OVERVIEW OF SOCIAL SECURITY DISABILITY BENEFITS AND SUPPLEMENTAL SECURITY INCOME

What is Social Security Disability Insurance (SSDI or DIB)?

Social Security Disability Insurance (SSDI) is a monthly benefit provided by the Social Security Administration to disabled workers and their dependents, similar to that paid to retired workers. Social Security Disability Insurance benefits are also sometimes referred to as Title II benefits or Disability Insurance Benefits (DIB).

What is Supplemental Security Income (SSI)?

Supplemental Security Income (SSI) for the disabled is a benefit paid to disabled people with limited income and resources. SSI may also be referred to as Title XVI benefits. SSI is paid only to people with limited income and resources, but applicants do not have to meet the past earnings requirements used in the SSDI program.

Differences Between SSDI and SSI

Social Security Disability Insurance (SSDI or DIB) is a program financed by the social security taxes paid by workers, employers, and self-employed people. These disability benefits may be available to

• Disabled workers
• Disabled surviving spouses and former spouses of deceased workers
• Adults who became disabled before age 22 and have a disabled, retired, or deceased parent
• The dependents of a disabled worker

A worker becomes "insured" and eligible for disability benefits by paying into the social security fund, usually through payroll deductions (FICA). The amount of the monthly disability benefit payment is based on the individual's earnings history.

Supplemental Security Income (SSI or Title XVI) is a means-tested program financed through general tax revenues. SSI disability benefits are payable to adults or children who are disabled and also meet SSA's income and resource requirements. You can be eligible for SSI even if you have never worked or paid social security taxes. No dependent benefits are paid with SSI.

Who qualifies for Social Security Disability Insurance benefits or SSI?

To receive benefits under the Social Security Disability or SSI programs, you must have a physical or mental health problem (or a combination of problems) that is expected to be severe enough to keep you from working in any full-time job for at least one year. The test is not whether or not you are able to go back to your old job or whether an employer is likely to hire you for another job. Rather, the issue is whether you are capable of doing any job in the national economy. In making this determination, SSA considers your medical condition, your age, your education, and your work experience.

SSA uses a five-step evaluation to determine if you are disabled:

Step 1: Are you working? If you are working and earning more than the current substantial gainful activity (SGA) amount, you generally cannot be considered to be disabled. In 2024, the substantial gainful activity amount is $1,550 per month.

Step 2: Is your condition severe? To be severe, your impairment must interfere with basic work-related activities.

Step 3: Is your condition found on SSA's list of impairments presumed to be disabling? If you meet the very specific criteria for one of these conditions, SSA will automatically find that you are disabled. If your impairment does not meet these criteria, SSA goes on to Step 4.

Step 4: Can you do any of your past relevant work? If so, your claim will be denied. If not, SSA will proceed to Step 5.

Step 5: Can you do any other type of work available in the national economy? SSA considers your age, education, past work experience, and transferable skills to determine if you can do any other kind of work that exists in significant numbers in the national economy. If you can not perform such work, your claim will be approved.

What are examples of medical problems that SSA might find disabling?

The Social Security Administration (SSA) in the United States recognizes a wide range of medical conditions that can be considered disabling, depending on their severity and impact on an individual's ability to work. The SSA maintains a listing of impairments known as the "Blue Book," which details the specific criteria needed to be considered disabled for each condition. Some examples of medical problems that the SSA might find disabling include, but are not limited to:

1. Musculoskeletal Problems: Conditions that affect bones, joints, and muscles, such as severe spinal disorders, amputations, or fractures that do not heal properly.

2. Cardiovascular Conditions: Heart-related problems, including chronic heart failure, coronary artery disease, or recurrent arrhythmias.

3. Respiratory Illnesses: Diseases affecting the lungs and breathing, like chronic obstructive pulmonary disease (COPD), asthma (if it's severe), or cystic fibrosis.

4. Neurological Disorders: Conditions affecting the nervous system, such as epilepsy, Parkinson's disease, multiple sclerosis, or cerebral palsy.

5. Mental Disorders: Mental illnesses that significantly impair functioning, including schizophrenia, autism, intellectual disability, depression, anxiety, and post-traumatic stress disorder (PTSD).

6. Immune System Disorders: Diseases that affect the immune system, like HIV/AIDS, lupus, rheumatoid arthritis, and kidney disease requiring dialysis.

7. Digestive Tract Problems: Conditions affecting the digestive system, such as inflammatory bowel disease or liver disease.

8. Endocrine Disorders: Diseases related to hormonal imbalances, like diabetes or thyroid disorders, especially if they cause significant complications.

9. Cancers: Various forms of cancer, especially those that are advanced, have recurred after treatment, or are inoperable.

10. Hematological Disorders: Disorders affecting blood and bone marrow, like hemophilia or sickle cell disease.

Other examples that qualify for this list are: Asbestosis • Asthma • Arthritis • Back Pain • Degenerative Disc Disease • Degenerative Joint Disease Blindness • Cancer • Carpal Tunnel Syndrome • Chronic Fatigue Syndrome • Diabetes • Neuropathy • Emphysema • Epilepsy • Fibromyalgia • Herniated Disc • Hip Replacement • HIV / AIDS • Heart Disease • Knee Replacement • Reflex Sympathetic Dystrophy • Leukemia • Multiple Sclerosis • Chronic Obstructive Pulmonary Disease (COPD) • Migraine • Parkinson's Disease • Headaches • Neck Pain • Joint Pain • Seizures • Stroke • Lupus • Hepatitis C • Rheumatoid Arthritis • Traumatic Brain Injury (TBI) • Psychiatric Impairments such as Post Traumatic Stress Disorder, Anxiety, Schizophrenia, Depression, Bipolar Disorder • Intellectual Disability or Mental Retardation

For any impairment, SSA will evaluate your specific work-related limitations to determine if you are disabled. This evaluation will be based on a medical diagnosis but also the severity and documented impact of the condition on you ability to perform work-related activities

How do I become insured for Social Security Disability benefits (SSDI or DIB)?

To qualify, or be "insured," for Social Security Disability benefits, you must have worked long enough and recently enough to meet SSA's requirements. This determination is based on the number of "quarters of coverage" you build up by working. You can earn up to a maximum of 4 quarters per year. In 2023, it takes $1,640 in earnings to get 1 quarter of coverage. The earnings required for 1 quarter typically increase each year.

The number of work quarters you need for Social Security Disability benefits depends on your age when you became disabled. Generally, you need 40 total quarters of coverage, with 20 of those quarters earned in the 10 years prior to your becoming disabled. However, younger workers under age 31 may qualify with fewer quarters.

If you do not have enough work quarters to qualify for Social Security Disability benefits, you may still qualify for SSI.

APPLICATION AND APPEALS PROCESS FOR SOCIAL SECURITY DISABILITY BENEFITS AND SSI

When should I apply for Social Security Disability benefits and SSI?

You should apply for disability benefits as soon as possible after you become unable to work because of your medical problems. You do not need to wait 12 months to apply. Your disability need only be expected to last for at least 12 months or result in death.

How do I apply for Social Security Disability and SSI benefits?

You can call the Social Security Administration at 1-800-772-1213 and tell the representative that you want to file an application for disability benefits. The representative will take some information and schedule a telephone or in-person appointment with your local Social Security office. You can also apply online through SSA's website. You will need to supply information about yourself, your medical condition and treatment, and your work history. SSA may ask you for documents such as a birth certificate, proof of citizenship, or tax forms.

Go ahead and file for disability as soon as you can, even if you don't yet have all the documents you think you might need.

What should I do if I am denied benefits?

Appeal! Many disabled people become so disheartened and frustrated after they receive a disability benefits denial that they do not appeal. This is usually a mistake. Some cases are won at the Reconsideration level, and most claims are won at the Hearing level. Government statistics show that claimants who have representatives are granted benefits at a rate nearly 3 times higher than those without representatives.

HIRING AN ATTORNEY

Do I need an attorney?

You have the right to have an attorney represent you in your Social Security Disability case. Government statistics show that claimants who have representatives are granted benefits at a rate nearly 3 times higher than those without representatives.

When hiring an attorney, keep in mind that not all attorneys practice regularly before the Social Security Administration, and even fewer are board-certified specialists. We believe that you are best served by an attorney familiar with the complex Social Security Disability regulations and procedures. Both attorneys in our firm have been certified as specialists in Social Security Disability law by the North Carolina State Bar.

What can my attorney do to represent me in my disability case?

Every case is different. The nature of your attorney's work will depend on the particular facts of your case. However, the attorneys at McGill & Noble will

• Talk to you in detail about your medical history, symptoms, and limitations
• Communicate with you regularly about your case throughout the appeals process
• Review the evidence SSA has compiled on your claim
• Gather medical and other evidence supporting your claim
• Analyze your case applying social security law and regulations
• Request reopening of a prior application, if appropriate
• Present written and/or oral legal arguments
• Prepare you to testify at your hearing
• Protect your right to a fair hearing by objecting to improper evidence and procedures
• Cross-examine medical and vocational experts whom SSA calls to testify at your hearing
• Ensure that SSA correctly calculates your benefits
• File appeals with SSA's Appeals Council and federal court, if appropriate

How much does it cost to hire an attorney?

There are no fees or costs unless we win. We will accept your case on a contingent fee basis. If we win, the fee will be 25% of past-due benefits or $7,200, whichever is less. If we win, you will be responsible for the costs of medical records and reports that we obtained to fully develop your case.

When should I contact an attorney?

As soon as possible. We are happy to talk to you at any point in the process. Typically, we begin representing you and working on your case as soon as your claim is denied by SSA. To represent you effectively, we need time to gather and analyze evidence, develop a legal strategy, and make persuasive arguments to SSA decision-makers. The earlier we start working on your case, the better your chances of winning.

Both attorneys in our firm have been certified as specialists in Social Security Disability law by the North Carolina State Bar and have practiced regularly before the Social Security Administration for more than 25 years. As a client, you will benefit from their expert knowledge of complex Social Security regulations and procedures.

What does it mean for an attorney to be a board-certified specialist in Social Security Disability law?

Both attorneys at McGill & Noble have been certified as specialists in Social Security Disability law by the North Carolina State Bar, the organization that governs the state's lawyers. To be certified as a specialist in a practice area, a lawyer must:

• Devote a substantial portion of his or her practice to Social Security Disability law,
• Earn favorable evaluations from other lawyers and judges,
• Pass a written exam on social security law, and
• Attend continuing legal education seminars in social security law and related topics

Not only are both of our attorneys board-certified, they have both served on the North Carolina State Bar committee that oversees the certification process for other attorneys. And they typically attend two or three seminars on social security law each year, which keep them informed of current developments in this complex field of law.

WHAT HAPPENS AFTER I AM APPROVED FOR SOCIAL SECURITY DISABILITY BENEFITS AND SSI

What happens if I qualify for Social Security Disability Insurance benefits or SSI?

If you are found to be eligible for Social Security Disability benefits, you will receive retroactive (past-due) benefits for some of the months in the past in which you were disabled. The number of months included in this retroactive payment depends on when you became disabled and when you filed your claim for benefits. There is a "five-month waiting period" after the date you became disabled. SSA will not pay retroactive benefits for the months in this "waiting period." Regardless of when you became disabled, SSA will only pay a maximum of 12 months of benefits before you filed your claim. In addition to these past-due benefits paid in a lump sum, you will also start receiving a monthly benefit payment from SSA, and eventually you will be eligible for Medicare.

Example 1: You applied for disability insurance benefits on June 15, 2021. SSA finds that you became disabled on March 23, 2021. You are entitled to a retroactive payment of benefits for the period beginning with September 2021. You will be eligible for Medicare in September 2023.

Example 2: You applied for disability benefits on June 15, 2022. SSA finds that you became disabled on March 23, 2016. You are entitled to a retroactive payment of benefits for the period beginning with June 2021. You will be eligible for Medicare in June 2023.

If you are found to be eligible for SSI, you can be paid retroactive benefits beginning with the first month after you filed your application. You will also start receiving a monthly benefit payment from SSA, and you will be eligible for Medicaid.

How much money will I receive if I qualify for Social Security Disability Insurance benefits?

As explained above, you may be entitled to retroactive (past-due) benefits. The amount of your monthly benefit depends on what is called your Primary Insurance Amount (PIA), which is based on your earnings while working. The PIA is also the basis of retirement benefits.

How much money will I receive if I qualify for SSI?

SSI past-due benefits begin with the first month following your application for benefits. The amount of your SSI benefit depends on several factors, including income and living arrangements. The maximum monthly benefit is $943 in 2024.

SSI also has resource limits. You cannot have more than $2,000 in assets if you are single and $3,000 in assets if you are married. Some major assets do not count against that limit (e.g. your home, household goods, the car you use for transportation).

If I receive Social Security Disability benefits or SSI and my disabilities get worse or I am diagnosed with other health problems, can my monthly benefit amount be increased?

No, for the purposes of Social Security Disability and SSI you are either disabled or you are not. Your benefits are calculated as described above; they will not increase if your condition worsens.

Will I be eligible for Medicare or Medicaid if I am found to be disabled?

Medicare is associated with Social Security Disability benefits. Medicare begins after you have been entitled to Social Security Disability benefits for 24 months. Medicaid is a needs-based program like SSI. In North Carolina, if you are approved for SSI, you are automatically entitled to Medicaid.

How long will I be able to receive Social Security Disability benefits?

You will receive Social Security Disability benefits as long as you remain disabled and unable to work. If you get better and can resume work, you must let SSA know. SSA will conduct periodic reviews of your case to determine whether you remain disabled.

Can I work while I am receiving SSDI?

If you start to work, your continuing entitlement to SSDI benefits depends on how much you earn. SSA defines "earnings" as the amount you are paid before taxes are deducted, not the net pay that you take home.

In 2023, if you earn $1,050 or less per month, your continuing eligibility for benefits is generally not affected. But if you earn more than $1,050 per month or if you work more than 80 hours per month in self-employment, you should be aware of the rules for a "trial work period."

SSDI recipients are entitled to a nine-month Trial Work Period (TWP) during which they can test their ability to work while continuing to receive full benefits, regardless of how much they earn. For 2023, SSA considers any month in which a person has monthly earnings of more than $1,050 a trial work month. If you are self-employed, any month in which you work more than 80 hours (or earn more than $1,050) is a trial work month. The earnings threshold for a trial work month usually goes up a little each year.

SSA allows nine trial work months of unlimited earnings in any 5-year period. The nine months of trial work do not have to be consecutive. Following a trial work period, the first month in which your earnings exceed the substantial gainful activity (SGA) level is the "cessation month." In 2023, the SGA level is $1,470 per month. You will continue to receive benefits for a three-month "grace period," which includes the cessation month and the two following months.

If your SSDI has been stopped because of your earnings, your benefits may be reinstated if your earnings drop below SGA level again. The Extended Period of Eligibility (EPE), or Re-entitlement Period, is a consecutive 36-month period that immediately follows the completion of a trial work period (TWP). During the EPE, you can be paid benefits for any month in which your earnings are below the SGA level.

Example: The ninth (and final) month of Hugo's trial work period was December 2014. Throughout 2015 and 2016, Hugo's earnings exceeded the SGA level. In January and February of 2017, his earnings dropped below the SGA level. In March 2017, he again earned above the SGA level and continued to do so through the remainder of 2017 and into 2018.

In this example, Hugo's 36-month EPE began in January 2015 and ran through December 2017. He earned at the SGA level during all but 2 months of this 36-month EPE. Therefore, he received SSDI payments in 5 months during the 36-month EPE months: the first three months of SGA-level work during the EPE (i.e., his three-month grace period) and the two months during which his earnings dropped below SGA level (i.e., January and February 2017).

If you perform work at the SGA level after the expiration of the 36-month EPE, but then stop working at the SGA level, you may be able to have your benefits restarted without having to file a completely new application. This is called Expedited Reinstatement (EXR). Your EXR request must be in writing and be received by SSA within the consecutive 60-month period that began in the month in which your SSDI entitlement terminated due to SGA. The entitlement termination month is the first month after the EPE that you were no longer eligible for SSDI because you performed SGA:

In the example above, Hugo was earning SGA in the final month of his EPE, December 2017. Therefore, Hugo's entitlement termination month was the following month, January 2018. This means that his 60-month time limit for requesting EXR began in January 2018 (the entitlement termination month) and runs through December 2023.

Can I work while receiving SSI?

Earnings at the substantial gainful activity (SGA) level never result in automatic termination of SSI benefits. When an SSI recipient works, even at wage levels exceeding the SGA amount, SSA performs a calculation to determine how much will be counted in determining SSI eligibility and the payment amount. In 2023, the federal benefit rate (FBR) for a disabled individual is $914. Your monthly benefit amount is the difference between the FBR and your countable income. If you have employment income, SSA will exclude the first $65 (if you don't have any unearned income, $85 will be deducted instead), plus half of the remainder amount over $65 that you earn each month.

For example, if you earn $1,285 per month and have no unearned income, SSA will subtract $85 (which leaves $1,200) and then half of the amount over $85 (which leaves $600). That $600 is your countable income from work, and it will be subtracted from the federal benefit rate of $914. Therefore, you would still get an SSI payment of $314.

Will my workers' compensation payments affect my Social Security Disability?

In North Carolina, your Social Security Disability benefit will be reduced so that the combined amount of the Social Security Disability and the workers' compensation does not exceed eighty percent (80%) of your average current earnings.

Will my workers' compensation payments affect my SSI?

Possibly. SSA will count workers' compensation payments as unearned income in determining whether you exceed the income limits for SSI.

Will my veterans disability compensation affect my Social Security Disability?

Veterans disability compensation does not affect your Social Security Disability benefits.

Will my veterans disability compensation affect my SSI?

It may. SSA will count VA disability compensation as unearned income in determining whether you exceed the income limits for SSI.

What should I keep in mind when dealing with the Social Security Administration?

• Keep all decisions, letters, and notices you receive from SSA in a safe place.
• If you speak to someone from SSA, always get the name and telephone number (including extension) of the person you talked to.
• Read everything you get from SSA. SSA's booklets and website are informative.
• Pay special attention to the kind of changes you are required to report to the Social Security Administration, such as employment. Report these changes promptly and in writing and keep a copy with your social security papers.
• If you call the SSA national 800 number, don't rely on everything you're told. If you have an important issue to take up with SSA, sometimes it is better to go to your local Social Security office.

Contact McGill & Noble, Attorneys at Law for a free consultation with a Board-Certified Specialist in Social Security Disability law. 

Free consultations • No fees or costs unless benefits are awarded • Evening and weekend appointments available.

Our office is on the fourth floor of the Westgate Office Center, located at the corner of Westgate Drive and University Drive in Durham.