What Is the Difference Between SSD and SSI benefits?
Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) differ in several important ways. SSDI is only available to individuals who have paid into the Social Security system for a specified length of time, who are unable to work for 12 months or more due to a disability, and who meet the definition of disability under the Social Security Administration (SSA)’s rules. SSDI is funded through payroll taxes.
In contrast, SSI is a needs-based program. To be eligible for SSI, an applicant must be blind, disabled, or age 65 or older and have limited income and assets. There is no requirement to have paid into the system by working to qualify for SSI. General taxes fund SSI benefits.
Should I apply for SSD or SSI benefits?
The answer to this question depends on your specific situation. As described above, SSD and SSI have different requirements for eligibility. You should apply for either SSD or SSI based on your circumstances — or in some cases, you may be eligible for both types of disability benefits.
Generally, if you have worked throughout your career and paid Social Security taxes, you may qualify for SSD benefits if you meet the definition of disabled. For most workers, this means that you have earned 40 work credits (up to 4 each year), 20 of which must have been earned in the last 10 years before applying. Younger people may be able to qualify with a lower number of credits.
SSI benefits are needs-based, which means that in addition to having a qualifying disability, you must also meet the income and assets criteria for SSI. The income and asset limits can be complicated, with only certain types of income and assets counted, and others excluded. If you are unsure if you may qualify for SSI, contact a New Jersey disability benefits lawyer.
Can I receive both SSD and SSI benefits at the same time?
Yes. If you qualify for both programs, then you may be able to receive SSD and SSI simultaneously. This may be referred to as “concurrent benefits.”
In most cases, you will only be eligible for concurrent benefits if you are approved for SSD, but do not receive a high level of benefits. This may happen for a number of reasons, such as becoming disabled before having a chance to build up a significant work history, or earning relatively low wages throughout your employment history.
SSI is based on need and has strict limits fo income and assets in order to qualify. SSD benefit payments are countable income (as “unearned income”) for purposes of SSI. In other words, the SSD benefits that you receive will count towards your total income and assets in an SSI evaluation. If your SSD benefits exceed a certain amount each month, then you won’t be eligible for SSI.
Am I disabled enough to qualify for SSD or SSI benefits?
To qualify for Social Security disability benefits, you don’t have to be confined to a bed or in a wheelchair — even if you’re a young person. If you cannot work at a regular job (including your past jobs) because of your medical problems, that will generally make you eligible for benefits. However, being unable to work and being found “disabled” by the Social Security Administration (SSA) are two different things.
It is often not easy to convince SSA that someone is “disabled” even when they genuinely cannot work. At the same time, however, it is not impossible. If cannot work due to a medical or mental health condition, you can apply for SSD and/or SSI benefits. In doing so, provide all the information that the SSA asks for in a straightforward, candid way. Be truthful, and don’t exaggerate or minimize your disability.
What are the eligibility requirements for SSD benefits?
To qualify for SSD benefits, you must have worked long enough in jobs covered by Social Security. Typically, you will need to have worked for 10 years in order to be eligible. You must also have a medical or mental health condition that meets SSA’s definition of disability. Under this definition:
- You must be unable to do any substantial work because of your medical condition(s); and
- Your medical condition(s) must have lasted, or be expected to last at least 1 year, or be expected to result in your death.
Generally, benefits are available to people who are unable to work for a year or longer, or who have a condition that is expected to be terminal. The disability must be so severe that an individual cannot work, taking into consideration their age, level of education, and experience.
Importantly, if you have a disability, you do not have to wait until you have been unable to work for a year before you can apply for benefits. You can apply at any time if your condition is anticipated to make you unable to work for 12 months or longer.
What are the eligibility requirements for SSI benefits?
SSI is available to anyone who is 65 or older, blind, or disabled (including children). In addition, an individual must have limited resources and income, as defined by the SSA.
For adults, you are considered disabled if you have a physical or medical impairment that results in the inability to do any substantial gainful activity and can be expected to result in death or has lasted or can be expected to last for 12 continuous months.
For children, there is a different definition of disability. A child with a physical or mental impairment may be considered disabled if they have a medical or mental health impairment that results in marked and severe functional limitations, and can be expected to result in death or has lasted or can be expected to last for 12 continuous months.
Income includes money that you earn from work, money that you receive from other sources, and free food or shelter. Resources include things that you own, include cash, vehicles, life insurance, land, and personal property.
What is substantial gainful activity?
The term “substantial gainful activity” (SGA) is used by the SSA to describe a level of work and earnings. It is one of the factors that the SSA considers to determine if you are eligible for disability benefits. If you earn more than a certain amount of income and are doing productive work, then you will usually be considered to be engaging in substantial gainful activity.
“Substantial” work is anything that requires significant physical and/or mental activities. “Gainful” work is anything that is performed for pay or profit, intended for profit (even if a profit isn’t made) or work that is typically performed for pay or profit. If you have a question about whether the work that you do may be considered SGA, a New Jersey disability benefits attorney can advise you about how the law may apply to your case.
What are work credits?
Work credits are used to determine eligibility for SSD benefits. You earn credits by working and paying Social Security taxes. You can earn up to 4 credits per year. The amount of earnings that it takes to earn a credit varies by year. In 2019, you needed to earn $1,360 to get one work credit or $5,440 per year for the maximum of 4 credits.
Most people need 40 credits to qualify for SSD benefits, which is the equivalent of 10 years of work. 20 of those credits must have been earned in the 10 years preceding the year that you became disabled.
The number of credits that you need to qualify may be lower based on your age. For example, if you became disabled before the age of 24, you may qualify if you have earned 6 credits in the 3 years before you became disabled.
What are the qualifying conditions?
The Social Security Administration maintains a listing of impairments. This list describes medical and mental health conditions that are considered severe enough to be a “qualifying condition.” There is a list for both adults and for children.
If you have a qualifying condition, you will still need to demonstrate that your medical or mental health diagnosis meets the criteria set forth in the listing of impairments. In other words, your symptoms must meet or exceed those listed in the listing manual for your specific condition. For example, if you have bipolar disorder, you will need to submit evidence of a diagnosis, plus proof that your condition limits you in specific ways, or that your bipolar disorder is “serious and persistent.”
What types of medical evidence can be used to support an SSD or SSI benefits application?
When applying for Social Security benefits, you will need to submit evidence of your diagnosis. According to the SSA, this must be “objective medical evidence” from an “acceptable medical source.”
In most cases, this means that you will need to submit evidence from one or more of the following medical professionals (acceptable medical sources):
- Licensed physicians
- Licensed psychologists
- School psychologists
- Licensed optometrists
- Licensed podiatrists
- Qualified speech-language pathologists
- Licensed physician assistants
- Licensed audiologists
- Licensed Advanced Practice Registered Nurses
This medical professional will need to provide objective medical evidence to establish the existence of a medically determinable impairment. Notably, the SSA will only consider evidence from medical sources who are not considered “acceptable medical sources” — such as chiropractors, therapists, or naturopaths — after a medically determinable impairment has been established.
Can non-citizens receive Social Security disability benefits?
It depends. For purposes of SSI, a non-citizen or alien may be eligible for benefits if they fall into certain immigration categories. They must also meet other conditions, in addition to qualifying for SSI under the standard requirements. Undocumented immigrants are not eligible for SSI.
Aliens are eligible for SSDI benefits if they meet all other criteria for the benefits, and if they are lawfully present in the United States.
How do I apply for Social Security Disability or SSI benefits?
There are three ways to apply for Social Security disability benefits: (1) apply online; (2) apply over the phone (1-800-772-1213, TTY 1-800-325-0778); or (3) apply in-person at your local Social Security office.
If you call, you will be given the option of 1) going to the Social Security office to apply for benefits, or 2) having your application taken over the telephone. If you choose to go to the Social Security office, the person at the 800 number will schedule an appointment for you and give you directions to the Social Security office. If you want to apply by phone, you will be given a date and an approximate time to expect a phone call from someone at the Social Security office who will take your application over the phone.
When should I apply?
As a general rule, the earlier that you apply for Social Security benefits, the better. If you believe that you will continue to be disabled for at least a year, or if you have already been disabled for that long, there is no reason to wait.
If you need to file an appeal, it can take a long time. The sooner that you apply for benefits, the sooner that you will resolve your claim. On the other hand, if you know that your disability is strictly “short-term,” such as having a broken foot — which will only keep you out of work for a few weeks or months — there is probably no reason to apply for benefits. In that case, it is probably better to wait and see how you recover, as neither SSD nor SSI offers temporary benefits.
Can I apply for Social Security benefits on behalf of my child?
A child with disabilities may be eligible for either SSD or SSI benefits. For SSD, a child with a disability that started before the age of 22 may receive Social Security benefits when their parent receives disability or retirement benefits, or if a parent passes away. The child must be 18 or older to receive SSD benefits in this way and must meet SSA’s definition of disability. In this situation, the child does not need to have worked in order to qualify for SSD benefits.
Children with disabilities who are under the age of 18 may qualify for SSI benefits. To be eligible, the child must have a disability, as defined by the SSA, and their parents must be within the income and asset guidelines for SSI benefits.
How long does it take to get a decision on an application for Social Security disability benefits?
As with any bureaucracy, it can take a fair amount of time to get a decision on your application for benefits through the SSA. As a general rule, it takes 3 to 5 months to get a decision. However, the length of time that it takes to receive a decision will depend on a number of factors, including:
- The nature of your disability;
- Whether you will need to undergo a medical examination; and
- How quickly your treating physicians send in documentation to support your application
You can check the status of your application using the SSA’s my Social Security tool.
Is there a way to get expedited benefits if I have a serious or terminal illness?
The Compassionate Allowances initiative (CAL) allows the SSA to quickly identify diseases and conditions that meet its definition of disability. In this way, the waiting time for people with serious and terminal conditions is significantly reduced. CAL conditions are identified through information from the public, counsel from medical and scientific experts, research from the National Institutes of Health, and other sources.
How do I appeal a denial of benefits?
If the SSA denies your application for disability benefits, you can appeal this denial in one of 3 ways:
- Have your attorney file the appeal;
- Call the Social Security office to make arrangements for your appeal to be handled by phone;
- Log on to the SSA website; or
- Go in-person to your local Social Security office.
There is a 60-day deadline to file an appeal of SSD or SSI benefits. If you fail to file an appeal within this time frame, you will usually have to start over with a new application. You may also lose some back benefits. For these reasons, it is important to appeal all denials within 60 days.
What are the levels of appeal in a Social Security disability benefits claim?
There are four levels of appeal in a Social Security disability benefits case. After an initial determination (approval or denial), you can appeal a number of legal or factual issues in your case, including the amount of your payment and your eligibility for benefits. The levels of appeal are:
- Administrative Law Judge (ALJ) hearing;
- Appeals Council Review; and
- Federal court (lawsuit)
A skilled New Jersey disability benefits attorney can help you with filing your initial application for benefits, as well as with any appeal of your claim.
Who makes a decision on my request for reconsideration?
Reconsideration involves a complete review of your claim by a person who did not take part in the initial decision. It involves an examination of the same evidence submitted with your application, along with any new evidence that you may have.
While reconsideration may seem pointless, it is an important step in the process. If you file to request reconsideration of a decision with 60 days, then you may be barred from appealing it any further.
What happens at a Social Security disability benefits hearing?
If you disagree with the decision on a request for reconsideration, you may request a hearing before an administrative law judge (ALJ). The ALJ will not have played any part in the original decision or in the reconsideration of your claim.
Before the hearing, you may be asked to submit additional evidence or to clarify information about your application. You can also submit new evidence or information. The hearing will typically be held within 75 miles of your home; the ALJ will notify you of the exact time and place of your hearing. In some cases, you may be asked to attend a hearing via video conference.
During the hearing, the ALJ will question you and any witnesses that you may bring. Other witnesses, such as vocational experts, may also testify. If you have an attorney, then they can question the witnesses at the hearing.
What is the biggest mistake that people make when trying to get Social Security benefits?
The biggest mistake that people make is failing to appeal a denial of Social Security benefits. More than half of the people who are denied social security benefits become discouraged and initially fail to request reconsideration, which is the first level of appeal.
Another mistake involves failing to get appropriate medical care. Some people with long-term chronic medical problems feel that they have not been helped much by doctors. As a result, they stop going for treatment. This is a mistake for both medical and legal reasons. First, no one needs good medical care more than those with chronic medical problems. Second, medical treatment records provide the most important evidence of disability in a Social Security disability case.
Do I need an attorney to apply for benefits or request a reconsideration of a denial?
Generally, an attorney is most helpful when a Social Security disability claim reaches the hearing stage — that is, after an initial application and request for reconsideration have been unfavorable. However, involving a lawyer in an earlier stage of the process can make the difference between winning and losing your claim.
In most cases, the attorney’s fee is the same whether you hire them at the beginning of your case or just before the hearing. For this reason, although you can file an application or request for reconsideration without a lawyer, applicants generally have more to gain than to lose by working with an attorney as early as possible.
If my application is approved, will I get my benefits right away?
There is a 5 month waiting period after you are approved before your benefits will start. Your disability benefits will start on the 6th full month after the date that the SSA determines that your disability began. For example, if the SSA determined that your disability started on September 1, 2019, then your benefits would begin in March 2020 — the sixth full month after your disability began. Importantly, because Social Security benefits are paid in the month after the month that they are due, a March 2020 benefit would be paid in April 2020.
Can I get disability benefits for a period of time before I apply?
Yes. If you are approved for Social Security disability benefits, you may receive benefits for as many as 12 months before you applied. The SSA will award these benefits if it found that you were disabled during that time and met the other requirements for SSD or SSI benefits. For example, if you applied for benefits on June 15, 2019, and the SSA determined that your disability started on January 1, 2019, then you will receive benefits from January 1, 2019, onward.
If I am approved for benefits, can I go back to work?
There are special rules for working while receiving Social Security disability benefits. While you can work while receiving SSD or SSI, if you earn over a certain amount of money each month, then you will be deemed to be engaging in substantial gainful activity (see above). You may then lose your benefits.
However, the SSA does offer programs to help people get back to work after becoming disabled — without losing their benefits. This includes a trial work period and the Ticket to Work program that helps beneficiaries find a job and/or get vocational rehabilitation.
Any income that you earn while receiving Social Security disability benefits must be reported to the SSA.
If I get married, will it affect my Social Security benefit payments?
If you receive SSD benefits, getting married will not impact the level of benefits that you receive. However, if you receive SSI benefits, then getting married may change the amount of benefits that you receive — or may even make you ineligible for benefits. If you get married, then your spouse’s income and resources may lead to a determination that you no longer qualify based on household income and assets, or that your benefits should be reduced due to your combined income and assets. If both you and your spouse receive SSI, then your benefit amount will change from an individual rate to a couple’s rate.
How do other types of benefits impact my Social Security benefits?
In many situations, if you qualify for Social Security disability benefits, you may also be eligible for other types of benefits, such as public disability benefits, workers’ compensation, or short or long-term disability benefits. If you are receiving workers’ compensation or public disability benefits, the SSA may reduce your Social Security disability benefits. If the combined total amount of your Social Security disability benefits, plus your workers’ compensation payment, plus any public disability payment you get, exceeds 80 percent of your average earnings before you became injured or ill, then SSA will reduce your benefits.
If you receive disability benefits through a private source, such as a short or long-term disability insurance policy, then it will not impact your Social Security disability benefits. However, if you are receiving these types of private disability benefits and are later approved for SSD benefits, then you may be required to pay back the insurance company for benefits received. The need to do this will depend on the terms of your insurance policy. A disability benefits attorney can analyze your policy and help you determine what you need to do if you are receiving both Social Security and private disability insurance benefits.
How can Bross & Frankel help me with my Social Security disability benefits case?
At Bross & Frankel, we know exactly what proof the law requires and how to best present that proof so that you will be awarded Social Security disability benefits. We review all of the complicated paperwork in your case and are with you every step of the way. We will work with you to process all aspects of your case in a diligent, professional manner. After representing thousands of satisfied clients, we have also learned that simply having an advocate — particularly a lawyer with a track record of success — helped to ease their anxiety about the process.
Here are some examples of things that we often do for our clients in Social Security cases:
- Review and file the many forms, applications, questionnaires, etc. which SSA asks you to complete;
- Participate in the ALJ (Administrative Law Judge) hearing through direct examination of you and any witnesses, cross-examination of any vocational and medical experts, and oral argument;
- Advise you as to your rights under the Social Security Act and explain the meaning of all terms, procedures, rulings, etc.
- Review and evaluate your medical situation as it pertains to SSA’s regulations for qualifying for SSD and/or SSI;
- Gather, organize, summarize, and clarify medical or other evidence needed;
- Recommend, if appropriate, physicians for treatment;
- Recommend, if appropriate, independent medical exams or reviews;
- obtain and review additional medical evidence from your physicians;
- Request, when necessary, special reports from your physicians and discuss, when appropriate, the requisite evidence with your physicians;
- Obtain and review documents from your Social Security file;
- Review actions taken by SSA and evaluate if they are proper;
- Ensure that your appeals are filed properly and timely;
- Prepare and submit appropriate evidence to SSA prior to, at the time of, or following any ALJ hearing;
- Prepare you and any witnesses for the ALJ hearing;
- Prepare and submit legal memoranda and briefs to the ALJ, Appeals Council, etc.;
- Request a review of the ALJ decision, if necessary, by the SSA Appeals Council or beyond to Federal Court;
- Communicate with your disability, health or other insurers to obtain documents, maximize coverage, and otherwise protect your interests as an insured.
- Research all legal issues which may affect and impact upon your particular claim;
- Effectively communicate with any claims adjudicators and disability analysts assigned to your claim.