What Can You Expect If You Win Social Security Disability Benefits?

Winning Social Security Disability benefits can be a huge help to most people.  As a disability lawyer I am in the business of helping people win their benefits, so I often hear questions about what exactly you get when you win.  Here are the details of the Social Security Disability program.

When You Win Social Security Disability benefits …

  • You will get a monthly income check from Social Security
  • You may be eligible to get a back award payment
  • You will get government health insurance (Medicaid, or Medicare)
  • Your family members may be eligible to receive auxiliary benefits (children of a disabled person)
  • You may receive an annual Cost of Living Increase in most years that increases your monthly check

Many of the details about what you win depend on what exactly you file for, and what you have won.  Some people qualify for SSI only, or SSDI only, while others qualify for both.  Every person’s eligibility for benefits is different based on their age, income, and work history.

With Social Security Disability the eligibility rules are pretty complex.  Many people will need help just understanding the rules about whether they should apply or not.  Most disability law firms offer free consultations to answer these questions in a short phone call.  If you are curious about your chances you should get professional help to evaluate your potential case.  After a short discussion you will know what benefits you may be eligible for.

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How Much Back Pay Can I Get If Approved?

“Date of Entitlement” to Past-Due Benefits

When you meet with an attorney about your social security disability case, one of the first topics discussed is the date you are entitled to benefits, or “onset date.”  This date determines when you will receive benefits if you are found disabled and meet all other requirements.  The date will vary depending on the type of disability you are applying for.  Please locate the type of disability you are applying for below to learn about your date of entitlement.

Title II, Social Security Disability Insurance Benefits (DIB) :

You are entitled to disability benefits before reaching full retirement age if: you have enough social security earnings to be insured for disability; you apply; you have a disability or had a disability that ended within a twelve month period before the month you applied, and you have been disabled for five full consecutive months.  See 20 C.F.R. § 404.315(a).  The date of entitlement establishes the date from which past due benefits will be paid.  In Title II Disability Insurance cases, the date of entitlement is five full months after the date of onset (the date you are alleging you became disabled) or seventeen months before the month of application no matter how long you were disabled before then.  No waiting period is required if you were previously entitled to disability benefits within five years of the month you again became disabled. See 20 C.F.R. § 404.315(a)(4).

The date of entitlement may also begin up to twelve months immediately before the month in which your application is filed.  See 20 C.F.R. §§ 404.315(a)(4), 404.320(b)(4) and  404.621(a).

Title XVI, Supplement Security Income (SSI):

In Title XVI Supplemental Security Income cases, applications have an entitlement date of the first of the month after the date of application or the first of the month after all requirements are met (you are disabled and meet income and asset requirements), whichever is later.

Payments of SSI benefits begin the month after the month of initial eligibility and each month after as long as all requirements for eligibility and payment continue to be met.  20 C.F.R. § 416.501.

Disabled widow(er)’s benefits:

You may claim widow(er)’s benefits if you are indeed the insured’s widow(er), you have applied, you are at least sixty years old or at least fifty and have a disability, you are not entitled to old age benefits and you are unmarried.  See 20 C.F.R. § 404.335.  Benefits will begin with the first month covered by the application in which all other requirements for entitlement are met.  See 20 C.F.R. § 404.337.

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Questions Asked During a Disability Hearing

In a typical disability hearing the judge and your attorney will take your testimony.  The questions they will ask fall into four broad categories: 1) background information, 2) work history, 3) medical conditions and symptoms, and 4) activities of daily living.

Background questions provide the judge general information about you.  This includes items such as your education, marital status, household income, and, if applicable, any military service or past criminal charges or incarcerations.  The judge might ask you whether you have used drugs or alcohol in the past.

The Administrative Law Judge (ALJ) should already be familiar with your work history in general from the information you provided in your application.  The ALJ might ask for additional information such as your job responsibilities, the mental and physical demands of those jobs, and whether your medical conditions affected your job performance.  This last item is the most important.  Giving the judge specific examples of problems with co-workers or bosses, meeting performance standards, or attending work consistently can convince the judge that your medical conditions would prevent you from working again.

The judge should also be somewhat familiar with your medical conditions as described in your medical records.  Although your medical records are in your disability file they don’t provide all the information the judge needs to make an informed decision.  The judge will likely ask you about how your medical conditions affect you.  What type of pain do they cause you?  How do you try to relieve the pain?  Are your medications effective?  How much can you lift and carry?  How long can you stand, sit, and walk?  Whatever your medical conditions may be, the hearing is your opportunity to provide details about your symptoms.

You may be asked about your activities of daily living, or “ADLs”.  Your ADLs include everyday activities like bathing and dressing yourself, cooking, cleaning, yard work, and grocery shopping.  If you have young children or disabled adults in your household the judge will likely asked detailed questions about who cares for them.

If you are very active this will suggest to the judge that you might be able to hold a job.  But discussing your ADLs is another opportunity to illustrate the problems your medical conditions cause you.  Do you have to take breaks while doing chores?  Do you have to ask for help to care for your children when your symptoms are at their worst?  Trying your best to help around the house isn’t a bad thing, but it’s crucial to explain to the judge how your medical conditions limit your efforts.

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If Denied for Social Security Disability or SSI, you Need to File an Appeal

There are four levels of appeal for denial of Social Security Disability or Supplemental Security Income (SSI) Benefits.  These generally include a Request for Reconsideration, a Request for a Hearing, a Request for Review by the Appeals Council, and filing a lawsuit in Federal District Court.

If you file an application for Social Security Disability or SSI benefits, and your case is denied, you will need to file a written Request for Reconsideration within 60 days.  A Request for Reconsideration involves a brand new review, by a different disability examiner, of all of the medical evidence you submitted when you first filed your application and any new evidence submitted at the reconsideration level.  If you disagree with the decision reached in your Request for Reconsideration, you may file a Request for a Hearing, in writing, within 60 days.

An Administrative Law Judge (ALJ), that took no part in the two prior decisions reached in your case, will look at all of your medical evidence, will listen to your testimony and that of any witnesses testifying on your behalf or that of any experts he or she has requested to be present at your hearing, and will reach a brand new and impartial decision in your case.  The Judge will issue his or her decision in writing and he or she will mail it to the address you have on file with the Social Security Administration.

If you disagree with the ALJ’s decision, you may file a Request for Review by the Appeals Council.  Although the Appeals Council looks at every request, it does not review every request.  If the Appeals Council finds that the ALJ’s decision was correct, it may deny your request for review.  The Appeals Council may also find that error was committed or that there is a further need for review and it may remand the case to the ALJ.  The Appeals Council also has the authority to vacate the ALJ’sdecision and issue its decision regarding your determination.  If any case, you will receive notice of the Appeal Council’s decision by mail.

If you disagree with the decision reached by the Appeals Council, you may file a lawsuit in Federal District Court.

Posted in Appealing a SS Decision, Basics of SSD, Filing Initial Application, Reconsidered Application, Why People Are Denied | 2 Comments