Social Security Disability comes with a lot of questions. While we can’t answer all of them on a single webpage, this article does address some of the biggest question marks that might be hovering over your own decision about whether to file as an individual (and how to do so).
Remember: every situation is different. Because of the uniqueness of your circumstances there is really no substitute for directly speaking with an experienced lawyer.
What is the definition of "Disability"
For all individuals applying for disability benefits under title II, and for adults applying under title XVI, the definition of disability is the same. The law defines disability as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.
Disability in children
Under title XVI, a child under age 18 will be considered disabled if he or she has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.
What is a "Medically Determinable Impairment"?
A medically determinable physical or mental impairment is an impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. The medical evidence must establish that an individual has a physical or mental impairment; a statement about the individual's symptoms is not enough.
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How is the disability determination made?
Most disability claims are initially processed through a network of local Social Security field offices and State agencies (usually called Disability Determination Services, or DDSs). Subsequent appeals of unfavorable determinations may be decided in the DDSs or by administrative law judges in SSA's Office of Hearing Operations (OHO).
How is the disability determination made?
SSA’s regulations provide a procedure known as the "sequential evaluation process" for disability evaluation. For adults, this is a five-step process that requires sequential review of:
- the claimant's current work activity (if any),
- the severity of his or her impairment(s),
- a determination of whether his or her impairment(s) meets or medically equals a listing (see Part III of this guide),
- the claimant's ability to perform his or her past relevant work, and
- his or her ability to do other work based on age, education, and work experience.
For children applying for SSI, the process requires sequential review of:
- the child's current work activity (if any),
- the severity of his or her impairment(s), and
- an assessment of whether his or her impairment(s) meets, medically equals, or functionally equals a listing.
If SSA can find an adult or child either disabled or not disabled at any step, the evaluation is complete.
When do disability benefits start?
Disability benefits for workers and widows usually cannot begin for 5 months after the established onset of the disability. Therefore, Social Security disability benefits will begin the sixth full month after the date the disability began. The 5-month waiting period does not apply to individuals filing as children of workers. The 5-month waiting period also does not apply if a worker’s disability results from amyotrophic lateral sclerosis (ALS) and he or she is approved for Social Security disability benefits on or after July 23, 2020. Under SSI, disability payments may begin as early as the first full month after the individual applied or became eligible for SSI.
In addition, under the SSI disability program, an applicant may be found "presumptively disabled or blind," and receive cash payments for up to 6 months while the formal disability determination is made. The presumptive payment is designed to allow an individual with limited income and resources to meet his or her basic living expenses during the time it takes to process the application. If it is later determined that the individual is not disabled, he or she is not required to refund the payments. There is no provision for a finding of presumptive disability or blindness under the Title II program.
Can individuals receiving disability benefits or payments get Medicare or Medicaid coverage?
Medicare helps pay hospital and doctor bills of disabled or retired people who have worked long enough under Social Security to be insured for Social Security benefits. It generally covers people who are 65 and over; people who have been determined to be disabled and have been receiving benefits for at least 24 months or have amyotrophic lateral sclerosis (ALS); and people who need long‑term dialysis treatment for chronic kidney disease or require a kidney transplant. In general, Medicare pays 80 percent of reasonable charges.
In most States, individuals who qualify for SSI disability payments also qualify for Medicaid. States may refer to the Medicaid program by different names. The program covers all of the approved charges of the Medicaid patient. Medicaid is financed by Federal and State matching funds, but eligibility rules may vary from State to State.