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FREQUENTLY ASKED QUESTIONS

Law Offices of Eric A. Shore, P.C.

100% Social Security Disability

  1. Q: If I have an illness, disease, or injury, am I eligible to receive Social Security disability benefits?
  2. Q: Is there an earnings requirement for disability benefits? How do I meet the earnings requirement for disability benefits?
  3. Q: What should I do if I think I am eligible for Social Security disability benefits?
  4. Q: When should I apply?
  5. Q: Who decides if I am disabled?
  6. Q: How is the decision made?
  7. Q: How will I know when a decision has been reached?
  8. Q: What do I do if my application for Social Security disability benefits is not approved?
  9. Q: Where and how can I appeal?
  10. Q: Are there any levels of appeal? If so, how many?
  11. Q: Am I eligible to receive Supplemental Security Income ("SSI")?
  12. Q: What would be the amount of the SSI payments?
  13. Q: How can an attorney advocate help me?
  14. Q: How long will it take to receive my disability benefits?
  15. Q: What is the difference between Social Security Disability (SSD) and Supplemental Security Income (SSI)?
  16. Q: Should I apply for Social Security Disability (SSD) Title II or Supplemental Security Income (SSI) Title XVI?
  17. Q: Does age make a difference when I apply for benefits under Title II or Title XVI?
  18. Q: Does education level make a difference when applying for benefits under Title II or Title XVI?
  19. Q: What happens if I qualify for Social Security Disability benefits?
  20. Q: How much money will I receive if I qualify for Social Security Disability benefits?
  21. Q: When will I receive benefits?
  22. Q: How does Social Security define a disability?
  23. Q: What is the difference between SSI and SSDI?
  24. Q: Can a child receive disability benefits?
  25. Q: I am disabled, but I have plenty of money in the bank. Do I have to wait until this money is gone before I apply for Social Security disability benefits?
  26. Q: Do you have to be permanently disabled to get Social Security disability benefits?
  27. Q: I have several health problems, but no one of them disables me. It is the combination that disables me. Can I get Social Security disability benefits?
  28. Q: How does Social Security determine if I am disabled?
  29. Q: Who decides if I am disabled?
  30. Q: If I am approved for Social Security disability benefits, how much will I get?
  31. Q: How far back will they pay benefits if I am found disabled?
  32. Q: What do I do if Social Security denies my claim for Social Security disability benefits?
  33. Q: Why does Social Security turn down so many claims for disability benefits?
  34. Q: I only want to get back the money I put in Social Security. Why do they make it so hard to do?
  35. Q: What is "reconsideration"?
  36. Q: Who makes the reconsideration determination?
  37. Q: What are my chances of winning at reconsideration?
  38. Q: Do I have to go through reconsideration?
  39. Q: What is the Social Security hearing like?
  40. Q: What are my chances of winning at a hearing?
  41. Q: If the Administrative Law Judge denies my claim, can I appeal any more?
  42. Q: What is the Appeals Council?
  43. Q: Can I appeal a case beyond Social Security to the Federal Courts?
  44. Q: If I get on Social Security disability benefits and get to feeling better and want to return to work, can I return to work?
  45. Q: Do I in fact have to hire a lawyer to represent me in my Social Security disability claim?
  46. Q: How do lawyers who represent Social Security disability claimants get paid?
  47. Q: Can alcoholics and drug addicts actually get Social Security disability benefits?
  48. Q: I know someone who is on Social Security disability and he does not look a bit disabled. Why do they put all these freeloaders on benefits?
  49. Q: I am disabled, but I have never worked. Can I get Social Security disability benefits?
  50. Q: I am a widow. I have not worked in many years. I am disabled. Can I get Social Security disability benefits?
  51. Q: I am already on Social Security disability benefits, but I am worried that my benefits will be stopped in the future. What are the chances of this happening?
  52. Q: If Social Security tries to cut off my disability benefits, what can I do?
  53. Q: My doctor says I am disabled so why is Social Security denying my Social Security disability claim?
  54. Q: I am disabled by mental illness. Can mental illness serve as the basis for a Social Security disability claim?
  55. Q: Will it help if I ask my Congressional Representative to help me get Social Security disability benefits?
  56. Q: What is the difference between Medicare and Medicaid?
  57. Q: If I get Social Security disability benefits will I get Medicare?
  58. Q: If I get Social Security disability benefits will I get Medicaid?

Q: If I have an illness, disease, or injury, am I eligible to receive Social Security disability benefits?


Yes. If you have a medical condition that has lasted, or is expected to last, for at least one (1) year or that will result in death, you may be eligible to receive Social Security disability benefits.

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Q: Is there an earnings requirement for disability benefits? How do I meet the earnings requirement for disability benefits?


It depends. For SSI there is no earnings requirement. However, there is an earnings requirement for disability insurance benefits. To qualify to receive disability benefits, there are two different earnings tests that you must meet.

1) A "recent work" test that is based on your age at the time you become disabled; and
2) A "duration work" test to determine if you have worked long enough under Social Security.

Q: What is the definition of disability used by Social Security?
Under the Social Security Act, "disability" means "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months."

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Q: What should I do if I think I am eligible for Social Security disability benefits?


You should apply for Social Security disability benefits by contacting the Social Security Administration through the Internet at www.socialsecurity.gov or you can call the Social Security Administration's toll-free telephone number, 1-800-772-1213 between 7:00 A.M. and 7:00 P.M. to make an appointment to file a disability claim at a Social Security office near your home.

If you are deaf or hearing-impaired, you can call the Social Security Administration's toll-free TTY number of 1-800-325-0788. Once you have scheduled an appointment, a Disability Starter Kit will be mailed out to you which help you prepare for your disability claims interview.

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Q: When should I apply?


You should apply for Social Security disability benefits as soon as you become disabled. The processing of a disability benefits application can take a long time so it's important you get started quickly.

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Q: Who decides if I am disabled?


Our firm will be happy to give you a free case analysis to help you decide if you may qualify. However, the Social Security Administration will review your application to see if you meet some of the basic requirements for disability benefits. Your current work activities and if you have worked long enough to qualify to receive Social Security disability benefits will be looked at and checked. If it is decided that you have met these requirements, your application will be sent to the Disability Determination Services Office in the state where you live. The state agency completes the disability decision by looking at the medical evidence from your doctors, hospitals, clinics, and/or institutions where you have been treated. Your doctors will be asked about your medical condition, when it began, how it limits your activities, what medical tests show about your medical condition, and the type of treatment you are receiving for your medical condition. Your doctors will also be asked about your ability to perform work-related activities but will not be asked to decide if you are disabled.

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Q: How is the decision made?


The following five-step process is used to determine whether or not you are disabled:

- Are you working?
- Is your medical condition severe?
- Is your medical condition on the List of Impairments?
- Can you do the work you did before?
- Can you do any other type of work?

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Q: How will I know when a decision has been reached?


The state agency will send you a letter. If your application has been approved the letter will show the dollar amount of your benefits and the date on which your payments will start.

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Q: What do I do if my application for Social Security disability benefits is not approved?


If you are not satisfied with the decision that has been made on your claim you can appeal it. The steps that you can take to appeal the decision include arranging to be represented by an attorney of your choice when challenging the decision made on your claim.

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Q: Where and how can I appeal?


If you decide to appeal the decision concerning your claim, you will need to put your request to appeal the decision in writing within sixty (60) days from the date that you have received the letter concerning the decision about your claim. If you find you need help, contact the Social Security Administration office near your home.

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Q: Are there any levels of appeal? If so, how many?


Yes, there are a number of appeal levels. Generally speaking there are three or four levels of appeal depending on the situation:

- Reconsideration - involves the review of your files without the need for you to be present at the time of the review and is constructed by someone who was not involved with any aspect of the first decision. Reconsideration is not required in certain states.

- Hearing - A hearing is conducted by an Administrative Law Judge who was not involved with any aspect of the first decision and is usually held near your home. The hearing must be attended by you and your representative - if you have one - to explain the reason you are unable to work. You are permitted to look at information and to provide new information.

- Appeals Council - If you disagree with the decision reached at the hearing concerning your claim, you can ask for a review by the Appeals Council.

- Federal Court - Should you not agree with the decision reached by the Appeals Council if the Appeals Council decides not to review your case, you have the option of filing a lawsuit in a Federal District Court.

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Q: Am I eligible to receive Supplemental Security Income ("SSI")?


SSI is a federal program that provides monthly cash payments to people who have very little income or do not own many things.

Elderly individuals, blind or disabled individuals of any age as well as children can receive SSI. In other words, if you are 65 or older, or totally or partially blind; or have a medical condition that keeps you from working and could result in death or last at least for one (1) year, and you are a United States citizen, you could be eligible to receive SSI.

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Q: What would be the amount of the SSI payments?


The basic monthly SSI payment is around $674, for one person, or $934 for a couple.

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Q: How can an attorney advocate help me?


Attorneys are experienced in meeting the strict deadlines required by the Social Security Administration. Attorneys are experienced in reviewing and evaluating medical records and in gathering and presenting evidence on behalf of their client. There is no better advocate than a lawyer experienced in preparing and presenting medical evidence on behalf of a client.

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Q: How long will it take to receive my disability benefits?


The entire process from beginning to end could from three months take up to five years.

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Q: What is the difference between Social Security Disability (SSD) and Supplemental Security Income (SSI)?


Social Security Disability is taken from the pool of funds that are used for retirement benefits. To qualify for Title II benefits one must have paid in for 20 quarters over the last 10 years. Supplemental Security Income is for those who are disabled, but do not have enough credit to qualify for Social Security Disability Title II.

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Q: Should I apply for Social Security Disability (SSD) Title II or Supplemental Security Income (SSI) Title XVI?


Always apply for both in case you are turned down.

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Q: Does age make a difference when I apply for benefits under Title II or Title XVI?


Yes. The Social Security Administration looks at age as one of the factors in determining disability. The Social Security Administration evaluates age as follows:
* 18-49 is a younger worker
* 50-54 is closely approaching advanced age
* 55-59 is advanced age
* 60-64 is closely approaching retirement age

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Q: Does education level make a difference when applying for benefits under Title II or Title XVI?


Yes. The Social Security Administration looks at education level as one of the factors in determining disability. The Social Security Administration evaluates education as follows:
* up to 6th grade is marginal
* up to 11th grade is limited
* H.S. graduate or GED is high school
* College is more than high school.

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Q: What happens if I qualify for Social Security Disability benefits?


A: Once the Social Security Administration determines that you are eligible to receive benefits, you will then be paid the benefits that you are entitled to. You may be entitled to retroactive benefits which are paid in a lump sum. However, you will also receive benefits that are paid out each month for as long as you continue to be disabled. The retroactive benefits, by law, are calculated so that you only receive benefit payments for the period beginning five full months after you became disabled up until the present. Be advised, that retroactive payments are limited to a 12 month period.

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


A: The total amount of money you receive will depend on how much time you have worked, when you last worked, and how much money you have paid into the Social Security system. The calculation of Social Security Disability benefits is the same as the calculation of your Social Security Retirement benefits. Therefore, you can expect to receive a monthly benefit payment that is equivalent to what your retirement benefit payment would have been.

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Q: When will I receive benefits?


A: The time from application to receipt varies from case to case. An applicant who is approved after making just one application to the Social Security Administration can expect to receive benefits three to four months after submitting the application. However, government statistics clearly show that most people who apply for Social Security Disability are not approved after submitting their first application. Usually, it will require two or three attempts before benefits will be awarded. Many times, a claim must go to a "hearing stage" before it is approved. Once you have been approved (either by application of hearing), the benefits you are paid will include a settlement amount that represents the benefits you should have received during the time that your claim was being processed.

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Q: How does Social Security define a disability?


To be eligible for benefits, a person must be unable to do any kind of substantial gainful work because of a physical or mental impairment (or a combination of impairments), which is expected either:
* to last at least 12 months, or
* to end in death.

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Q: What is the difference between SSI and SSDI?


Supplemental Security Income, or SSI, is a program financed through general tax revenues-not through Social Security trust funds. SSI disability benefits are paid to people who have a disability and who do not own much or have a lot of income.

Social Security disability insurance is a program that workers, employers and the self-employed pay for with their Social Security taxes. You qualify for these benefits based on your work history, and the amount of your benefit is based on your earnings.

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Q: Can a child receive disability benefits?


Yes a child can receive either SSI or SSD is they are disabled. There is a set of criteria for children. They can get SSD based on their parents earning record, or SSI if no earning record or a combination up to the maximum SSI amount.

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Q: I am disabled, but I have plenty of money in the bank. Do I have to wait until this money is gone before I apply for Social Security disability benefits?


No. If you have worked in recent years or if you are applying for Disabled Widow's or Widower's benefits or Disabled Adult Child benefits, it does not matter how much money you have in the bank. There is no reason to wait to file the claim.

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Q: Do you have to be permanently disabled to get Social Security disability benefits?


No. You have to have been disabled for at least a year or are expected to be disabled for at least a year or have a condition that can be expected to result in death within a year.

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Q: I have several health problems, but no one of them disables me. It is the combination that disables me. Can I get Social Security disability benefits?


Social Security is supposed to consider the combination of impairments that an individual suffers in determining disability. Many, perhaps most claimants for Social Security disability benefits have more than one health problem and the combined effects of all the health problems must be considered.

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Q: How does Social Security determine if I am disabled?


Social Security is supposed to gather your medical records and carefully consider all your health problems, as well as your age, education, and work experience. In general, Social Security is supposed to decide if  you are able to do your past work. If Social Security decides that you are unable to do your past work, they are supposed to consider if there is any other work which you can do considering your health problems and your age, education, and work experience.

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Q: Who decides if I am disabled?


After an individual files a Social Security disability claim, the case is sent to a disability examiner at the Disability Determination agency in your state. This individual, working with a doctor, makes the initial decision on the claim. If the claim is denied and the individual requests reconsideration, the case is then sent to another disability examiner at the Disability Determination agency, where it goes through much the same process. If a claim is denied at reconsideration, the claimant may then request a hearing. At this point, the case is sent to an Administrative Law Judge who works for Social Security. The Administrative Law Judge makes an independent decision upon the claim. This is the only level at which the claimant and the decision maker get to see each other.

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Q: If I am approved for Social Security disability benefits, how much will I get?


For disability insurance benefits, it all depends upon how much you have worked and earned in the past. For disabled widow's or widower's benefits, it depends upon how much the late husband or wife worked and earned. For disabled adult child benefits, it all depends upon how much the parent worked and earned. For all types of SSI benefits, there is a base amount that an individual with no other income receives. Other income that an individual has reduces the amount of SSI which an individual can receive.

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Q: How far back will they pay benefits if I am found disabled?


For Disability Insurance Benefits and for Disabled Widow's and Widower's Benefits, the benefits cannot begin until five months have passed after the person becomes disabled. In addition, benefits cannot be paid more than one year prior to the date of the claim. For a Disabled Adult Child, there is no five-month waiting period before benefits begin, but benefits cannot be paid more than six months prior to the date of the claim. SSI benefits cannot be paid prior to the start of the month following the date of the claim.

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Q: What do I do if Social Security denies my claim for Social Security disability benefits?


First, do not be surprised. Only about 40% of Social Security disability claims are approved at the initial level. If you are denied at the initial level, unless you have already returned to work or expect to return to work in the near future, you should appeal, that is, file a request for reconsideration. You should also consider employing an attorney to represent you.

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Q: Why does Social Security turn down so many claims for disability benefits?


There is no simple answer to this question. One reason is that there is no simple way to determine if an individual is disabled. Most people who are disabled suffer from pain. There is no way of determining whether or not another individual is in pain, much less how much pain they are in. A second reason is that Social Security over the years has been more concerned with making sure that everyone who is receiving Social Security disability benefits is "truly" disabled than with making sure that everyone who is disabled receives Social Security disability benefits. An underlying reason is that Congress has always believed that, given a chance, many people will "fake" disability in order to get benefits.

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Q: I only want to get back the money I put in Social Security. Why do they make it so hard to do?


Actually, when you file a Social Security disability claim, you are not trying to just get "your own money" back. The money that an individual may have paid into Social Security over the years would not last very long if that was all that an individual could draw from Social Security.

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Q: What is "reconsideration"?


When a claim for Social Security disability benefits is denied at the initial level, the claimant may then request "reconsideration" of that decision. The case is then sent to a different disability examiner for a new decision. Unfortunately, about 80% of the time the reconsideration decision is the same as the initial decision - a denial.

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Q: Who makes the reconsideration determination?


A disability examiner at the Disability Determination Section makes the reconsideration determination. Most of the time, the claimant does not see the disability examiner or even know his or her name.

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Q: What are my chances of winning at reconsideration?


Statistically, about 20% of the time a claimant wins at reconsideration.

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Q: Do I have to go through reconsideration?


If you want to appeal a denial of Social Security disability benefits, you have to go through reconsideration. There is no way to avoid it.

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Q: What is the Social Security hearing like?


The hearings are fairly informal. The only people likely to be there are the judge, a secretary operating a tape recorder, the claimant, the claimant's attorney, and anyone else the claimant has brought with him or her. In some cases, the Administrative Law Judge has a medical doctor or vocational expert present to testify at the hearing. There is no jury nor are there any spectators at the hearing. There is no attorney at the hearing representing Social Security trying to get the judge to deny the disability claim.

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Q: What are my chances of winning at a hearing?


Statistically, over half of the claimants who have a Social Security disability hearing win. Statistics also show that claimants represented by an attorney are much more likely to win.

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Q: If the Administrative Law Judge denies my claim, can I appeal any more?


Yes. You can appeal to the Appeals Council which is still within Social Security.

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Q: What is the Appeals Council?


The Appeals Council exists to review Administrative Law Judge decisions. The Appeals Council is located in Falls Church, Virginia, and neither the claimant nor the attorney sees the people at the Appeals Council who are working on the case.

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Q: Can I appeal a case beyond Social Security to the Federal Courts?


Yes. After being denied by the Appeals Council, it is possible for a claimant to file a civil action in the United States District Court, requesting review of Social Security's decision. A Social Security disability claim can go all the way to the Supreme Court. Perhaps once every year or two years, the United States Supreme Court actually hears an appeal about a Social Security disability case.

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Q: If I get on Social Security disability benefits and get to feeling better and want to return to work, can I return to work?


Certainly you can return to work. Social Security wants individuals drawing disability benefits to return to work and gives them every encouragement to do so. For persons receiving Disability Insurance Benefits, Disabled Widow's and Widower's Benefits, and Disabled Adult Child Benefits, full benefits may continue for a year after an individual returns to work. Even thereafter, an individual who has to stop work in the following three years can get back on Social Security disability benefits immediately without having to file a new claim. In SSI cases, things work a differently, but there is still a strong encouragement to return to work.

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Q: Do I in fact have to hire a lawyer to represent me in my Social Security disability claim?


No. You can go through all of the levels of review on your own, if you wish, but statistically claimants who are represented by an attorney win a good deal more often than those who are not represented.

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Q: How do lawyers who represent Social Security disability claimants get paid?


In almost all cases, the attorney receives one- quarter of the back benefits if the claimant wins and no fee if the claimant loses.

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Q: Can alcoholics and drug addicts actually get Social Security disability benefits?


Not anymore. There never were all that many people getting Social Security disability benefits on account of alcoholism or drug addiction, but Congress has now prohibited Social Security from paying disability benefits on the basis of alcoholism or drug addiction. However, alcoholics and drug addicts have heart attacks, get cancer or get sick in other ways just like everyone else. Alcoholics and drug addicts who become disabled apart from their alcoholism or drug addiction can become eligible for Social Security disability benefits.

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Q: I know someone who is on Social Security disability and he does not look a bit disabled. Why do they put all these freeloaders on benefits?


When it comes to disability, looks can be very deceiving. There are many people who look quite healthy but who are quite disabled by anyone's standard. For instance, many individuals who suffer from very severe psychiatric illnesses are physically healthy and able to do things such as mow their yards.

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Q: I am disabled, but I have never worked. Can I get Social Security disability benefits?


If you are poor enough, you can qualify for Supplemental Security Income (SSI) if you are disabled, even if you have never worked in the past. It is also possible to qualify for Disabled Adult Child Benefits on the account of a parent if you became disabled before age 22 or for disabled widow's or widower's benefits on the account of a late husband or wife.

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Q: I am a widow. I have not worked in many years. I am disabled. Can I get Social Security disability benefits?


If you are over 50 and became disabled within seven years after your husband or wife died or within seven years after you last drew mother's or father's benefits from Social Security, you can get Disabled Widow's or Widower's Benefits. Perhaps more important, if you are poor, you can draw Supplemental Security Income benefits no matter what age you are or when you became disabled.

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Q: I am already on Social Security disability benefits, but I am worried that my benefits will be stopped in the future. What are the chances of this happening?


Social Security is not supposed to cut off disability benefits for an individual unless his or her medical condition has improved. When Social Security reviews a case of someone already on Social Security disability benefits, they continue benefits in the vast majority of cases. In recent years, Social Security has been doing few reviews to determine whether or not individuals already on Social Security disability benefits are still disabled. This is changing and Social Security should be doing far more reviews in the next few years. However, the vast majority of individuals who are reviewed will see their Social Security disability benefits continued.

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Q: If Social Security tries to cut off my disability benefits, what can I do?


You should appeal immediately. If you appeal within 10 days after being notified that your disability benefits are being ceased, you can ask that your disability benefits continue while you appeal the decision cutting off your benefits. You may also want to talk with an attorney about representation on your case, but you should file the appeal immediately.

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Q: My doctor says I am disabled so why is Social Security denying my Social Security disability claim?


Social Security's position is that it is not up to your doctor to determine whether or not you are disabled. It is up to them and they will make their own decision regardless of what your doctor thinks.

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Q: I am disabled by mental illness. Can mental illness serve as the basis for a Social Security disability claim?


Yes. Mental illness is a frequent basis for awarding Social Security disability benefits.

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Q: Will it help if I ask my Congressional Representative to help me get Social Security disability benefits?


Many Social Security disability claimants become frustrated with claim delays and eventually ask their U.S. Representative or Senator to help. The local Congressional office typically will have staffers who are experienced with Social Security procedures and personnel. A "Congressional Inquiry," as it is called at Social Security, may help to get a stalled process moving again. Note that the inquiry will have no impact on how Social Security decides the outcome of the case.

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Q: What is the difference between Medicare and Medicaid?


The short answer is that Medicaid is a poverty program and Medicare is not. Many disabled people who get Medicaid get it because they are on Supplemental Security Income (SSI). This is called "categorical" Medicaid eligibility. To get SSI and thereby get Medicaid you have to be poor and disabled. Medicaid pays doctors at very low rates. People who have only Medicaid can have a hard time finding doctors willing to take them on as patients. Medicaid does pay for prescription medications. Medicaid can go back up to three months prior to the date of a Medicaid claim. Note that it is possible to apply for Medicaid directly - through a local Medicaid office - without having a companion claim for SSI.

For Medicare it does not matter whether you are rich or poor. If you have been on Disability Insurance Benefits, Disabled Widows or Widowers Benefits or Disabled Adult Child Benefits for 24 months you qualify for Medicare. The good thing about Medicare is that it pays doctors at a higher rate than Medicaid. Almost all doctors are happy to take Medicare patients. The bad things about Medicare are that it does not begin until after a person has been on cash disability benefits for two years and that it generally does not pay for prescription medications.

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Q: If I get Social Security disability benefits will I get Medicare?


If you are approved for any kind of Social Security disability benefit other than SSI you will get Medicare after you have been entitled to Social Security disability benefits for two years.

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Q: If I get Social Security disability benefits will I get Medicaid?


If you are approved for SSI you will get Medicaid. It is possible to get both Medicare and Medicaid if you are entitled to SSI and some other type of Social Security disability benefit. Also see question #56, above.

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