Medical Records and Disability Insurance (SSDI)

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Social Security disability insurance (SSDI) is a benefit through Social Security that pays you monthly if you become disabled before reaching retirement and are no longer able to work. This may also be known as “workers’ disability.”

Eligibility for Social Security Disability Benefits

To qualify for SSDI benefits, you must have worked in a job where you paid Social Security taxes (FICA) and did so for a number of years.

If you did not work long enough before becoming disabled, and have low income and assets, Supplemental Security Income (SSI) might be available instead. In particular, you need to have earned a certain number of work credits. You are able to earn up to four work credits per year.

Work Credits

The number of credits needed for qualification of SSDI benefits depends on what age you became disabled. As an example, a 50-year-old becoming disabled would need 28 work credits (or have worked for seven years). At least five of those working years must have been during the last 10 years.

Health Insurance

Health insurance is not required for qualification of SSDI or SSI benefits. Nor does having health insurance create any conflicts with either benefit. Your insurance may be considered primary or secondary to these benefits depending on your plan and living situation. Your primary insurance always pays first while your secondary insurance pays only after the primary insurance.

Medical Eligibility

To receive benefits, you must have a medical condition that meets the definition of disability, according to the SSA. Benefits are only eligible to those with severe, long-term, and total disabilities.

Severe means the condition must interfere with primary work activities. Long-term means your condition is expected to last for at least for one year. Total disability means that you cannot perform “substantial gainful activity” for at least one year.

If you can currently work and make over a certain amount ( currently $1,220 per month in 2019 for disabled applicants and $2,040 for blind applicants), the SSA will find that you are performing “substantial gainful activity” and you do not qualify for SSDI benefits.

Medical Examinations and History

A medical exam is required for those seeking to claim SSI and SSDI benefits. These examinations are brief, only lasting about 20 minutes, and their primary purpose is to confirm that the disability is present and accurate to the description that is provided when applying for benefits. Note that doctors performing these exams may be suspicious as many seek to apply for disability benefits without an actual disability or with an inaccurate, often exaggerated, portrayal of their disability. It’s recommended that you be cooperative with your physician and as honest as possible to assure that your examination runs smoothly.

Providing a history of medical records is an important part of the application process. Medical records can be requested by Social Security from your doctor’s office or hospital, which may take some time to retrieve as they are often overwhelmed with requests for information. This may present issues, especially if Social Security doesn’t receive the documents in a timely manner, resulting in a possible rejection of your application. It helps if you directly request records yourself so that you may have copies on hand, know what medical evidence you have on you and what may be missing. Some offices may charge for the obtaining of records, requesting information electronically and directly speaking with your doctor about obtaining records may help midigate costs.

Approval for Disability Benefits

After approval for disability programs benefits, you will not receive SSDI benefits until the disability has lasted five full months. This is due to SSDI’s five-month waiting period.

Unfortunately, it’s more likely you won’t be approved closer to six months or a year (and likely at least one appeal). When you do finally get approved, you do get paid disability backpay starting on the sixth month after the disability began (the disability onset date).

Once the backpay is received, you would get a disability benefit check every month. This can cause you to pay taxes on your benefit income if your household income exceeds a certain amount.

Certain family members / dependents may also be able to receive partial monthly benefits.

You may keep receiving SSDI for the duration that your medical condition prevents you from working. To check this, the SSA performs continuing disability reviews (CDR) on your file. These happen every one to three years to determine if there are changes and improvements to your condition.

Denial of Disability Benefits

If an application for SSDI is denied, as most initial applications are, you are able to appeal the decision. Once you receive the denial letter, you have 60 days to request a review. The first step of appeal, in most states, is the Request for Reconsideration. This is a review of the file by a different disability claims examiner. Then, if you are denied again, you can submit an appeal to the next stage. This is a request for a hearing with an SSA administrative judge.

Social Security Disability and Supplemental Security Income Differences

The main difference between Supplemental Security Income (SSI) and Social Security Disability (SSDI), is that SSDI is available to workers who have accumulated enough work credits. This is compared to SSI disability benefits, which is available to low-income individuals. Individuals who have either not worked or who have not yet earned enough work credits to qualify for SSDI.

Both SSI and SSDI are both overseen by the Social Security Administration but are managed as part of different government programs.

What Is SSI?

Supplemental Security Income (SSI) is a program based strictly on needs, called a “means-tested program.” Thus this is based on an individual’s income and assets, not work history. It is funded through general taxes, instead of the Social Security trust fund. An individual’s contributions can be found through their social security statement.

SSI income requirements, require you to have less than $2,000 in assets (or $3,000 for a couple) combined with a limited income.

Disabled individuals who are eligible for SSI under the income requirements are also able to receive Medicaid from their state of residence. Most people who qualify for SSI can also be eligible for food stamps. SSI benefits begin the first of the month when your application is submitted to the application process.

What Is SSDI?

Social Security Disability Insurance (SSID) is a government program funded through payroll taxes. Recipients of SSDI are considered “insured” because of the years they have worked and made contributions to the Social Security trust fund. SSDI candidates must have earned enough work credits and be younger than 65. After receiving SSDI for two years, the disabled individual will become eligible for Medicare.

Only adults (of the age 18 years and older) can receive SSDI disability benefits. But under SSDI, a disabled individual’s spouse and child dependents are eligible to receive partial benefits, called auxiliary benefits.

A five-month waiting period for SSDI benefits applies. This means you will not receive benefits for the first five months after you become disabled through SSDI. The amount of the benefit paid monthly, depends on your earnings record, like the Social Security retirement benefit does.

Approval rates for SSDI are generally higher on average than they are for SSI. SSDI recipients are more likely to have higher incomes and insurance coverage. Seeing a doctor more regularly makes it easier to win disability benefits. Claim examiners tend to give more credibility to applicants with longer work histories as well.

Veterans & Survivors

Social Security for veterans or survivors does not operate under the same program, but is instead, offered through the Department of Veteran Affairs, a different government program. Veterans with a service-related injury may qualify for entitlement to a VA disability compensation, a tax-free monthly benefit. Survivors may also be entitled to these benefits in certain circumstances. Note that this benefit is specifically for veterans who have served in a wartime period as part of a wartime operation.

If you are a veteran or a survivor, you may qualify for Veterans or Survivors Pensions depending on your income level. If you meet below a certain level, you may qualify for these benefits. This differs from Disability compensation in that the disability came about either as a result of or made worse by military service. VA pensions, on the other hand, are for low-income veterans with a disability that is not related to their military service.

Visit VA.gov for more information on qualification and filing.