Are you suffering from a severe injury or health condition that prevents you from working in Maine? If you have become disabled before retirement age, you may qualify for Social Security Disability benefits. How do you know if you are eligible?
Social Security Disability Insurance (SSDI) is a benefits program run by the United States Government that is part of the Social Security Administration (SSA). It was established by the Federal Government and is outlined in the Code of Federal Regulations. Instead of providing payment to retired persons, SSDI is designed to provide income supplements to people who are not yet of retirement age, who cannot work, or who are severely restricted in their ability to work, because of a significant disability or illness.
SSDI benefits may be awarded on a temporary or long-term basis. SSDI benefits are paid until the disabled person can regularly work again, or in some cases, dies. A person is eligible for SSDI when the applicant’s disability makes it impossible for him to do his job or is unable to do other kinds of work that might be available to the applicant based on his training and education. The government reviews an applicant’s case by carefully considering an applicant’s medical records and work and education history.
While
the government is generous in its concept to provide for individuals still of a prime working age who are unable to work due to severe injury or health condition, the government sets a high bar to qualify to receive these benefits. Those specific criteria must be met in order to qualify for and receive SSDI. The process can be complex and getting approved can be difficult, which is why many applicants get legal representation from a Maine disability lawyer. Attorneys can present a case in the best light and may improve the chance of getting a successful result.
A claim begins with an application processed through a local SSA field office and State agencies called Disability Determination Services (DDS). The application is filed in person, by telephone, by mail, or online.
What Are the Criteria And Qualifications to Receive SSDI Benefits?
First, the sort of job an applicant held prior to becoming disabled will be considered.
Through his employment, the applicant must already have had a job that paid into the Social Security system. The applicant must have paid into FICA in some capacity. How long ago the applicant worked before application for SSDI is made is also important. A certain number of “work credits” are necessary to be eligible for SSDI benefits. “Work credits” are calculated by reviewing the number of hours an applicant worked, the recency of the applicant’s employment and in some cases his wage level. The number of “work credits” needed for eligibility will vary based on the age of the applicant when disability occurs. Furthermore, SSDI will not be awarded to an applicant whose earnings exceed a number set by the SSA.
SSA will also consider the type of work the applicant performed or could perform when considering eligibility for SSDI benefits. SSA will consider whether an applicant is still suited and able to do work other than the work for which the applicant was employed at the time of the disability. SSA will review an applicant’s ability to work in concert with an applicant’s physical limitations or disability to determine if an applicant can absolutely not work or if the applicant could work in another capacity doing something that may be new to the applicant.
For SSDI Purposes, What Is Considered a Disability?
For adult SSDI benefits, disability is defined relative to an applicant’s ability or inability to work. The Federal regulation pertaining to SSDI defines disability as the inability to, “engage in any substantial gainful activity.” 20 C.F.R. ss.404.1505, 416.905. This definition of disability differs from the definition of disability for other governmental programs.
The SSA developed a five-step process to help determine when a person is disabled for purposes of SSDI. Essentially, the SSA has derived 5 questions for an applicant to answer to assist SSA in determining eligibility for SSDI. Each step is further defined by the SSA, but in summary the questions are:
Step 1: Are you engaged in “substantial gainful activity?” The SSA has a number of rules and standards used to determine what is substantial gainful employment. If SSA determines you are still so engaged, SSA will find that you are not disabled.
Step 2: Is your medical impairment “severe?” If you do not have a severe medically determinable physical or mental impairment that lasted or is expected to last for a continuous period of at least 12 months or result in death, or a combination of impairments that is severe and meets the duration requirement, SSA will find that you are not disabled.
Step 3: SSA also considers the medical severity of your impairment(s). SSA has developed a list of health problems, known as “Listed Impairments,” that are of such a severity they automatically satisfy the definition for disability for SSDI, so long as your illness also meets the duration requirement mentioned in the step above.
Step 4: Can you still do your past relevant work? If so, SSA will find that you are not disabled.
Step 5: Can you perform other work, different from your occupation prior to your health issue? SSA assesses your residual functional capacity and your age, education, and work experience to see if you can make an adjustment to other work. If you can make an adjustment to other work, SSA will find that you are not disabled. If you cannot make an adjustment to other work, SSA may find that you are disabled.
Why You Should Consider Contacting a SSDI Attorney in Maine
Applying for SSDI is an arduous process. Medical histories and work and educational histories must be assembled and provided in great detail. Many inclusions and exclusions are in play. Many rules have been established. Many details are necessary to satisfy government requirements.
The application process is time consuming. Most people are initially denied and must file an appeal to receive the benefit. That appeal must be filed within 60 days of denial, or the application process must begin anew from the beginning. An appeal may provide more detail regarding an applicant’s illness or it may detail that a work history does in fact meet the requirements. There are four levels of possible appeal, so even if a first appeal affirms a denial of benefits there are still avenues to pursue.
Should an initial request for SSDI be denied, an applicant would first file for Reconsideration. Should an applicant wish to appeal that decision, a hearing by an Administrative Law Judge would follow. If satisfaction is still not reached, there would next be a review by the Appeals Council. Should an applicant still be dissatisfied, the applicant could file a civil lawsuit and the final level of review will be by a Federal Court. The suit could, in theory, even reach the United States Supreme Court if the court were to accept it.
SSDI is an insurance benefit provided by the government for those suffering a long term, total disability that interferes with their ability to earn a living. Individuals with a short term or partial disability will not qualify. But if you believe you may fit the criteria, SSDI can be an important lifeline provided to you.
If you or a loved one needs a Social Security disability attorney, contact the Law Offices of Joe Bornstein. Call 1-800-CALL-JOE (1-800-225-5563) or visit www.joebornstein.com. Your consultation is free, and you only pay a fee if we get you benefits. Offices in Sanford, Biddeford, Portland, Lewiston, Augusta and Bangor and serving all of Maine.