Any family caregiver who has tried to navigate the Social Security Disability Insurance maze knows how confusing and frustrating the process can be. Some may not even realize that their loved ones are eligible to receive Society Security Disability Insurance. In an effort to take a little bit of the mystery out of this government program, NFCA posed some general questions to the folks at Allsup, a nationwide, private Social Security disability claims services company and an NFCA founding partner.
What Is Social Security Disability Insurance?
Social Security Disability Insurance (SSDI) is a payroll tax-funded, federal insurance program. SSDI was established in 1954 to provide people with income if they are unable to work due to a disability, and guarantees income if their condition does not improve. Once retirement age is met — 65 or older — recipients move from SSDI to Social Security retirement income.
Regardless of your age, 24 months after your date of entitlement to SSDI, you are eligible for Medicare benefits.
How do I know if my family member/friend qualifies for Social Security disability benefits?
To help determine whether your loved one is eligible for SSDI, answer these three questions:
1. Does my loved one have enough work credits?
When you work and pay Social Security taxes, you earn up to a maximum of four “credits” for each year. The number of work credits needed for disability benefits depends on your age when you become disabled. Generally you need 40 credits, 20 of which were earned in the last 10 years. In other words, you must have worked for five of the last 10 years. However, younger workers may qualify with fewer credits.
SSA rules state:
- Before age 24 — You may qualify if you have six credits earned in the three-year period ending when your disability starts.
- Age 24 to 31 — You may qualify if you have credit for working half the time between age 21 and the time you become disabled. For example, if you become disabled at age 27, you would need credit for three years of work (12 credits) out of the past six years (between ages 21 and 27)
- Age 31 or older — In general, unless you are blind, you must have earned at least 20 of the credits in the 10 years immediately before you became disabled.
2. Could my care recipient meet the SSA’s definition of disabled?
People are generally considered disabled if:
• They cannot do the type of work that they did previously.
• It is determined that they cannot adjust to other work because of their medical and/or psychological condition(s). These conditions can include the effects of diseases such as cancer, Alzheimer’s, multiple sclerosis, or Parkinson’s disease; physical trauma such as stroke, brain injury, or post-traumatic stress disorder; mental health disorders; or any combination of illness and symptoms that make it impossible for an individual to work. The disability must meet or equal an SSA medical listing (see sidebar).
• Their disability has lasted or is expected to last for at least one year or result in death.
To be eligible for SSDI, individuals must have been disabled before reaching full retirement age (65-67).
If you answered yes to all three questions, your loved one may be eligible for SSDI.
When should my loved one apply for SSDI?
It’s best to apply for SSDI as soon as possible to receive and protect all the benefits your loved one might be eligible for, including:
• Regular Monthly Income
SSDI is a regular monthly payment with annual cost-of-living increases. A portion of these disability benefits may be tax free.
• Medicare Benefits
Regardless of your age, 24 months after your date of entitlement to SSDI benefits, you are eligible for Medicare benefits, which includes Part A (hospital benefits) and Part B (medical benefits). A variety of Medicare Advantage plans are also available to you.
• Prescription Drug Coverage
Once entitled to Medicare, you are also eligible for Medicare Part D, the prescription drug plan.
• COBRA Extension
If you receive SSDI benefits, the length of your COBRA benefits may be extended an additional 11 months.
• Long-Term Disability (LTD) Benefits
If you have private long-term disability insurance, your provider will most likely require you to seek SSDI. Complying with this requirement could help protect your ability to receive LTD income.
• Protected Retirement Benefits
When you reach retirement age, SSDI ends and you transition to Social Security retirement benefits. SSDI entitlement “freezes” your Social Security earnings record during your period of disability. Your years of no income because you’re not working due to your disability will not be averaged into your total earnings. Because those years will not be counted when computing future benefits, the amount of your Social Security retirement benefits may be higher.
• Dependent Benefits
If you receive SSDI benefits and you have a dependent under age 18, he or she also may be eligible for benefits.
• Return-to-Work Incentives
Social Security will provide you opportunities to return to work while still paying you disability benefits.
How long can we expect the application process to take and what can we do to ensure that it goes as quickly and smoothly as possible?
The SSDI application process can be difficult, confusing, and time consuming. The wait to receive benefits can be from two to four years and can vary depending on where you live. You may want to consider getting professional representation to help you through the process. On average, individuals who have professional representation are approved at higher rates than those who apply on their own, including at both the application and reconsideration levels. This means a representative can help you receive your award quicker and avoid the hearing and Appeals Council levels.
Typically, there are two major types of paid SSDI representatives. First, there are specialized organizations that have multiple representatives and specialists experienced in handling SSDI claims in local communities across the country. There also are law firms that may have attorneys solely dedicated to SSDI claims.
When selecting representation you should ask the following questions:
§ What is the organization’s award rate? The national average is 36 percent, so you should look for results that exceed that rate.
§ Will the organization handle all of your paperwork and filing? Some representatives will have you retrieve medical records and documents from your healthcare practitioners while others will handle those tasks for you.
§ How will the organization monitor the status of your claim and keep you informed of impending deadlines, scheduled hearings, or when to submit additional documents?
§ How long has the organization been providing SSDI representation?
§ What is the organization’s experience and success rate with on-the-record requests? Approximately one-quarter of SSDI cases will proceed to the hearing level. If your representative can obtain a favorable on-the-record decision from the administrative law judge, you will not have to appear at a hearing.
§ Are there additional costs other than the standard fee? The fee for SSDI representation by any organization or attorney is determined by the SSA. Currently, under the SSA’s fee agreement approval process, it is 25 percent of the retroactive dollar amount awarded, not to exceed $6,000. However, many companies/attorneys charge clients for travel, postage, collecting medical records, and other hidden costs. Make sure you know all the costs you will be responsible for before choosing your SSDI representative.
Although the SSDI application process is challenging, it can be much easier with expert help. If your loved one is eligible for SSDI, it will be worth the time and effort to obtain the benefits he/she deserves.
About Allsup
Allsup is a nationwide provider of Social Security disability representation and Medicare plan selection services. Founded in 1984, Allsup employs nearly 700 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Illinois, near St. Louis. To learn more, go to www.allsup.com or call 800/279-4357.
My loved one does not have enough work credits to qualify and is only 61 years old. Are there any other programs available that she might be eligible for?
Posted by: Ted Collins | 08/20/2010 at 06:17 PM