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1. SSDI is not a short term solution for an ‘acute’ crisis: its a long term solution for a chronic medical condition

This is perhaps the most common misunderstanding I have seen in my 25+ years of social security disability representation in Dallas Fort Worth. The sad fact is most Americans live on the financial edge. According to a 2016 GOBankingRates survey, 35 percent of all adults in the U.S. have only several hundred dollars in their savings accounts and 34 percent have zero. Only 15 percent have over $10,000 in savings.

Becoming disabled and unable to work is not just a medical crisis: it likely is the most profound financial crisis anyone can experience. Few of us in good health have planned for a disability or even considered that possibility. It is unsurprising that most Americans have not considered and sought to understand the SSDI program and its requirements. So when a disability does strike, it is understandable that most Americans think SSDI is the solution to their immediate medical and financial crisis.

Unfortunately when the primary earner’s paycheck stops and the family has little in savings SSDI in most cases will not be available to meet the immediate financial crisis. Here are the reasons:

To qualify for SSDI your inability to work due to your medical condition(s) must last or be expected to last at least 12 months, or be expected result in death. By definition SSDI will not be available for a year unless social security determines the medical condition is “expected” to last at least a year. For many “acute” disabilities such as stroke, heart failure, back surgery, and skeletal-muscular injury (i.e., auto accident) there is a high likelihood of improvement. The stroke survivor will regain some and maybe all functionality. Heart failure often improves with medications. Spinal surgery for a ruptured disc followed by physical therapy results in return to work for many. Broken bones from a car wreck mend. To qualify for SSDI for these and other “acute” conditions within a year social security must speculate that medical treatment will essentially be unsuccessful. As you might imagine, social security has a hard time assuming a person will not improve with medical treatment and quickly putting them on SSDI.

Even if social security does quickly approve you for SSDI there is a 5 month waiting period. So for example, if you are found to be disabled on January 1, 2018 you will not receive disability benefits until July of 2018. So even under the best circumstances the financial “cavalry” in the form of SSDI benefits will take at least 5 full months to come to your aid.

2. SSDI is not the way to get medical coverage and treatment: medical treatment is required to get social security disability benefits

SSDI eligibility allows those under 65 years of age to receive Medicare after 24 months of entitlement to SSDI. Over the years, I have had many prospective clients tell me that their main goal in seeking SSDI is Medicare eligibility because they have lost their health insurance. Unfortunately, one must be receiving medical treatment in order to qualify for SSDI. Again, the SSDI program addresses the long term issues regarding disability. Medicare eligibility through the SSDI program does not address the typical short term problem where a worker loses medical insurance when they leave their job because (i) there is a 24 month waiting period, and (ii) cessation of medical treatment makes it virtually impossible to qualify for SSDI.

3. Your medical condition does not have to be on “the list” to qualify for SSDI

The law governing SSDI qualification is simple, but the rules and criteria for implementing the law created by the social security administration are complex (surprised that a government agency would make things complicated?). The so-called 5-step sequential evaluation process and the terms used by social security has created confusion. One step in the process asks whether the medical condition(s) is a “listed” condition. If the condition is indeed “listed” – and if the symptoms and medical findings meet a specific set of criteria – eligibility for SSDI is automatic. Not all medical conditions, however, that can result in disability are “listed” conditions.

Over the years I have heard many questions from prospective clients about the so-called “Listings”. There is a widespread misperception that only certain medical conditions can qualify for disability benefits, and that the condition has to be on “the list”. If a condition is not a listed condition, using the 5-step sequential evaluation process, it simply means the inquiry as to SSDI eligibility moves to the next step. The same is true for a condition that is in fact listed but does not meet the specific symptoms and criteria that are set out. Any medical or mental condition that is diagnosed and supported by medical findings can be the basis for SSDI eligibility.

4. SSDI is not the solution if you were laid off and can’t find a job

The definition of disability under the SSDI program is strict: you must be unable to do any type of work. Often times Americans who do have real health problems but have been able to work lose their job due to a layoff or plant closing. When faced with the difficulties of finding a new job coupled with a legitimate health problems, some look toward SSDI for help.

Administrative Law Judges (ALJ) who decide SSDI eligibility after 2 denials will always carefully examine why the most recent job ended. In the case of a layoff, the ALJ will want to know the circumstances of the layoff. Sometimes a worker’s health problem is eroding job performance and the layoff is grounded in that inability to do the job. This is a factor supportive of the disability claim. But if, for example, the last job ended because the plant moved to Mexico or due to a company-wide reduction in workforce the ALJ may question whether the claimant is truly disabled. When I talk with a prospective client who was laid off I always ask: “If you had not been laid off would you still be doing that job?” A “yes” answer can indicate that the person’s problem is not inability to work due to a medical or mental condition but rather the problem is they cannot find a job. Unfortunately people – particularly older Americans – can find it hard to get a new job: age discrimination is real. The SSDI program is not designed or intended, however, to address problems in securing employment: it is intended only to address inability to work due to a physical or mental impairment.

5. You cannot “have too much money” to qualify for SSDI

This post has been confined to SSDI – Social Security Disability Insurance benefits. SSDI eligibility is based upon your payment of payroll taxes (FICA). There is a disability program – Supplement Security Income – that pays monthly benefits to those unable to work but who have not worked enough to qualify for SSDI. SSI is a welfare program that examines whether you “really need” the benefits, whereas SSDI is an insurance-based “entitlement” that has nothing to do with wealth, savings, spousal income or resources. People denied SSI benefits at social security they don’t “need” the benefit are often told that they “make too much money” or have too much money in the bank.

Many who have heard from family or friends of people denied disability benefits due to “too much money” wrongly assume that disability benefits are in fact welfare. These stories came from persons who were denied SSI not SSDI. For SSDI purposes, there is no such thing as “too much” money or resources in the family.