Many people plan for their future by investing money in the stock market, paying off their home and mapping out the travel and adventure they will experience in retirement. Yet, few people plan for the possibility of becoming disabled and unable to work. Studies show one in four of today’s 20-years-olds will become disabled before the age of 67, yet 70 percent of the private workforce has no long-term disability insurance and does not understand the disability benefits that are available to them through the Social Security Administration (SSA).
The SSA has two disability programs – Social Security Disability (SSD) and Supplemental Security Income (SSI). Under both programs, an individual must qualify under a strict set of medical or vocational guidelines to be found disabled. There are three ways to qualify for disability benefits. First, the SSA evaluates whether your physical and/or mental impairments meet the SSA’s disability listing. In order to meet the disability listing, an individual must have every objective symptom documented under SSA’s criteria. SSA’s medical listings can be found at 20 C.F.R. 404, Subpart P, Appendix 1.
Second, if you do not meet the listing, you can be found disabled if you “equal” the listed impairments. For example, if you lack certain symptoms of depression, but have other severe impairments like psychosis or severe anxiety, those symptoms may add up to “equal” the listing. Equaling the listing is a subjective determination, which is usually made by a judge at a hearing. Third, the SSA may find you disabled vocationally by determining that you cannot perform your past work and there are no other jobs available to you in the national economy. The SSA’s vocational analysis is based upon your age, education, skills you may have from your past relevant work and a medical determination of your physical and mental functional capacity. Typically, a finding of disability based upon vocational factors is determined by a judge who relies on vocational expert testimony at a hearing.
The main difference between the SSD and SSI programs is that the amount of an individual’s SSD benefits are based upon their past earnings and SSI benefits are only available to individuals who are disabled and meet the government’s income and asset restrictions. In other words, SSI is a supplement, currently set at $733 in Utah, which provides basic subsistence for those who have not worked, have not paid taxes, or have earned a low income. SSI benefits are also available for disabled children. Many people get the two programs confused, thinking there are asset restrictions for those who receive SSD benefits, when there are not. If you paid taxes and worked a sufficient number of quarters, you are eligible for SSD benefits if you become permanently or even temporarily disabled, as long as your disability lasts longer than one year. For example, if you have multiple sclerosis that prevents you from working, you may be entitled to ongoing monthly SSD benefits. Additionally, you could be entitled to SSD benefits during a period of recovery if you are suffering severe injuries from a car accident and expect to be off work for over a year.
Obtaining disability benefits is a lengthy, difficult process. While the application for benefits can be completed online, the application answers can delay and affect the outcome of your case. Even if you correctly complete the application and submit all of your medical records, there is a 70 percent chance the claim will be denied and you will need to file a request for reconsideration. At the reconsideration stage, 70 percent of claims are also denied and you must file a request for a hearing before a judge. Currently, this appeal process takes approximately two years. Finally, you should be aware that if you do not win benefits at a hearing, your disability case can be appealed to the Appeals Council, the SSA’s internal review system. If the Appeals Council denies review of the case, the case can be appealed to Federal Court. The Federal Court has de novo review and can deny, remand, or grant the case and order Social Security to pay disability benefits.
Because the Social Security appeals process is so lengthy, you should buy a private long-term disability policy either through your employer or on the open market. Since obtaining disability benefits takes an average of two years, you would be forced to live off savings or loans before receiving SSD or SSI benefits if you don’t purchase a private long-term disability (LTD) policy. Living off of your assets can be avoided by purchasing an LTD policy with a short waiting period, that will cover basic expenses while you apply for SSD benefits.
The advantages in obtaining disability benefits go beyond simply receiving a monthly payment. For example, most SSD benefits include a monthly benefit amount for you and a family benefit for your children. Additionally, being found disabled by the SSA “freezes” the years in which you are unable to work, so the SSA will look back to your highest earning years when they calculate retirement benefits. SSD benefits also entitle you to Medicare after a 29-month waiting period. SSI benefits entitle you to Medicaid, which begins from the date of application. Medicare and Medicaid benefits can be retroactively applied and can pay for past surgeries or other overdue medical bills. If you are 50 years old and win SSD benefits at $2,000 a month, you have won $408,000 in disability benefits and ongoing Medicare coverage, which you will receive until you reach full retirement age. It is important for every lawyer to understand these substantial benefits, both for themselves and their clients, because these benefits can help replace lost income, support children, and provide ongoing medical treatment in the face of illness and disability.