Social Security Disability Insurance, or SSDI, is one of two disability programs administered by the U.S. Social Security Administration. The other program is known as Supplemental Security Income (SSI). If you are a disabled individual who has worked and paid Social Security taxes for an extended period of time (generally, for 10 years total), you may be eligible for Social Security Disability Insurance (SSDI) benefits.

What is the difference between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)?

SSDI and SSI are primarily different in three ways. First, there are different requirements to be eligible for either program. A disabled or blind individual must have paid Social Security taxes to become insured for SSDI benefits. Alternatively, to be eligible for SSI, a disabled or blind adult or child must meet all of the following categories: (1) limited income; (2) limited resources (such as personal property, insurance policies, and vehicles); (3) be a U.S. citizen, national, or certain categories of aliens; and (4) live in the U.S. or Northern Mariana Islands.

Second, SSI and SSDI differ in how payments are handled. The SSDI program’s monthly benefit amount is based on the Social Security earnings record of the insured worker. SSI’s monthly payment is based on need and varies up to the maximum federal benefit rate. Pennsylvania adds money to federal SSI payments.

Finally, SSI and SSDI offer differing medical coverage at different times. In Pennsylvania, it you receive SSI, you usually can get medical assistance (Medicaid) automatically. However, Under SSDI, a worker will get Medicare (our country’s basic health insurance program) automatically after receiving disability benefits for two years.

Am I eligible for SSDI?

The standard factors that establish disability in both Social Security Disability (SSD) and SSI cases include the individual’s age, education, work experience, and ability to communicate, read, and write in English. These factors, coupled with the individual’s physical and/or emotional health problems, determine whether an individual may have a winnable claim.

In order to qualify for SSDI, generally an individual will have had to have worked and paid taxes in the United States for at least 10 years.

Because you essentially purchase SSDI coverage as you work, you must prove disability within a period of time after you stopped working. For example, if you have worked steadily for 10 years and then stop, you will need to prove that you became disabled within approximately 5 years of when you stopped working.

So there are two components for disability insurance. The first is whether you have worked long enough and recently enough. The second, as with SSI, is whether you are disabled. Unfortunately, the Social Security Administration, and not your doctor, will make its own independent decision on whether or not you are disabled.

Do family members qualify?

Pennsylvania Social Security Disability Insurance benefits are available for family members under certain circumstances.

Disabled Widow’s and Widower’s Benefits are available for individuals who are at least 50 years old and become disabled within a certain amount of time after the death of a spouse who worked under Social Security.

There are also benefits available for children and adult children. To qualify, the child must be unmarried and younger than 18. If the child is 18-19 and still in school they also qualify. A child may also qualify if they are 18 and older and suffer from a disability that happened before age 22. The child must have a parent who is disabled, retired and entitled to SSDI benefits, or a parent who died after having worked in a job for a certain length of time where they get paid Social Security taxes.

How do I know if I’m “disabled” under the definition of the program?

“Disability” under Social Security is based on your inability to work. The Social Security Administration will consider you disabled under Social Security rules if:

• You cannot do work that you did before;
• The Social Security Administration decides that you cannot adjust to other work because of your medical condition(s); and
• Your disability has lasted or is expected to last for at least one year or to result in death.

This is a strict definition of disability. Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers’ compensation, insurance, savings and investments.

When determining if you are disabled, the Social Security Administration will ask a number of questions including whether those concerning whether or not you are currently working, the severity of your condition, and your ability to do other types of work.

In the end, the standard for disability is the same for both SSI and SSDI. In the simplest possible terms, disability is the inability to perform full time work due to limitations caused by disabling medical conditions. Having an experienced lawyer on your side ensures that all physical and mental health impairments are considered and evaluated. Medical tests also can be ordered and performed that could lead to findings that support the disability claim.

What are some examples of qualifying disabilities?

Many physical impairments may qualify you for SSDI benefits including:

• Asthma
• HIV/AIDS
• Arthritis
• Multiple Sclerosis
• Diabetes
• Hepatitis
• Carpal Tunnel Syndrome
• Degenerative Disc Disease

You may also qualify to collect SSDI benefit payments based on your psychological and emotional disabilities, including:

• Anxiety
• Bipolar Disorder
• Depression
• Mental Capacity Limitations
• Learning disorder
• Schizophrenia
• Posttraumatic Stress Disorder

What if my claim was denied?

If your claim was denied, don’t be discouraged. Our experienced Social Security Disability lawyers are ready to appeal your claim to a Social Security Administrative Law Judge, Appeals Council, or Federal Court, if necessary.

It’s important to note that there are two types of denials: technical and medical.  A technical denial happens when the government considers you simply ineligible to receive benefits. This may be because you haven’t worked and paid sufficient FICA taxes into the system. It may also be because you are currently working and earning more than the current limit.  A medical denial happens when the state agency reviews your available medical records and determines that you either aren’t “disabled” or they don’t expect you to remain disabled for 12 months. Both types of denials can be appealed.

The first step to successfully appealing a denial is to hire a competent SSDI lawyer.

Your denial was determined without a hearing and was based largely on your submitted medical records and various forms. In Pennsylvania, you now have the option to pursue an appeal by requesting a hearing.

During a hearing, usually lasting no more than an hour, an administrative law judge will decide you case based on the evidence in your file. Often, this decision is made before the hearing even begins. This makes it important to have a lawyer present who can coherently make your argument to the judge prior to the actual hearing.

If your hearing is unsuccessful and you decide to appeal, the Appeals Council will review your case. The Council will not hold a hearing and will never see you. An appeal of the Council’s decision will bring your case to federal court in a lawsuit against the government. A federal judge will review your case on paper only and, again, there will be no hearing. The fees you pay in these cases are set by federal law.

The impersonal nature of this process beyond the hearing stage makes having a well-practiced SSDI attorney essential. Kraemer, Manes & Associates LLC can provide you an SSDI attorney with the right credentials and experience to give you the best possible chance of making a successful claim.

What if I miss the appeal deadline?

If you wish to appeal your initial denial, you have just 60 days from the date that you received your letter. The Social Security Administration assumes that you receive your denial letter five days after the date on the letter, unless you can show that you received it later. A missed deadline for filing your appeal will force you to start the entire process over again.

How long do I have to be out of work before I can claim disability?

To begin with, your inability to work must be due to medical problems, whether physical or mental. In other words, no matter how long you are out of work, you cannot get disability unless your inability to work is caused by medical conditions.

Under the Social Security Act in order to be considered disabled, you must have been out of work or be expected to be out of work due to medical problems for at least one year. That means if you have already been out of work for one year as a result of medical conditions, you would be eligible. It also means that if you are expected to be unable to work for at least one year due to your medical conditions, then you are eligible immediately even if you have not been out of work for one day on the date that you apply.

If you are unsure whether you will be out of work for a full year, it may be best to apply and then see when happens later. There is no penalty for withdrawing you application because you were able to return to work before a full year had run.