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DDSSA
FREQUENTLY ASKED
QUESTIONS AND ANSWERS
1)
What is the definition of disability?
2) What is a Medically Determinable Impairment?
3) What determines who may be eligible
for disability benefits?
4) What is the difference between title
II and title XVI?
5) How is the disability determination
made and eligibility determined?
6) When do disability benefits start?
7) What is the definition of an "onset"
date?
8) Can someone work and still receive
disability benefits?
9) Is eligibility for benefits retroactive
to the onset date?
10) Who determines whether or not a
claimant meets or equals a listing?
11) How does the filing process work?
12) What if a claimant is denied benefits?
13) How long does the entire process
take?
14) What if the claimant's case is reversed
during any of the appeal stages and he/she is determined
to be disabled - is the claimant only eligible to
receive disability payments from the time of reversal?
15) How is payment received?
16) How long can an individual stay
on disability?
17) How does an individual cease to
be eligible for disability?
18) Does the Arkansas Disability Determination
agency have a fraud unit?
19) What are the consequences if it
is determined that a claimant committed fraud or similar
fault?
20) What is fraud?
21) What is similar fault?
22) If a claimant has received disability
payments for several years, are they subject to re-evaluation?
23) Can a claimant hire a lawyer?
24) How many Social Security disability
claims are processed each year in the State of Arkansas?
25) Does Arkansas get its fair share
of benefits for its population compared to other states?
26) Can individuals receiving disability
benefits or payments get Medicare or Medicaid coverage?
27) Where does the money come from to
pay for these benefits?
MOST
FREQUENTLY ASKED QUESTIONS ABOUT SOCIAL SECURITY DISABILITY
BENEFITS
1)
What is the definition of disability?
Disability is defined in the Social Security Act as
the 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 which has lasted or can be expected to last
for a continuous period of not less than 12 months.
2)
What is a Medically Determinable Impairment?
Medically determinable impairment is an impairment that
results from anatomical, physiological, or psychological
abnormalities which can be shown by medically acceptable
clinical and laboratory diagnostic techniques. A physical
or mental impairment must be established by medical
evidence consisting of signs, symptoms, and laboratory
findings - not only by the individual's statement of
symptoms.
3)
What determines who may be eligible for disability
benefits?
Under the Social Security Administration's (SSA) disability
insurance program (title II of the Act), there are three
basic categories of individuals who may be able to qualify
for benefits on the basis of disability:
- a
disabled insured worker under the age of 65;
- a
person who became disabled before age 22 who is a
dependent of a deceased insured parent or a parent
entitled to title II disability or retirement benefits;
and
- a
disabled widow or widower age 50-60 if the deceased
spouse was insured under Social Security.
Under
title XVI, Supplemental Security Income (SSI), there
are two basic categories under which a financially needy
person can get payments on the basis of disability:
- an
adult age 18 or over who is disabled and
- a
child (under age 18) who is disabled.
4)
What is the difference between title II and title
XVI?
Title II provides for payment of disability benefits
to individuals who are "insured" under the
Act by virtue of their contributions to the Social Security
Trust Fund through the Social Security tax on their
earnings, as well as to certain disabled dependents
of insured individuals. Title XVI provides for SSI payments
to individuals (including children under age 18) who
are disabled and have limited income and resources.
SSI
is not the same as Social Security, even though the
program is run by the SSA. Supplemental Security Income
(SSI) is the first federally administered cash assistance
program in this country available to the general public.
It is designed to provide a floor of income for the
aged, blind or disabled who have little or no income
and resources. The program establishes that payment
may be received as a right by those U.S. Citizens or
legally admitted aliens residing in this country who
qualify as aged, blind, or disabled and who meet income
and resource criteria. No work credits are necessary
for entitlement under this program.
5)
How is the disability determination made and eligibility
determined?
A sequential review is made of the claimant's current
work activity, severity of the impairment(s), age, impact
of impairment on work related abilities, past and current
work experience, age and education. A disability claims
adjudicator obtains any existing medical evidence. If
that evidence is unavailable or if further examination
or testing is needed to make a determination, the Disability
Determination Service (DDS) will, at its expense, arrange
for a consultative examination. The claimant's treating
source is usually the preferred source for performing
the examination on his /her own patient.
6)
When do disability benefits start?
The law provides that, under the Social Security disability
program, disability benefits for workers and widows
usually cannot begin for 5 months after the established
onset of the disability. The 5 month waiting period
does not apply to individuals filing as children of
workers. Under SSI, disability payments usually begin
the first month following the month of application.
7)
What is the definition of an "onset" date?
An "onset" date is the date the DDS determines
a claimant was eligible for disability benefits.
8)
Can someone work and still receive disability benefits?
Social Security rules make it possible for people to
test their ability to work without losing their right
to cash benefits and Medicare or Medicaid. These rules
are called "work incentives." The rules are
different for title II and title XVI, but under both
programs they may provide:
- continued
cash benefits;
- continued
help with medical bills;
- help
with work expenses; or
- vocational
training.
9)
Is eligibility for benefits retroactive to the onset
date?
In some cases, yes; however, title II payments may only
be made 12 months prior to the application date. For
title XVI, payments may begin the first month after
the month of application.
10)
Who determines whether or not a claimant meets or
equals a listing?
The DDS agency has a staff of trained people, including
disability adjudicators and doctors, who decide if Social
Security's criteria for eligibility is met.
11)
How does the filing process work?
The following steps must be taken in order to file a
claim:
- a
claim may be filed by mail, telephone, or in person
at any Federal Social Security Office;
- the
Federal Social Security Office initially screens claimants
to determine whether they meet basic work and age
requirements;
- when
claimants pass the initial screening, their applications
are referred to DDS.
12)
What if a claimant is denied benefits?
If denied benefits, a claimant can proceed with the
following steps:
- the
claimant may ask to be reconsidered. This is called
the reconsideration step. This process is similar
to the initial filing except that a different adjudicator
and a different doctor make the determination. If
a claimant is denied a second time, he/she may appeal
to a Federal Social
Security Administrative Law Judge;
- if
the Administrative Law Judge denies the case, the
claimant may appeal to the Social Security Appeals
Council;
- if
the claimant exhausts all administrative appeals but
wishes to continue pursuing the case, he/she may file
a civil suit in Federal District Court and eventually
appeal all the way to the United States Supreme Court.
13)
How long does the entire process take?
On an average, the entire process is broken down into
the following categories:
- the
interview with the Federal Social Security Office
and mailings usually take between 5 to 10 days;
- once
the State DDS agency receives the claim, it takes
an average of 3 months to process the case;
- the
reconsideration process takes an average of 4 months;
- the
Administrative Law Judge process takes a average of
10-12 months to process;
- the
Appeals Council process could take in excess of 1
year to complete.
14)
What if the claimant's case is reversed during any
of the appeal stages and he/she is determined to be
disabled? Is the claimant only eligible to receive disability
payments from the time of reversal?
Payment is based on the onset date and the filing date.
The onset date is the date that the claimant is first
found to be severe enough to meet SSA's criteria. For
title XVI claimants, payments can begin as early as
the month after the month of filing. Title II claimants
usually must serve a waiting period of 5 full months
after the onset is established and in some cases may
be paid retroactively up to 12 months prior to the application
date.
15)
How is payment received?
Checks are mailed from a federal payment center on a
monthly basis. Once a claimant's case is approved he/she
will receive a lump sum check for any retroactive eligibility,
and monthly disability payments will follow. The State
Disability Determination agency is not involved in the
issuance or mailing of Social Security disability payments.
Payments are made by the federal Social Security Administration.
16)
How long can an individual stay on disability?
While there is no specified time-frame for how long
a claimant can remain on disability, individuals who
have been on disability for several years are subject
to a "continuing disability review" (CDR).
Most individuals remain on disability until their physical
or mental impairment has had sufficient improvement
to allow them to re-enter the work force.
17)
How does an individual cease to be eligible for disability?
A claimant ceases to be eligible for disability when
one or more of the following criteria apply:
- the
claimant reaches the age of 65 or retires at age 62
with regular Social Security benefits;
- the
claimant's physical or mental condition improves to
a level that no longer prevents work;
- the
claimant dies; or
- it
is determined that the claimant committed fraud or
similar fault.
18)
Does the Arkansas Disability Determination agency
have a fraud unit?
Yes; an aggressive fraud department is fully staffed
and uses state-of-the-art surveillance techniques and
trained investigators to detect fraud or similar fault.
19)
What are the consequences if it is determined that
a claimant committed fraud or similar fault?
If it is determined that a claimant has committed fraud
or similar fault, the following action(s) may be taken:
- disability
benefits may be stopped;
- the
claimant may be referred to the Prosecuting Attorney,
the Office of Inspector General (OIG), the Federal
Bureau of Investigation (FBI) and/or the United States
Attorneys Office; or
- if
found guilty, the claimant may be expected to repay
benefits deemed fraudulent and may be incarcerated.
20)
What is fraud?
The term fraud describes the actions of a person who
has the intent to fraudulently secure payment either
in a greater amount than is due or when no payment is
authorized. These actions constitute a felony. Title
18, U.S.C. provides for a fine or imprisonment for not
more than five years, or both, upon conviction thereof.
21)
What is similar fault?
Sections 205 and 1631 of the Social Security Act define
similar fault as follows:
- an
incorrect or incomplete statement that is material
to the determination is knowingly made; or
- information
that is material to the determination is knowingly
concealed.
22)
If a claimant has received disability payments for
several years, are they subject to re-evaluation?
Yes; the Federal Social Security Administration sends
cases to the DDS to be reviewed by an experienced adjudicator.
If the adjudicator determines that the claimant is still
disabled, the claimant remains on disability. If it
is determined that the claimant is no longer disabled,
the claimant is notified and is given the opportunity
for a face-to-face hearing with a DDS hearing officer.
23) Can a claimant hire a lawyer?
Yes. Some claimants decide to hire personal lawyers
when they first apply. Many claimants hire a lawyer
after their claim is denied during the first two levels
and they decide to appeal to a Federal Administrative
Law Judge. Other claimants never hire a lawyer. There
are no statistics to show whether hiring a lawyer significantly
increases the likelihood of a claimant's case being
allowed.
24)
How many Social Security disability claims are processed
each year in the State of Arkansas?
Over 60,000 claims are processed each year in Arkansas
in a timely manner.
25)
Does Arkansas get its fair share of benefits for
its population compared to other states?
Arkansas has the 4th highest percentage of its population
on Social Security disability. Nearly two-hundred thousand
claimants in the State of Arkansas currently are awarded
Social Security disability benefits. The federal government
pays about $80,000,000 each month to disability beneficiaries
in the State of Arkansas.
26)
Can individuals receiving disability benefits or
payments get Medicare or Medicaid coverage?
Yes. Medicare helps pay hospital and doctor bills of
disabled or retired people who have worked long enough
under Social Security to be insured for Social
Security benefits. It generally covers people who are
65 and over, people who have been determined to be disabled
and have been receiving benefits for at least 24 months,
and people who need long-term dialysis treatment for
chronic kidney disease or require a kidney transplant.
In general, Medicare pays 80 percent of reasonable charges.
In
most states and in Arkansas, individuals who qualify
for SSI disability
payments also qualify for Medicaid. The program covers
all of the approved charges of the Medicaid patient.
Medicaid is financed by federal and state matching funds,
but eligibility rules may vary from state to state.
27)
Where does the money come from to pay for these benefits?
The money for SSI checks comes from the general revenues
of the United States Treasury. Social Security benefits
are paid from contributions of workers, employers, and
self-employed people. Social Security funds are not
used for SSI checks. People who get Social Security
checks may get SSI checks too, if they are eligible
for both. However, a person does not have to be eligible
for Social Security to get SSI. People getting federal
SSI checks or state supplemental checks may also be
eligible for social services provided by a state. These
services help people meet problems in daily living or
special problems related to age or a handicapping condition.
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