Life is filled with uncertainty. Accidents can happen anytime and could result in the loss of bodily functions leaving a person who use to be gainfully employed unable to now perform tasks in the workplace. It is possible that the employer can accommodate the worker’s limitation, however sometimes the worker has to stop going to work altogether and will be confined to his house.
What are the options for a person who has encountered the kind of situation mentioned above? If this person was employed prior to the accident, then he probable had Social Security withdrawn from his check. The Social Security Administration provides options that address the needs of people who are living with disability.
Social Security Disability is comprised of two programs, namely: the Social Security Disability Insurance Program (SSDI) and the Supplemental Security Income Program (SSI). These two programs utilize similar standards for establishing disability and provide a certain amount of income replacement to disabled individuals. However, the programs differ in many ways.
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Eligibility
One primary area where the two categories differ is eligibility. Generally, to be eligible for SSDI, an individual must not only prove that he or she is disabled, but also that he or she worked and contributed to the Social Security system for a certain period of time before claiming disability. This period of contribution is often measured in work credits. You receive a credit for every fiscal quarter you pay social security. To be eligible for SSDI you are generally required to have earned credits for 20 out of the last 40 quarters. However, the required number of credits will vary with age.
For example, if the applicant is 24 years old and has become disabled, he needs to have 1.5 years of work during the three-year period ending with the calendar quarter his disability began. This is based on the premise the applicant began working at the age of 21. The quarter system referred to here is as follows: First Quarter: Jan 1-March 31; Second Quarter: April 1-June 30; Third Quarter: July 1-September 30; Fourth Quarter: October 1-December 31.
However, if the applicant becomes disabled at age 31 or older, he/she must have worked 5 out of the last 10 years ending with the quarter his/her disability began. Regardless of your age, you only remain insured for 5 years from the last quarter you earned a work credit.
Eligibility for SSI is reserved for people who either don’t have enough quarters of coverage or fall below the asset and earning requirements. The earning requirement is $721 for an individual or $1,082 for a married couple. The asset requirement is $2,0000 for an individual or $3,000 for a married couple with many different exclusions (house, car, furniture). Additionally, the two programs differ in how the monthly benefits is determined – for SSDI, the calculation focuses on and can vary depending on how much you have paid in, while SSI benefits are capped.
Determination of Disability
As soon as the application is received by the SSA, they will review the application to determine eligibility based on the number of years the applicant has worked and the current “work activities” you are or are not capable of doing. If the applicant meets the requirements set by the SSA, the SSA will then send the application to the office of Disability Determination Services (DDS) in your state. This state agency completes the disability decision for SSA. Doctors and disability specialists from local DDS offices will ask the applicant’s doctor for information regarding your medical condition. DDS will then use the medical evidence from the applicant’s doctors and hospitals and any other clinics or institutions where the applicant has been treated. DDS will look at:
- What the medical condition is
- When the condition began
- How the medical condition limits the applicant’s activities
- What objective medical tests show
- What treatment the applicant has received
DDS is particularly interested in your ability to walk, sit, lift, stand, carry, do fine finger manipulation, remember instructions, etc.
Basically SSA decides that you are eligible for disability benefits based on:
- Earning status (earning less than the SSA limit, $1040 per month)
- Ability to do work
- Severity of medical condition (limitation in basic work activities like walking, sitting, standing, ability to remember instructions, for at least a year),
- Whether your condition is listed in the Listing of Impairments
- Whether you can return to any job you held in the last 15 years
- There is no other job in the National Economy you could do based on your age, education, and transferable work skills
If you satisfy the eligibility requirements, you are entitled to receive disability benefits. However, the answers to many of these eligibility questions require complicated legal tests and heavy burdens of proof. You may need help establishing all the evidence required to obtain disability benefits.
Reasons Many People Are Denied
- The SSA can’t find you: The SSA must be able to contact and locate you for medical examination scheduling and for important information related to your claim. If you have designated an attorney to handle your case, this problem can be avoided. If you have an attorney you will want to make sure they have your updated information as communication is vital to the success of your claim.
- You refuse to cooperate: You failed to provide the SSA your complete records which are essential for your disability claim To avoid denial of your claim, make sure you have submitted everything the SSA requires. This includes completely filled out forms, and all your medical records.
- You fail to follow prescribed treatment: Failing to follow your doctors prescribed treatment orders can result in denial of benefits. Failure affects your credibility as an applicant.
- Disability is based on Drug Addiction or Alcoholism: Drug and Alcohol addiction are one of the most prevalent reasons for denial of a claim. Failure to be honest about such a problem is even more detrimental to your claim. If such a problem has existed in your past, but has been followed by a documented period of rehab and sobriety the problem will not affect your claim.
- Committing Fraud: If benefits were obtained by dishonest means, once found out the SSA will cut off the benefits and bring you to court for fraudulent acts.
- Criminal Involvement: Any injury that has resulted during the commission of a felony or arisen during a stay in prison cannot be the basis of a disability claim.
At Good Guys Injury Law our goal is to help people get the most out of their SSA claims. We encourage all disability claimants to work closely with a competent lawyer. For more information or to set up a free consultation, call us at (801) 506-0800.
photo courtesy of Flickr.