SSI & SSDI FAQ
- What is the difference between Social Security Disability benefits and SSI benefits?
- What are the procedures used by SSA to determine eligibility for SSDI or SSI benefits?
- Are benefits available for disabled children?
- Why should I have a lawyer to represent me in my claim for SSDI or SSI benefits?
- What other types of cases does your office handle?
To learn more about Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) law, contact the Newark and Manhattan law offices of Josephine Gottesman, Attorney at Law, for a free and confidential consultation. Call us toll free at 1-888-375-3060.
What is the difference between Social Security Disability benefits
and SSI benefits?
Social Security disability insurance (SSDI) is an insurance program by which a person who works on-the-books has deducted from his/her earnings a certain amount per paycheck to be used by SSA in case he/she becomes disabled and can no longer work. As such, it is required that those who would qualify for such benefits have credited to their SSA account at least 20 calendar quarters (5 years) of earnings out of the last 40 quarters (10 years) prior to their becoming disabled. However, for a younger adult Claimant (usually under age 30), less than 20 quarters of coverage is required.
SSI (Supplemental Security Income) benefits have no such earnings requirement. Thus, people who have no earnings, or few earnings, posted to their SSA account could qualify for SSI benefits but not SSDI benefits. This also includes individuals who may have worked "off the books." Another difference is that SSI benefits are means-tested. Thus, as in public assistance (welfare), one must financially qualify to receive such benefits. This requires that an individual have very limited assets and/or savings and income in his/her name. SSI benefits are substantially lower than SSDI benefits, which are tied in to the earnings reported over a working individual's lifetime. An individual may, in certain circumstances, qualify for both SSDI and SSI.
Finally, SSDI recipients qualify for Medicare benefits once they have reached 24 months of disability, counted from the date first financially qualified, not from the application date. SSI recipients only qualify for Medicaid, unless they are Medicare-eligible due to age. There is no waiting period for Medicaid benefits.
What are the procedures used by SSA to determine eligibility for SSDI
or SSI benefits?
While it is impossible to exhaustively describe these procedures here, the reader should understand that SSA is a bureaucracy. As such, it often has convoluted, tedious and repetitive procedures.
Once a person submits an application for SSDI or SSI benefits, the application is sent to a local State agency for development of medical evidence. There, staff will collect information concerning the Claimant's medical condition. The Claimant may be sent for at least one consultative examination performed by SSA's doctors. If the initial application is denied (about 70% of them are denied outright), the next step in New York is to apply for a hearing by an Administrative Law Judge (ALJ). Until recently, NY also had the reconsideration stage, which has now been eliminated. Most other states have retained the reconsideration stage, which is a review of the file by a different claims examiner. Most of these reconsiderations also result in a denial affirmance.
It can take well over a year for the case to be assigned to an ALJ once a request for hearing is received. Once assigned, the hearing office makes sure all available evidence is in the file, and then a hearing date is set. SSA is required to give the Claimant at least twenty (20) days' notice of the hearing date. At the hearing, SSA may produce a medical expert or experts, whose job is to enable the ALJ to understand the Claimant's various medical conditions. SSA may also produce a vocational expert to testify as to the availability of jobs in the national economy which the Claimant can do despite his/her medical condition. Although the Claimant is allowed to cross-examine these experts, and to produce rebuttal witnesses, most often a Claimant is not aware of this or does not know how to go about doing this.
Should the Claimant lose the hearing, he/she can send a letter to the Appeals Council, asking that it review the ALJ's decision, and stating his/her reasons for arguing that the decision was incorrect. At present, the Appeals Council is taking up to two (2) years to decide whether to review an ALJ's decision. During this time, although benefits continue to accrue to the Claimant's account, the Claimant receives no benefits or medical coverage. The Appeals Council may deny the request for review, grant the request and send the claim back for another hearing, or award benefits outright. Of these three options, most often the Appeals Council sends the claim back for another hearing. It rarely awards benefits outright.
If the Claimant does not win at the Appeals Council, he/she may take the claim to Federal Court. A Claimant may file a pro se (without an attorney) complaint; however, the Court may, in certain circumstances, assign an attorney from the pro bono panel to represent the Claimant.
Are benefits available for disabled children?
The only benefits available solely for disabled children are SSI benefits, which are means-tested as described above. This is because a parent has a legal obligation to support a child, in whatever state of health, until the child is at least 18 years of age. The child, just like the adult, must prove that he/she is so disabled that his/her functioning is severely impaired. However, if a disabled parent receives SSDI, benefits are available to a non-working spouse and the Claimant's minor children as auxiliary benefits. There is a family maximum amount which serves as a cap on the total benefits awarded a family.
Why should I have a lawyer to represent me in my claim for SSDI
or SSI benefits?
Although it is not necessary to retain an attorney to represent you in your claim, the process will be easier for you if you have counsel and more likely to result in a favorable decision. This is because there are many forms to be completed and a multiple-stage appeal process. In addition to protecting your legal rights, your attorney should assist you in gathering any necessary medical evidence, interface with your service providers to document your disability according to Social Security law, and represent you at your hearing. This will ensure that your appeals are timely filed and that your retroactive benefits are protected. Moreover, the attorney is able to charge the same fixed fee, whether you meet him/her on the day of your hearing or prior to filing your initial claim. Therefore, the sooner you retain an attorney, the sooner he/she will start working for you. Your attorney should be fully conversant with Social Security and disability law in order to be able to protect your rights and represent you in a Federal Court appeal, if necessary.
What other types of cases does your office handle?
Our office is a general practice law office. In addition to Social Security disability law, we specialize in assisting disabled individuals in several areas. Among these are: disability discrimination; failure to accommodate; long-term disability benefits; disability pensions; and buyout (severance) packages. In addition, we handle divorces (New York only), IRS disputes (New York and New Jersey), wills, and estates. In some instances we are able to refer callers to other attorneys if we are unable to handle a particular matter.