Background Information. To be designated “disabled” with a physical or mental impairment, a person must meet certain criteria. For a mental impairment, the following questions are asked:
- What is the person’s medical diagnosis?
- What activities of daily living can the person not do?
- What is the level of the person’s social functioning?
- What is the person’s mental functioning in the area of concentration, following through with mental tasks, and the persistence and pace of mental functioning?
- How recently and how often has there been decompensation?
Overview. Disabled people who have worked and paid Social Security taxes may be eligible for SSDI (Social Security Disability Income). The amount of their monthly stipend depends on the amount they have paid into Social Security. Disabled people who have very low or no income and savings and have not worked or paid into Social Security may be eligible for SSI (Supplemental Security Income).
Process. A planning tool is available via the Social Security Administration (https://www.socialsecurity.gov/planners/disability/dqualify2.html). To begin the process of obtaining financial support from the Social Security Administration (SSA), a person can go online to www.socialsecurity.gov or to the local Social Security office. The advantage of the website is that you can read about eligibility guidelines, benefits and the application process and actually begin the application process. You can also call the Social Security Hotline (800-772-1213) for information and to request that Social Security send you pamphlets that explain the benefits and rules for applying for disability. This hotline is available 7 a.m.-7 p.m., Monday through Friday; the best times to call are early in the morning and/or later in the month.
In your application for Social Security disability income, it is important to fully document your disabilities, including as many medical and psychiatric conditions as are applicable. For a mental illness, medical documentation by a psychiatrist is crucial. A medical consultant in SSA will look over the information and decide whether or not to continue with the application.
If your application is rejected initially, there are several ways to appeal for reconsideration. Usually, a person re-applies by hiring a lawyer or an agency who specifically deals with disability benefits to help with the process. Typically lawyers and agencies who do this type of work do not require payment until the person has received Disability status and an initial payment, even if the process takes years. Then the lawyer will receive a percentage, usually about 25%, of the first payment, which represents the accumulated amount, retroactively, from the date of the person’s first filing, even if it was several years earlier.
To appeal, the person goes before an Administrative Law Judge to explain the case and tell why the Disability designation is needed. Very specific information must be given, describing in concrete, behavioral terms how the disability interfere with the person’s daily functioning, and giving medical evidence of the disability. Particularly in psychiatric cases, this concrete information is very important. The person’s psychiatrist must attest that, in the psychiatrist’s opinion, the person is unable to work for at least a year.
If the case is rejected by the Judge, the person can appeal to the Appeals Counsel in Virginia. That involves writing a Brief or summary of the case and sending it to the Appeals Counsel. In three out of four cases, the appeal is refused. Sometimes, the person can write back with new evidence that may reverse the decision. Or the person can start over again, with more thorough and specific information.
From the time the person applies for benefits to the time s/he finally gets approval may take years. However, if you believe that you have a real disability, “apply sooner rather than later.” As already stated, once a person is approved for SSI or SSDI, their financial coverage begins retroactively, from the date that they first applied and/or six months following the date of disability. So, there is a financial advantage to applying as soon as the disability begins. If the person is able to work and earns more than what SSA considers Substantial Gainful Activity (SGA) s/he will not be considered disabled.
People on SSI or SSDI have periodic Case Reviews. You will have to document for specific ways in which you are still disabled. If you can not return to the job you had before becoming disabled, the Social Security Administration may try to find another type of job you could do instead. The Administrative Law Judge will have an employment specialist find out if other types of jobs that you might be able to do are available and if such jobs are available, you may be advised to apply for these jobs and begin working. A person who is over 50 is less likely to be required to apply for an alternative job and get off disability.
Persons who are on SSDI/SSI and return to work. There are incentive programs for people who are able to work while disabled. These programs are explained in the “Redbook”, available from the Social Security Administration. This is a summary guide to employment supports for person with disabilities under the SSDI and SSI programs. The Special Needs Alliance Newsletters for October 5 and 18, 2011 describe the options for beginning to work while continuing to receive disability benefits (available at https://www.specialneedsalliance.org/the-voice/title-ii-disability-work-rules-part-i-will-i-lose-my-disability-benefits-if-i-try-to-work-2/ and https://www.specialneedsalliance.org/the-voice/how-work-can-affect-title-ii-disability-benefits-part-ii-ticket-to-work-and-extension-of-medicare-a-2/). For more information about participating in programs to help you get started working while maintaining your benefits or for help with problems regarding working while on SSDI/SSI, call the Disability Rights Network of Pennsylvania Work Incentives Planning and Assistance program at 800-692-7443 (X309).
Children with disabilities:
Disabled children whose parents have little income or resources may be eligible for Supplemental Security Income benefits. Benefits will continue at age 18 to a child who is disabled. Childhood disability benefits are also payable after attainment of age 18, if the disability began before age 22. More information on this topic is available via the special Social Security publication Benefits for Children with Disabilities, available at https://www.socialsecurity.gov/pubs/EN-05-10026.pdf.
This document is available at www.NAMIpaMainLine.org; it has been updated December 2015, and is based on input from Michael Boyle, Esq., Alice Fitzcharles, Patsy Koning, Ingrid Waldron and Susan Weiss.