Overview

If someone files a claim with the Social Security Administration on the basis of a physical or mental disability, he or she usually files a Social Security Disability (“SSD”) application, or a Supplemental Security Income (“SSI”) application, or a combination of the two. Let’s take a moment to explain a few basic differences between SSD and SSI, because they aren’t the same thing.

We’ll start with differences that don’t have to do with medical issues. If someone is eligible for SSD benefits, then they must have worked and paid federal taxes during their years of employment. On the other hand, for someone to be eligible for SSI, they may or may not have a work history, but they must have sufficiently limited income and resources. Further, someone eligible for SSD is also eligible for Medicare health insurance, whereas someone eligible for SSI is eligible for Medicaid health insurance. Some people have work histories and sufficiently limited resources that allow them to receive a combination of SSD and SSI.

Regardless of whether an individual has filed a SSD or a SSI claim on the basis that they are disabled, they have to prove that they are medically unable to work. This usually means that the individual has to have been out of work—or would reasonably expected to be out of work—for at least one year because of a severe medical impairment, or a severe combination of impairments. That impairment, or combination of impairments, may be a physical condition, a mental condition, or both. Whatever the severe impairment may be, it must be shown to “meet or equal” factors described in the Listing of Impairments—which is found in Social Security regulations and describes particularly severe forms of a large variety of medical conditions—or that their impairment so reduces their capacity to perform mental or physical functions, they cannot return to the work they used to do, or perform other work generally available in the national economy.

If you file a SSD or a SSI claim, statistics show that you should be prepared to have it denied after an initial review (and following a reconsideration review, as well, in certain states), and to appeal that denial. Further, an appeal that follows such a denial frequently involves a long waiting period before a hearing with an administrative law judge is scheduled by the SSA’s hearing office.

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