Disability and SSI FAQ
Q: What is the difference between Social Security Disability benefits and Supplemental Security Income benefits?
A: Social Security disability insurance (SSDI) is an insurance program. Working individuals deduct a certain amount from each paycheck to be used by the Social Security Administration (SSA) in case he or she becomes disabled and can no longer work. The SSA requires 5 years of earnings out of the last 10 to qualify for the program. Those under 30 may qualify with fewer years of earnings.
Supplemental Security Income (SSI) benefits have no earnings requirement. People who have worked fewer than 5 out of the last 10 years, who have worked “off-the-books,” or who have not worked, still qualify for SSI, if they have limited assets, finances, and income.
Finally, SSDI recipients qualify for Medicare benefits once they have reached 24 months of disability, counted from the date first financially qualified, not from the application date. SSI recipients only qualify for Medicaid, unless they are Medicare-eligible due to age. There is no waiting period for Medicaid benefits.
Q: How does Social Security define someone as disabled?
A: Someone who is disabled cannot perform substantial gainful activity for at least 12 months due to a medical condition, which is documented through medical evidence. Social Security also considers age, education, and past work.
Q: If I can’t perform the job I had done does that automatically entitle me to disability benefits?
A: No. Social Security will consider whether you can do other work based on your experience, age, education, and other skills. However, Social Security has the burden to prove that you can do this other work.
Q: How do I prove that I am disabled?
A: Medical evidence is provided through a medical exam with the Utah Office of Disability Determinations. Qualified medical professionals collect objective medical evidence such as x-rays and other tests so that Social Security can make an informed decision.
Q: What specific medical information will Social Security consider?
A: They will inquire as to when did the medical condition began, details of the medical condition, how the medical conditions limit your activities, and what medical treatment you have received.
Q: How much medical treatment should I receive?
A: Continue visiting the doctor. By receiving regular and ongoing medical treatment an Administrative Law Judge (ALJ) or other decision-maker can obtain current medical evidence with which to substantiate a decision of disability.
Q: How does the appeal process work?
A: There are generally five levels of appeal:
- First, an initial decision by a state agency adjudicator, in Utah it is Disability Determination Services.
- Second is a reconsideration where the state agency obtains additional medical evidence and performs a paper review.
- Third, the conducting of a hearing with an Administrative law Judge (ALJ) based on medical evidence and sometimes medical and/or vocational experts as well as other witnesses. Included is the right to cross-examine witnesses. The ALJ decides the case independently of all previous decisions.
- The fourth level is the Appeals Council Review that is a paper review of a decision based on new evidence that could change the outcome. Such new evidence may warrant a new hearing. However, this review occurs very slowly and usually warrants a second application for disability to be filed.
- The fifth level is federal court.
Q: Should I hire an attorney to represent my claim for SSDI or SSI benefits?
A: Yes. The Social Security Administration denies up to 75% of all claims. The disability system involves many rules, regulations, and procedures. Receiving benefits from the government can be a hard and confusing process. You will dramatically increase your chance of success if you have the help of an experienced disability attorney. The attorneys at Dexter & Dexter have achieved a tremendous level of success in winning disability claims. As always, there is no fee unless you are awarded benefits from the Social Security Administration.