Disability, Insurance and Pension Frequently Asked Questions

Will I receive Medicaid or Medicare or both?

It depends.  While Medicaid is funded by the federal government, it is administered by the state, creating different eligibility requirements.  In Florida (and Georgia), people who receive Supplemental Security Income are automatically eligible for Medicaid. If a person receives Social Security Disability Insurance, they must wait two years from the date they became entitled to benefits for Medicare coverage to begin.  In certain situations a person may be awarded retroactive benefits for up to 12 months prior to the date the person filed their initial application for disability.  Exceptions to the two-year rule include people who have endured permanent kidney failure or have amyotrophic lateral sclerosis (ALS).  People with these conditions are automatically eligible for Medicare coverage.

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Who is eligible for disability benefits from Social Security?

Under the current rules of Social Security, a person must have an injury or a medical condition that is expected to keep them from working for a minimum of 12 months in order to be considered disabled (and therefore eligible to receive benefits). Physical conditions, mental conditions, and a combination of the two can be disabilities.

What can I do if I have already been denied Social Security disability benefits?

The most important thing is not to get discouraged.  It is very common to get denied the first time applying for Social Security disability benefits.  If an attorney has not already been obtained for the initial application process, it is strongly recommended that one at least be consulted at this point.  An attorney will assist the applicant in filing a “Request for Reconsideration.”  This request must be filed within 60 days date of the original denial letter.  Not filing within that time period will likely result in the applicant having to start over from the beginning, and could result in lost benefits (not to mention lost time and effort).  Because time is a factor, it is important to request reconsideration right away. The second most important thing is to still not get discouraged if you are denied a second time.  Less than one-third of people who are denied disability the first time apply for reconsideration.  Roughly one-fourth of the people who apply a second time are actually approved.  It is not uncommon for applicants to have to continue the appeals process to the 8th Circuit Appellate Courts or Federal Court.  While going through appeals, applicants should still remain in contact with their doctors and follow medical instructions as not to damage their case.

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Is applying for Social Security disability benefits difficult?

The Social Security Administration Office has 3 ways to apply for Social Security disability benefits, in an attempt to make it as easy as possible. Each method will have advantages and disadvantages based on an individuals unique situation. The most direct method is to visit a local Social Security Administration building and file in person. The second method is to call Social Security toll-free at 1 (800) 772-1213 and use an automated system to set an appointment for a phone interview. After completing the phone interview, during which basic information is collected, the necessary paperwork is sent to the applicant. Finally, applications can be filled out on the official Social Security website.

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If I expect to get better and go back to work, can I still get Social Security disability benefits?

It depends.  A person has to have either been disabled for at least one year, or expects to be.  If a person expects to be disabled for at least a year, they can file for Social Security disability benefits as soon as they become disabled.  This is known as a “Closed Period of Disability.”  Without proper medical documentation from the treating physician, Closed Periods of Disability are rarely approved.

How is Social Security Disability different from Supplemental Security Income (SSI)?

Both types of benefits are for people who suffer from a disability and are no longer able to work. The difference is determined by whether a person has worked long enough to pay into the Social Security system in order to qualify for Social Security Disability Insurance Benefits (known as DIB for short). If the person has worked long enough to pay a minimum amount in taxes based on the Federal Insurance Contributions Act (FICA), they will be eligible to qualify for DIB. An important note here is that even if a person qualifies for eligibility, their claim may still be denied by the government. For people who have not paid the sufficient amount into the Social Security system for them to qualify for eligibility, there is the option of Supplemental Security Income (SSI). In this case, a persons income status and other resources available to them will be reviewed by the government to determine if the person is qualified to receive SSI benefits.

How do Social Security Disability Attorneys get paid?

Disability attorneys get paid on a contingency basis.  This means that they get paid a percentage of the applicant’s back pay only if the case is won.  Currently, disability attorneys are entitled to receive up to 25% of the applicant’s back pay, with a cap of $6,000.  Fees for both disability attorneys and non-attorney disability representatives are regulated by both the Social Security Administration and by Congress, making this maximum amount non-negotiable.  It is important to remember that this is a cap based on percentage.  If an applicant is only awarded $1,000, the attorney can only receive a maximum of $250 for representation fees, plus incidental fees. If the applicant is turned down for benefits, the attorney will not receive a portion of the back pay, but will still be due expenses for incidentals.  These incidentals are covered in the fee agreement, which the applicant must sign before the attorney will agree to take the case.  Common incidentals include obtaining medical records, making copies, and travel expenses.  It is important to read the fee agreement carefully before signing it.

Do I have to wait a certain amount of time before I file for Social Security disability benefits?

If a person believes they will be out of work for at least one year, they can apply for Social Security disability benefits on the very same day they become disabled. There may even be social workers at the hospital who can assist the disabled person and their family with getting in touch with the Social Security Administration.

Do I have to hire a lawyer to represent me in my Social Security disability claim?

No, claimants are allowed to represent themselves throughout the entire process of applying for Social Security disability. There are benefits to hiring an attorney, though. A disability attorney will evaluate the strengths and weaknesses of the case, collect all the available evidence in order to present the case in front of the SSA, and will fight for the claimants cause.

Can I lose disability benefits after I am approved for them?

Disability benefits can be terminated if the person collecting them meets certain criteria. Benefits can be discontinued if a person collecting disability goes back to work and earns enough to exceed the amount known as the Substantial Gainful Activity for at least 9 months (considered a Trial Work Period, or TWP). Additionally, each case is subject to a periodic review known as a Continuing Disability Review, or CDR. If the Social Security Administration determines a persons condition has improved based on the results of the CDR, their disability benefits will be terminated.

Are mental illnesses eligible for disability benefits?

Mental illnesses are indeed eligible for receiving disability benefits through Social Security.

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