Social Security Disability Insurance Benefits - Presentation by Pat A. Schuster, Public Affairs Specialist with the Social Security Administration, Harrisburg PA,
IMPORTANT: Call for appointment -1-800-772-1213 and/or visit: www.ssa.org
and/or www.ssa.gov/dibplan/dqualify.htm

Social Security Disability Insurance Benefits (SSDI) is funded by your social security taxes (FICA) and is an insurance program for workers. An independent agency, the Disability Determination Services (DDS) in each state, makes the medical decisions, not Social Security. This agency is contracted by the Social Security Administration (SSA) to perform this function to eliminate any bias.

Social Security's Definition of Disability
Is based on your inability to do work you did before and it is decided you cannot adjust to other work because of your medical condition(s);
Must last or be expected to last for at least a year or result in death;
Not payable for short-term disability

Who is eligible for Social Security Disability Insurance Benefits?
Disabled workers under age 65 who worked long enough and recently enough in covered employment and cannot work due to their impairment
Disabled Adult Child (your unmarried son or daughter, age 18 or older whose disability started before age 22)
Disabled widows or widowers, age 50 or over

How much work do I need?
Credits needed for disability benefits depends on your age when you became disabled.
Generally, 20 credits earned in the last 10 years ending with the year you became disabled;
Younger workers may qualify with fewer credits.

Application Process
Call 1-800-772-1213 for an appointment. That call will record the date you filed and will be used as your protective filing date. Also, keep a record of the date yourself. You can only go back one year for entitlement from the date you file your first claim. Then the first 5 months are a waiting period before your actual date of entitlement starts.
You should receive a form SSA-3368 (about 10-12 pages) which is your medical documentation form. You can also download this form from their website above. THIS FORM IS YOUR MOST IMPORTANT FORM.
You must document everything about your medical condition from the date you were first disabled even if you have to attach additional pages of information.
Keep a journal from the date you file for disability insurance benefits, day by day. DOCUMENT, DOCUMENT, DOCUMENT. Explain everything happening to you such as: you had a terrible headache and took so much medications (type) and had no relief. This lasted how many days. You had extreme fatigue and could not get out of bed and so on.
Make sure your doctor is aware you are filing for benefits and give him a copy of your recorded day by day symptoms.
What to take to your appointment:

Your social security number;
Your birth record;
Names, addresses and phone numbers of doctors, hospitals, clinics and institutions that treated you and dates of treatment;
Names of medications you are taking;
Medical records from all doctors, therapists, hospitals, clinics and caseworkers;
Laboratory and test results;
A summary of where you worked and the kind of work you did;
Your most recent W-2 form, or your tax return if youre self-employed.

Make sure your doctor fills out the necessary medical forms. Sometimes a claim is denied because the doctor never filled out the medical report.
You should hear about your claim within 60-90 days.

Denial of Claim
If you disagree with the decision, you have the right to ask to have your application reviewed again. The notice you receive from social security will explain how to make that request and the time period involved.
When you go before the Judge reviewing your case, take your Day by Day Journal with you. That way, you can answer any of the Judges questions concerning your medical condition. Continue this journal.
If you feel you need an attorney at this stage, find one that deals in social security disability. Remember, the attorney takes 25 percent of your past-due benefits for his fee unless you qualify for a legal-aid attorney.

NOTE: People who do not have enough work credits to be eligible for Social Security Disability benefits may possibly quality for Supplemental Security Income if they have limited income and resources.

There are three steps to Appealing the Decision:
Hearing by Administrative Law Judge;
Review by Appeals Council;
Federal District Court.

Other Payments May Affect Your Disability Insurance Benefits and Reduce Them
Workers Compensation;
Public disability benefits;
Pensions based on work not covered by Social Security.

Medicare Coverage When Disabled
You are automatically enrolled in Medicare after you get disability benefits for two years.
Medicare has two parts:
Hospital insurance helps pay for inpatient hospital bills and some follow-up care. The taxes, you paid while you were working, finance this coverage, so it is free.
Medical insurance helps pay doctors bills, outpatient hospital care and other medical services. You will need to pay a monthly premium for this coverage if you want it. Currently, it is $50 per month.

Reviewing Your Disability
In general, your benefits will continue as long as you are disabled. However, the law requires that your case is periodically reviewed to see if you are still disabled. How often your case is reviewed depends on whether your condition is expected to improve.
If medical improvement is expected, your case will normally be reviewed within 6 to 18 months after benefits start;
If medical improvement is possible, your case will normally be reviewed no sooner than three years.
If medical improvement is not expected, your case will normally be reviewed no sooner than seven years.

What Can Cause Benefits To Stop?
Benefits will stop if you work at a level considered substantial. Usually, average earnings of $740 or more per month are considered substantial.
Benefits will also stop if your medical condition has improved to the point that you are no longer disabled. You are responsible for promptly reporting any improvement in your condition.

Supplemental Security Income (SSI) - is a needs-based Federal welfare program administered by the Social Security Administration. The following are eligible:
Blind or disabled children;
Blind or disabled adults; and
Have limited income and resources

If you get SSI, you usually get food stamps and Medicaid, too. You might be eligible for both SSDI and SSI benefits. Medical decisions are based on the same information for both of these programs.

The basic SSI check is the same in all states. It is:
$531 for one person; or
$796 for a couple.
Not everyone gets this exact amount, however. You may get more if you live in a state that adds to the SSI check. Or you may get less if you or your family have other money coming in each month.

Working While Disabled
There are a number of rules that provide work incentives as listed below:
Cash benefits while you work;
Medicare or Medicaid while you work;
help with any extra work expenses you may have as a result of your disability;
Help with education, training and rehabilitation to start a new line of work.

Most recently Congress passed the Ticket to Work and Work Incentives Improvement Act of 1999, which substantially expands opportunities for people with disabilities. It provides beneficiaries with disabilities a ticket they can take to an employment network for rehabilitation and employment services. This year (2001) the ticket program will start in 10 states and more states will be added as experience is gained in administering this program. The 13 states are: Arizona, Colorado, Delaware, Florida, Illinois, Iowa, Massachusetts, New York, Oklahoma, Oregon, South Carolina, Vermont and Wisconsin.

If you live in one of these states, you will receive an instruction booklet explaining how to use the ticket from the ticket program manager, MAXIMUS, Inc. The number is 1-866-968-7842.

Any further information needed, contact the 1-800-772-1213 or the website at www.ssa.org