Common Questions about Social Security Disability Programs
This information is designed to provide a more thorough understanding of the disability programs administered by the Social Security Administration. The following are some of the most frequent questions asked about these programs.
Q: Who can get disability benefits under Social Security?
A: Under the Social Security disability insurance program (Title II), there are three basic categories of individuals who can qualify for benefits on the basis of disability:
- A disabled insured worker under 65.
- A person disabled since childhood (before age 22) who is a dependent of a deceased insured parent or a parent entitled to Title II disability or retirement benefits.
- A disabled widow or widower, age 50-60, if the deceased spouse was insured under Social Security.
Under Title XVI, or SSI, there are two basic categories under which a financially needy person can get payments on the basis of disability:
- An adult age 18 or over who is disabled.
- A child (under age 18) who is disabled.
Q: How is the disability determination made?
A: Social Security’s regulations provide for disability evaluation under a procedure known as the “sequential evaluation process.” For adults, this process requires a five-part sequential review of:
- The claimant’s current work activity – (Are they engaged in SGA?);
- The severity of his or her impairment(s);
- The claimant’s residual functional capacity;
- The claimant’s past work; and
- Their age, education, and work experience.
Q: When do disability benefits start?
A: Under the Social Security disability insurance program (Title II), the law provides that disability benefits for workers and widows usually cannot begin for 5 months after the established onset of the disability. The 5-month waiting period does not apply to individuals filing as children of workers. Under SSI, disability payments may begin as early as the date the individual files an application.
In addition, under the SSI disability program, an applicant may be found “presumptively disabled,” and receive cash payments for up to 6 months while the formal disability determination is made. The presumptive payment is designed to allow a needy individual to meet his or her basic living expenses during the time it takes to process the application. If it is finally determined that the individual is not disabled, he or she is not required to refund the payments. There is no provision for a finding of presumptive disability under the Title II program.
Q: What can an individual do if he or she disagrees with the determination?
A: If an individual disagrees with the initial determination in the case, he or she may appeal. The first administrative appeal is for Reconsideration, which is generally a case review at the state level by an adjudicative team that was not involved in the original determination. If dissatisfied with the reconsideration determination, the individual may request a hearing before an administrative law judge. If he or she is dissatisfied with the hearing decision, the final administrative appeal is for review by the Appeals Council. In general, a claimant has 60 days to appeal an unfavorable determination or decision. Appeals must be filed in writing and may be submitted by mail or in person to any Social Security office. If the individual exhausts all administrative appeals, but wishes to continue pursuing the case, he or she may file a civil suit in Federal District Court.
Q: Can individuals receiving disability benefits or payments get Medicare or Medicaid coverage?
A: Medicare helps pay hospital and doctor bills of disabled or retired people who have worked long enough under Social Security to be insured for Social Security benefits. It generally covers people who are 65 and over; people who have been determined to be disabled and have been receiving benefits for at least 24 months; and people who need long-term dialysis treatment for chronic kidney disease or require a kidney transplant. In general, Medicare pays 80 percent of reasonable charges.
In most states, individuals who qualify for SSI also qualify for Medicaid. The program covers all of the approved charges of the Medicaid patient. Medicaid is financed by Federal and State matching funds.
Q: Can someone work and still receive disability benefits?
A: Once a person is approved for benefits, Social Security rules make it possible to test one’s ability to work, under limited circumstances without losing the right to cash benefits and Medicare or Medicaid. These rules are called “work incentives” and are different for Title II and Title XVI. Work incentives may provide:
- Continued cash benefits;
- Continued help with medical bills;
- Help with work expenses; or
- Vocational training.
It is possible, however, to lose eligibility to receive any benefits if a person earns too much. For this reason, it is very important to understand Social Security’s rules about earnings and what Social Security calls “Substantial Gainful Activity (SGA)”. These rules are complicated and we suggest consulting with an attorney.
Q: How can the individual receive vocational training services?
A: Applicants for disability payments may be referred to a state vocational rehabilitation agency for services. The referral may be made by a state welfare agency, or by personal request. The services may include counseling, teaching of new employment skills, training, and/or job placement. Participation in vocational rehabilitation services can be very beneficial to a claim for Social Security disability benefits in that it shows a person’s willingness to try, and demonstrates that they would rather work than just sit at home.