Tell me about disability benefits

Factual Questions
1

Social security has disability right? Is eligibility the same as for retirement? Are benefits calculated based on earnings…like retirement?

How about worker’s comp…I think you can get disability thru it for work related injuries. How does that coordinate with SS?

How about private policies or group policies thru your employer…how do they coordinate with the others? Does some governement body enforce certain aspects of them at all. What if the insurance company just blows off a claim?

Overall, if one of the above says “Ok, your a little disabled but you can surely work somewhere. Go away and get a job” might SS come to the rescue?

2

Social Security has disability benefits, but to get them you must be “disabled,” as that term is defined by the Social Security Act and the regulations promulgated pursuant to that Act. In brief, to be “disabled” you must be both unable to perform your past relevant work or to make a vocational adjustment to other work due to your limitations imposed by your disability. This “disability” must last at least one year to be eligible for benefits.

Not only must you be “fully insured” as a retiree would have to be, but you also must be “currently insured” when your disability began. To be fully insured you must have at least 40 quarters of coverage (10 years, but they do not have to be consecutive). To be “currently insured” you must have 20 QC in the 40-quarter period ending with that quarter. There are special rules for those under age 31.

You can also be entitled to child’s insurance benefits if the wage earner parent is receiving benefits and you become disabled before the age of 22.

If you receive worker’s comp, there will be an offset on those benefits due to your SS benefits. The same may be true for any private policy. SS will never “come to the rescue.” The requirements for disability under SS are very strict.

3

Code of Federal Regulations, Part404 Enjoy.

4

My employer has a optional disability policy. It guarantees 60% of your salary if you get disabled.

Social Security disability typically pays about 40% to 50% of what you were earning. Depending on how long you had paid into social security.

then this optional policy kicks in the rest so you get 60% of what you had been earning.

Getting on disability isn’t easy. It takes several doctors visits and lots of paperwork to convince them to grant a disability claim. They often make people get new paperwork from their doctor every year or two to confirm they are still disabled.

5

I am on SS disability after a work accident. Disability is seperate from SS reierment and you benefit is based on the number of years worked and the amount of money you made over your working life. If you get approved for disability you will also be reliable for Medicare insurance after 6 months.

Applying for and getting approved for disability isn’t easy. There are specific injures//illneses that qualify. It is quite q mystery as some people that you would think have no problem getting approved are turned down, while others are approved with what can be considered a minor disability. The approval process is a long one and except for extreme cases (brain injury, paraylisis, etc…) almost everyone is denied during the first review. It took me five years to finally be approved for disability and required me getting an attorney and going before a Federal judge.

Even though I it can take years for an approval to come, you are paid benefits retroactive to the date you first applied. Also, the waiting period for Medicare is counted from the first day of application. When I was finally approved for disability I was immediately covered by Medicare and received a back payment of $65,000 (five years of benefits) and my children received a retroactive payment as well.

The attorney was paid for by SS, so if you are applying for disability I would recommend getting an attorney. Approval will be dependent on proper filing of the paperwork and proper detail of medical reports. Despite what critics say, it is not easy to get approved. The judge that reviewed my case went into much detail concerning my medical I jury and the nature of that injury. To get approved you must show that you can no longer do any substantial work in the field you are qualified for or will not be able to maintain any reasonable employment.

A note on the back payment. Some of you might think that the amount of the back payment awarded to me is excessive. It is Important to understand that this amount was for FIVE years of benefits during which time I was waiting for approval. During that time I was not alble to work and ran through my savings and without the help of family I would have Ben living n the street. Also, to get approved you cannot have much in the way of assets. Meaning, if you have a million dollars in the bank, you are not going to get approved.

I mentioned my children above, minor children whose parent is disabled are entitled to SS benifits as well, the amount based on that parent’s income. The benefit stops when that minor reaches the age of 18.

Living on disability isn’t easy. As mentioned above, our benefits are based on time working and income. The more you paid into the system, the higher your benefit. I was a fairly high income earner, my last year working my annual pay was $83,000. My monthly benefit from SS is $1655 per month, minus $89 to pay for Medicare health insurance. My children receive $800 a month between the two of them, although I don’t be this money for them as I am divorced, so my ex-wife receives the payments to use for their benefit. Their back payment was $26,000 It is important to note that the Ss they recieve is counted as my child support by the courts.

I have tried to be as detailed as possible in my answer. If you have any need for more specifics, feel free to ask. On a personal note I will tell you that living on disability sucks big time. As you can see, no one is getting wealthy being on disability. It is very difficult to make ends meet and quite a contrast to my previous income. Besides the financial difficulties, the mental strain of being on disability is enormous. I feel as if I am useless and am ashamed that I am not able to work despite wanting to. That feeling is tempered by the fact that i paid into the system and this is no difference between SS disability and insurance. I paid into the system and unfortunately needed the service.

I have to return to Easter things now. I apologize for spelling and/or grammatical errors as I am typing this on a mobile device. Happy Easter to all. I will re-read when I have time and add or correct as needed.

6

I was under the impression that the attorney was paid out of a percentage of your delayed benefits - something on the order of 20 or 25%. I could be wrong, of course.

But thanks for the open and thorough write-up. It’s very insightful.
-D/a

7

My apologies, as I misspoke, I guess I either wasn’t paying attention or I wasn’t thinking clearly in my statement. The attorney is paid via a contingency on your retroactive payment. If I recall correctly it is 25% of you reteoactive payment with a maximum payout of around $5400. My Retro payment was so large I really wasn’t concerned about the fee. I would strongly recommend an attorney regardless of it costing some out of a retro payment. I would like think that I eventually would have prevailed in my claim, but the paperwork was quite daunting and if you make a serious enough mistake you risk losing your benefit.

The really nice thing about using an attorney was the fact that so much time had elapsed between my filing and approval, that without one I don’t know how many people would have what it takes to follow through to the end. When you are going through this generally you aren’t in the best of health and you are mentally beat down.

The one thing that struck me as so very strange was the determination hearing in front of the judge. It was over in a matter of minutes. The Jude asked me basic questions like name and such, asked how have I been supporting myself since the injury etc. He then told me that he had spent time reviewing my medical file, said “You are clearly disaled, I approve you claim”! That was it! My fate decided inside of ten minutes. It was apparent that the judge had made up his mnd prior to me ever stepping into court he had all the info he needed from my medical files. What I couldn’t figure out is why couldn’t a SS case worker have made that determination years ago? They had the same information. During those 5 years I was scared to death trying to figure ut how I was going to support myself. I tried to return to work a few times as I was nearing complete insolvency, but found I could not do what was neccassary to perform on a job. The whole process was extreamly taxing on one’s mental state.

8

Attorney’s fees are limited to 25% of past benefits, but an administrative law judge (ALJ) (the “federal judge” above referred to) can approve a larger amount if the contract so provides and the ALJ feels it is just considering any extra effort the attorney made (20 CFR 404.1730).

Medicare benefits begin two years after the onset date of disability, not six months.

To obtain disability benefits, one must first file an application with the district office. It will have its own doctors review your medical treatment, alleged limitations, vocational and educational background (20 CFR 404, subpart P.) If your disorder(s) does not meet or equal one listed in the Listing of Impairments (described in Appendix 1 to 20 CFR 404, subpart P - a link to which I gave), the district office will then consider if you are disabled due to your residual functional capacity and vocational factors if you are unable to return to your past relevant work (appendix 2 to 20 CFR 404, subpart P). Once the district office denies benefits (which it usually does), you must file a request for reconsideration. If again denied (very likely), you have 60 days to file a request for a hearing before an ALJ. 70% of cases previously denied are granted benefits at this level. (The disparity was so great that one attorney filed an action to have SSA explain this large percentage of reversals. SSA agreed to review the process and the case was dismissed. One reason for this disparity is that the ALJ considers 20 CFR 404 and the Rules promulgated pursuant to that regulation; whereas, the district office considers an internal guideline called POMS (Program Operating Manuals) which is basically a restatement of the regs but in simplified terms, along with SSA’s interpretations of the regs.) If you are again denied, you can file for review by the Appeals Council (near DC). If again denied, you have then exhausted your administrative remedies and now you can file an action in the district court (20 CFR 404, subpart J.) If the Court denies, you can appeal pursuant to the appeals process for any suit filed in the district court.

Once you are determined to be disabled, your disability must be reviewed periodically (20 CFR 404.1594). SSA must first determine if there is medical improvement related to your ability to work or if you come under one of the exceptions therein noted. Medical improvement was added as a requirement in 1992 after the judicial system mandated that such improvement be shown before disability can end.

9

Benefits are paid retroactive to the date you alleged disability began, or at a later date if so determined by SSA. (20 CFR 404.316)

This is absolutely false, unless you are referring to Supplemental Security Income. Disability insurance benefits do not take into consideration your financial situation.

The benefits are based on your primary insured amount and the years you worked, and are computed as if you began receiving old age insurance benefits at age 62. (20 CFR 404.317) There is no additional premium for Medicare, Part A; the additional premium (which is now more than $89 a month) is for Part B.

To correct something I posted earlier, your benefits may be reduced by worker’s compensation benefits or to other retirement benefits, if the worker’s compensation benefits are based on a periodic basis (20 CFR 404.317 and 404.408). However, that reduction is not made if the worker’s compensation law or plan under which the periodic benefits are paid are reduced by the SS benefits (20 CFR 404.408.) The total of your SS benefits and other benefits cannot exceed 80% of your “average current earnings” (20 CFR 404.408).

10

I must modify that by noting there is a 5-month waiting period before you can receive benefits, and this waiting period cannot begin earlier than the 17th month before the month you apply. This waiting period is not required if you were disabled within 5 years of the present disability (20 CFR 404.315(a)(4)).

11

In my observation, almost all disability claims, unless there is a very serious and obvious cause, the first application will be denied as a matter of course. Then one has to appeal the decision and the time until that appeal is even heard can be very long.

12

You are correct here, from my imitial denial until my hearing was a period of five years. I had pretty much given up on it and got a call out of the blue from the attorney one day telling me that the hearing was scheduled in 30 days. Quite a shock after hearing nothing for so long.

As far as any mistakes in my statement, I am relying on memory and it should be noted that as I had an attorney, some details were not studied by me as deeply had I been filling everything myself. The two year mark for Medicare is correct, for some reason I remembered it as six months. Since my case took so long to approve I was eligible for Medicare from the first day. The asset imformation I stated was incorrect as well. I was confusing what I had remebered about SSI with disability. The information I have offered wasn’t meant to reflect that of a SS expert, rather of someone who has gone through the long process and is currently on disability.

I found the whole process not only confusing, but frustrating as well.

13

The law firm I used for SSDI–which advertises on TV ( fine in these cases)–handled the unbelievable amount of time-dependent paperwork, and will send a lawyer with you to the judge for the ultimate go/no-go.

I believe their fee was 0.50% of the first monthly benefit.

Definitely worth it.

14

This is only partly true, although you kinda-sorta corrected it lower down. Social Security benefits may be offset against workers’ compensation benefits; however, in the 18 reverse offset states (or Puerto Rico) your workers’ compensation benefits may be offset against Social Security benefits instead. Doesn’t make much difference to the recipient, but still.

This is a bit misleading; once you reach age 62, SSDI is automatically converted into SS retirement. You can’t collect both at once.

15

True, however’it’isimportant that it is understood that the benefit that one receives can vary greatly depending on a persons income and time paying into the system. From what I have seen, the monthly benefit I am recieving is quite high compared to many others. Im kow of some who receive about 1/2 of what I do because their income was much lower when they were working. However, it seems that no matter your income while working, the benefit provided by SS disability is a fraction of your working income. I am thankful for it, but woild’certainly return to work if it was possible.

16

The age when disability benefits are converted into old-age benefits is the full retirement age:

20 CFR 404.321

The significance of that is your benefits would no longer be subject to continuing periodic review.

17

Oops. Yes, 65 not 62.

18

It’s no longer 65. It’s 66 and 4 months:

19

I would like to say thank you to all the posters especially to obbn. I have MS and have been waiting 2 years and have not heard a thing from the SSA.

By the way, Binder and Binder [the big national advertiser] is not a good choice for SSA cases. Do a google search and you will find out why.

I have 160 quarters of work history and a three inch thick medical file and just want to get in front of a judge.

TA

20

Forgive me if I missed it above… when did social security expand into disability? I assume it started as simply a retirement benefit.

Can you expand a bit on SS disability benefits for dependants… spouse too or just kids? Isn’t there a benefit for kids upon the death of the parent… is that something different or just the ultimate disability?

Are the benefits limited to children living at the time the disability started?

Do worker’s comp and private plans also cover dependents?