In order for a person to be considered disabled, the individual must be unable to engage in any substantial gainful activity (SGA), essentially “full-time work”, due to severe medical problems (physical, mental, or both).
Social Security Disability (SSD) and Supplemental Security Income (SSI) benefits are assistance payments paid to individuals with disabilities, but they are separately funded and have different eligibility requirements. A primary SSD beneficiary’s entitlement is based off being disabled and having earned sufficient accumulated work credits the recipient paid through taxes on one’s earnings; SSI is based on disability and financial need alone.
Disability must be established through documentation provided by doctors, therapists, hospitals, clinics, and rehabilitation centers, including any pertinent diagnostic and treatment information. Though claims examiners at the state agency initially determine eligibility, the decision can be appealed at a number of levels.
Although almost 65 percent of disability applicants have their first requests denied, about 66 percent who file an appeal are approved by an administrative law judge. This means that perseverance, particularly with the assistance of an experienced disability attorney, pays off.
As with other government procedures, SSD and SSI are slow and cumbersome claims, taking under less than twelve months under a best case scenario and many years in a worst case scenario. For West Virginia workers’ compensation benefits, there are numerous appeal deadlines with insurance companies and the courts. For simply the slow factor alone, it is always best to file claims for any of these benefits as quickly as possible. Usually, there is a waiting period for nearly any benefit as well. Your attorney will know specific time limitations for filing and whether, in your particular case, you will be reimbursed retroactively. Adding in the very narrow windows to protect your rights on workers’ compensation issues, you must always act quick. Retaining Bowman Law Office will help you act quickly and responsively in your case, and should help reduce your stress.
Certain medical diagnoses are considered conditions eligible for Compassionate Allowances, meaning they will be processed “quickly” -- for the government this typically means within 1 month. These diagnoses include: Lou Gehrig's Disease (ALS) and several types of cancer with dire prognoses, such as pancreatic cancer or acute leukemia. Certain surgeries also qualify patients automatically, such as organ transplants. Even with “automatic disabilities, the Social Security Administration will still reassess each patient’s health periodically.
There are various psychiatric disorders -- including autism, bipolar disorder, and schizophrenia -- considered eligible for an SSD/SSI designation, but each case is still evaluated individually. The patient must be found to have limited ability to perform tasks or function socially to a degree that makes gainful employment impossible in order to qualify for SSD.
This is a tricky question to answer, but the short answer is “unlikely”. If medical evidence shows that your substance abuse is not a material factor to your disability, whether severe psychiatric, neurological, or digestive disorders, then a person qualify for SSD/SSI. However, addiction alone will not be sufficient for a person to receive benefits. Moreover, if you have a medical condition that has been caused or worsened by substance abuse, and you are still actively addicted, SSD will be again be very unlikely to approve you for benefits.
SSD is based on your covered earnings, meaning the earnings on which you paid FICA taxes. For most recipients, the amount is between $700 and $1700 per month (the average for 2016 was $1166). If you are receiving other disability payments, your payment from SSD may be reduced. By contrast, SSI is needs-based and maximum monthly payment for 2017 is $735 (with increases based upon ended of year inflation review). Also, any income above $20 per month is likely to reduce a person’s monthly SSI payment for that month dollar for dollar.
At the time your claim is approved, the claims examiner will project from the medical data presented whether you are expected to recover from your disability or whether it is likely to improve. Depending on the prediction, your case may be reviewed within 6 to 18 months, every 3 years, or as infrequently as every 7 years.