involves determining whether the condition is so severe that it “meets or equals” a category of conditions and associated diagnostic findings which social security deems so severe that, if met by an applicant, will lead to an automatic finding of disability at this step – this list is commonly referred to as a Listing.  If no Listing applies, then the evaluation moves to step 4.
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  • Step 4: At step 4, social security will ask whether a person can perform their prior relevant work based on the level of functioning that their condition leaves them at.  The last 15 years of a person’s work history will be looked at to determine whether their conditions allow them to perform any of these prior jobs.  If it is determined that a person can perform their previous work, their case will be denied.  If not, the process moves on to step 5.
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  • Step 5: In the final step, social security looks at whether the person can perform “any other work” given their age, education, previous work experience and physical and mental restrictions due to their medical conditions.  A vocational expert is generally used to help determine the availability of any other such jobs, particularly when a case is in front of a judge.  Additionally, the Medical Vocational Guidelines or “grids” list certain situations, categorized by age, education, work history and physical capabilities, in which it is assumed that no jobs exist for an applicant who meets these specific conditions.
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What Is the Procedure For Applying for Benefits and Appealing Denials?

 
In Pennsylvania, there are 4 possible levels of review for an application: 
 

  • The first level is the initial application. This determination is performed by the bureau of disability determinations and is made by social security employees that are not judges.  You will not have to go into hearing office or courtroom.  An application can take three to six months, on average to process.
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  • If one’s application is denied, they have 60 days to appeal to an administrative law judge. At this second level, one can present their case, in person, in front of the judge who will actually be making the determination.  It generally takes more than one year from the date an appeal is filed to get a hearing in front of a judge.
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  • If the judge denies the claim, the next level of review is to the Appeals Council. At the Appeals Council level, the judge’s decision is reviewed for errors and new evidence can be submitted, though it is rare for one to be able to testify in front of the Council.  Wait times for Appeals Council decisions could be even longer than for the administrative law judge level.
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  • The final level of review after the Appeals Council is in federal court.

 

Do You Need Help with Applying for Benefits or Appealing a Denial?  Do You Have Questions About Any Step of the Process?

 
You do not need to go through the process alone.
 
Contact us at any step of your application or appeal for a free consultation.
 
Our office works on a contingency fee, which means that we receive no fees unless you receive payment.


Social Security Benefits for Disabled Individuals Attorneys:

 
Joseph G. Muzic, Jr.

Angel E. Torres