Social Security Disability Guide

Approximately one tenth of the U.S. population reports having a severe disability.  If you’re among the millions of Americans living with a serious health condition, and your disability prevents you from working, you may be eligible for federal assistance.  The Social Security Administration, or SSA, offers several different forms of social security benefits to people who cannot work because of long-term, disabling medical conditions. These programs are known as:

  • SSI — Supplemental Security Income
  • SSDI — Social Security Disability Insurance

You may qualify for SSI, SSDI, or even both programs at the same time, which is referred to as concurrent benefits.  These programs all grant recipients monthly payments which can help to cover the costs of housing, groceries, medications, and other daily expenses.

In this comprehensive guide for disabled residents of New Jersey and Pennsylvania and their family members, our social security attorneys will cover everything you need to know about the application process, from eligibility criteria, to why claims are denied, to what you should do if the SSA rejects your application.

To talk more about monthly benefits for yourself or a loved one in a free and private consultation, call the experienced attorneys of Young, Marr & Associates at (609) 557-3081 in New Jersey or (215) 515-2954 in Pennsylvania.

cheerful middle aged woman embracing disabled senior mother outdoors

What’s the Difference Between SSI and SSDI?

SSI and SSDI are both intended for people with severe medical impairments, both make monthly payments, and are both administered by the Social Security Administration. However, they also have some important differences, and one program may be more appropriate than the other depending on your background and your current circumstances.

SSI is based largely on financial need, and is only awarded to claimants who have limited financial resources.  By comparison, SSDI is based primarily on employment history, and requires that you have earned a certain total of work credits over your years in the workforce.  We’ll explore the differences between SSI and SSDI in greater depth later on as we cover the specific eligibility requirements for each program.

Average Disability Payments

Because SSI and SSDI are federal programs under the direction of the SSA, the maximum monthly payment totals are fixed regardless of which state you reside in.  However, these payment maximums change every year to adjust for inflation and the economic climate. This is referred to as COLA, or the Cost of Living Adjustment.

Maximum and Average SSI Payments

The 2014 maximum monthly SSI payments are:

  • Individual — $721.00
  • Couple — $1,082.00

The 2015 maximum monthly SSI payments are:

  • Individual — $733.00
  • Couple — $1,100.00

Note that these are the maximum available amounts, not the average amounts.  The SSA reports that as of September, 2014, the average monthly SSI payment is:

  • Under Age 18 — $640.39
  • Age 18-64 — $552.72
  • Age 65 and Up — $430.55
  • Overall Average — $535.21

The SSA follows two basic steps to calculate SSI payments:

  1. The SSA subtracts any income not counted toward your total gross income.  The number that remains is called countable income.
  2. The SSA subtracts your countable income from the FBR (Federal Benefit Rate), which changes by year.

Maximum and Average SSDI Payments

SSDI payments have increased by 1.5% from 2013.

The 2014 maximum monthly SSDI payment is $2,642.

The 2014 average monthly SSDI payment is $1,148.00.

The SSA uses highly detailed and complex formulas to calculate SSDI payments.  But in simple terms, the calculation is based on two figures:

  • AIME (Average Indexed Monthly Earnings) — To determine your AIME, the SSA will adjust (index) earnings over the course of your lifetime for the overall increase in wages caused by inflation.
  • PIA (Primary Insurance Amount) — The SSA uses your AIME to determine your PIA.

Balancing The Accounts

Am I Eligible for Disability?

While social security benefits provide an invaluable resource to millions of New Jersey and Pennsylvania residents, qualifying can be difficult — and the statistics prove it all too clearly.  The current average claim approval rates are:

  • Initial Application (Step 1):
    • Pennsylvania Average — 32%
    • New Jersey Average — 43.2%
    • National Average — 31.7%-32.1%
  • Reconsideration (Step 2):
    • Pennsylvania Average — 20.7%
    • New Jersey Average — 14.3%
    • National Average — 11%-11.3%

As you can see, you’re up against a challenge, particularly depending on where you live and what stage of the process you’ve reached.  However, your chances will improve if you have a good understanding of the basic eligibility criteria:

  • You must have a disability.  This disability must be:
    • Severe, meaning it prohibits you from working.  To gauge whether a disability is severe, the SSA uses its Listing of Impairments, a medical catalog which contains severity guidelines for many different conditions.  However, you can still qualify if your condition does not match or does not appear in the Listing, as long as you are able to demonstrate limited functional capacity.  This is referred to as getting a medical-vocational allowance.  For more information, browse some conditions that can qualify you.
    • Long-term, meaning it either will last or has lasted for at least 12 consecutive months, or is expected to result in death.
  • You must not be earning too much income:
    • SSI Claimants — No more than the current FBR of $721 per month.  However, not all of your income will be counted toward the FBR, so in reality you could be earning more and still qualify.  You must also have limited resources, including land, vehicles, and life insurance.
    • SSDI Claimants — No more than $1,070 per month.  Note: blind claimants are capped at $1,800 per month.  You must also have earned the appropriate number of work credits for your age and the year you became disabled.  You can refer to the SSA work credit table.

Hands of medical doctor with a stethoscope. Isolated on white.

How to File a Claim for Social Security Disability Benefits

If you think you meet the eligibility criteria, it’s time to actually apply.  There are three ways to get started:

  • In Person — Use the SSA’s field office locator to find a convenient location to visit. You should also call to make an appointment in advance so that you don’t have to waste time waiting to be seen.
  • Via Phone — Call (800) 772-1213, Monday through Friday, 7 A.M. to 7 P.M.  If you have trouble hearing, call (800) 325-0778.
  • Via Web — Apply for disability online using the SSA’s secure submission form.

When you file your application, you should be prepared with the following:

  • Original or certified copies of personal identification.
  • Addresses and phone numbers of prior and current treating physicians.
  • Details about where you have worked, and the type of work you performed.
  • Employment records, such as tax returns and W-2 forms.

In Pennsylvania, the SSA works with the Bureau of Disability Determination (BDD).  If you live in Bucks County, Dauphin County, Montgomery County, or Philadelphia County, you can call or visit the BDD at:

351 Harvey Avenue
P.O. Box 25200
Greensburg, PA 15605
(724) 836-5100

If you live in Berks County, Lehigh County, or Northampton County:

47 South Washington Street
Wilkes-Barre, PA 18701
(570) 824-8971

In New Jersey, the SSA works with the Division of Disability Determination Services (DDS). If you have questions about your claim, you can refer to the DDS directory, or call the DDS at (866) 920-6997.  If you have difficulty hearing, call (973) 648-2983.

Social Security Benefits

Why Was My Disability Claim Denied?

While some claims are accepted, many more will be turned away.  In order to be more successful during the next stages of the application process, it’s important to understand what was “wrong with” your first claim so you can address it going forward.  The SSA includes detailed explanations with all denial letters, so be sure to read the explanation carefully.

There are two broad categories of denials:

  • Medical Denials — Most claims are rejected for medical reasons, meaning the SSA either determined that:
    • Your impairment doesn’t meet the SSA’s severity standards.
    • Your impairment won’t last long enough to warrant benefits.
  • Technical Denials —  These are less common than medical denials, but can still be a problem.  Examples of technical denials include:
    • You earn too much income.
    • You haven’t earned enough work credits.

Social Security Claim Denied Stamp Shows Social Unemployment Ben

What to Do if Your Benefits Claim is Rejected: The Disability Appeals Process

If your claim is denied, don’t panic: you can appeal a disability decision if you disagree with the SSA’s findings.  So how do you begin the process?

Reconsideration

If you live in New Jersey, you need to file a Request for Reconsideration within 60 days of the date of your rejection.  You can request Reconsideration by:

  • Using the SSA’s online disability appeals application.
  • Submitting the following forms:
    • Form SSA-561 — Request for Reconsideration
    • Form SSA-3441 — Disability Report – Appeal
    • Form SSA-827 — Authorization to Disclose Information to the Social Security Administration

Traditionally, Reconsideration has a poor prognosis for applicants, but don’t get discouraged: the next step, the ALJ Hearing, has a far better success rate.  (Note that if you live in Pennsylvania, you do not need to request Reconsideration at all, and can move directly to the ALJ Hearing.)

ALJ Hearing

The ALJ Hearing is named for the Administrative Law Judge, and most claims that are successful occur at this level.  Nationally, in New Jersey, and in Pennsylvania, the ALJ Hearing approval rate averages out to approximately 60%. 

In some cases, the Administrative Law Judge will issue a decision immediately following the hearing, but in most cases, he or she will forward a written decision two to three months after the hearing.  If the decision is favorable, you should be receiving your benefits approximately two to three months later.

Appeals Council Review

If the Administrative Law Judge issues a non-favorable decision, the next step is to request review by the Appeals Council.  This process must be completed within 60 days of the decision.  It is critical to have experienced legal counsel to request the review, since there will not be a hearing regarding your review, and it is based upon the law and findings in your case.

If you fail to request Appeals Council review and cannot show good cause for failing to request the review, your case will end, and if you wish to pursue the matter further, it will be necessary that you start the process over.

However, if a request to the Appeals Council is made within 60 days, your claim will be reviewed, and the Appeals Council will make an independent decision based upon a determination of whether the Administrative Law Judge’s decision was supported by substantial evidence.

Federal Court

If the Appeals Council decides not to reverse or remand (send the matter back for a new hearing) the Administrative Law Judge, you have 60 days to file a complaint in Federal District Court.

At that time, a Complaint and legal brief will be filed, and a Federal Judge will decide your claim. The judge may:

  • Send your case back for a new hearing.
  • Deny your claim.
  • Award benefits.

Social security disability benefits can have a tremendous positive impact on your life, but the application or appeals process can be extremely difficult to navigate.  Let the experienced disability lawyers of Young, Marr & Associates help guide your way.  To set up a confidential case evaluation free of charge, call our law offices at (609) 557-3081 in New Jersey or (215) 515-2954 in Pennsylvania today, or contact us online.

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