Disability is defined in the Social Security Act as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

Medically determinable impairment is an impairment that results from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques. A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings – not only by the individual’s statement of symptoms.

Under the Social Security Administration’s (SSA) disability insurance program (title II of the Act), there are three basic categories of individuals who may be able to qualify for benefits on the basis of disability: ~ A disabled insured worker under the age of 65; ~ A person who became disabled before age 22 who is a dependent of a deceased insured parent or a parent entitled to title II disability or retirement benefits; and ~ A disabled widow or widower age 50-60 if the deceased spouse was insured under Social Security. Under title XVI, Supplemental Security Income (SSI), there are two basic categories under which a financially needy person can get payments on the basis of disability: ~ An adult age 18 or over who is disabled and ~ A child (under age 18) who is disabled.

Title II provides for payment of disability benefits to individuals who are “insured” under the Act by virtue of their contributions to the Social Security Trust Fund through the Social Security tax on their earnings, as well as to certain disabled dependents of insured individuals. Title XVI provides for SSI payments to individuals (including children under age 18) who are disabled and have limited income and resources. SSI is not the same as Social Security, even though the program is run by the SSA. Supplemental Security Income (SSI) is the first federally administered cash assistance program in this country available to the general public. It is designed to provide a floor of income for the aged, blind or disabled who have little or no income and resources. The program establishes that payment may be received as a right by those U.S. Citizens or legally admitted aliens residing in this country who qualify as aged, blind, or disabled and who meet income and resource criteria. No work credits are necessary for entitlement under this program.

A sequential review is made of the claimant’s current work activity, severity of the impairment(s), age, impact of impairment on work related abilities, past and current work experience, age and education. A disability claims adjudicator obtains any existing medical evidence. If that evidence is unavailable or if further examination or testing is needed to make a determination, the Disability Determination Service (DDS) will, at its expense, arrange for a consultative examination. The claimant’s treating source is usually the preferred source for performing the examination on his /her own patient.

The law provides that, under the Social Security disability program, disability benefits for workers and widows usually cannot begin for 5 months after the established onset of the disability. The 5 month waiting period does not apply to individuals filing as children of workers. Under SSI, disability payments usually begin the first month following the month of application.

An “onset” date is the date the DDS determines a claimant was eligible for disability benefits.

Social Security rules make it possible for people to test their ability to work without losing their right to cash benefits and Medicare or Medicaid. These rules are called “work incentives.” The rules are different for title II and title XVI, but under both programs they may provide: ~ continued cash benefits; ~ continued help with medical bills; ~ help with work expenses; or ~ vocational training.

In some cases, yes; however, title II payments may only be made 12 months prior to the application date. For title XVI, payments may begin the first month after the month of application.

The DDS agency has a staff of trained people, including disability adjudicators and doctors, who decide if Social Security’s criteria for eligibility is met.

The following steps must be taken in order to file a claim: ~ A claim may be filed by mail, telephone, or in person at any Federal Social Security Office; ~ The Federal Social Security Office initially screens claimants to determine whether they meet basic work and age requirements; ~ When claimants pass the initial screening, their applications are referred to DDS.

If denied benefits, a claimant can proceed with the following steps: ~ The claimant may ask to be reconsidered. This is called the reconsideration step. This process is similar to the initial filing except that a different adjudicator and a different doctor make the determination. ~ If a claimant is denied a second time, he/she may appeal to a Federal Social Security Administrative Law Judge; ~ If the Administrative Law Judge denies the case, the claimant may appeal to the Social Security Appeals Council; ~ If the claimant exhausts all administrative appeals but wishes to continue pursuing the case, he/she may file a civil suit in Federal District Court and eventually appeal all the way to the United States Supreme Court.

On an average, the entire process is broken down into the following categories: ~ The interview with the Federal Social Security Office and mailings usually take between 5 to 10 days; ~ Once the State DDS agency receives the claim, it takes an average of 3 months to process the case; ~ The reconsideration process takes an average of 4 months; ~ The Administrative Law Judge process takes a average of 10-12 months to process; ~ The Appeals Council process could take in excess of 1 year to complete.

Is the claimant only eligible to receive disability payments from the time of reversal? Payment is based on the onset date and the filing date. The onset date is the date that the claimant is first found to be severe enough to meet SSA’s criteria. For title XVI claimants, payments can begin as early as the month after the month of filing. Title II claimants usually must serve a waiting period of 5 full months after the onset is established and in some cases may be paid retroactively up to 12 months prior to the application date.

Checks are mailed from a federal payment center on a monthly basis. Once a claimant’s case is approved he/she will receive a lump sum check for any retroactive eligibility and monthly disability payments will follow. The State Disability Determination agency is not involved in the issuance or mailing of Social Security disability payments. Payments are made by the federal Social Security Administration.

While there is no specified timeframe for how long a claimant can remain on disability, individuals who have been on disability for several years are subject to a “continuing disability review” (CDR). Most individuals remain on disability until their physical or mental impairment has had sufficient improvement to allow them to re-enter the work force

A claimant ceases to be eligible for disability when one or more of the following criteria apply: ~ The claimant reaches the age of 65 or retires at age 62 with regular Social Security benefits; ~ The claimant’s physical or mental condition improves to a level that no longer prevents work; ~ The claimant dies; or ~ It is determined that the claimant committed fraud or similar fault.

Yes; an aggressive fraud department is fully staffed and uses state-of-the-art surveillance techniques and trained investigators to detect fraud or similar fault.

If it is determined that a claimant has committed fraud or similar fault, the following action(s) may be taken: ~ Disability benefits may be stopped; ~ The claimant may be referred to the Prosecuting Attorney, the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI) and/or the United States Attorneys Office; or ~ If found guilty, the claimant may be expected to repay benefits deemed fraudulent and may be incarcerated.

The term fraud describes the actions of a person who has the intent to fraudulently secure payment either in a greater amount than is due or when no payment is authorized. These actions constitute a felony. Title 18, U.S.C. provides for a fine or imprisonment for not more than five years, or both, upon conviction thereof.

Sections 205 and 1631 of the Social Security Act define similar fault as follows: ~ An incorrect or incomplete statement that is material to the determination is knowingly made; or ~ Information that is material to the determination is knowingly concealed.

Yes; the Federal Social Security Administration sends cases to the DDS to be reviewed by an experienced adjudicator. If the adjudicator determines that the claimant is still disabled, the claimant remains on disability. If it is determined that the claimant is no longer disabled, the claimant is notified and is given the opportunity for a face-to-face hearing with a DDS hearing officer.

Yes. Some claimants decide to hire personal lawyers when they first apply. Many claimants hire a lawyer after their claim is denied during the first two levels and they decide to appeal to a Federal Administrative Law Judge. Other claimants never hire a lawyer. There are no statistics to show whether hiring a lawyer significantly increases the likelihood of a claimant’s case being allowed.

Over 60,000 claims are processed each year in Arkansas in a timely manner.

Arkansas has the 4th highest percentage of its population on Social Security disability. Nearly two-hundred thousand claimants in the State of Arkansas currently are awarded Social Security disability benefits. The federal government pays about $80,000,000 each month to disability beneficiaries in the State of Arkansas.

Yes. Medicare helps pay hospital and doctor bills of disabled or retired people who have worked long enough under Social Security to be insured for Social Security benefits. It generally covers people who are 65 and over, people who have been determined to be disabled and have been receiving benefits for at least 24 months, and people who need long-term dialysis treatment for chronic kidney disease or require a kidney transplant. In general, Medicare pays 80 percent of reasonable charges. In most states and in Arkansas, individuals who qualify for SSI disability payments also qualify for Medicaid. The program covers all of the approved charges of the Medicaid patient. Medicaid is financed by federal and state matching funds, but eligibility rules may vary from state to state.

The money for SSI checks comes from the general revenues of the United States Treasury. Social Security benefits are paid from contributions of workers, employers, and self-employed people. Social Security funds are not used for SSI checks. People who get Social Security checks may get SSI checks too, if they are eligible for both. However, a person does not have to be eligible for Social Security to get SSI. People getting federal SSI checks or state supplemental checks may also be eligible for social services provided by a state. These services help people meet problems in daily living or special problems related to age or a handicapping condition.

Under the Social Security Administration’s (SSA) disability insurance program (title II of the Act), there are three basic categories of individuals who may be able to qualify for benefits on the basis of disability: – a disabled insured worker under the age of 65; – a person who became disabled before age 22 who is a dependent of a deceased insured parent or a parent entitled to title II disability or retirement benefits; and – a disabled widow or widower age 50-60 if the deceased spouse was insured under Social Security. Under title XVI, Supplemental Security Income (SSI), there are two basic categories under which a financially needy person can get payments on the basis of disability: – an adult age 18 or over who is disabled and – a child (under age 18) who is disabled.

Disability is defined in the Social Security Act as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

Medically determinable impairment is an impairment that results from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques. A physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings – not only by the individual’s statement of symptoms.