There are two main Social Security programs that support people with disabilities: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
Social Security Disability Insurance benefits are available to workers who have “medically determinable” impairments that prevent them from staying on the job or from performing any “substantial gainful activity.” SSDI is the safety net for workers who cannot be helped by adjustments and adaptations called "reasonable accommodations” set forth by the Americans with Disabilities Act (ADA).
Disability under Social Security is based on one's inability to work. Under the rules, you are considered disabled if you cannot do the work you did before and it is concluded that you cannot adjust to other work because of your medical condition. It must be expected that your disability will last for at least one year or result in death. In addition, you must have worked long enough and recently enough under Social Security to qualify for disability benefits. This means that a person must have worked at least 5 of the 10 years immediately before the disability and paid FICA taxes during that time.
A high percentage of initial SSDI claims are denied by Social Security, but there are various levels of the appeals process. To win a claim at any level, an applicant must provide medical evidence of a disabling condition. The best source of this evidence is the applicant's doctor, not the applicant.
Supplemental Security Income is a program that provides monthly payments to people who have limited income and resources if they are 65 or older or if they have a disability. SSI benefits are not based on your work history or that of a family member. Depending on the state where you live, the benefits and services that come with SSI include food stamps and paid Medicare premiums (all states). In most states, SSI recipients can also get Medicaid coverage for hospital stays, doctor bills, prescription drugs, and other health costs.
The Appeals Process
Social Security, ever vigilant toward waste and fraud, does not always make it easy to get or keep benefits. If the agency decides that you are not eligible or are no longer eligible for benefits, or that the amount of your payments should be changed, you will receive a letter explaining the decision. If you don't agree, you can ask them to look at your case again. If you wish to appeal, you must make your request in writing within 60 days of the date you receive the letter. There are four levels of appeal.
A reconsideration is a complete review of your claim by someone who didn't take part in the original decision. This person will look at all the evidence submitted when the original decision was made, plus any new evidence.
If you disagree with the reconsideration, you may ask for a hearing. The hearing will be conducted by an administrative law judge who had no part in either the first decision or the reconsideration of your case. You and your representative, if you have one, may come to the hearing and explain your case. You may review anything in your file and provide new information.
If you disagree with the hearing decision, you may ask for a review by the Social Security's Appeals Council. The Appeals Council looks at all requests for review, but it may deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review your case, it will either decide your case itself or return it to an administrative law judge for further review.
If you disagree with the Appeals Council's decision or if the Appeals Council decides not to review your case, your final option is to file a lawsuit in a federal district court.
Because the rules are complicated, many applicants hire lawyers who specialize in Social Security law. The National Organization of Social Security Claimants' Representatives may be able to suggest local referrals. For any questions about SSI, SSDI or other disability benefits programs, contact the nearest Social Security office.
Below are some helpful links specific to Social Security: