Social Security Disability Benefits
Authored By: Washington Legal Clinic for the Homeless
What is the difference between Supplemental Security Income (SSI) benefits and Social Security Disability Insurance benefits (SSDI)?
The Social Security Administration runs two major programs that help people with disabilities.
1) SSDI: Generally, to qualify for Social Security Disability Insurance or SSDI benefits, you had to have paid enough in Social Security payroll taxes to earn "insured" status.
The amount you can receive in SSDI will depend on how much you paid in payroll taxes when you were working: the more you paid in, the more you can receive each month. The amount of money you presently do or do not have is not a factor.
2) SSI: Supplemental Security Income or SSI is for people who have very little income and assets or resources. There is a maximum amount you can receive in SSI. If you have no other countable income you will get the maximum amount.
As of January 1, 2012 the maximum SSI amount is $698 per month for an eligible individual, and $1,048 per month for an eligible couple. If you have income other than your SSI payments, you may not get the maximum SSI amount.
* The kind of evidence you have to show to prove you are disabled and the process Social Security uses to decide if you are disabled is the same for both programs.
Can I get both SSDI and SSI?
Some people can get both SSI and SSDI benefits if the amount they get in SSDI is low. If you contact Social Security about whether you qualify for a disability benefit, Social Security should look at whether you qualify under both programs.
Does all of the work I did count in deciding if I have "insured status"?
Not necessarily. Your work has to be in "covered employment" for it to count in deciding if you have "insured" status. Many jobs with the government are not covered by Social Security. People who worked for the government might qualify for a disability retirement benefit through the Office of Personnel Management.
You can find more information about this at www.opm.gov or contact the human resources department where you used to work.
How do I apply for SSDI?
- You can apply for SSDI over the Internet at: www.socialsecurity.gov/applyfordisability.
- You can also call Social Security at 1-800-772-1213. You may be able to submit your application over the telephone but you may be asked to bring documents in to a Social Security office.
- You can call the 1-800-772-1213 number to set up an appointment to apply. You will be given an appointment at the Social Security office closest to your home. If you call to make an appointment, the date you call may count as your application date, which may help you qualify for more months of benefits.
- You can also walk in to a Social Security office to file an application but you may have to wait longer to see someone if you do not have an appointment.
Where are the Social Security offices in the District of Columbia?
M Street District NW Office
2100 M Street NW
Washington, D.C. 20037
(202) 653-5040 phone
(202) 653-7041 fax
Sheperd Park NE Office
7820 Eastern Avenue, NE
Washington, D.C. 20012
(202) 673-5159 phone
(866) 737-4559 fax
Postal Plaza NE Branch Office
1905-B 9th St., NE
Washington, D.C. 20018
(202) 376-5049 phone
(202) 376-7245 fax
Anacostia SE Branch Office
2041 Martin Luther King, Jr. Avenue, SE
Washington, D.C. 20020
(202) 755-0630 phone
(202) 755-0618 fax
What will happen at the application interview?
You will be asked questions about your medical condition and why you think you are disabled.
The Social Security worker you meet with will have you sign papers, including release forms that will allow Social Security to send for your medical records.
At the end you should be given a receipt for your application and you may be given a list of documents to bring back.
What should I bring with me?
You should bring:
- Your birth certificate;
- If you were not born in the United States, you should bring proof of your immigration status;
- Social Security numbers for yourself, your husband or wife and your children;
- Information about any bank accounts you have or any other assets you have;
- Information about where you have worked (generally, Social Security looks back 15 years);
- Information about where you get medical care including the name(s) and address(es) of the doctor(s) you see and any place that you have been hospitalized;
- Information about the medications you take;
- Any medical records you have in your possession.
Do I need to bring original documents?
Social Security usually wants to see original documents. They should copy them and give you them back when your appointment is over.
What if I do not have all of the documents at the time of my appointment?
You should go to your appointment anyway. You can turn in missing documents later or Social Security should help you get the missing documents or help you figure out other documents that will meet the requirements.
What is the Social Security standard for a disability that will qualify me to get benefits?
SSDI and SSI share the same definition of disability. The Social Security law defines disability as "the inability to do any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment that can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months."
How does Social Security decide if I meet that standard?
Social Security uses a five-step process, called the "sequential evaluation" to decide if you are disabled:
1) At step one, Social Security decides whether you are engaged in "substantial gainful activity." If Social Security decides that you are engaged in "substantial gainful activity," they will say that you are not disabled no matter how bad your medical condition may be.
Social Security will assume that you are engaged in substantial gainful activity if you are working and earning more than $980 per month.
2) At step two, Social Security will decide if you have a "severe impairment," which is a medical condition that significantly limits your ability to do basic work functions.
3) At step three, you will be found disabled if you can produce medical evidence that you meet or equal one of the "Listings of Impairments."
The Listings are organized according to different parts or functions of your body and contain requirements for particular medical findings for different kinds of medical problems. If your medical records include the same findings as are required by the Listing for your medical problem, you are entitled to a finding of disability.
4) If you do meet a Listing, the next step in the "sequential evaluation" is whether you can return to your past work despite your medical problems. If Social Security decides that you can return to your past work, you will be found not disabled.
5) If Social Security decides that you cannot return to your past work, then the final step is whether you could do some other work that exists in the national or regional economy in significant numbers.
In deciding if you can do other work, Social Security will look at what you can still do despite your medical problems and must take into account how old you are, how much education you have and what kind of job skills you have. If Social Security decides you can do other work, you will be found not disabled. If Social Security decides you cannot do other work, you will be found disabled and eligible for benefits if you meet the other requirements.
Does drug or alcohol abuse affect whether Social Security will find me disabled?
If you wouldn't be disabled except for how drugs or alcohol limit your ability to do things, you will not qualify for disability benefits.
- However, if your medical condition would prevent you from working whether or not you continue to use drugs or alcohol, you may still qualify for disability benefits, even if some of your conditions may have been caused by drug or alcohol use.
- If you qualify for benefits and your medical records show that you have trouble controlling the use of alcohol or that you use illegal drugs, Social Security may require that you have a "representative payee." A representative payee would receive and manage your benefits on your behalf.
Does the local Social Security office decide if I meet the disability standard?
No. At the first step of the process and the first level of appeal, a different agency called the Disability Determination Division decides if you are disabled. If they decide you are not disabled and you appeal, an Administrative Law Judge or the Appeals Council will decide if you are disabled.
How do I contact the Disability Determination Division to ask about my case?
The Disability Determination Division can be contacted at P.O. Box 37608, Washington DC 20013, (202) 442-8500, FAX: (202) 442-8501.
What can I do to improve my chances of being found eligible for disability benefits?
Go regularly to your doctor and follow your doctor's recommendations.
- Tell your doctor that you are applying for disability and explain that he or she may get forms to fill out about you that are very important.
- Attend any appointments Social Security schedules for you to see a doctor and tell that doctor everything you can about your medical problems.
- Complete and send back any forms or questionnaires you get from Social Security.
What if my claim is denied?
You should receive a written decision telling you that you were denied and why. The letter will also explain your right to appeal.
How do I appeal?
There are three levels of appeal within the Social Security Administration.
- If your application is denied, you can request Reconsideration.
- If your Reconsideration is denied, you can request a hearing by an Administrative Law Judge.
- If the Administrative Law Judge denies your claim, you can appeal to the Appeals Council.
- For all of the different appeals, you have 60 days to file an appeal starting with the date you receive your letter or decision saying you were denied.
- Social Security will assume that you received the letter five days after the date on it, unless you can show that you received it later.
- Social Security has forms you can use to request the different levels of appeal. If you go to a Social Security office, someone there should help you complete the paperwork. You may also be able to get a lawyer or someone else to help you complete the forms.
- You can submit additional evidence later on so you shouldn't wait to file your appeal.
- If you do not appeal within 60 days, you will probably have to start the process over again.
How long does an appeal take?
The different appeal stages take different amounts of time. Reconsideration usually takes 3 or 4 months. It may take 6 to 10 months to get a hearing by an Administrative Law Judge. The Appeals Council can often take 2 years or longer to make a decision.
If you are still unable to work because of your medical conditions, it is usually a good idea to file a new application while you are waiting for the Appeals Council.
When should I contact a lawyer to assist me in the process?
Different lawyers and organizations are willing to get involved in Social Security cases at different stages of the process. Some lawyers or legal services programs will help you with a Reconsideration appeal but others will not get involved until you are ready to appeal to an Administrative Law Judge.
The way you present evidence and legal arguments to an Administrative Law Judge can make a big difference, and a lawyer can help a lot at an Administrative Law Judge hearing.