Q: What is the Social Security Disability Program?
A: It is not short-term disability i.e. Temporary Disability Insurance (TDI) or Workers' Compensation. It is a program designed to provide long-term protection to individuals who are totally disabled using Social Security criteria. It is meant to provide benefits to only those individuals with the most serious impairments. For more information see General Information and the Definition of Disability on this site.
Q: How do I apply for disability benefits?
A: You can complete some or all of the forms online or call the Social Security Administration's toll-free number, 1-800-772-1213 to schedule an appointment and they will help you in person or by phone. You can apply for disability benefits online at www.socialsecurity.gov/applyfordisability.
You can find the most convenient Social Security office at www.socialsecurity.gov/locator/
People who are deaf or hard of hearing may call a toll-free "TTY" number, 1-800-325-0778, between 7 a.m. and 7 p.m. Monday through Friday.
The Disability Starter Kit will help you get ready for your disability interview or help you complete the online application. Kits are available in English and Spanish for adults and for children under age 18.
The starter kit provides information about the specific documents and the information that we will request from you. We will ask for more details during the disability interview or when you complete the online Child or Adult Disability Report Form.
The kits also provide general information about the disability programs and our decision-making process that can help take some of the mystery out of applying for disability benefits.
Each Disability Starter Kit contains a:
A factsheet that answers questions most people ask about applying for disability benefits,
A checklist of documents and information we will request, and
A worksheet to help you gather and organize the information you will need for your disability interview or to complete the online forms.
Q: What is the difference between Social Security disability and SSI disability?
A: The Social Security Administration is responsible for two major programs that provide benefits based on disability: Social Security Disability Insurance (SSDI), which is based on prior work under Social Security, and Supplemental Security Income (SSI). Under SSI, payments are made on the basis of financial need.
Social Security Disability Insurance (SSDI) is financed with Social Security taxes paid by workers, employers, and self-employed persons. To be eligible for a Social Security benefit, the worker must earn sufficient credits based on taxable work to be "insured" for Social Security purposes. The amount of the monthly disability benefit is based on the Social Security earnings record of the insured worker. Disability benefits are payable to: blind or disabled workers, widow(er)s, or adults disabled since childhood, who are otherwise eligible.
Supplemental Security Income (SSI) is a program financed through general revenues. SSI disability benefits are payable to: Adults or children who are disabled or blind, have limited income and resources, meet the living arrangement requirements, and are otherwise eligible.
The monthly payment varies up to the maximum federal benefit rate, which may be supplemented by the State or decreased by countable income and resources. See http://www.socialsecurity.gov/pubs/11000.html for an explanation of SSI benefit payment rates.
Q: Do disabled children qualify for benefits?
A: There are two Social Security disability programs that include disabled children.
Under the Supplemental Security Income (SSI) program, a child from birth to age 18 may receive monthly payments based on disability or blindness if:
Under the Social Security Disability Insurance (SSDI) program, an adult child (a person age 18 or older) may receive monthly benefits based on disability or blindness if:
He or she has an impairment or combination of impairments that meets the definition of disability for adults; and the disability began before age 22; and the adult child's parent worked long enough to be insured under Social Security and is receiving retirement or disability benefits or is deceased.
Under both of these programs, the child must not be doing any "substantial" work, and must have a medical condition that has lasted or is expected either to last for at least 12 months or to result in death.
You will find helpful links to the online forms and the steps you need to take to apply for childhood disability benefits at www.socialsecurity.gov/applyfordisability. At this time, you cannot complete an application for SSI childhood disability online, but you can complete the Child Disability Report Form online. You can also view the Fact Sheet and Checklist in the Child Disability Starter Kit to see what information you will need and the kinds of questions we will ask when you have your disability interview in your local Social Security office or over the phone. The Disability Report asks for information about the child's conditions or impairments.
Call 1-800-772-1213 (TTY 1-800-325-0778) or visit your local Social Security office right away so that you do not lose potential benefits, even if you complete the Disability Report Form online.
Q: How does Social Security decide if I am disabled?
A: Disability under Social Security for an adult is based on your inability to work because of a medical condition. To be considered disabled:
You must be unable to do work you did before and we decide that you cannot adjust to other work because of a medical condition.
Your disability must last or be expected to last for at least one year or to result in death.
Social Security pays only for total disability. No benefits are payable for partial disability or short-term disability.
For adults, we use a five-step evaluation process to decide whether you are disabled under Social Security. The process considers any current work activity you are doing, and your medical condition and how it affects your ability to work. For more information, we recommend that you read the publication, Disability Benefits (SSA Publication No. 05-10029)
Q: I applied for disability benefits 3 months ago and still haven't received an answer. When should I expect to be notified of the decision?
A: The length of time it takes to receive a decision on your disability claim is from 3 to 5 months. It can vary depending on several factors, but primarily on:
the nature of your disability; how quickly we obtain medical evidence from your doctor or other medical source; whether it is necessary to send you for a medical examination in order to obtain evidence to support your claim; and if your claim is randomly selected for quality assurance review of the decision.
If you have further questions, you may call our toll-free number, 1-800-772-1213 or TTY 1-800-325-0778. Our representatives will be glad to help you in any way they can.
Q: Is there a time limit on Social Security disability benefits?
A: No. Your disability benefits will continue as long as your medical condition has not improved and you cannot work. Your case will be reviewed at regular intervals to make sure you are still disabled.
If you are still receiving disability benefits when you reach full retirement age, they will automatically be converted to retirement benefits.
Q: If I go back to work, will I automatically lose my disability benefits?
A: No, the Social Security Administration has several work incentives that may help you to return to work without losing your benefits.
For more information about Social Security's work incentives you should: - call our toll-free number at 1-800-772-1213; - contact your local Social Security office; or - visit our special "Worksite". For more information on SSA's work incentive rules, see also the Red Book on Work Incentives.
Q: What do I do if I disagree with a decision to deny my application for benefits?
A: The Social Security Administration wants to be sure that every decision made regarding a Social Security or Supplemental Security Income claim is correct. All the information in a claim is considered before a decision is rendered regarding eligibility or benefit amount. If we decide a person is not eligible or is no longer eligible for benefits, or if Social Security decides that the amount of payment should be changed, we send a notice explaining our decision.
If an individual disagrees with the decision, they can request a review. This is called an "appeal." The request for an appeal must be made in writing within 60 days (plus 5 days mailing time) from the date of the notice they receive. Under certain conditions, an extension of this time frame can be granted. There are four levels in the appeals process.
RECONSIDERATION: A reconsideration is a complete review of the claim by someone other than the individual who made the original decision. All evidence, plus any additional evidence submitted, will be reevaluated and a new decision will be rendered. If an individual disagrees with the reconsidered decision, they can choose to go to the next level of the appeals process.
HEARING: A hearing will be conducted by an Administrative Law Judge (ALJ). The individual and/or their representative may come to the hearing and present their case in person. The ALJ will evaluate all the evidence on record, plus any additional evidence brought to the hearing, and will render a decision. A "Notice of Decision" will be issued to the individual and their representative. If they disagree with the hearing decision, they can choose to go to the next level of appeal.
APPEALS COUNCIL: The Appeals Council may decide to issue its own decision, remand the case to the ALJ to issue another decision, or allow the ALJ's decision to stand. The appellant will receive a copy of the Appeals Council's action.
FEDERAL COURT REVIEW: If the claimant disagrees with the Appeals Council's action, he or she has the right to file a civil suit in Federal District Court.
Many people handle their own appeals, but they can choose an attorney or non-attorney to help them. Your representative cannot charge or collect a fee from you without first getting written approval from Social Security. for See Appointment of Representative for a necessary form.
For more information, you may Social Security's toll-free number, 1-800-772-1213, and ask for our fact sheet called "The Appeals Process," publication number 05-10041, and "Social Security And Your Right to Representation," publication number 05-10075. People who are deaf or hard of hearing may call our toll-free TTY number, 1-800-325-0778, between 7 a.m. and 7 p.m. on Monday through Friday.
Q: Can someone on disability return to work and still receive disability benefits?
A: Social Security rules make it possible for people to test their ability to work without losing their rights to cash benefits and Medicare or Medicaid. These rules are called “work incentives”. The rules are different for Social Security and SSI disability, but under both programs they may provide:
- Continued cash benefits;
- Continued help with medical bills;
- Help with work expenses; or
- Vocational training.
Q: What happens if your claim is denied?
A: If an individual disagrees with the initial determination in the case, he or she may appeal it. Appeals must be filed in writing and may be submitted by mail or in person to any Social Security Office. For more details click The Appeals Process.
Q: How do I supply medical information on my patient?
A: After your patient has applied for benefits, the Division of Disability Determination Services, where the medical determination will be made, provides Electronic Records Express.
Q: Can my patient get benefits while you are processing the application?
A: Under the SSI (Title XVI) disability program, an applicant may be found “presumptively disabled,” and receive cash payments for up to six months while the formal disability determination is made. When the individual will clearly be found disabled, but required medical evidence is still outstanding, a presumptive disability decision can be made. If it is finally determined that the individual is not disabled, he or she is not required to refund the payments. There is no provision for presumptive disability under the Title II (Social Security Disability Insurance) program.
Q: I understand that to get Social Security Disability benefits, disability must be expected to last a year. Does this mean that your patient must wait a year after being disabled before he/she can file for benefits?
A: Your patient does not have to wait a year after the onset of the disability before filing for benefits. However, the impairment must have lasted or be expected to last for a continuous period of not less than 12 months, or result in death.
Q: What constitutes Medical Evidence of Record?
A: Your report should present symptoms, signs and laboratory findings that will establish that your patient has a medically determinable impairment severe enough to prevent him or her from working for a year or more or to result in death.In most cases, this initial medical evidence is all that is needed by Social Security to make a disability determination. This is because the evidence provided by you, the treating source, usually is based on a long-term relationship. You are familiar with your patient and can trace or establish the beginning and course of the impairment(s)’ response to treatment and prognosis. Social Security Administration guidelines emphasize the importance of the treating source’s evidence in the decision making process. more
Q: What are acceptable sources?
A: The SSA has specific criteria for acceptable medical sources.
Q: What should a medical report include?
A: In order for a medical report to furnish the Social Security Administration with sufficient medical evidence, it should include:
Medical evidence, including clinical and laboratory findings, should be complete and detailed enough to allow Social Security to make the disability determination. In addition, the report should enable Social Security to determine the nature and limiting effects of the impairment(s), its probable duration, and the claimant’s remaining capacity to engage in work related physical or mental activities.
Q: Who reviews the reports I send in on my patient?
A: A team composed of a medical consultant and a claims adjudicator reviews the reports. It is strictly a paper review. The physician or psychologist has no contact with the claimant. The importance of this review lies in the requirement that claims for disability benefits must be reviewed and signed by physicians or qualified psychologists. If the team finds that additional evidence is still needed, the consultant or adjudicator may recontact you for supplemental information.
Q: I know that you send some claimants for an independent medical evaluation. Why?
A: In the absence of sufficient or current medical evidence of record, Social Security through the New Jersey Division of Disability Determination Services may request additional examinations. These consultative examinations or “CEs” are performed by licensed physicians, licensed osteopaths or a licensed or certified psychologist. While New Jersey maintains extensive CE “panels” and are continually looking for additional CE sources, you, the treating source, are the preferred CE source if you are qualified, equipped and, willing to perform the CE for the fee schedule payment. Fees for CE’s are set by each state and vary from state to state.
Q: You sent my patient for a Consultative Examination. My patient was not satisfied with the quality of the exam. What can I do?
A: If your patient tells you that they were not treated in a professional manner, you or your patient should call and report the complaint to the Professional Relations Unit immediately. All complaints are thoroughly investigated and resolved. It is through feedback such as this that we can effectively monitor our panelists. It should be noted that the Consultative Examiner makes no recommendations as to whether or not the claimant is disabled. Their responsibility is to give a report of their clinical findings based on signs, symptoms and laboratory findings.
Q: I am interested in becoming a medical consultant with your agency. Who can I contact?
A: We currently employ approximately 70 physicians/psychologists full and part time. From time to time we have openings for part-time positions which we try to fill from pending applications. You may apply by writing to our Medical Director, Joseph Aaron MD, at New Jersey Division of Disability Determinations Services, Post Office Box 649, Newark, New Jersey 07101.
Q: I would like more information concerning performing Consultative Examinations for your agency. Who should I contact?
A: The Professional Relations Unit of New Jersey Division of Disability Determination Services is responsible for recruiting physicians, osteopaths and psychologists. You can call either Alex Balaban, Professional Relations Chief at 973-648-6971 (e-mail Alex.Balaban@ssa.gov ). They will be able to explain the process for you to join our CE panel, our fee schedule and what is expected from a CE panelist. . They will be able to explain the process for you to join our CE panel, our fee schedule and what is expected from a CE panelist.