In short, the main benefit that is available to persons with disabilities are payments made through the Social Security and Supplemental Security Income (“SSI”) programs. Through the Social Security Administration, individuals who have worked for a sufficient time and paid social security taxes are eligible for social security disability insurance (“SSDI”).

It is important to note that both federal programs are administered by the Social Security Administration (“SSA”).

How Is “Disability” Defined Under Social Security Programs?

Once again, the Social Security Administration is the federal program that is responsible for defining what constitutes a disability. The SSA maintains an exhaustive list of requirements that define the term disability and disability eligibility requirements.

One of the main determining factors when determining whether or not a person is considered disabled is whether the person’s disability prevents them from both obtaining a job and maintaining that job for a set period. The SSA determines this set period.

Disability eligibility requirements are often very complicated to understand, as they are especially nuanced. However, the SSA generally follows the following three-step determination process:

  1. Determination of Disability Severity: The SSA maintains a comprehensive list of conditions that result in automatic disability coverage. These automatic qualifiers vary based on whether the recipient is an adult or a child.
    • Some especially severe disabilities will automatically qualify an applicant for social security assistance.
    • In general, this list includes heart disease, severe arthritis, kidney failure, brain damage, and various severe mental illnesses;
  2. Determination of Prevention: For disabilities that are not considered severe and automatically qualify for disability by the SSA, the SSA will then make efforts to determine whether the disability prevents the applicant from performing their current or former work.
    1. Importantly, the SSA may administer a work test to make this determination; and
  3. Alternative Work Suggestion: If the disability case is not as simple as determining whether the disability is severe, the SSA will then take steps to determine whether the disability prevents the applicant from finding other available work.
    1. When making this finding, the SSA will consider economic conditions, among other things.

Are Benefits Affected by Whether or Not an Individual’s Disability Is Total or Partial?

Another factor that the SSA will consider in determining disability and disability payments is whether or not an individual’s disability is total or partial. Partial disability is defined as any disability in which the employee cannot perform at full physical capacity.

Generally, this is due to an on-the-job injury or sudden severe illness. In contrast, a total disability is one in which the employee is prevented from performing any work directly because of a work-related injury or condition.

Total disability is generally defined as the loss of the use of:

  • Both legs;
  • Both arms;
  • Both hands;
  • Both eyes;
  • Any two such parts, like a leg and arm; and/or
  • Impairment due to a serious occupational disease.

When collecting disability payments, there can be considerable differences in the amount available between total and partial disability. In order to receive full social security disability benefits, the disability generally must be “permanent” in nature. This means that the disability or injury is lasting and permanent, as opposed to being a temporary condition.

For example, the loss of limb use must be permanent and not a strain or sprain from which an individual can recover. It is important to note that both total and partial disabilities can be permanent in nature. This means a person can sustain either a “permanent total disability” or a “permanent partial disability.”

What Could Cause an Individual’s Social Security Disability Claim to Be Denied?

It is worth noting that the SSA frequently denies social security disability claims for various reasons. Examples of the most common reasons for denial include the following:

  • The applicant is making too much or enough income to qualify for payments, even if it is not as much as they made before becoming disabled;
  • The applicant failed to submit substantial medical documentation of their disability, which the SSA requires;
  • The SSA determined that the applicant can perform another type of job with their disability; or
  • The applicant does not have enough work credits with the SSA to receive the specific benefits for which they are applying.

What Happens if Government Benefits Are Denied?

Individuals applying for social security disability may be entitled to an appeal of their denied claim by making a written request for reconsideration with the SSA. The SSA will then review the claim again.

However, the SSA officials responsible for denying the claim will not be a part of the review process. Instead, a medical consultant and an examiner must properly review a denied social security disability claim. After a review, some claims may get overturned and the applicant will begin to receive benefits. However, most applicants will be denied again. If denied at first reconsideration, the applicant will receive another written notice of the denial and the next steps to appeal.

The next appeal phase includes a hearing with an Administrative Law Judge (“ALJ”). ALJs are specific attorneys holding a hearing in which the applicant must appear in front of the judge to have their claim heard. The ALJ will then determine whether their denial should stand or be overturned.

The applicant can then begin receiving benefits if the denial is overturned. In general, about half of the applicants that have an ALJ hearing will receive benefits. Additionally, many federal and local disability assistance programs may represent the applicant at little to no cost in the administrative hearing.

The next phase in the appeals process is the SSA Appeals Council. If an individual’s claim is still denied after an ALJ hearing, they may appeal to the SSA Council. However, the council is under no obligation to hear an individual’s case. Instead, the council may choose to do so if the ALJ makes some mistake. As such, getting a case heard by the council can be difficult, and the council overturning an ALJ judge’s decision is unlikely.

The last and final appeal option would be to file a lawsuit against the SSA in federal court. This final option is only available after the first three appeal phases. Filing a lawsuit in federal court is a time-consuming and expensive process. However, those who feel they were wrongfully denied their disability claim must be heard and have their legal rights protected.

What Is Supplemental Security Income (“SSI”)

Once again, Supplemental Security Income (“SSI”) is the federal government program that offers stipends to low-income individuals who are age 65 or older, blind, or disabled. This federal government program provides cash payments for an individual’s necessities, such as food, clothing, and shelter. An individual may qualify to receive SSI if they are:

  1. Age 65 or older, blind, or disabled; and
  2. Are a legal resident of one of the 50 states, the District of Columbia, or Northern Mariana Islands.
    • An individual may also qualify if their parents are in the military, and have received assignments of permanent duty abroad or if the individual is a student abroad on a temporary basis.

Do I Need a Lawyer for Help With Disability Government Benefits?

If you are seeking to apply for government benefits as a result of a disability, you should consider consulting with an experienced government lawyer. An experienced Social Security Disability attorney will be able to help guide you through the application process. Additionally, they can represent you if you have been denied benefits and wish to appeal your application.

Alternatively, if your current disability payments have stopped without a clear reason, an experienced attorney can inform you of how to best proceed. Finally, an attorney can also represent you in court, such as at an administrative hearing, as necessary.