Common Questions

The best way to file a Social Security disability claim is to go to the nearest Social Security office in person and wait (often for a few hours) to see someone to file the claim in
person. Otherwise, a person may contact Social Security by telephone and arrange for a telephone interview to file their claim. 

 Under the Social Security Act, “disability” means “inability to engage in any substantial 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 no less than 12 months.” 

Unless your disability is catastrophic (such as terminal cancer, a heart condition so bad that you are on a heart transplant waiting list, total paralysis of both legs, etc.), there is no easy way for you to tell whether you will be found “disabled” by Social Security. In the end, the decision of whether or not to apply for Social Security disability benefits should not be based upon whether or not the person feels that Social Security will find them disabled.

For disability insurance benefits, it all depends upon how much you have worked and earned in the past. For disabled widow’s or widower’s benefits, it depends upon how much the late
husband or wife worked and earned. For disabled adult child benefits, it all depends upon how much the parent worked and earned. For all types of SSI benefits, there is a base amount that
an individual with no other income receives. Other income that an individual has reduces the amount of SSI that an individual can receive. 

For disability insurance benefits and disabled widow’s and widower’s benefits, the benefits cannot begin until five months after the person becomes disabled. Benefits also
can’t be paid more than one year prior to the date of the claim. For a disabled adult child, there is no five-month waiting period before benefits begin, but benefits cannot be paid more than six
months prior to the date of the claim. SSI benefits cannot be paid prior to the start of the month following the date of the claim. 

There are at least five major types of Social Security disability benefits. Disability insurance benefits are the most important type of Social Security disability benefits. It goes to individuals
who have worked in recent years (five out of the last 10 years in most cases) and are now disabled.

Disabled widows and widower’s benefits are paid to individuals who are at least 50 and become disabled within a certain amount of time after the death of their husband or wife. The late husband or wife must have worked enough under Social Security to be insured. Disabled adult child benefits go to the children of persons who are deceased or who are drawing Social Security disability or retirement benefits. The child must have become disabled before age 22.

For disability insurance benefits, disabled widow’s or widower’s benefits, and disabled adult child benefits, it does not matter whether the disabled individual is rich or poor. Benefits are
paid based on a Social Security earnings record.

Supplemental Security Income benefits, however, are paid to individuals who are poor and who are disabled. It does not matter for SSI whether an individual has worked in the past or not. SSI child’s disability benefits are a variety of SSI benefits paid to children under the age of 18 who are disabled. The way in which disability is determined is a bit different for children. 

Yes. There is an offset that reduces Social Security disability benefits when worker’s compensation benefits are paid, but in virtually all cases there are still some Social Security disability benefits to be paid. In a few states, the offset works the other way: worker’s compensation benefits are reduced because of Social Security disability benefits.

No. There are no percentages of disability in Social Security disability determination. For purposes of Social Security disability benefits, you are either disabled or not disabled. There are no percentages of disability and no percentages of disability benefits.

Getting help with medical bills is usually tied up with getting cash benefits. That means you don’t start getting help with medical bills until after you start getting the cash benefits, so you have to keep going with the Social Security disability claim in order to get the help with medical bills.

Yes,  you can return to work. Social Security encourages individuals drawing disability benefits to return to work. For persons receiving disability benefits, disabled widow’s and widower’s benefits, and disabled adult child benefits, full benefits may continue for a year after an individual return to work. Even thereafter, an individual who has to stop work in the following three years can get back on Social Security disability benefits immediately without having to file a new claim.

You should appeal immediately. If you appeal within 10 days of being notified that your disability benefits are being ceased, you can ask that your disability benefits continue while you appeal the decision cutting off your benefits.

Social Security is not supposed to cut off disability benefits for an individual unless his or her medical condition has improved. When Social Security reviews a case of someone already on Social Security disability benefits, they continue benefits in the vast majority of cases.

In recent years, Social Security has been doing fewer reviews to determine whether or not individuals already on Social Security disability benefits are still disabled. This is changing, and Social Security should be doing far more reviews in the next few years. However, the vast majority of individuals who are reviewed will see their Social Security disability benefits continued.

No. You have to have been disabled for at least a year, expect to be disabled for at least a year, or have a condition that can be expected to result in death within a year. 

Social Security is supposed to consider the combination of impairments that an individual suffers in determining disability. Many, perhaps most claimants for Social Security disability benefits have more than one health problem, and the combined effects of all of the health problems must be considered. 

If you expect to be out of work for a year or more on account of illness or injury, you should file for Social Security disability benefits. 

Maybe. It depends on how badly the disease affects you.” The question in each individual case is “How sick is this particular individual and how long is this person going to remain sick?”

Thus almost without exception the mere fact that an individual has a disease with a certain name does not guarantee that the individual either will or will not be found disabled.

 Yes. Mental illness is a frequent basis for awarding Social Security disability benefits. 

 If you are poor enough, you can qualify for Supplemental Security Income (SSI) if you are disabled, even if you have never worked in the past. It is also possible to qualify for disabled adult child benefits on the account of a parent if you became disabled before age 22 or for disabled widow’s or widower’s benefits on the account of a late husband or wife. 

 If you are over 50 and became disabled within seven years after your husband or wife died or within seven years after you last drew your mother’s or father’s benefits from Social Security, you can get disabled widow’s or widower’s benefits. More importantly, if you are poor you can draw Supplemental Security Income (SSI) benefits no matter what age you are or when you became disabled. 

Possibly. If the child is under 18 and you are poor enough, the child may be able to qualify for Supplemental Security Income (SSI) child’s disability benefits. If the child is over 18, they may qualify for SSI disability benefits without regard to the income of her parents. If his/her father or mother is drawing Social Security benefits of some type or is deceased, the child may be eligible for disabled adult child benefits. 

Possibly. If you have worked 5 out of the past 10 years under Social Security before becoming disabled, you will have enough earnings to potentially qualify for Social Security disability benefits. For individuals 31 or less, the requirements are a little different, since such individuals have not had such a long time to work. Unless a person has been staying home and taking care of their children for quite a long time, however, it is very possible that they will qualify for Social Security disability benefits based on their own earnings. Also, a homemaker, if poor enough, can qualify for Supplemental Security Income (SSI) whether he or she has worked in the past or not. 

When it comes to disability, looks can be very deceiving. There are many people who look quite healthy but who are very disabled by anyone’s standard. For instance, many individuals who suffer from very severe psychiatric illnesses are physically healthy and able to do things such as mow their yards. 

Not anymore. There never were all that many people getting Social Security disability benefits on account of alcoholism or drug addiction, but Congress has now prohibited Social Security from paying disability benefits on the basis of alcoholism or drug addiction. However, alcoholics and drug addicts have heart attacks, get cancer, or get sick in other ways just like everyone else. Alcoholics and drug addicts who become disabled apart from their alcoholism or drug addiction can become eligible for Social Security disability benefits. 

You can file for Social Security disability benefits on the very same day that you become disabled. Many individuals make the mistake of waiting months and even years after becoming disabled before filing a Social Security disability claim. There is no reason to file a Social Security disability claim if you have only a minor illness or one that is unlikely to last a year or more. However, an individual who suffers serious illness or injury and expects to be out of work for a year or more should not delay filing a claim for Social Security disability benefits. 

No, you do not have to wait until the sick leave is exhausted. You should file for Social Security disability benefits now if you believe that you will be out of work for a year or more. 

You don’t have to wait until the worker’s compensation ends, and you shouldn’t wait that long. An individual can file a claim for Social Security disability benefits while receiving worker’s compensation benefits. It’s best to file the Social Security disability claim as soon as possible because otherwise there may be a gap between the time the worker’s compensation ends and the Social Security disability benefits begin. .

No. If you have worked in recent years or if you are applying for disabled widow’s or widower’s benefits or disabled adult child benefits, it does not matter how much money you have in the bank. There is no reason to wait to file the claim.  

 After an individual files a Social Security disability claim, the case is sent to a disability examiner at the Disability Determination agency (DDS) in your state. This individual will work with a doctor and make the initial decision on the claim. If the claim is denied and the individual requests reconsideration, the case is then sent to another disability examiner at DDS, where it goes through much of the same process. If a claim is denied at reconsideration, the claimant may then request a hearing. At this point, the case is sent to an Administrative Law Judge (ALJ) who works for Social Security. The Administrative Law Judge makes an independent decision on the claim. This is the only level at which the claimant and the decision-maker get to see each other.  

 Social Security has to consider age because that is what the Social Security Act requires. As people get older, they become less adaptable and less able to switch to different jobs to cope with health problems. A severe foot injury might cause a 30-year-old to switch to a sitting job, but a 60-year-old person with the same disability might not have the option to adjust to a different type of work.  

 Not really. Because most types of illness can vary from minor to severe, there’s not one simple list of illnesses that Social Security considers to be disabling. However, if an illness has reached a very severe level with certain medical hallmarks, Social Security will award benefits on the basis of medical considerations alone. 

 In most cases, Social Security makes the first decision within four months.   

 There is some variation around the country, but the national average reached 541 days in mid-2008.

 Statistically, over half of the claimants who have a Social Security disability hearing win. 

 Be honest and complete in giving information to Social Security about your disability. For instance, many claimants fail to mention their psychiatric problems to Social Security because they are embarrassed about them. In almost all cases, individuals who were slow learners in school fail to mention this fact to Social Security, even though it can have a good deal to do with whether or not the Social Security disability claim is approved.

Beyond being honest and complete with Social Security, the most important thing that you can do is just keep appealing and hire an experienced person to represent you. It is important to appeal because most claims are denied at the initial level but approved at higher levels of review. Statistically, claimants who employ an attorney to represent them are much more likely to win than those who go unrepresented because most people do not understand the way Social Security works. 

For help, go to a lawyer or other person who represents Social Security disability claimants on a regular basis. NRJ Disability Advocates has a 98% success rate of representation. 

No. You can go through all of the levels of review on your own if you wish, but statistically, claimants who are represented by an attorney or licensed advocate win much more often than those who are not represented. 

 We recommend you use a successful and experienced advocate from the NRJ Disability office. You can call for a free consultation at 1-877-232-9964.    

In almost all cases, the attorney receives 25 percent of the back benefits if the claimant wins. There is no fee if the claimant loses. 

Many Social Security disability claimants become frustrated with claim delays and eventually ask their U.S. Representative or Senator to help. The local Congressional office typically has staffers who are experienced with Social Security procedures and personnel. A 'Congressional Inquiry', as it is called at Social Security, may help to get a stalled process moving again. 

Note: A Congressional Inquiry will have no impact on Social Security’s decided outcome of the case. 

Only about 40 percent of Social Security disability claims are approved at the initial level. If you are denied at the initial level, unless you have already returned to work or expect to return to work in the near future, you should appeal. In most states, you do this by filing a request for reconsideration. Be sure to consider employing an attorney to represent you. In a few states, you file a request for a hearing before an Administrative Law Judge and do not need to go through the reconsideration step. 

There is no simple answer to this question. One reason is that there is no simple way to determine whether an individual is disabled. Most people who are disabled suffer from pain. There is no way of determining whether or not another individual is in pain, much less how much pain they are in.

A second reason is that Social Security over the years has been more concerned with making sure that everyone who is receiving Social Security disability benefits is 'truly' disabled than with making sure that everyone who is disabled receives Social Security disability benefits. An underlying reason is that Congress has always believed that given the chance, many people will 'fake' disability in order to get benefits.

 Social Security’s position is that it is not up to your doctor to determine whether or not you are disabled. It is up to the SSA, and they will make their own decision regardless of what your doctor thinks. 

 It is Social Security’s position that VA decisions are not binding upon them. Social Security and the VA have very different standards for approving disability claims. 

 Actually, when you file a Social Security disability claim, you are not trying to just get “your own money” back. The money that an individual may have paid into Social Security over the years would not last very long if that was all that an individual could draw from Social Security.  

 Yes. You can appeal to the Appeals Council, which is still within Social Security. 

When a claim for Social Security disability benefits is denied at the initial level, the claimant must request 'reconsideration' of that decision to start the appeal process. The case is then sent to a different disability examiner for a new decision. Unfortunately, about 80% of the time the reconsideration decision is the same as the initial decision – a denial.  

A disability examiner at the Disability Determination Section makes the reconsideration determination. Most of the time, the claimant does not see the disability examiner or even know his or her name.   

 Statistically, about 20 percent of the time a claimant wins at reconsideration.

 In most states, if you want to appeal a denial of Social Security disability benefits, you have to go through reconsideration. There is no way to avoid it. In a few states the Social Security Administration has abolished reconsideration and you can file an immediate request for a hearing before an Administrative Law Judge. The denial notice from Social Security will tell you what the next step is that you need to take. If you do move forward with reconsideration, you should strongly consider obtaining an attorney to represent you. 

 In most cases, Social Security makes the reconsideration determination within four months.  

 The Appeals Council exists to review Administrative Law Judge decisions. The Appeals Council is located in Falls Church, Virginia, and neither the claimant nor the attorney sees the people at the Appeals Council who are working on the case.  

 About a year, maybe longer.

 Yes. After being denied by the Appeals Council, it is possible for a claimant to file a civil action in the United States District Court, requesting review of Social Security’s decision. A Social Security disability claim can go all the way to the Supreme Court. Perhaps once every year or two, the United States Supreme Court actually hears an appeal about a Social Security disability case. 

 If you are approved for SSI you will get Medicaid. It is possible to get both Medicare and Medicaid if you are entitled to SSI and some other type of Social Security disability benefit.  

The short answer is that Medicaid is a poverty program and Medicare isn’t. Many disabled people who get Medicaid get it because they are on Supplemental Security Income (SSI). This is called 'categorical' Medicaid eligibility. To get SSI and thereby get Medicaid you have to be poor and disabled. Medicaid pays doctors at very low rates, so people who have only Medicaid can have a hard time finding doctors willing to take them on as patients. Medicaid does pay for prescription medications, and it can go back up to three months prior to the date of a Medicaid claim. Note that it is possible to apply for Medicaid directly—through a local Medicaid office—without having a companion claim for SSI.

To receive Medicare it does not matter if you’re rich or poor. If you have been on disability insurance benefits, disabled widows or widowers Benefits, or disabled adult child benefits for 24 months you qualify for Medicare. The good thing about Medicare is that it pays doctors at a higher rate than Medicaid and almost all doctors are happy to take Medicare patients. The bad things about Medicare are that it does not begin until after a person has been on cash disability benefits for two years and it generally does not pay for prescription medications.

If you are approved for any kind of Social Security disability benefit other than SSI you will get Medicare after you have been entitled to Social Security disability benefits for two years.