The federal government recognizes that some members of our society need financial assistance due to their physical or mental disabilities. The Social Security Administration (“SSA”) administers benefits to qualifying individuals who have severe mental and/or physical disabilities. Social Security Income (“SSI”) pays eligible recipients benefits based upon financial need, while Social Security Disability Insurance (“SSDI”) pays benefits to eligible recipients and sometimes family members, if the applicant is “insured,” meaning that the applicant worked for a long enough period of time – paying Social Security taxes – before applying for benefits. Additionally, a recipient receiving benefits under SSDI for 24 months becomes eligible for Medicare benefits.
Regardless of which SSA program you desire to apply for, you must in fact qualify to receive benefits. Each of the two major programs, SSDI and SSI, have independent, though overlapping, requirements for eligibility. In general, the SSA must determine if you are disabled, and abides by a strict definition of “disability.” Knowing the criteria which the SSA looks for when determining whether an individual is eligible for benefits is the first step in the determination process.
To receive benefits you must file an application which is reviewed by one of many SSA field offices, along with other state agencies, called Disability Determination Services (“DDS”). The field offices verify non-medical eligibility requirements, while the DDS’s review the applicant’s medical sources. After review, the DDS returns the case to the appropriate field office with a determination – that the applicant is disabled and computes his or her benefit amount, or that the applicant is not disabled and not eligible to receive benefits. If the DDS denies the application, the applicant has the right to file an appeal and have a hearing held before an administrative law judge (“ALJ”) whose purpose is to hear evidence and rule whether the DDS and SSA were correct in their initial determination. However, this is an incredibly long appeals route, which takes around 22 months before an ALJ will actually hear the case. Thereafter, the applicant can appeal again to the SSA Appeals Council or to a federal court.
While you can choose to go through this process alone, it is quite burdensome without the assistance of a qualified and experienced attorney. Your attorney’s experience will help you craft your application so as to correctly convey the relevant characteristics of your unique situation to the SSA. Doing so thereby assists the SSA in quickly granting you a favorable decision. But, should your claim be denied, your attorney will be vital to assisting you in preparing for and arguing on your behalf at your appeal hearing. Additionally, if youyou’re your appeal, you can be awarded “back-pay” which are the benefits which have accrued while an applicant is waiting for the SSA to approve his or her claim. The amount of accrued back-pay is based upon the alleged date of disability, the application date, and whether the applicant is applying for SSDI or SSI benefits. This means that even an individual without substantial resources can afford to seek the assistance of an attorney for this process.
If you believe that you or a family member have become mentally disabled and are now eligible to receive benefits from the SSA, review the SSA’s website and speak to an experienced attorney who works in mental health law. Additionally, take the time to review the following SSA resources to better understand the process, limitations, and the application itself.
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