Social Security Disability Law 101
Social Security Law Group
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To better familiarize you with what we do, it helps to have a working vocabulary of the social security disability process. Below are some key terms that can help you file your application and prepare for your disability hearing. Please remember that your claim has the best chance of succeeding with the help of a professional. For a FREE consultation, don’t wait. Call the experienced social security attorneys of the Social Security Law Group at 800-909-7754.
Social Security Disability Insurance (SSDI) is a monthly benefit for people who have worked in the past and paid Social Security taxes. SSDI benefits are paid to people who are legally determined to be unable to work for a year or more because of one or more medical conditions. Medical evidence must sufficiently demonstrate disability.
Supplemental Security Income is a program run by Social Security that pays monthly benefits to the elderly, the blind, and people who have disabilities and very low income and assets. The medical requirements for disability payments are the same under both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs, and the same process is used for both programs to determine your client's disability. When benefits are awarded there is no waiting period, however, there are no Past Due Benefits under the SSI program.
- Disability advocate representative
This person can be either an attorney or non-attorney, who you designate to help file your application for Social Security Disability benefits, develop supportive medical evidence, monitor the government’s day to day handling of your claim, and present your case to a federal Administrative Law Judge, if necessary.
This is the common acronym for “Disability Determination Services.” This is the most common name for state agencies who the Social Security Administration assigns to evaluate claims at both the Initial and Reconsideration levels of the determination process.
- Initial Claim
As the name implies, once your application for Social Security Disability has been filed, this is the first level of the determination process. The Social Security Administration assigns the matter to the DDS in the state where you live. At this stage, the DDS is empowered to either award your claim or deny it.
Should DDS deny your Initial Claim, you can appeal that judgment by asking the state agency to “reconsider” the initial denial. This stage is called Reconsideration.
- Administrative Law Judge / Administrative Law Hearing
Once DDS has denied your claim, both initially and on reconsideration, you may appeal these lower level judgments to a federal Administrative Law Judge. This person works directly for the Social Security Administration, and is tasked with conducting a full evidentiary hearing at which government paid medical and vocational experts may be asked to provide independent testimony. In addition, should you have a disability advocate representative, this person will argue your case, cross-examine any government experts, and ensure you provide helpful testimony of your own.
The Social Security Administration recognizes that it becomes more challenging to make a vocational adjustment once a person turns 50 years of age, and even more so after the age of 55. The term “Grids” is a shortened reference for Medical Vocational Guidelines. These are special rules that sometimes make it easier for people in these age categories to win their claim for disability on the basis that the skills they have acquired in the workforce may not be transferable after age 50 based on their medical limitations.
When a claim is denied at any level of the claim determination process, you typically have a statutorily set time to appeal an adverse judgment. Barring narrow exceptions, failure to timely appeal an adverse judgment at any level (Initial, Reconsideration, Hearing) will result in a final and unchangeable determination by the Social Security Administration. Procedural pitfalls are one more reason to hire a professional who knows the ropes!
- Past Due Benefits
Statistically, a claimant’s best chance of being awarded SSDI is after a hearing in front of an Administrative Law Judge. By the time this takes place, you probably will have filed your application more than a year ago. When a decision is finally issued by the Social Security Administration, certain Past Due Benefits or “back pay” will likely have accrued. While there are exceptions, past due benefits usually go back a maximum of one year from the date you apply for benefits. Your payments should start five full months after your disability began. If you are presently receiving monthly benefits from a Long Term Disability (LTD) carrier, all or a portion of these sums may be contractually owed to your LTD carrier. To avoid surprises, be sure to closely read the contents of any private insurance policy under which you are a beneficiary.
Before age 65, you are eligible for free Medicare Hospital Insurance (Part A) if:
*You have been entitled to Social Security disability benefits for 24 months; OR
* You receive a disability pension from the railroad retirement board and meet certain conditions; OR
*If you receive Social Security disability benefits because you have Lou Gehrig’s disease (amyotrophic lateral sclerosis); OR
*You worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program; OR
*You are the child or widow(er) age 50 or older, including a divorced widow(er), of someone who has worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program; OR
*You have permanent kidney failure and you receive maintenance dialysis or a kidney transplant and you are eligible to receive monthly benefits under Social Security or the railroad retirement system; OR
*You have worked long enough in a Medicare-covered government job; OR
*You are the child or spouse (including a divorced spouse) of a worker (living or deceased) who has worked long enough under Social Security or in a Medicare-covered government job.
Anyone who is eligible for free Medicare Hospital Insurance (Part A) can enroll in Medicare Medical insurance (Part B) by paying a monthly premium. If you have Medicare Parts A and B, you can join a Medicare Advantage plan. Medicare Advantage plans are offered by private companies and approved by Medicare. Anyone who has Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Joining a Medicare prescription drug plan is voluntary, and you pay an additional monthly premium for the coverage. Applications for Medicare may be made online at ww.ssa.gov or by going to your local Social Security Office.
Source: Social Security Administration. More detailed coverage information is available at the following link: http://www.socialsecurity.gov/pubs/10043.html#a0=2
While Medicare and Medicaid sound alike, they are very different. Whereas Medicare is a federally governed program extended mainly to retirees over the age of 65 as well as those found eligible for Social Security Disability, Medicaid is a state governed program that is broadly available to low income earners, including pregnant women, children under the age of 19, people age 65 and over, people who are blind, as well as people who are disabled or need nursing home care. You can apply for Medicaid by inquiring with the proper state agency where you live.