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Social Security Disability Law Services for the Richmond, VA, Area

 
 



 
Couple Reading Letter About Husband's Injury - SSD, Social Security Disability in Richmond, VA
 

Over 35 years of practicing Social Security Disability law

  • Member of the Virginia Trial Lawyers Association (VTLA) Committee on Social Security
  • Member of the National Organization of Social Security Claimants’ Representatives (NOSSCR)
  • Lecturer on Social Security Disability and SSI before Bar and Client Groups
  • Representing Social Security Disability and SSI Claimants before the Social Security Administration (SSA), Office of Disability Adjudication and Review (ODAR), Administrative Law Judge (ALJ), Appeals Council (AC), and Remanded Hearings
  • Over 1,000 Successful Social Security Disability Hearings
 
 
 
WHEN SHOULD I APPLY FOR SOCIAL SECURITY DISABILITY BENEFITS?
You should apply for Social Security Disability benefits as soon as possible after you become disabled and unable to work.

You do not need to wait 12 months to apply; your disability need only be expected to last for at least 12 straight months or will result in death.

Apply immediately because Title II Social Security Disability Insurance (SSDI) benefits can only go back as far as 1 year before the date of application and Title XVI Supplemental Security Income (SSI) benefits can only go back as far as the date of application.

It is also important to apply immediately because you might not have sufficient work quarters for SSDI if you wait too long to apply after you stop working.

Those who apply are often made to feel like they are asking for something that they do not deserve, and nothing could be further from the truth. SSDI benefits are paid for by you and were intended to act as a financial buffer in case you or a family member became seriously ill or injured.
 
HOW DO I APPLY FOR SOCIAL SECURITY DISABILITY BENEFITS?
You can apply online at https://www.ssa.gov/disabilityssi/ or call SSA at 1-800-772-1213.

Be prepared to provide SSA the following:
  1. SSNs and DOBs – current/former spouse and minor children
  2. Bank Information – your bank Routing Transit Number and Account Number;
  3. Your last earnings – amount of money you earned last year and this year, name and address of your employer(s) this year and last year (W-2, last pay stub, Social Security statement)
  4. Work history – where you have worked the past 15 years, beginning and ending dates of any active US military service;
  5. List of medical providers – full name, facility, address, phone, conditions treated, treatment received, date of first/next/last visit;
  6. List of medications – name, condition/reason, prescriber, side effects;
  7. Medical records – any in your possession, SSA can request records from your providers at no cost to you;
  8. Other disability information – workers compensation, civil service disability retirement, federal employees’ retirement/compensation, state/local government disability insurance benefits, VA disability benefits

Please note, however, that you should not delay filing for benefits if all documents are not immediately available.
 
WHO QUALIFIES FOR SOCIAL SECURITY DISABILITY?
To receive benefits under the Title II Social Security Disability Insurance (SSDI), you must have a physical or mental health problem (or a combination of problems) severe enough to keep you from working in any regular paying job for at least one year or result in death.

The test isn’t whether or not you are able to go back to your old job, and the test isn’t whether or not you have been able to find a job lately. Rather, the test is whether you are capable of doing any job available in the national economy (even if this job involves different skills or pays less than your previous work.)

By using an extensive set of regulations, the Social Security Administration takes into account your medical condition, your age, your abilities, your training and your work experience in deciding your case.

The Five Step Evaluation that Social Security uses to determine if you are disabled is as follows:

1. Are you working? If you are working and earning more than the current Substantial Gainful Activity (SGA) amount, you generally cannot be considered disabled. For 2017, SGA is $1,170 per month for non-blind individuals and $1,950 per month for statutorily blind individuals. Even if you are working under SGA, you must prove you are not “self-limiting” your work hours. Your doctor must explain in writing exactly why your medical condition limits you to working only part-time.
2. Is your condition severe? Your impairment must be expected to last at least 12 consecutive months or result in death, and interfere with basic work-related activities (lifting, standing, walking, sitting, remembering, etc.). If you have mild depression and anxiety, SSA may find you capable of a low stress job away from the public. If you have mild fibromyalgia, SSA may find you capable of a desk job with a sit or stand option.
3. Do you meet or medical equal an Impairment Listing? SSA has a Listing of Impairments for each of the major body systems that they consider severe enough to prevent a person from completing SGA regardless of age, education, or work experience. If your medical condition (or combination of conditions) is not on this list, Disability Determination Services (DDS) looks to see if your condition is as severe as a condition on this list. If you meet or equal a listing, your claim is approved. If not, DDS goes to step 4.
4. Can you do the work you did before? Does your condition prevent you from doing any work that you did in the last fifteen (15) years as normally performed in the national economy? If it does not, your claim will be denied. If it does, your claim will be considered further to step 5.
5. Can you do any other type of work available in the national economy? Social Security considers your age, education, past work experience, and transferable skills against the job demands of occupations as determined by the Department of Labor. If you cannot adjust to less demanding work, your claim will be approved. If you can, your claim will be denied.

 
I APPLIED AND GOT DENIED, NOW WHAT?
Don’t give up. If your doctors tell you that you cannot work in ANY capacity, you should appeal. Many disabled people become disheartened and frustrated after they receive a disability benefits denial notice and do not appeal. Nationally, about 75% of all applicants are denied initially. Many of these people ultimately receive their benefits, nationally about 70%. If you are denied, you should file a Request for Reconsideration appeal within 60 days of the date you receive the initial denial to keep your claim going.

However, Social Security Disability is not available for everyone who has an impairment.
If you are under age 50 and are still capable of some kind of employment in the national economy, then you probably cannot get Social Security Disability. What you can do is contact the Virginia Department of Aging and Rehabilitation (804) 662-7000 to seek free vocational retraining or job placement.

If you are 55 or over, then proving disability gets somewhat easier. If you have a severe impairment that prevents Past Relevant Work (PRW), then you are a better candidate for disability at age 55+. If you have less than a high school education, are 55+, and have only a history of unskilled work, then you are even a better candidate for disability, provided you have a severe impairment. As the above discussion shows, when applying for Disability, it is better to be older than 55, uneducated, and have no skills. If you lack any of these, the case for Disability becomes harder. Alternatively, it is also helpful if the skills you acquired from your work are job specific and are not readily transferable to other occupations.

There are those cases in which the impairment is so severe that all employment is precluded even though the claimant is young, highly skilled, or highly educated. But most cases involve claimants who, because of their impairment, cannot do their Past Relevant Work (PRW). Then the big question becomes can they do other light work or perhaps sedentary/sit-down work in the national economy despite their impairment.

Where a case fits in the process can be determined by an experienced Social Security Disability Attorney. The lawyer can evaluate the case and advise whether or not it is worth going forward.

 
TOP REASONS WHY SOCIAL SECURITY DENIES DISABILITY CLAIMS
Based on over 35 years of practice, these are the top reasons why claimants are denied Disability at the initial level:

1. Still Working – Even if you are having difficulty working or only working part-time, the fact that you are working at all is a strong indicator that you are not disabled under Social Security rules. If you make more than $1,170 in a month ( SGA 2017), you may not be eligible for Disability benefits.
2. Failure to Pay into Social Security – If you have been a housewife, you got paid under the table, or you have worked for yourself and have not paid into the Social Security system, you may not qualify. If your work has been on and off or it has been many years since you worked, then you may not have enough “work quarters” to qualify.
3. Not Severe Impairment – You must have a significant medical problem that requires doctor's care and negatively affects your daily activities and functional abilities. Old age is not enough, and inability to find work is not enough.
4. Too Young – Social Security considers anyone under age 50 to be a younger individual. Younger individuals must prove with written doctor support that they cannot do ANY type of job in the entire national economy, even a low stress sit-down job. It is not enough to show you cannot do your past work.
5. Disability is Short-term – Your disability must last at least 12 straight months. It is not enough if you are going to recover or improve within 12 months.
6. Unemployment Compensation – In order to receive Unemployment Compensation, you must certify you are able to work and show you are looking for work. Most Social Security judges feel that being on unemployment is a direct conflict with a Disability claim.

If your Disability claim has been denied, contact the Law Office of Gerald G. Lutkenhaus for a free consultation immediately because there is a 60-day deadline to file an appeal.
 
WILL I BE APPROVED AFTER I APPEAL FOR RECONSIDERATION?
Probably not, but don’t be upset. About 90% of claims are denied at Reconsideration. If you are denied at this point, you should Request a Hearing appeal within 60 days.

The hearing is where you have the best chance of winning. You and your attorney will have a chance to present your case before a Social Security Judge. You can have witnesses testify on your behalf. You will be able to testify about your medical condition, daily activities, functional limitation, work history, and education. A vocational expert will testify about the skill level and physical and mental demands of your past relevant work as normally performed in the national economy, whether you have any transferrable skills, and whether any jobs exist within your residual work capacity.
 
TOP FIVE REASONS FOR APPEALS COUNCIL REVERSAL AND REMAND OF ALJ HEARING DECISIONS
You received an Unfavorable Hearing Decision by a Social Security Administrative Law Judge. How can you get the Appeals Council (AC) to reverse and remand the ALJ Hearing Denial? (“Remand” means the AC reverses the ALJ decision and sends the case back to ODAR for another hearing.) The Social Security Appeals Council tracked the reasons for over 100,000 remands it issued in 2010. The list of the leading reasons for remands was published in the July Social Security Forum. The Appeals Council continues to remand about 22% of its cases. You can increase your odds of a Remand by focusing on these high percentage reasons:

42% Evaluation of the medical evidence or Residual Functional Capacity (RFC) assessment
15% Step 2 analysis of severe/non-severe impairments
14% Procedural errors or improper dismissal
10% Step 5 analysis of the grid and vocational expert testimony
8% Credibility determinations
 
 
DO I NEED AN ATTORNEY?
If you have been denied, you should contact an experienced Social Security Disability attorney immediately. A lawyer will be able to assist you in determining if you are disabled as defined by the Social Security Act. Your attorney can begin developing ways to prove to SSA that you are disabled.

Attorneys in Social Security Disability cases do much more than sit in at a hearing and ask a few questions. Much pre-hearing preparation, analysis and evidence gathering go into adequate representation for your case. Therefore, you should not wait until a week or two before a hearing to contact an attorney. The earlier an attorney is able to start working on your case, the better your chances of winning.

Please note that not all lawyers practice before the Social Security Administration. You will do best to find an attorney familiar with the complex Social Security Disability regulations and procedures.
 
WHAT CAN THE LAW OFFICE OF GERALD G. LUTKENHAUS DO FOR ME?
Every case is different, but these are some of the things we can do for you:
  1. File appeals;
  2. Gather medical records;
  3. Determine if you meet an Impairment Listing;
  4. Give you a Residual Functional Capacity Questionnaire for your doctor;
  5. Review your Social Security file and prior SSA actions;
  6. Request reopening of prior denials, if appropriate;
  7. Prepare and present the hearing testimony you and your witnesses;
  8. Cross examine Social Security’s vocational expert at the hearing;
  9. Present the appropriate argument at the hearing;
  10. Request a review of an unfavorable judge’s decision, if appropriate.
 
WHAT IS MR. LUTKENHAUS’ ATTORNEY’S FEE?
Most cases will be accepted on a 25% contingency fee. The attorney will receive 25% of past-due benefits not to exceed $6,000. This means there is no attorney’s fee unless you win. Social Security approves all fee agreements. Win or lose, you may be responsible for legal costs incurred (ie. fees for medical records requests, etc.).

 
WHAT GEOGRAPHICAL AREAS DOES MR. LUTKENHAUS REPRESENT?
I represent claimants with hearings in Richmond, Charlottesville, Farmville (video), and Norfolk.
Find your local SSA Field Office: www.ssa.gov/locator
ODAR Richmond
services the following
SSA Field Offices:
ODAR Charlottesville
services the following
SSA Field Offices:
ODAR Norfolk
services the following
SSA Field Offices:
Fredericksburg Charlottesville Accomac
Glen Allen Culpeper Hampton
Midlothian Danville Newport News
Petersburg Farmville Norfolk
Richmond Harrisonburg Portsmouth
Sandston Lynchburg Suffolk
Winchester Martinsville Virginia Beach
South Boston
Staunton
Find your local SSA Field Office: www.ssa.gov/locator
 
WHAT SHOULD I BRING TO MY FIRST APPOINTMENT WITH MR. LUTKENHAUS?
1. All claim documentation – application, confirmation receipts, denial letters, appeals, etc.;
2. Medical records – any you already have in your possession, your patient portal logins;
3. List of doctors – name, facility, address, phone, fax, MRN, conditions treated, tests ordered, treatment received, date of first/last/next visit;
4. List of medications – name, condition/reason, prescriber, side effects;
5. SSNs of minor children.
 
WHAT IS THE EARLIEST AGE A PERSON CAN RECEIVE SOCIAL SECURITY DISABILITY BENEFITS?
There is no minimum age. However, to qualify for Title II Social Security Disability Insurance (SSDI) benefits, you must have worked long enough and recently enough under Social Security.
 
WHEN DO MY DISABILITY BENEFITS START?
If you are approved for Title II Social Security Disability Insurance (SSDI), you will receive retroactive benefits beginning 5 months after the date SSA finds you disabled. However, benefits can only go as far back as 12 months before the date of application. Medicare Part A hospital insurance starts 29 months after the date SSA finds you disabled. Medicare Part B medical insurance starts the month after the SSA decision. Medicare premiums are $181.20 per month for 2017 and are deducted from your monthly SSDI check. You have the option to sign up for Medicare Part D prescription drug coverage if you wish.

If you are approved for Title XVI Supplemental Security Income (SSI), you will receive retroactive benefits beginning 1 month after the date SSA finds you disabled. However, benefits can only go as far back as the date of application. You will be eligible for Medicaid.

SSA will mail you a Notice of Award explaining your benefit amounts and when you should receive them. Benefits are paid the month after they are due. For example, a January benefit would be paid in February, and so on. The particular date each month that you receive benefits depends on your age. If you are approved, make sure SSA has your bank account information so they can direct deposit your benefits. You can start or change your direct deposit information online via your My Social Security account under the “My Profile” tab. If you are approved but don’t have a bank account, ask SSA to mail you a Direct Express® card. You can use this card to make purchases anywhere a debit MasterCard is accepted. You can use this card to get cash back with purchases at US retail locations, banks, and ATMs.

 
HOW DO I CALCULATE MY DISABILITY BENEFIT?
If approved for Social Security Disability Insurance (SSDI), how much money will I get?
SSDI benefits start 5 months after the date SSA finds you disabled but can only go back as far as 1 date before the date of application. The amount based on your lifetime average work-related earnings subject to Social Security taxation, and is equal to what your Full Retirement benefit would be. Each year Social Security mails you a projected estimate, or you can view this online via My Social Security account. Also, you can use the Social Security online Benefit Calculators. For the “retirement date,” type the month and year you became disabled and stopped working into the calculator. Remember, these figures are estimates.

If approved for Supplemental Security Income (SSI), how much money will I get?
SSI benefits start 1 month after the date SSA finds you disabled, but can only go back as far as the date of application. The maximum federal SSI payment for 2017 is $735 per month for an eligible individual (and $1,103 per month for an eligible individual with an eligible spouse). The monthly amount may be reduced by subtracting any “countable income” (anything you receive during a month that you can use to meet your needs for food or shelter). For example, if you are single and living with another person rent-free, then Social Security will deduct about $245 from your monthly SSI check as countable income for the free shelter you are receiving in 2017.

Generally, you cannot receive SSDI and SSI during the same period of time; you will receive the higher benefit for which you are eligible. The higher benefit is usually SSDI, unless you have a very low earnings record. Generally, if you are approved for a concurrent SSDI and SSI claim, you will receive SSI for the first 5 months after you are found disabled, then SSI will stop and SSDI will start.
 
CAN MY MONTHLY BENEFIT INCREASE IF MY DISABILITIES WORSEN?
No, your benefit is not based on the degree of your disability. Title II Social Security Disability Insurance (SSDI) benefits are proportional to your earnings record and Title XVI Supplemental Security Income (SSI) is a maximum of $735.00 per month for 2017.

However, you may receive annual Cost of Living Adjustments (COLA). For 2017, the COLA increase is 0.3%.

 
 
WILL MY WORKERS’ COMPENSATION PAYMENTS AND OTHER DISABILITY PAYMENTS AFFECT MY SOCIAL SECURITY DISABILITY?
Ordinarily, disability payments from other sources do not affect your Social Security Disability benefits. However, your and your family’s Social Security benefits may be reduced if the disability payment that you receive is Workers’ Compensation or another public disability payment (such as some civil service disability benefits, some military disability benefits, some Federal, State or Local government retirement benefits which are based on disability).

Your Social Security Disability benefit will be reduced so that the combined amount of the Social Security Disability benefit you and your family receive plus your Workers’ Compensation payment and/or public disability payment does not exceed eighty percent (80%) of your average current earnings.

If you received Long-term Disability for the same period you got Social Security Disability, most Long-term Disability policies will require you to pay them back.

 
HOW LONG CAN I RECEIVE SOCIAL SECURITY DISABILITY BENEFITS?
Your Title II Social Security Disability Insurance (SSDI) will continue as long as you remain disabled and unable to work. Your benefits will not run out because you did not contribute enough into the Social Security system. Your Title XVI Supplemental Security Income (SSI) will continue as is provided that you remain disabled and you have no other household countable income.

However, about 3 years after you were approved, SSA may conduct a Disability Review of your claim to determine if you are still disabled.

Once you reach Full Retirement age, SSDI benefits will switch to Retirement benefits, but the amount should stay the same.

 
TEN SOCIAL SECURITY DISABILITY MISTAKES TO AVOID
1. You must apply for disability after you stop working. If you stop working due to a disability, then you need to apply. Social Security only gives you a window of opportunity to apply. Usually, this is five (5) years, but if there is a gap in your work record it can be much shorter like one (1) or two (2) years. This is often a problem with housewives who drop out of the work force for a number of years to raise children.

2. You must have enough “work quarters”. If you have worked very little and Social Security says you do not have enough quarters, you may have to continue working in order to gain enough quarters to qualify.

3. Your disability must last at least twelve (12) consecutive months without improvement. If you have a serious injury but you are going to recover within twelve (12) months, you are not going to qualify for Social Security Disability. A prerequisite for Social Security is that you have an impairment that has or is expected to disable you for twelve (12) consecutive months.

4. You cannot be working when you apply. If you think you can work part time and qualify for Social Security Disability, you probably are not going to win your case. Social Security considers earned income an automatic disqualifier in most cases. In 2017, Social Security considers earning $1,170.00 per month as Substantial Gainful Activity (SGA) and an automatic disqualifier. So, if you make this amount even working part-time, you cannot qualify for Disability. Also, even working part time, shows you have the ability to work.

5. The Social Security doctor will probably declare you not disabled. Assuming a Social Security doctor will examine you and agree you are disabled is a common misconception. Most often, Social Security doctors rush people through like an assembly line. The exam is often very cursory and the examiner may not have the medical expertise to really understand your ailment. Usually, they give very little credence to subjective complaints.

6. You fail to file a timely appeal of a denial. Only about a third of claimants are granted at the initial level. After a denial, you have 60 days to appeal. Your case cannot be given additional consideration unless you appeal.

7. You fail to get medical treatment. Failure to obtain consistent treatment for your ailment is a common problem. Most Social Security judges will give little credence to an ailment that you have not sought medical treatment for. Thus, if you have a chronic pain complaint, you should at least make an attempt to manage the pain through a pain clinic or some other approach.

8. You fail to have your own doctor's support. Social Security rules give a lot of weight to a well written opinion by the claimant's own treating physician. Thus, if you believe you are disabled, you need to first consult your own physician for his/her opinion.

9. You fail to consult a specialist. It may be well and good to have an opinion from your family doctor. However, if you have an impairment that requires the opinion of a specialist, then you need to see one. For example, a lung problem may require a breathing test and the opinion of a pulmonologist. A heart problem may require a stress test and the opinion of a cardiologist.

10. You fail to consult a Social Security Disability attorney. Social Security law is a unique area of the law. If you have a brain tumor, you would not see a family doctor, you would see a specialist. Likewise, for Social Security Disability, you need to see an attorney who specializes in that field.

In summary,
many of the above mistakes listed above can be avoided if the claimant consults early on with an attorney who is a specialist in Virginia Social Security Disability law.

 
FIVE TIPS TO WIN YOUR SOCIAL SECURITY DISABILITY HEARING IN VIRGINIA
You have been denied twice and now your case is going to be heard at a hearing by an Administrative Law Judge (ALJ). These are the five best ways to win your ALJ hearing:

1. Get the best judge. Some judges approve 50 to 60% of appeals, but others only approve 15 to 20%. However, you cannot shop around and get the good judge. The Office of Disability Adjudication and Review (ODAR) scheduler assigns the Administrative Law Judge (ALJ). Thus, you may be stuck with the bad judge unless you want to withdraw and start the entire process over, which can take over a year. Withdrawal may now be the only way to avoid the bad judge. ALJ Disposition Data.

2. Have the support of your treating doctor. It is almost impossible to win without the support of your treating doctor. If your treating doctor does not support your case, then this is a signal you are not “disabled” at all. Not only must he/she support your case, he/she must write an evaluation supporting your case. Social Security will not accept a bare statement from a doctor saying you are “disabled” for work.

3. Get medical treatment for your condition. Social Security will not accept your say-so that you are in pain or cannot work. You must have medical treatment for your condition that demonstrates you have an impairment that impairs your ability to work.

4. Review the prior denials and Disability Determination Explanations carefully. The Department of Disability Determination Services (DDS) will prepare a Disability Determination Explanation (DDE). The DDE includes history of your medical care, a residual functional capacity assessment, etc. It will state the reasons why DDS found you “not disabled” and be supported by a doctor who reviewed the records. The DDE is important because the first thing the judge will look at in evaluating your case. Also, reviewing the DDE will show what you have to do to win the case.

5. Pick the right lawyer. Lawyers specialize just like doctors do, so you should pick a lawyer who specializes in Social Security Disability. You should pick a local lawyer. If you pick a 1-800 number lawyer, you will never meet the lawyer until the date of the hearing. That lawyer will not know the judge, the vocational expert or your doctors. Your lawyer should be AV rated by Martindale-Hubbell and a member of the National Organization of Social Security Representatives (NOSSCR).

In summary, these are my five tips for winning your Disability Case based on my 35 years of experience in doing these cases.
 
WILL A DISABILITY STATEMENT FROM A FAMILY MEMBER, FRIEND, PASTOR, OR FORMER EMPLOYER HELP MY CLAIM?
The medical evidence will carry the most weight in SSA’s decision, but a Witness Support Letter or Disability Statement may help with your credibility. SSA will wonder if you are really as disabled and limited as you claim to be or you are exaggerating.

When you have the right person with the right story to tell, it can be powerful evidence.
§404.1513(d)(4) states that Social Security will consider evidence from “other non-medical sources (for example, spouses, parents and other caregivers, siblings, other relatives, friends, neighbors, and clergy).” A “lay statement” (non-medical statement) can be important because it puts a disability case in human context. I always ask my clients with upcoming hearings for at least 3 statements from family members, friends, pastors, or former employers about how the claimant's impairments have restricted his/her ability to perform work and daily activities. The statements are usually thoughtfully written one to two-page typed letters telling the story of how the claimant used to be before s/he became disabled, what changed medically, and what life is like now. There is a genuine quality to these letters and they are often very moving.

Ideally, the statements should be in the record far enough in advance so the judge can read them before the hearing. In a typical case, the judge can only review the medical records and various SSA forms in the file prior to the hearing. The human element is pretty scarce until the actual hearing when the judge finally meets the claimant. They also often provide an excellent summary of the claim. Since the statements are in the record as evidence, the claimant's attorney can refer to them in his/her closing argument.

In a recent hearing, my client got a statement from his former employer graphically detailing his failed attempt to continue working despite his disability. The judge said it was the most compelling statement he had ever seen! We won the case and I believe the statement played a big factor in the judge's favorable decision.

 
WHAT ARE EXAMPLES OF DISABILITIES?
These are some examples of disabilities:

Allergies
Anxiety
Arthritis
Asbestosis
Asthma
Back/Neck Pain
Blindness
Cancer
Carpal Tunnel
Chronic Fatigue
Chronic Regional Pain Syndrome
Depression
Diabetes
Emphysema/COPD
Epilepsy/Seizures
Fibromyalgia
Hepatitis C
Herniated Disc
High Blood Pressure/Hypertension
Hip/Knee Replacement
HIV/AIDS

Joint Pain

Leukemia
Lupus
Mental Retardation
Migraine Headaches
Multiple Sclerosis
Stroke

Complete Social Security Disability Impairment Listing:

www.socialsecurity.gov/disability/professionals/bluebook/AdultListings.htm.

165 Compassionate Allowances that may get you immediate disability:
www.ssa.gov/compassionateallowances/conditions.htm.

 
SOCIAL SECURITY DISABILITY V. SUPPLEMENTAL SECURITY INCOME

Issue Title II - SSDI Title XVI - SSI
Medical Disability same standard same standard
Current Income must be under SGA must be under SGA
Earnings Record sufficient work quarters not required
Resource Limit none $2,000 individual; $3,000 couple*
Household Income spouse’s income doesn’t matter spouse’s income may reduce your benefit
Payment Amount proportional to earnings record; max. $2,639/month* max. $735/month individual;
max. $1,103/month couple*
Child Benefit Kids under 18 get 50% of parent’s benefit N/A
Max. Back-Benefits 1 year before date of application date of application
Payments Begin 5 months after date found disabled 1 month after date found disabled
Medicare Begins 29 months after date found disabled N/A
*These figures are for the year of 2017 and are subject to change annually.

Title II Social Security Disability Insurance (SSDI) is a program financed with Social Security taxes paid by workers, employers and self-employed persons. Disability benefits are payable to disabled workers, disabled widow(er)’s or adults disabled since childhood, who are otherwise eligible. Auxiliary benefits may be payable to a worker’s dependents, as well. The monthly disability benefit payment is based on the Social Security earnings of the insured worker on whose Social Security number the disability claim is filed. When you become entitled to twenty-four (24) months of SSDI you are entitled to Medicare at a nominal cost.

Title XVI Supplemental Security Income (SSI) is a welfare type program financed through general tax revenues. SSI benefits are payable to adults or children who are disabled, meet the income/resource/living arrangement requirements, and are otherwise eligible. No Auxiliary benefits are paid with SSI in Virginia. You can be eligible for SSI even if you have never worked or paid taxes under FICA. Generally, however, you need to be a U.S. citizen or meet certain requirements for non-citizens to be eligible for SSI. If you receive SSI, you are eligible for free Medicaid.

Examples of the differences between SSDI and SSI:

1. For SSDI, you must have an earnings record and show you are disabled.
Housewife: “Why can't I get disability?”
Response: “Where is your earnings record?”

Self-employed: “Where is my disability?”
Response: “Did you ever file taxes and pay into Social Security?”

People who are paid in cash or under the table: “Why can't I get Social Security?”
Response: “You only get out what you paid in; it is not a free ride.”

2. For SSI, you must meet the low income household requirements and show you are disabled.
SSI is a welfare program and even though its full name is Supplemental Security Income, it probably should have been called “Welfare Disability.” Even if you are disabled, you may not be eligible for SSI if you have too much household income or resources. Income includes wages, Social Security benefits, and pensions. Resources are things you own like real estate, bank accounts, cash, stocks and bonds.

For 2017, an individual who has more than $2,000.00 in countable resources cannot qualify for SSI, and a couple who has more than $3,000.00 in countable resources cannot qualify for SSI.

The same housewife who could not obtain Social Security may also not be able to obtain SSI if: (1) she has other unearned income, (2) her husband has too much income, and/or (3) she or her husband has too many assets.

3. The SSDI is proportional to the earnings the worker paid in and could be as high as $2,639 per month in 2016.
Question: “Why isn't my benefit higher?”
Answer: “You get out what you paid in.”
Not working for a number of years or working at a minimum wage job is going to result in a lower benefit. On the other hand, the maximum SSI amount an individual can receive in 2017 is $735.00 per month, but this does not depend on earnings.

4. An individual on SSDI can also expect a payment to dependent children up to age 18 or until the child graduates from high school.
Question: “Why isn't my benefit higher?”
Answer: The dependent children share equally about 50% of the parent's benefit. On the other hand, there is no dependent care benefit for a recipient of SSI.

5. SSDI & SSI are similar in one way: the disability test is the same.

6. When you file for Disability, Social Security will first check if you are eligible for SSDI before allowing you to apply for SSI. Generally, if your monthly Social Security check is higher than $735.00 (for 2017), you would not be eligible for SSI. On the other hand, if your monthly Social Security check is lower than $735.00, you may be able to receive a small SSI check so your total benefit is about $755.00 per month.

In summary, when a person says I am on “disability” or I want “disability,” there is a big difference between SSDI and SSI. Remember, SSDI is an earned benefits and SSI is a welfare benefit.

 
WHAT ARE WORK QUARTERS?
Title II Social Security Disability Insurance (SSDI) requires you to:
1. be found disabled under SSA’s rules, AND
2. have worked long enough and recently enough to earn sufficient “work quarters” to qualify for benefits.

You can earn a maximum of 4 work quarters each year:
First Quarter is January 1 through March 31
Second Quarter is April 1 through June 30
Third Quarter is July 1 through September 30
Fourth quarter is October 1 through December 31.
*For 2016, you must earn $1,260 to receive 1 quarter of coverage. For 2017, you must earn $1,300 to receive 1 quarter of coverage.

To meet the earnings requirement for SSDI benefits, you must pass:


1. A recent work test based on your age at the time you became disabled:
    RULES FOR “RECENT” WORK TEST
    If you become disabled…
    Then, you generally need:
    In or before the quarter you turn age 24
    1.5 years of work during the 3-year period ending with the quarter your disability began
    In the quarter after you turn age 24 but before the quarter you turn age 31
    Work during half the time for the period beginning with the quarter after you turned 21 and ending with the quarter you became disabled (Example: If you become disabled in the quarter you turned age 27, then you would need 3 years of work out of the 6-year period ending with the quarter you became disabled.)
    In the quarter you turn age 31 or later
    Work during 5 years out of the 10-year period ending with the quarter your disability began.

    AND

    2. A duration work test to show you worked long enough under Social Security (your work does not have to fall within a certain period of time):
    RULES FOR “DURATION” WORK TEST
    If you become disabled… Then, you generally need:
    Before age 28 1.5 years of work
    Age 30 2 years
    Age 34 3 years
    Age 38 4 years
    Age 42 5 years
    Age 44 5.5 years
    Age 46 6 years
    Age 48 6.5 years
    Age 50 7 years
    Age 52 7.5 years
    Age 54 8 years
    Age 56 8.5 years
    Age 58 9 years
    Age 60 9.5 years
    *This table does not cover all situations.
 
WHAT IS A DATE LAST INSURED (DLI) FOR DISABILITY BENEFITS?
The Date Last Insured (DLI) is the last day of the quarter a claimant meets insured status for Title II Social Security Disability Insurance (SSDI). You must have worked long enough and recently enough to earn sufficient quarters of coverage to be eligible for SSDI benefits. You may not have enough work quarters if you have not paid into Social Security, not worked in over 5 years, worked on and off, worked part-time, or earned very little income. Your SSA Field Office will calculate your Date Last Insured (DLI) for benefits based on your work quarters. You must prove disability before your DLI to be approved for benefits.

Generally, you meet the disability insured status if you have earned at least 20 quarters of coverage during the last 10 years.

 
WHAT IS THE ROLE OF THE VOCATIONAL EXPERT AT THE HEARING?
The Vocational Expert (VE) will provide testimony about your past work, transferrable skills, and any jobs you can do. The VE will identify the physical demand level and skill level of each job you have held in the past 15 years. The VE will testify if you could adjust with transferrable skills from your past jobs to lighter/easier work. The ALJ may pose hypothetical questions to the VE about your Residual Functional Capacity (RFC) such as:
  • 1. Based on the doctor’s RFC that the claimant is restricted to light duty, can the claimant perform any Past Relevant Work (PRW) in the last 15 years?
  • 2. Can the claimant do any PRW as normally performed in the national economy as defined in the Dictionary of Occupational Titles?
  • 3. Based on the RFC to perform light duty except that the claimant is limited to sitting 4 hours a day, lifting no more than 20 pounds, and needs 15 minute breaks every hour, do any jobs exist in the national economy?

Then your attorney can pose questions to the VE as well.