Common Frequently Asked Questions and Answers About Social Security Disability Programs (As outlined in Disability Evaluation Under Social Security 2006 From The Social Security Administration)

This information is designed to provide a more thorough understanding of the disability programs administered by SSA.  Following are some of the most frequent questions asked about these programs.

1.  Q.  Who can get disability benefits under Social Security?

A.        Under the Social Security disability insurance program (Title II of the Act), there are three basic categories of individuals who can qualify for benefits on the basis of disability:

Under title XVI, or SSI, there are two basic categories under which a financially needy person can get payments on the basis of disability:

2.  Q.  How is the disability determination made?

A.        SSA’s regulations provide for disability evaluation under a procedure known as the “sequential evaluation process.”  For adults, this process requires sequential review of the claimant’s current work activity, the severity of his or her impairment(s), the claimant’s residual functional capacity, his or her past work, and his or her age, education, and work experience.  For children applying for SSI, the process requires sequential review of the child’s current work activity (if any), the severity of his or her impairment(s), and an assessment of whether his or her impairment(s) results in marked and severe functional limitations.  If an adult or child is found disabled or not disabled at any point in the evaluation, the evaluation does not continue.

3.  Q.  When do disability benefits start?

A.        The law provides that, under the Social Security disability program, disability benefits for workers and widows usually cannot begin for 5 months after the established onset of the disability.  Therefore, Social Security disability benefits will be paid for the sixth full month after the date the disability began.  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 first full month after the individual applied or became eligible for SSI.

In additional, 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.

4.  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 it.  The first administrative appeal is a 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 and eventually appeal all the way to the United States Supreme Court.

5.  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 disability payments also qualify for Medicaid.  (The name varies in some States-the term “Medicaid” is not used everywhere.)  The program covers all of the approved charges of the Medicaid patient.  Medicaid is financed by Federal and State matching funds, but eligibility rules may vary from State to State.

6.  Q.  Can someone work and still receive disability benefits?

A.        Social Security rules make it possible for people to test their ability to work without losing their rights to cash benefits and Medicare or Medicaid.  These rules are called “work incentives.”  The rules are different for Title II and Title XVI, but under both programs, they may provide:

Whether preparing an initial filing for benefits or filing an appeal after benefits have been denied, I can help you through the process. No payment is required from you up front and I only collect a fee if you are awarded benefits.

Having trouble getting Social Security Disability? Pasco County’s Kemp, Ruge & Green Law Group can evaluate your claim, help you with your initial application and assist you with your appeal. If your case goes to a judicial hearing, we can ensure that you are well represented in court and will give you the best chance possible of obtaining a favorable outcome.

Pasco County’s Kemp, Ruge & Green Law Group has the knowledge of the rules that regulate Social Security Disability. Many valid claims are denied because the evidence is presented in an unorganized manner without consideration to the methodology that Social Security uses to understand and approve claims.

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