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Frequently Asked Questions

1. VA says I am disabled, so why is Social Security denying my Social Security disability claim?

It is Social Security's position that VA decisions are not binding upon them. Social Security and VA have very different standards for approving disability claims.

2. 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.

3. How long does it take before Social Security makes a decision once I file a claim for Social Security disability benefits?

In most cases Social Security makes the first decision within four months.

4. How long does it take for Social Security to make a reconsideration determination on my Social Security disability claim?

In most case Social Security makes the reconsideration determination within four months.

5. How long does it take for Social Security to act upon a request for Appeals Council review?

About a year, maybe longer.

In most case Social Security makes the reconsideration determination within four months.

6. What is the difference between Medicare and Medicaid?

The short answer is that Medicaid is a poverty program and Medicare isn't. 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.

7. 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.

8. 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.

9. I used to work but lately I have been staying home taking care of the kids. I have now become sick. Can I get Social Security disability benefits?

Possibly. If you have worked five out of the 10 years under Social Security before becoming disabled, you will have enough earnings in to potentially qualify for Social Security disability benefits. For individuals 31 or less, the requirements are a little different, since such individuals have not had such a long time to work. Unless a person has been staying home and taking care of their children for quite a long time, however, it is very possible that they will qualify for Social Security disability benefits based upon their own earnings. Also a homemaker, if poor enough, can qualify for Supplemental Security Income (SSI) whether he or she has worked in the past or not.

10. How long do I have to wait after becoming disabled before I can file for Social Security disability benefits?

Not even one day. You can file for Social Security disability benefits on the very same day that you become disabled. Many individuals make the mistake of waiting months and even years after becoming disabled before filing a Social Security disability claim. There is no reason to file a Social Security disability claim if one has only a minor illness or one which is unlikely to last a year or more. However, an individual who suffers serious illness or injury and expects to be out of work for a year or more should not delay in filing a claim for Social Security disability benefits.

11. Can I get both worker's compensation and Social Security disability benefits?

Yes. There is an offset, which reduces Social Security disability benefits because of worker's compensation benefits paid, but in virtually all cases, there is still some Social Security disability benefits to be paid. In a few states the offset works the other way - - worker's compensation benefits are reduced because of Social Security disability benefits.

12. How can I tell if I will be found disabled by Social Security?

Unless your disability is catastrophic (such as terminal cancer, a heart condition so bad that you are on a heart transplant waiting list, total paralysis of both legs, etc.), there is no easy way for you to tell whether you will be found disabled by Social Security. In the end, the decision of whether or not to apply for Social Security disability benefits should not be based upon whether or not the person feels that Social Security will find them disabled. Attorneys familiar with Social Security disability can make predictions about who will win and who will lose, but even they can seldom be sure. An individual should make the decision about whether or not to file for Social Security disability based upon their own belief about their condition. If the individual feels that he or she is disabled and is not going to be able to return to work in the near future, the individual should file for Social Security disability benefits. If denied, the individual should consult with an attorney familiar with Social Security disability to get an opinion as to the chances of success on appeal.

13. I got hurt in an automobile accident. I am disabled now, but I expect that I will be able to return to work after I recover. Should I file for Social Security disability benefits?

If you expect to be out of work for a year or more on account of illness or injury, you should file for Social Security disability benefits.

14. How does Social Security determine if I am disabled?

Social Security is supposed to gather your medical records and carefully consider all of your health problems, as well as your age, education, and work experience. In general, Social Security is supposed to decide whether 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 whether there is any other work which you can do considering your health problems and your age, education, and work experience.

15. What is the difference between Medicare and Medicaid?

The short answer is that Medicaid is a poverty program and Medicare isn't. 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.

16. 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.

17. 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.

18. 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.

19. How long does it take before Social Security makes a decision once I file a claim for Social Security disability benefits?

In most cases Social Security makes the first decision within four months.

20. How long does it take for Social Security to make a reconsideration determination on my Social Security disability claim?

In most case Social Security makes the reconsideration determination within four months.

21. 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.