The Difference Between SSI & SSDI |SSI & SSDI Work Incentives

There recently was a man who had his head cut off in an accident at work. When he went to apply for Social Security Disability Insurance, he was denied. The denial letter stated that although he had permanently lost the use of his head, the Social Security Administration had determined he was still capable of finding employment because his body still worked.

Of course this never happened, but anyone who has ever applied for either Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) can tell you that gaining approval for these federal programs is extremely difficult. These programs are administered through the Social Security Administration (SSA) and are set up to provide financial assistance for disabled individuals who are unable to work.

Gaining approval for SSI and SSDI is not only difficult, but usually is a very lengthy process. It can take months to receive a decision on an application and the process of filing a reconsideration or getting a hearing decision can be just as lengthy.

Step I: The Interview

The first step is to contact the SSA (1-800-772-4222) and set up an appointment for an interview. Applicants will be given an appointment at the Social Security office closest to their home. The SSA will mail the applicant forms that will need to be completed prior to the appointment. These forms will ask questions pertaining to the disability claim and ask specifically for information on any treatment received for the disability and the limits the disability has on a person's ability to work. Filling the forms out in their entirety prior to the appointment will make the interview quicker and more efficient.

Individuals must wait five full calendar months after a disability begins before receiving SSDI benefits. However, an application may be filed as soon as the disability is identified. No waiting period is required before receiving SSI benefits.

Prior to the interview, applicants should try to obtain any medical records that will substantiate a disability claim. This will help to speed up the decision making process. If an applicant can not obtain copies of medical records, the SSA will have the applicant sign releases of information and obtain the medical records to be used in making a decision on a claim.

At the time of the interview, the applicant will be required to provide identification. A picture I.D. (i.e. driver's license) and a birth certificate is sufficient. Expect the interview to last up to two hours. The interviewer will assist the applicant in filling out numerous forms that will be part of the disability claim. The interviewer should be made aware of any problems that the disability has caused in someone's ability to work and/or perform daily activities.

If a person is unable to go to the Social Security Office, the claim can be made through a telephone interview between the applicant and an interviewer from SSA. If necessary, a third party may be designated (i.e. family member) to represent the applicant at the interview.

After the interview the SSA will collect any medical documentation that will be pertinent to the claim. The claim is then reviewed for a decision. This can take from three to six months. While waiting for an initial decision it is important to continue with any treatment that is recommended for the disability. Any records that are developed in treatment during the time a person is waiting for an SSI and/or SSDI claim to be decided can be used in future stages of the application process.

If a favorable decision is awarded with the initial application, the benefits are retroactive to the date of application.

Step II: If Benefits are Denied

The majority of first time applications for SSI and SSDI benefits are denied. Unfortunately, many of the people who receive a denial fail to follow-up with a request for reconsideration.

A reconsideration must be filed with the SSA within 60 days of receiving a denial letter from the initial application. A reconsideration is very similar to the initial application. An interview is held with the applicant and information is obtained that will substantiate the claim.

The decision is made at an administrative level and based on the documentation that has been provided. It will also take anywhere from three to six months to receive a decision on a reconsideration claim. If the decision is favorable on the reconsideration claim, the benefit awarded will be retroactive to the date of the initial application. If a denial is received at the reconsideration claim, the next step is to file for a hearing.

Step III: Filing for a Hearing

A hearing is the applicant's only opportunity to meet the person rendering the decision on the claim. The hearing takes place in front of an Administrative Law Judge. A hearing must be requested within 60 days of receiving a denial of the reconsideration claim.

Legal assistance is recommended at a Social Security Hearing. The New York State Bar Association (518-463-3200) can provide a list of disability lawyers that will represent SSI and SSDI applicants. Free legal representation can be obtained for individuals applying for only SSI through the Legal Aid Society. Legal Aid has offices in each region of New York State.

The Administrative Law Judge reviews the two prior denials and takes into review any new evidence for the claim. The applicant can relay any information that has been left off the claim and provide witnesses (i.e. family members) to support and substantiate the claim.

If the Administrative Law Judge finds for the applicant, the award will be retroactive to the initial date of application. If the judge does not rule in favor of the applicant, the applicant can file a claim with the Appeals Counsel Review Board.

The Appeals Counsel Review Board is located in Falls Church, Virginia. They review the decision of the Administrative Law Judge. Decisions by the Review Board usually take up to one year. Their decision will be to either deny the claim or send it back to the Administrative Law Judge for another hearing.

If all of the previous steps have been exhausted, the last opportunity to continue with a claim and have the award date back to the initial date of application is to file a civil suit. The other option is to start from scratch and begin a new claim.

Income During the Interim

Obviously, people who apply for SSI and SSDI benefits are not able to work. A number of options are available that provide income during the time it takes to gain approval from either SSDI or SSI.

Most people who have applied for SSDI have a recent work history. Because SSDI will not start paying benefits until five months after the last date of work, applicants must access other programs for income. Workers Compensation and New York State Disability can offer benefits that will assist disabled individuals prior to obtaining SSDI.

Most SSI applicants do not have a work history and often can not qualify for either New York State Disability or Worker's Compensation. SSI applicants can receive financial assistance from the Public Assistance Program offered by the Department of Social Services during the SSI application process. However, when an SSI applicant receives Public Assistance, SSI retroactive benefits will be used to pay the county back for benefits it has provided the applicant. A payback for Social Services benefits does not occur with SSDI.

Once an SSI/SSDI Award Has Occurred

Once an individual has received notice that they have been approved for SSI or SSDI, another interview will need to occur with the SSA to determine the exact need for the individual who has been approved. The amount of an individual's SSI cash benefit can vary depending on the living situation (ex. living alone, living with others, married) and if the person is receiving any income.

If during the review of the SSI/SSDI claim it was determined the individual will not be capable of handling the cash benefit appropriately due to their illness, a representative payee will need to be assigned. If a substance abuse problem is determined during the review of records, a representative payee will be required also.

A representative payee is an individual that is designated to receive the cash benefit for a beneficiary of either SSI or SSDI. The representative payee is responsible to ensure that the cash benefit is used for the needs of the beneficiary. The representative payee can not be an individual who has been convicted of a felony. Records of how the money is used for the beneficiary should be kept. If an appropriate representative payee can not be identified from friends or family of the beneficiary, Adult Protective Services through a county's Department of Social Services can take on the role of representative payee.

If an individual receiving SSDI benefits has children under the age of 18, those children are eligible to receive a cash benefit based on the parent's disability. The amount of the child's benefit is determined as a percentage of what the disabled parent receives.

If an SSI recipient was receiving benefits (Public Assistance) from the Department of Social Services during the time they were waiting for the SSI decision, Social Services will receive any retroactive SSI payment due the individual.

Retroactive payments go back to the date of the original application for SSI benefits. The amount that the person received from Social Services during the time he/she was waiting for SSI approval will be recouped by the Department of Social Services from the retroactive SSI payment. Any balance after Social Services has recouped their money is sent to the beneficiary or their payee. Retroactive SSDI payments go directly to the beneficiary or representative payee. The Department of Social Services can not demand repayment of a Public Assistance grant that was provided to an individual during the time they are awaiting approval for an SSDI claim as back payment for the Public Assistance grant.

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