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Social Security Disability - Supplemental Security Income
The Social Security Act defines disability as the "inability to engage in any substantial or gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months" (www.ssa.gov).
Social Security Disability Insurance (SSDI)
SSDI is a federal disability insurance program designed for individuals who have worked enough to earn sufficient "work credits." Monthly payments are based on the individual's work history. SSDI benefits can be paid retroactively to the original date of a disability, if a claim was filed at that time. If you do not have a long enough work history to qualify for SSDI then you may be eligible for SSI.
Supplemental Security Income (SSI)
SSI is a federal financial entitlement program that provides monthly payments to individuals who either have never worked or do not have enough work credits to qualify for SSDI. SSI recipients must have limited resources/assets - $2,000 for a single person or $3,000 for a couple.
Individuals who apply for SSDI are also screened for SSI benefits. Benefits become payable the month after the application is filed. Those eligible for SSI are also eligible for Medicaid benefits.
The Social Security Administration (SSA) can make a determination of "presumptive disability" for SSI benefits. Presumptive Disability allows SSA to pay up to six months of SSI payments before they make their disability determination. SSA does not provide for presumptive payments to individuals applying for SSDI benefits (www.alsa-stl.org).
The SSA has an expedited procedure for processing claims for the terminally ill. Known as “TERI Claims”, these cases are flagged by SSA representatives to ensure they move quickly though the Social Security system. To qualify, an individual's medical records or pathology report must reflect that the claimant is terminally ill or about to expire in six months or less (www.alsa.stl.org.)
The Application Process
Most Social Security disability claims are initially processed through a network of local Social Security Administration field offices and State agencies called Disability Determination Services (DDS). The field offices obtain applications for disability benefits in person, by telephone, by mail or by filing online. The application and related forms ask for a description of the claimant's impairment(s), treatment sources and other information related to alleged disability. The field office is responsible for verifying non-medical eligibility requirements, which may include age, employment, marital status or Social Security coverage information. The field office then sends the case to the DDS for evaluation of disability.
Normally, DDS tries to obtain evidence from the claimant's medical sources first. If evidence is unavailable or insufficient to make a determination, DDS will arrange for a Consultative Examination (CE) by a physician to obtain additional information. After medical evidence is compiled, DDS makes a disability decision. DDS then returns the case to the local field office for appropriate action. If DDS finds the claimant disabled, the local Social Security Office computes the benefit amount and begins paying cash benefits to the claimant.
In making its determination, DDS takes into account the age, education and work experience of the claimant in addition to the medical records and the residual functional capacity to determine whether the claimant is "disabled.”
If you become disabled, you should file for disability benefits as soon as possible to maximize your benefits. (Depending on your state of residence, your eligibility date for Medicaid may be tied to your Social Security disability filing date.) You can file for Social Security benefits by calling or visiting your local Social Security office. You can also call 1-800-772-1213 toll free. If you have access to the internet, you can apply online at www.ssa.gov.
To shorten the time it takes to process, have the following medical vocational information available when you apply:
Medical records from your doctors, therapists, hospitals, clinics, and caseworkers
Your laboratory and test results
The names, addresses, phone and fax numbers of your doctors, clinics and hospitals
The names of all medications you are taking
The names of your employers and job duties for the last 15 years
Submit a copy of your most recent tax return along with a recent pay check stub
A letter from your attending physician that includes the phrase as written: "...will be unable to work for 12 months or longer"
Up to 60% of all claims filed are denied the first time. You have the right to appeal a denial and can do so effectively with proper medical documentation that may include: physician's notes, history and physicals, consultations, MRIs, cat scans and pathology reports. Include other pertinent information that would indicate a decline in your condition as well as any side effects to medications (memory loss, fatigue, nausea, etc.). Do not file a new application after a denial or you may lose benefits. Appeal the original decision.
The Appeals Process
Appeals must be filed in writing within 60 days from the date you receive your SSA denial letter. If you are denied for a second time, it is advisable to seek legal assistance. Attorney’s that practice in this area work on a contingency basis, taking part of your back pay from Social Security as payment for their services.
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