The Social Security system is a system that provides various benefits to citizens who have paid into the system over the course of their or their spouses' work lives. Most people think of Social Security as retirement benefits.While retirement benefits are a large part of what the Social Security system does, there are other forms of benefits available, such as disability, family benefits, survivor or death benefits, medicare and supplemental security income (SSI) benefits.
To determine what type of benefits may be available to you, you need to merely contact your local Social Security office or 1-800-772-1212 to speak to a Social Security representative.
What type of benefits are available from Social Security?
There are five major categories of benefits available through Social Security.
Full retirement benefits are payable at age 65 to anyone with enough Social Security credits. When you pay Social Security taxes, sometimes referred to as FICA, you earn Social Security credits. The maximum number of credits an individual can receive per year is 4. Most people need 40 credits (10 years of work) to qualify for benefits. If a person decides to retire as early as age 62, the benefits that person will receive will be reduced. Individuals who delay retirement beyond age 65 receive a special increase in their benefits.
Disability benefits are payable at any age to people who have enough Social Security credits and who have a severe physical or mental impairment that is expected to prevent them from doing "substantial" work for a year or more, or who have a condition that is expected to result in death. Generally, earnings of $500 or more per month are considered substantial. The disability program includes incentives to smooth the transition back into the work force,
including continuation of benefits and health coverage while a person attempts to work.
If you are eligible for retirement or disability benefits, other family members might receive benefits too. These include: your spouse if he or she is at least 62 years old or under 62 but caring for a child under age 16; and your children if they are unmarried and under age 18, under 19 but still in school, or 18 or older but disabled. If you are divorced, your ex-spouse could be eligible for benefits.
Survivor or Death Benefits
When you die, certain members of your family may be eligible for benefits if you earn enough Social Security credits while you are working. The family members include: A widow(er) age 60 or older, 50 or older if disabled, or any age if caring for a child under age 16; your children if they are unmarried and under age 18, under 19 but still in school, or 18 or older but disabled; and your parents if you were their primary means of support. A special one-time payment of $255.00 may be made to your spouse or minor children when you die. If you are divorced, your ex-spouse could be eligible for a widow(er)'s benefit.
There are two parts of Medicare: hospital insurance (sometimes called "Part A") and medical insurance (sometimes called "Part B"). Generally, people who are over age 65 and getting Social Security automatically qualify for Medicare as do people who have been getting disability benefits for two years. Others must file an application. Part A is paid for by a portion of the Social Security tax of people still working. It helps pay for inpatient hospital care, skilled nursing care and other services. Part B is paid for by monthly premiums for those who are enrolled and from general revenues. It helps pay for such items as doctor's fees, outpatient hospital visits and other medical services and supplies.
What must be proved in order to receive disability benefits?
Social Security defines disability as a person's inability to work. A person will be considered disabled if he or she is unable to do any kind of work for which he or she is suited and the disability has lasted or is expected to last for at least a year or to result in death.
In order to determine if you are eligible for disability benefits through Social Security, you need to apply at any Social Security office as soon as you become disabled. However, Social Security benefits will not begin until the sixth full month of disability. This "waiting period" begins with the first full month after the date you decide your disability began.
What can I do to speed up the claim processing procedure?
It is vitally important to obtain certain documents that you can bring with you when you apply for disability benefits. These documents and other information include:
social security number and proof of age for each person applying for benefits (this includes your spouse and children if they are applying for benefits);
names, addresses and phone numbers of the doctors, hospitals, clinics and institutions that treated you, and dates of treatment;
names of all medications you are taking;
medical records from your doctors, therapists, hospitals, clinics and case workers;
laboratory and test results;
a summary of where you worked in the past 15 years and the kind of work you did;
a copy of your W-2 form, or if you are self-employed, your federal tax return for the past year; and
dates of prior marriages if your spouse is applying.
How does the Social Security Administration determine disability?
Determining disability is a step-by-step process involving five basic questions. They are:
1. Are you working? If you are working and earning an average of more than $500 a month, you generally cannot be considered disabled.
2. Is your condition "severe"? Your impairments must interfere with basic work-related activities for your claim to be considered.
3. Is your condition found in the list of disabling impairments? The Social Security Administration maintains for each of the major body systems a list of impairments that are so severe they automatically mean that you are disabled. If your condition is not on the list, they have the right to decide if your impairment is as severe as an impairment on the list. If it is, your claim is approved. If it is not, they go to the next step or question.
4. Can you do the work you did previously? If your condition is severe, but not the same severity as an impairment on the list, then the Social Security Administration must determine if your impairment interferes with your ability to do the same work you have done in the past 15 years. If it does not, your claim will be denied. If it does, your claim will be considered further.
5. Can you do any other type of work? If you cannot do the same work you have done in the past 15 years, the Social Security Administration will then look to see if you can do any other type of work. They consider your education, age, past work experience and transferable skills, and they review the job demand of occupations as determined by the Department of Labor. If you cannot do any other kind of work, your claim will be approved. If you can, your claim will be denied.
What do I do if my claim is denied?
You have 60 days from the day you receive your denial notice to request that the Social Security Administration reconsider its position.
If your claim is denied and you wish to appeal the decision, you must make your request in writing within 60 days of the date you receive your denial notice. There are four different levels of appeal. They are reconsideration, hearing by an administrative law judge, review by the Appeals Council, and a lawsuit filed in the United States Federal District Court.
What is reconsideration?
A reconsideration is a complete review of your claim by someone who didn't take part in the first decision. That individual will look at all the evidence submitted when the original decision was made, plus any new evidence. Most reconsiderations involve a review of your file without the need for you to be present. When you appeal a decision that you are no longer eligible for benefits because your condition has improved, you have a choice of a file review or an actual meeting with a Social Security representative to discuss your case. You can meet with the disability hearing officer and explain why you still believe you have a disability.
What is a hearing by an administrative law judge?
If the reconsideration process does not work and you still disagree with the agency's decision, you can request a hearing. The hearing will be conducted by an administrative law judge who had no part in either the first decision or the reconsideration of your claim. You and your representative or attorney, if you have one, may come to the hearing and explain your case in person. You may look at information in your file and give new information.
The administrative law judge will question you and any witness you bring to the hearing. You and your representative or attorney may also question the witnesses.
It is usually to your advantage to attend an administrative law hearing. If you do not wish to do so, you must tell the Social Security Administration in writing that you do not want to attend. Unless the administrative law judge believes your presence is needed to decide the case, he or she will make a decision based on all the information in your file including any new information given. After the administrative law judge has concluded the hearing, a letter and a copy of the judge's decision will be mailed to your attention.
What is an Appeals Council?
If you disagree with the finding by the administrative law judge, you may request a review by the Social Security Appeals Council.
The Appeals Council looks at all requests for review, but it may deny your request if it believes the hearing decision was correct. If the Appeals Council decides to review your case, it will either decide your case itself or return it to an administrative law judge for further review. Typically you will receive a copy of the Appeal Council's decision or order sending your case back to an administrative law judge.
What is a federal court review?
If you disagree with the Appeals Council's decision, or if the Appeals Council decides not to review your case, you may file a lawsuit in the United States Federal District Court. Typically, if you are successful, the court can allow a reasonable fee for your attorney. The fee usually will not exceed 25% of all past-due benefits which result from the court's decision.
It is always advisable, particularly in an area that can seem as complicated as Social Security claims, to seek competent counsel who can aid and assist you during the appeals process. It is an absolute necessity if you decide to continue with the appeals process and have the matter heard in the United States Federal District Court.