Applications and Entitlements
1. How do I apply for SSDI or SSI benefits?
You can telephone the SSA at 1-800-772-1213 and select the option of either having your application taken over the telephone or by going to your local social security office to apply for benefits. The 800 number is open between 7:00 a.m. to 7:00 p.m. The tele-service is most busy on Mondays and Tuesdays and between 10:00 a.m. and 3:00 p.m. daily.
2. If I want to apply for SSDI benefits, what are my next steps?
To expedite your SSDI or SSI claim, gather the following information:
- Your Social Security number.
- Contact information for doctors and hospitals that have treated you, including dates.
- Your most recent W2.
- Call 1-800-772-1213 or contact your local Social Security office to apply for benefits.
- You may apply for dependent SSDI benefits at the same time.
3. How do I contact Social Security?
For more information, visit the SSA website at www.socialsecurity.gov or call toll free, 1-800-772-1213 (for the deaf or hard of hearing, call the TTY number, 1-800-325-0778).The SSA can answer specific questions from 7a.m. to 7p.m. Monday through Friday and can provide information by automated phone service 24 hours a day.
The SSA will treat all calls confidentially, and also wants to make sure you receive accurate and courteous service. That is why the SSA will have a second Social Security representative monitor some telephone calls, so be sure to be courteous and kind as well.
So we hope that this information has been helpful. If you are disabled and approaching retirement age, or if you need any further information concerning the inter-play of disability, (SSDI) retirement and which would benefit you and your family, you may contact Mike Murburg through our website.
4. Do I need medical evidence to win my SSDI or SSI case?
Yes. Your disability claim whether it is SSI or SSDI must be supported by objective material medical evidence of record, meaning diagnoses during doctors visits and by medical test results like MRI, CT Scans, X-Rays and blood tests. It is established law that the lack of medical treatment is a strong factor against finding disability. Moreover SSR 02-1p restricts the award of benefits to those claimants who do not refuse to follow prescribed treatment, like giving up smoking in COPD cases, or by failing to take prescribed medications, or by failing to stop using illegal drugs or alcohol, when those substances can exacerbate physical and mental illnesses. The simple rule is that you must treat medically and follow what your doctor prescribes or you may expect no help from the SSA. There can be extenuating circumstances though which will be covered further in this tome.
5. Do I need appropriate medical care while my application is pending?
No one needs good medical care more than the disabled. Moreover, medical treatment records from your treating physicians provide the most important evidence of disability in a social security case. Obtaining medical reports and sending your doctor the proper forms and questionnaires concerning your care may be something best left for an experienced lawyer to do.
6. If I don’t have any regular health care, how do I get medical treatment while I am waiting for a decision from the Social Security Administration?
Sorry, you may be on your own, look to a charity government programs for the indigent. This access varies from state to state, county to county and even between rural and city areas.
7. How many times do I have to get turned down by Social Security before I get my benefits?
Many people get turned down the first time they apply. Rather than going back and filing a new SSDI or SSI claim, one whom is denied can and should appeal his or her case. By failing to appeal your case, you will lose the benefits to which you would otherwise be entitled and start a new application based on a later date. This means less money for you and your family. Moreover, if you have worked enough quarters to be insured under SSDI, you only remained insured for five years or less after you stopped working. By waiting and refilling after being turned down, one could be outside of his or her period of insurance and not be able to receive SSDI benefits. So, once turned down the first time, either you or your attorney will have to file a “Request for Reconsideration” within 60 days of your receipt of your initial “Notice of Disapproved Claim”, Form SSA-561-U2, that you have been turned down to preserve your appeal. You will also have to file concurrently with it Form SSA-3441- BK, known as a “Disability Report-Appeal” form. If you are turned down you will receive a “Notice of Disapproved Claim” letter telling you that you must file a “Request for Hearing by Administrative Law Judge.” After that, you or your attorney will again have to file within 60 days another form, a “Request for Hearing by Administrative Law Judge”, Form HA-601-U5, and again a “Disability Report-Appeal” form.
8. Does persistence help?
Yes. Be persistent. Social Security disability benefits can help you and your family significantly.
9. Do you have any special tips in dealing with the SSA?
Yes. Once you call SSA and actually talk to a claims representative, always ask for his or her telephone number. They are unlisted, and you cannot get them from the phone company. Do not lose the number, save the number so you can re-contact your claim representative in 3 or 4 days for a follow-up.
The SSA is a gigantic bureaucracy. Make sure to write down the names, dates and location of everyone you talk to at SSA, and, if you complete forms always keep copies, and, if at an SSA office, ask to be provided with stamped and dated copies of the records you submit. Organize your records in a file and always bring your own records to the SSA office and ask for a supervisor if you have a problem.
Finally, dealing with the SSA can be frustrating and disheartening. Do not let yourself despair. Seek help if you need it and never give up.
10. If I am a Social Security Disability Claimant and a Veteran who has applied for Social Security Disability or SSI Benefits, must my VA Doctor assist me in completing paperwork helpful to my Social Security Disability or SSI case?
Yes. According to VA Directive, a claimant’s VA Physician is mandated by VA Directive 2008-071 to render assistance to the claimant in completing forms that will assist the claimant in his petition for Social Security Benefits and benefits through other Federal programs.
A copy of VA Directive 2008-071 may be found in the Appendix of this website and Publication. If your VA physician refuses to help, print out a copy of the “VA Directive” and show it to him. That may help.
11. What is my “Alleged Date of Onset of Disability,” and why is it important to select the correct date?
The date alleged for an onset of disability “AOD” is the date from which entitlement to Social Security Disability Insurance benefit entitlement (less the 5 month elimination period for financial entitlement and payments), SSI (immediate entitlement to payment of funds on AOD), Medicaid (immediate entitlement on AOD) and Medicare (less the 2 year elimination period) entitlements run. The AOD should be the first day when a claimant was unable to engage in SGA, “Substantial Gainful Activity”. This term of art when broken down essentially means, “Could a claimant work a 40 hour week without significant interruption from symptoms and/or need for treatment?” AND, no matter how sick the claimant was, and no matter how many workdays the claimant missed, was the claimant still able to make gross earnings of over $1,000 (or so) per month? If the answers to both are “No”, then the claimant is unable to engage in SGA and hence, is disabled note that the required definition AOD and SGA have different applications and erroneous interpretations by those unfamiliar with the application of the term. For example, in some cancer cases, those not listed as Compassionate Allowance cases the patient is most often denied because the SSA will take a wait and see attitude. This is because people do get better within a year, and the applicant must be incapable of SGA for at least 12 months after their AOD.
Regarding the proper onset date of disability within the AOD, it is important to get the right onset date, as the wrong date holds up the SSD/SSI process until the proper date is decided by a judge. By asserting the correct onset date one may circumvent the necessity of having one’s case heard and get an award even before trial. I have had cases, where, for example a bipolar adult will say the onset of disability began in 1977 when he was 8, but he worked until 2002 when he had a nervous breakdown from which he never recovered or returned to work. Such a case was won by seeing the error and filing a written formal motion to move the onset date to the last day of continuous work, i.e. first day of psychiatric hospitalization. Unfortunately, we do not get these types of files until they are ready for hearing and people have suffered too long.
So, getting the proper AOD is very important. It is why an attorney should be consulted or retained immediately after a claim is denied, so that one does not necessarily have to wait for a hearing.
12. What date should I use for my “Alleged Onset Dater of Disability” when I apply for Social Security Disability?
Many people who are seeking disability may have a long-standing condition, like diabetes or depression. Often they make the mistake of using the first date on which they received a diagnosis of their illness. This complicates matters in their cases, especially when a claimant has worked after the alleged onset date and has earnings posted after that date, almost an automatic guarantee for a denial. Citing too early a date is a common cause of gumming up the system and preventing a claimant from getting his or her benefits. Use too early a date, and you will wait years for your hearing. Use too late a date, you may be past your DLI or “Date of Last Insured”, the last date of eligibility for getting SSDI insurance benefits and after which date one gets no SSDI benefits. As a rule of thumb, your alleged date of onset should be the day after the last date on which you were able to work at any job at a full time bases. This is often the date when a claimant finds himself or herself unable to work at all or only work a few hours per day or a couple of days per week because of a disabling condition. REMEMBER, ONE CAN HAVE A “DISABILITY” AND STILL NOT BE “DISABLED”.
13. What do Social Security Disability, (SSDI) and Social Security Retirement, (SSR) have to do with each other?
Both SSDI and SSR programs are separate parts of the Social Security Protection umbrella. If you were born before 1938, your full retirement age is 65. Because of the 1983 change in law, the full retirement age will increase gradually to 67 for people born in 1960 or later. Some people retire before their full retirement age. You can retire as early as early as 62 and take retirement benefits at a reduced rate. If you work after your retirement age, you can receive higher benefits because of additional earnings and credit for delayed retirement. If you are disabled prior to your full retirement age and receive SSDI due to your disability, your retirement will not be reduced, because you will collect SSDI until your full retirement age.
Disability – for example, if you become disabled before your full retirement age, you can receive disability benefits after six months if you file for them and have:
- Enough credits from earnings (depending on your age, you must have earned six to 20 of your credits in the three to 10 years before you became disabled); and
- A physical or mental impairment that’s expected to prevent you from doing “substantial” work for a year or more or result in death.
13a. Do the rules change if I am a veteran?
Yes, they may. If you are filing for disability benefits, please let the Social Security Administration know if you are on active military duty or are a recently discharged veteran, so that the Social Security Administration can handle your claim more quickly. There is an offset for Non-Service Connected VA disability benefits against your SSDI but not for VA service connected Disability Benefits thus allowing entitled Veterans to collect both Social Security Disability and Service Connected VA Disability Benefits.
13b. How does all this SSDI and SSR information apply to my family?
Family- If you are eligible for disability or retirement benefits, your current or divorced spouse, minor children, or adult children disabled before age 22 also may receive benefits. Each may qualify for up to 50 percent of you benefit amount.
Survivors – When you die, certain members of your family may be eligible for benefits:
- Your spouse age 60 or older (50 or older if disabled, or any age if caring for your children younger than age 16); and
- Your children if unmarried and younger than age 18, still in school and younger than19 years old, or adult children disabled before age 22. If you are divorced, your ex-spouse could be eligible for a widow’s or widow’s or widower’s benefit on you record when you die.
13c. If I am on SSDI or SSR can I get extra help with Medicare?
Yes, you can get extra help with Medicare. If you know someone who is on Medicare and has limited income and resources, extra help is available for prescription drug costs. The extra help can help pay the monthly premiums, annual deductibles, and prescription co-payments. To learn more or to apply, visit www.socialsecurity.gov or call 1-800-772-1213 (TTY 1-800-325-0778).
14. If I am getting close to early retirement age, even if I think I am disabled, why shouldn’t I just forget about filing for SSDI and file for early SSA Retirement?
If you do not file for SSDI this may result in a lost of over $100,000.00 in benefits over your projected lifetime. So, carefully consider the advantages and disadvantages of early retirement and not simultaneously filing for both which you can do. If you choose to receive benefits before you reach full retirement age, your monthly benefits will be permanently reduced, unless you are adjudicated as disabled. To help you decide the best time to retire, the Social Security Administration offers a free booklet, Social Security-Retirement Benefits (Publication No. 05-10035) that provides specific information about retirement. You can calculate future retirement benefits on the Social Security Administration website at www.socialsecurity.gov by using the Social Security Benefits Calculators.
14a. Are there any other SSA publications which may be helpful to me in making my decision?
Yes. Other helpful free publications include:
- Understanding The Benefits (No. 05-10024)
- Your Retirement Benefit: How it Is Figured (No. 05-10070)
- Windfall elimination Provision (No. 05-10045)
- Government Pension Offset (No. 05-10007)
- Identity Theft And Your Social Security Number (No. 05-10064)
The Social Security Administration also has other leaflets and fact sheets with information about specific topics such as military service, self-employment or foreign employment. You can request Social Security publications at the Social Security Administration website, www.socialsecurity.gov, or by calling the Social Security Administration at 1-800-772-1213. The Social Security Administration website has a list of frequently asked questions that may answer questions you have. The Social Security Administration easy-to-use online applications for benefits that can save you a telephone call or a trip to a field office can be found on line. You may also qualify for government benefits outside of Social Security. For more information on these benefits, visit www.govbenefits.gov.
15. If I am disabled or thinking of retiring what are my options and what do I need to consider?
As you approach the age when you can receive Social Security retirement benefits, you have options to consider and decisions to make. Before making your retirement decisions or filing for disability simultaneously, we hope you will consider all the options.
There are important questions that you need to ask yourself, 1. At what age do you want to begin receiving benefits? 2. Do you want to stop working and receive benefits? 3. Do you want to work and receive benefits at the same time? 4. Or do you want to work beyond your full retirement age and delay receiving benefits? 5. Will it be financially advantageous to go on disability and file for retirement?
15a. Is there any reason for me to work past my full retirement age if I can?
Beside the beneficial mental and physical health reasons, when you continue working beyond full retirement age, your benefits may increase because of your additional earnings. If you delay receiving benefits, your benefits will increase because of the special credits you will receive for delaying your retirement. This increase benefit could be important to you later in life. It also could increase the future benefit amounts your family and survivors could receive. This is why you should also consider filing for SSDI if you are incapable of working the equivalent of a 40 hour work week due to physical or mental limitations.
Each person’s retirement situation is different. It depends on the circumstances such as health, financial needs and obligations, family responsibilities, amount of income from work and other sources. It also may depend on the amount of your Social Security benefit.
We hope the above information will help you make your retirement decision.
15b. If I decide to file for SSDI, will Social Security disability insurance help my dependents?
Yes. If you are approved for SSDI benefits, other family members may also qualify for benefits. Generally, benefits will be available for:
- children under 19 who have not finished high school
- a spouse who is caring for a child under the age of 16
- a spouse over age 62
15c. Should I wait until I get my SSDI benefits to apply for SSDI dependant benefits?
Yes. To avoid unnecessary delays, apply for SSDI dependent benefits at the same time you are applying for your own benefits.
16. So, why shouldn’t I just file for my Social Security Retirement Benefits early and not file for Social Security Disability?
There are advantages of receiving Social Security disability benefits. When people think of Social Security, they think of retirement benefits. But Social Security also provides financial protection in the event that you suffer a serious disability, regardless of your age. This protection is provided under the Social Security Disability Insurance program (SSDI). Think of Social Security as an insurance program that you paid for through Social Security (FICA) taxes that were deducted from your paycheck.
There are a number of advantages to receiving Social Security disability benefits. Depending on your individual circumstances, advantages may include:
Higher Social Security retirement benefits: Generally, Social Security retirement benefits are calculated based on your average earnings during your working life. For people whose earnings have been reduced due to disability, this can mean lower retirement benefits. However, if you are approved for Social Security disability benefits, your Social Security retirement benefits will be calculated based on your earnings before your became disabled.
The impact of SSDI on your Social Security retirement benefit is significant. For example, an individual earning $50,000.00 a year who became disabled at age 40 and remained disabled until retirement would receive more than $130,000.00 in additional retirement benefits over a 20-year retirement:
We therefore recommend that you protect your future retirement benefits by filing for Social Security Disability and filing for your retirement benefits simultaneously.
16a. Will being adjudicated Disabled entitle me to Medicare?
Yes. Medicare eligibility: If you are found to be disabled, you will become eligible for Medicare 24 months after your Social Security effective date, regardless of your age. This is important, especially if you do not have or cannot afford private health insurance after you have early SSA retirement.
16b. If I am adjudicated “disabled” will I to be entitled to SSDI Cost of Living Adjustment (COLA)?
Automatic cost of living increases: Every year, Social Security gives SSDI recipients an increase in their benefits based on the Consumer Price Index.
17. I hate not working and being without any money for medicine or food or extras. Should I try to work after I have filed for SSDI or SSI?
You can try. The best proof someone is disabled in a strong earnings record in the past. I always tell my clients “Don’t live your life for a lawsuit or a disability claim, we deal with facts and proof, you have to deal with life”. If your return to work is less than six months generally and you earn less than approximately $1,000.00 per month, it should not be counted against you if you are forced to discontinue your work due to your disabling condition. It is known as an “unsuccessful return to substantial gainful activity or employment”. There are other determinations of employment known as “Extended Periods of Employment and “Trial Work Periods” which may apply if you are found to be disabled.
18. What happens if I try to return to work?
We always recommend that our clients not live their lives for a lawsuit or a Social Security Disability claim. If you can return to work and do and subsequently fail, the Social Security Administration may deem that an unsuccessful return to work, if the monies you earn are not significant or your return to work lasts generally less than six months. If you return to work and succeed, you may have your claim changed from an open-ended period of disability to a closed ended period of disability, as long as your disability made you unable to work for twelve months or more. If your return to work is successful, please let us know in writing and as to whether you want to continue on with either an open ended or closed ended period of disability.
19. What if I have investment income, (stocks, bonds, and rental income) does that affect what I receive if I am disabled?
Passive income from the sale, trade or dividends received do not generally constitute substantial gainful activity (SGA), unless you are substantially active in producing that income. In 2012 SGA was set at $1,110.00 per month or more. This is only used to determine your eligibility at the time you apply. This gets a bit difficult with dividends from a small business or corporation and with rental income, as these often involve some gainful activity to produce the income other than just receiving and depositing a check or moving monies from place to place on your computer. Of course, work and investment income will affect directly your SSI (Supplemental Security Income) claim as there is a need based financial offset involved.
19a. So, how is income treated if I am an on SSI?
Since SSI is an assets based entitlement, “unearned income” will reduce your benefit dollar for dollar after the first $20.00 of unearned income. Earned income is encouraged so your first $65.00 of earned income is ignored and benefits are offset by 50% to $ 398.00 so that if you earn $1, 481.00 your SSI benefit amount will zero out.
20. If I am struggling with a physical or mental diagnosis and problem and I am still working part-time, should I file for Social Security Disability or SSI?
If you are still working and earning gross wages of $1,000.00 per month or have not worked “on the books” for 5 of the last 10 years and gained sufficient “quarters” i.e. 20, you do not financially qualify for SSD or SSI no matter how sick you are, As of 2008, if you earn more than $740/mo or have property in excess of $2,000.00 you are not entitled to SSI. As of 2012, the earnings number rose to $1,010.00 and the maximum SSI benefit was $698.00. When you cannot make this amount due to your physical or mental conditions then file for Social Security Disability and contact us to set and appointment and look at your case.
21. What if I cannot keep my job due to being late or absent on account of my illness?
Special determination and Vocational allowance comes in to play with chronic absences. So, keep track of your pay stubs and keep a calendar upon which you should mark the days you were sick or late or had to go home early from work on account of your illness. Keep track of doctor’s visits too. If you have co-workers who know of your condition, keep in touch with them as, when it is time for you to stop work, you may ask them to write a statement for you about how you were unable to perform your job full time or without required help. Remember that if you get laid off due to economic circumstances, it will be presumed that you could have remained working and employed and not disabled and that your lack of work was based on economic circumstances, not your disability. This presumption can be overcome with testimony and medical records however.
22. If I have earnings after I apply for SSDI or SSI, should I report them?
Yes. Another reason people are denied benefits and have to wait for a hearing is because earnings show up on their record and there may be no obvious explanation for them. So the SSA presumes the earnings were from some gainful employment. An unexplained earning like severance pay or a 401 K cash-out will almost always guarantee a long wait for a hearing. So, report all income to SSA and explain it. Do this even if it is Workers’ Compensation Benefits, Unemployment benefits, Long term and Short-term disability benefits. Do not only report the amount, but the source of the benefits and the nature of them, what they were for. This will have to be clarified at some point and if you do it during the pre-hearing process, you may avoid a long, unnecessary wait for a Social Security Disability Hearing.
22a. Can I collect Unemployment Benefits and still apply for and get Social Security Disability?
That is a tricky question. Many judges look at this issue unfavorably. Technically, when you ask for unemployment, you are saying that you can work, and if you ask for SSD or SSI, you are saying that you cannot work. These are two opposite positions to some Judges. In fact, they are not opposite positions. The difference is very important. When one applies for unemployment benefits, one is saying that he or she is ready, willing and able to work at any job, even part time that he or she can do physically or mentally. With SSDI or SSI, one is stating, to the Social Security Administration that they cannot return to their former employment or do other substantial gainful employment for which they are mentally and physically able to do eight hours per day and seven days per week because their impairments prohibit such full time work on a regular and ongoing ability to earn more than $940.00 per month.
23. What are Disabled Widow’s, Widower’s or Surviving Divorced Spouse’s Benefits, and how is entitlement to these benefits determined?
As the title denotes, these benefits are determined by both disability and marital status. To get these benefits, you must have been married to your deceased spouse for at least 10 years, be a widow or widower or surviving spouse and be at least 50 years of age and your health problems must:
- Keep you from doing any kind of substantial work (described below), and
- Last, or be expected to last for at least 12 months in a row, or result in death, and
- Have started before the end of a special period.
The special period starts with the latest of:
- The month your spouse died, or
- The month your Social Security benefits as a parent ended, or
- The month your earlier period of widow(er)’s disability ended.
The special period ends at the close of the 84th month (7 Years) after the month it started.
24. Maybe I can work part time. If I do or try to, can I receive widow, widowers, or surviving spouse benefits and still work?
Yes. You can work and still get retirement or survivors’ benefits. If you are younger than your full retirement age, there are limits on how much you can earn without affecting your benefit amount. As the benefits change yearly, when you apply for benefits, the Social Security Administration will tell you what the limits are and whether work would affect your monthly benefits. When you reach full retirement are, the earning limits will no longer apply.
25. Will I lose my Social Security disability benefits if I return to work?
Not necessarily. You can continue to receive Social Security benefits for at least nine months after you return to work. If you can’t continue to work beyond this nine-month period, your Social Security benefits will continue.
In addition, your Medicare will continue for at least 8 ½ years after you return to work. These work incentives allow you to test your ability to work without fear of losing your benefits.
For more information regarding work incentives, see the “Red Book on Work Incentives” published by the SSA – www.ssa.gov/work/ResoucesToolkit/redbook_page.html.* See: *How Work Affects Your Benefits (publication No. 05-10069)
26. If I am receiving VA Disability, should I let Social Security know and give them a copy of my VA Award notice before my case is set or soon after my case is set for hearing?
Yes. The ALJ will consider a favorable decision by the VA to award you benefits as favorable evidence in your case so make sure you provide SSA with written notification
26a. What are “Wounded Warrior’s Benefits” and how may I be entitled to them?
The “Wounded Warrior Program” allows service personnel who were on active military service on or after October 1, 2001 to receive expedited processing of their Social Security Disability Claims. There is also a related program through the Department of Defense. Both require a separate application. The SSA program allows for a wounded warrior to file for benefits, even while collecting military pay when the claimant is unable to do substantial work because of his/her medical condition which has lasted or is expected to last for 12 months or more.
In “Wounded Warrior” cases the amount of pay a wounded warrior receives is not the controlling factor in determining disability. The actual work activity is. A wounded warrior might work in sheltered employment for the Army during his/her periods of in-patient and out-patient medical treatment. Had the soldier had “employment” where he could sit, stand and walk at his option and had a desk from which to work and if the wounded warrior could come and go as he pleased and was taken to his medical appointments by the car pool established at his unit where he reported for duty while on the program AND was allowed to rest and not have to engage in any activities related to his work and to lie down at the facility for two or more hours per day, this would probably not be considered “substantial work for pay or profit.” This is because these allowances are part and parcel of sheltered work and not a competitive job environment.
Such sheltered “employment” though creates a very gray area for these veterans both as a matter of entitlement, due to their earnings and activities in the workplace and what might otherwise be termed Substantial Gainful Activity, or SGA, and the potential for benefits that might otherwise awarded. Unfortunately Congress did not give much guidance in this area and the subject is presently about as clear as mud. One can imply though, a wide latitude given to both the Department of Defense and to the Social Security Administration in making sure these wounded warriors are not without funds with which to keep them and their families. That is the only clear intent I can glean from the law in this area. Remember that service connected disability benefits and SSDI benefits are available simultaneously to veterans and such “double dipping” is not only allowed but encouraged with present laws.
The bottom line is to file as early as you can for WW benefits. Document your job duties while you are still working and how much or how little was required of you. Keep in touch with your work supervisors who can testify on your behalf as to your ability to work less than a full week and get your treating physicians to set plausible work restrictions on you as early as possible.