D.Frequently Asked Questions About Social Security Disability

CHAPTER 1  |  WHAT IS SOCIAL SECURITY DISABILITY?  |  23



current work activity, the severity of your

impairment, your remaining physical and

mental abilities, your past work, and your

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, and an assessment of

whether the impairment results in marked

and severe functional limitations.

The ­sequential evaluation process is

discussed in Chapter 7.



2. When do disability benefits start?

SSDI payments cannot be made until

five months after the date of the onset

(beginning) of disability. SSDI claimants

may be entitled to retroactive (past)

benefits, if the SSA finds they were disabled

before their application date. Cash benefit

payments c­ annot be paid retroactively to

cover more than 12 months before the

application date—no matter how severe

your disability.

There are exceptions to the five-month

waiting ­period requirement. These excep­

tions, along with more detailed infor­mation

about the onset of disability, can be found

in Chapter 10.

Under SSI, disability payments may begin

as early as the first day of the month after

an individual files an application, but no

earlier. If your claim isn’t approved until



months after you apply, you’ll be entitled

to back payments to that date. In addition,

under the SSI program, you may be found

“presumptively disabled” and receive cash

payments for up to six months while the

formal disability determination is made. The

presumptive payment is designed to allow a

needy person to meet his or her basic living

expenses during the time it takes to process

the application. If a claimant is denied SSI

benefits, he or she is not required to refund

the payments. Presumptive disability is

covered in Chapter 4.



3. What if I disagree with

the determination?

If you disagree with the SSA’s initial deter­

mination, you can appeal the decision.

The first appeal of a denial is called a

reconsideration, which is a review of your

case by a DDS (Disability Determination

Services) team that was not involved in

the original determination. If your case is

denied at the reconsideration stage, you can

request a hearing before an administrative

law judge. If you are dissatisfied with that

decision and wish to continue pursuing

the case, you can request a review by the

Appeals Council and then file a civil lawsuit

in federal district court and eventually

appeal all the way to the U.S. Supreme

Court. (Appeals are covered in Chapter 12.)



24  |  NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY



• If you have end-stage renal disease with

kidney failure and you require dialysis

or a kidney transplant, coverage by

Medicare can begin the third month

Yes. Medicaid and Medicare are our

­after the month in which dialysis ­began.

country’s two major government-run

• If you are terminally ill with a life

health insurance programs. Generally,

­expectancy of six months or less and

people on SSI and other people with

receive hospice care, coverage by

low incomes qualify for Medicaid, while

Medicare can begin immediately.

Medicare coverage is earned by working

• Individuals with amyotrophic lateral

in jobs covered by Social ­Security, the

sclerosis (ALS) qualify for Medicare as

Railroad Retirement Act, or for the federal

soon as they begin collecting disability

government. Many people qualify for

benefits.

both. In most states, you do not have to

If you get Medicare and have low i­ncome

do anything special or additional to obtain

and few resources, your state may pay your

Medicare or Medicaid coverage once you

Medicare premiums and, in some cases,

have qualified for disability. If and when

other out-of-pocket Medicare ­expenses such

you qualify for such coverage, the federal

as deductibles and co­insurance. Contact

government will send you any forms

your local welfare office or Medicaid agency

you need to fill out. This is not true for

or look for Medicare Savings for Qualified

Medicaid in all states, however. See SSI and

Beneficiaries on the SSA’s website, www.

Medicaid, below.

ssa.gov, or get Nolo’s book Social Security,

SSDI and Medicare. SSDI claimants granted

Medicare & Government Pensions.

disability benefits qualify for Medicare

SSI and Medicaid. In most states, SSI

coverage. However, the coverage doesn’t start

recipients who are granted disability benefits

for two years from the date of entitlement

automatically qualify for Medicaid coverage.

to disability benefits—and that means two

Where SSI recipients automatically qualify,

years starting after the initial five-month

Medicaid coverage starts immediately.

waiting ­period. Therefore, you may be left

In a few states, eligibility for Medicaid

without medical insurance coverage for

is not automatic when you receive SSI,

several years if you don’t have some other

and you will need to apply for Medicaid

type of coverage or are not poor enough to

separately. Your local SSA office can tell you

qualify for SSI M

­ edicaid coverage. There are

if you need to file a separate application for

three exceptions to the two-year rule:



4. Can I receive disability benefits

or payments while getting

Medicare or Medicaid coverage?







CHAPTER 1  |  WHAT IS SOCIAL SECURITY DISABILITY?  |  25



Medicaid. You can call your state medical

assistance office for help applying; call the

Centers for Medicare and Medicaid Services

at 800-633-4227 to get the telephone

number of your state medical assistance office.



5. Can I work and still receive

disability benefits?

Social Security rules make it possible for

people to test their ability to work without

losing their rights to cash benefits and

Medicare or Medicaid. These are called

work incentives. The rules are different for

SSDI and SSI, but under both programs,

you can receive:

• continued cash benefits

• continued help with medical bills

• help with work expenses, or

• vocational training.

For more information about work incen­

tives, see Chapter 13, Section D. There

is also more information available in the

SSA’s A Summary Guide to Social Security

and Supple­mental Security Income Work

Incentives for People With Disa­bilities on the

SSA’s website, www.ssa.gov.



6. How can I receive vocational

training services?

Claimants for SSDI or SSI may be referred

to a state vocational rehabilitation agency

for rehabilitation s­ ervices. The referral may



be made by the DDS (see Chapter 6), the

SSA, a treating source, or personal r­ equest.

The services may be medical or nonmedical

and may include counseling, teaching of

new employment skills, training in the use

of prostheses, and job placement. In deter­

mining whether vocational rehabilitation

services would benefit you in returning to

work, medical evidence from your treating

doctor may be very important. Vocational

rehabilitation is discussed more in Chapter 9.



7. I understand that to get disability

benefits, my disability must be

expected to last at least a year.

Does this mean that I must wait

a year before I can get benefits?

You do not have to wait a year after the

onset of the disability before you can get

benefits. File as soon as you can after

­becoming disabled.



8. I have been receiving Social Security

disability benefits for the past four

years and my condition has not

improved. Is there a time limit on

Social Security disability benefits?

No. You will continue to receive a disability

benefit as long as your condition keeps

you from working. But, your case will be

reviewed periodically to see if there has

been any improvement in your condition



26  |  NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY



and whether you are still eligible for

benefits (see Chapter 14). If you are still

eligible when you reach 66, your disability

benefits will be automatically converted to

­retirement benefits.



a­ fter benefits stop can have his or her

checks start again, beginning with the first

full month of disability, if the new claim

is approved. (For SSDI, the five-month

waiting period can be waived.)



9. I had a serious back injury four years

ago and received disability benefits

for about 18 months, until I could

return to work. Unfortunately, my

back problems have recurred and

I don’t know how much longer I

will continue working. If I reapply

for benefits, will my wait be as

long as it was the first time?



10. My brother had an accident

at work last year and is now

receiving SSDI disability benefits

for himself, his wife, and daughter.

Before his accident, he helped

support another daughter by a

woman to whom he has never

been married. Is the second child

entitled to some benefits as well?



Maybe not. It depends on what the new

medical reports say and whether additional

evidence is required. A worker who becomes

disabled a second time within five years



Yes. Even though your brother was not

married to the second child’s mother, Social

Security pays benefits to all of his children.

Each child is entitled to equal ­benefits.



l



C H A P T E R



Applying for Disability Benefits

A. Preparing to Apply..............................................................................................................................28

1. Document Your Symptoms Early and Often...................................................................28

2. Help Your Doctor Help You.......................................................................................................28

3. Record How Your Condition Affected You on the Job...............................................28

B. Applying for Disability Benefits..................................................................................................28

1. Your Application...............................................................................................................................30

2. What the SSA Needs to Process Your Claim.................................................................... 31

3. Field Office Observations...........................................................................................................72

4. Onset of Your Disability...............................................................................................................73

5. Nonmedical Eligibility Requirements...................................................................................73

6. Processing Your Application (or Claim)..............................................................................73

C. The Role of Health Care Professionals..................................................................................... 74

1. Treating Sources............................................................................................................................... 74

2. Consultative Examination (CE) Sources..............................................................................75

3. Medical Consultants......................................................................................................................75

4. Medical Experts................................................................................................................................76

D. How Other Disability Payments May Affect Social Security Benefits.................76

1. Workers’ Compensation and Public Disability................................................................76

2. Railroad Retirement Act and Social Security Disability..............................................78

3. Black Lung Benefits and Social Security Disability........................................................79

4. What Payments Do Not Affect Your Social Security Disability Benefits?.........79

E. Availability and Disclosure of Confidential Records......................................................79

1. Your Medical Records...................................................................................................................79

2. Consultative Examination (CE) Records.............................................................................82

3. Disclosure With Consent.............................................................................................................83

4. Disclosure Without Consent.....................................................................................................83

5. Penalties for Violating Disclosure Laws...............................................................................84

6. Reporting Possible Violations...................................................................................................85

F. Fraud and Other Crimes..................................................................................................................85



2



28  |  NOLO’S GUIDE TO SOCIAL SECURITY DISABILITY



T



his chapter explains how to apply

for disability benefits.



A. Preparing to Apply

You can play an active and important role

in ensuring that your claim is processed

accurately and quickly. The best advice is to

keep thorough records that document the

symptoms of your illness or injury and how

it affects your daily activities before you

apply. Then, provide this information to the

Social Security Administration when you

file your claim.



medical sources are covered in Chapter 5.)

If you don’t have a doctor, the SSA will have

you examined at its expense.



3. Record How Your Condition

Affected You on the Job

If you were working, but lost your job

because of your illness or injury, make notes

that describe what it is about your condition

that forced you to stop working.



B. Applying for Disability Benefits



You can apply for disability benefits at a local

Field Office or contact station. You do not

have to call or make an appointment to visit

1. Document Your Symptoms

a Field Office or contact station, but it is

Early and Often

advisable that you do. Otherwise, you might

Use a calendar to jot down brief notes about

have to wait or come back another time. You

how you feel each day. Record any of your

can also apply for benefits online or over the

usual activities that you could not do. Be

phone. See “Applying Over the Phone” and

specific. Remember to include any psycho“Applying Online,” below, for details.

logical (emotional or mental) difficulties.

If you apply at an SSA office, when you

arrive, tell the desk or counter clerk that you

2. Help Your Doctor Help You

want to apply for disability benefits. You’ll be

scheduled to meet an interviewer, who will

Not all doctors are aware of the kind of

inform you of your rights and responsibilities,

information the SSA needs to document a

assist you in completing your application, and

disability. Ask your doctor to track the course

obtain information and evidence from you

of your symptoms in detail over time and to

that is needed to determine your eligibility.

keep a thorough record of any evidence of

Note the name of the specific person assigned

fatigue, depression, forgetfulness, dizziness,

to help you in case you need to later contact

and other hard-to-document symptoms. Note

him or her for help. Bring reading materials

that the SSA will accept medical opinions as

with you. You may have a bit of a wait before

to your limitations only from doctors who

you see the interviewer.

are acceptable medical sources. (Acceptable







CHAPTER 2  |  APPLYING FOR DISABILITY BENEFITS  |  29



TIP

The Social Security Administration

has a helpful website filled with useful information

and up-to-date rules and regulations for disability

claimants at www.ssa.gov. Another useful website,

disabilitysecrets.com, is one of Nolo’s partners.



Applying Over the Phone

If you prefer, you can call the SSA at

800-772-1213 to file an application. This

is especially convenient if you live some

distance from the nearest Field Office or

contact station (you can find the location

of the nearest SSA facility by calling the

800 number listed above). If you need help,

a family member, caseworker, or other

representative can contact the SSA for

you. You do not have to give that person a

power of attorney—the authority to sign

legal documents and make legal decisions

for you—to help you obtain an application

form and file a claim.

If you cannot go to the Social Security

office because of poor health, or if there is

no Social Security office nearby, you can

get full information and application forms

by making an appointment for a telephone

interview. Even if you cannot get to the

Field Office to file an application (due to

illness, lack of transportation, or whatever

other reason), an SSA representative can do

the interview over the telephone.



You can speed up the processing of your

claim by being as prepared as possible before

contacting the SSA Field Office. Remember

that the SSA is a huge and complex bureau­

cracy that needs a lot of information about

you. If you do some basic preparation, the

whole process can proceed smoothly. On the

other hand, do not wait until you have every

conceivable detail ready for review before you

contact the Field Office.

You are responsible for submitting the

necessary evidence to support your claim

of disability (see Chapter 5). The Social

Security office will assist you by telling

you what evidence is required to establish

your claim and how you can obtain that

evidence. If you can’t get the necessary

evidence, the Social Security office will offer

special assistance, based upon your needs,

to ensure the proper resolution of the claim.

Never assume that the claims represent­

ative can read your mind if you have a special

problem regarding your application. If you

have some concern, mention it. SSA claims

representatives are instructed to help you if

they can reasonably solve a problem that is

related to your application.

For example, if a claimant cannot read

or write, the claims representative will

provide assistance in completing the forms.

In addition, the SSA Field Office will

provide an interpreter if you need language

assistance. The SSA uses whatever qualified

interpreters or interpreter services are most

appropriate to the situation and are most

reliable and readily available.