How Does Social Security Disability Work? A Virginia Disability Lawyer Explains
Everything You Need to Know to Get the SSDI and SSI Benefits You Need in Virginia
Lawyers for Social Security Disability in Virginia
Hi. I’m Corey Pollard, a top-rated disability lawyer in Richmond, Virginia. Welcome to my Guide to Social Security Disability Benefits.
Most of us don’t like to think about becoming disabled. But it happens. Often. Studies show that a 20-year-old worker has a higher than 1-in-4 chance of becoming disabled and unable to work before reaching full retirement age.
This website aims to help you qualify for Social Security Disability benefits if your health forces you to stop working before you’re ready.
This article answers the medical and legal questions that come up at every step of Social Security Disability claims and related issues you may have to deal with, particularly if you have an associated workers compensation, long term disability, or car accident claim.
Unfortunately, you cannot count on the Social Security Administration (SSA), your employer, or agents of your long term disability insurance company to help you apply and prove your eligibility for Social Security Disability benefits. But when you hire me as your disability attorney, you can count on me to do everything I can to help you win your SSDI or SSI claim.
Keep reading if you are:
- Injured or sick and want to know if you are eligible for disability benefits
- Ready to apply for disability benefits and want to know how to build the best case possible
- Interested in filing an appeal of the decision denying your disability benefits
- Researching Social Security Disability lawyers in Virginia (Richmond, Chesterfield, Mechanicsville, Stafford, Chesapeake, Winchester, Harrisonburg, Roanoke, Newport News, Virginia Beach, Fredericksburg, Norfolk, Charlottesville, Manassas, or Fairfax) to help you at a disability hearing in front of an administrative law judge (ALJ).
- Helping an adult or child apply for and obtain disability benefits but are getting overwhelmed by the endless paperwork, wait, and denials.
- Receiving disability benefits and want to know how to protect this income, or
- You are checking out the results from searching for a “disability lawyer near me” because you want to hire a local attorney.
If you have any questions about Social Security Disability that this site does not answer or would like a free consultation, please e-mail me at cpollardjba@gmail.com or call me at (804) 251-1620. See why other attorneys and my past clients have voted me one of Virginia’s best disability attorneys.
What Disability Programs Pay Benefits?
The United States Government pays disability benefits through two programs: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. Both programs provide medical services and cash payments for persons with physical or mental disorders (and their dependents) who cannot work because of a medical condition expected to last at least one year or result in death.
For more information on the similarities and differences between the two federal disability programs, please read my article: SSDI vs. SSI.
Social Security Disability Insurance Program (SSDI, DIB, or SSD)
The SSDI program is for workers who have paid into the Social Security trust fund through payroll taxes but who are now unable to work full-time because of a physical or mental disability.
Supplemental Security Income Program (SSI)
The SSI program is for disabled persons with limited incomes and assets.
Who Can Get Social Security Disability Benefits?
Social Security pays disability benefits if you (1) have a medical condition or a combination of medical conditions that meet the SSA’s definition of disability and (2) satisfy the SSA’s non-medical requirements for the disability program applied to.
Later in this article, I discuss how Social Security defines “disabled.”
But first, let’s discuss the non-medical requirements for both the SSDI and SSI programs.
How Do I Meet the Earnings Requirement for Social Security Disability Insurance Benefits?
To get SSDI benefits, you must have worked both long enough and recently enough.
The Social Security Act requires you to have a certain number of work credits in a certain period before you meet the non-medical requirements for the SSDI program. You can earn up to four work credits per year, each representing three months (a quarter). The amount of earnings you need to receive a work credit varies from year to year.
The number of work credits you need to qualify for SSDI depends on your age when you first become disabled. The general rule is that you must have earned 20 work credits over the last ten years, which means you must prove that you meet the medical definition of disability within five years of the date you last worked continuously. But exceptions may apply, mainly if you are under the age of 31.
What are the Income and Resource Limits for the SSI Program?
Your household income and assets cannot exceed specific amounts to qualify for SSI.
The general rule to get SSI benefits is that your monthly income cannot exceed the federal benefit rate (FBR). In 2020, the FBR is $783 per month for an individual and $1,175 per month for a couple.
If you earn less than the FBR rate, the SSA will next look at the resources you and your spouse have (if you are married). A resource is cash or any other asset that you can use to get some money, such as land or personal property.
Certain items are not considered “resources” by the SSA and do not count against you when you are trying to meet the SSI program’s non-medical requirements. These items include:
- Your home
- Household goods and possessions up to $2,000 in value
- One wedding ring and one engagement ring, regardless of value.
- One automobile, regardless of value.
- Any money you have in an ABLE account, up to $100,000
The general rule to get SSI benefits is that you cannot have more than $2,000 in resources if you are single or $3,000 in resources if you are married.
How Do I Apply for Social Security Disability Benefits?
There are three ways that you can apply for disability benefits through the Social Security Administration. You can:
- Apply online at www.socialsecurity.gov.
- Call the SSA’s toll-free number, 1-800-772-1213, to make an appointment to file a disability claim at your local Social Security office or schedule a disability claims interview.
- Hire a Virginia disability lawyer to complete the SSD application on your behalf.
For more information, read my article: How Do I Apply for Disability Benefits?
When Should I Apply for Social Security Disability Benefits?
You should apply for disability benefits as soon as you realize that you are disabled and may never return to the type of work you have done in the past or to the workforce in general. Do not wait until you have been out of work for one year or longer. There are two reasons I recommend applying for SSDI or SSI sooner rather than later.
First, it can take a long time for the SSA to process your application for disability benefits and decide. Even in the best circumstances, it can take the SSA three to five months to review and approve your disability claim. And in the worst of times, it can take up to two years or more to receive a final decision if your application is denied initially and requires multiple appeals.
Second, there is no penalty for withdrawing your disability claim if you return to work before the SSA decides your case. You can always reapply for disability benefits if you later realize you are unable to continue working.
Who Decides if I am Disabled under the SSDI or SSI Programs?
Depending on when you are approved for Social Security Disability benefits and how many appeals you have to file to get that favorable decision, up to five different tribunals and departments may review and decide your disability claim.
First, the SSA will review your application to ensure you meet the non-medical requirements for the disability program.
If you meet the non-medical requirements, the SSA will forward your case to the Disability Determination Services (DDS) office in Virginia.
DDS offices are run by the state in which they are located but funded by the federal government. DDS makes the initial disability determination decision on the SSA’s behalf using federal laws and regulations. It also decides your Request for Reconsideration if you file one.
The DDS claim examiner assigned to your case may decide that more information is needed. The examiner may request your medical records, ask a state agency medical specialist to give an opinion on your physical and mental capabilities, or send you for a consultative examination. Using this data, the DDS claim examiner will decide if you are disabled or not disabled.
If DDS denies your claim at the initial application and reconsideration levels, you may request for hearing before an administrative law judge (ALJ). The ALJ is part of the SSA’s Office of Hearings Operations (OHO).
If the ALJ denies your claim, you can file a Request for Review by the SSA’s Appeals Council. The Appeals Council is headquartered in Falls Church, Virginia, and reviews ALJ decisions.
If the Appeals Council affirms the ALJ’s denial of benefits, you can file a civil action against the Social Security Administration in federal court. A federal district judge will decide your claim.
For more information on this topic, read my article: Who Will Decide My Disability Claim?
Defining Disabled under Social Security
To be eligible for Social Security Disability benefits under either the SSDI or SSI program, you must have a medical condition or a combination of medical conditions that meet the Social Security Administration’s disability definition.
You cannot have a temporary or partial disability to meet SSA’s definition of disability. Instead, you must have:
- A medically determinable physical or mental impairment or combination of severe impairments; and,
- That have lasted or can be expected to last for at least 12 months or to result in your death; and,
How Does Social Security Decide if I am Disabled?
Whether the Virginia DDS, an ALJ based in Richmond, Norfolk, Charlottesville, Roanoke, or Washington DC, or the federal court is deciding your claim, a five-step evaluation process decides you are disabled. The five steps are:
Step One: Are you working? The SSA will deny your application if you are making more than a specified amount each month.
Step Two: Do you have at least one severe medical condition? It is not enough to have a diagnosed medical condition. The medical condition must affect your ability to perform work-related tasks and daily living activities, even with medication.
Step Three: Do any of your medical conditions meet or equal one of Social Security’s listings? You qualify for disability benefits automatically if your medical condition meets the criteria of one of the medical conditions on the SSA’s list. Do not worry if your diagnosis isn’t listed or if you don’t meet the criteria, a skilled disability attorney can help you win your case anyway.
Step Four: Can you perform any of your past work? The SSA will decide whether you can perform any of the jobs you have held in the past fifteen years based on your residual functional capacity.
Step Five: Is there any other work you can perform? The SSA will determine whether other work in the national economy is available based on your age, education, and acquired job skills. Your age is one of the most critical factors determining whether you are disabled under Social Security’s Rules. The general rule is that it’s easier to win if you are over age 50.
What Medical Conditions Frequently Result in Disability under Social Security’s Rules?
Any medical condition that has a severe effect on your ability to work may help you qualify for SSDI or SSI benefits. Some of the most common disabilities suffered by my clients include:
- Musculoskeletal Disorders such as Arthritis, Back Pain, Amputations, Knee Injuries resulting in Joint Replacement, Torn Rotator Cuffs and Shoulder Injuries, Chronic Fatigue Syndrome, and Fibromyalgia
- Respiratory and Breathing Disorders such as Asthma, Chronic Pulmonary Hypertension, Lung Transplant, Chronic Obstructive Pulmonary Disease (COPD), and Sarcoidosis
- Cardiovascular Disease such as Heart Attacks, Angina, Congestive Heart Failure, Peripheral Arterial Disease, and Hypertension. Many firefighters and police officers who qualify for workers compensation benefits under the Workers Comp Heart Disease Bill also qualify for SSDI benefits.
- Digestive System Disorders such as Crohn’s Disease, Gastrointestinal Bleeding, Chronic Liver Disorder, Inflammatory Bowel Disease, Short Bowel Syndrome, Weight Loss, and Liver Transplant
- Kidney Diseases such as Chronic Kidney Disease requiring Dialysis and Nephrotic Syndrome
- Mental Disorders such as Neurocognitive Disorders, Schizophrenia, Depression, Bipolar Disorder, Intellectual Disorder, Anxiety, Panic Attacks, Obsessive-Compulsive Disorder, Somatic Disorder, Personality Disorder, Autism Spectrum Disorder, Eating Disorder, and Post Traumatic Stress Disorder (PTSD)
- Nervous System Disorders such as Epilepsy, Vascular Insult, Stroke, Brain Tumors, Parkinson’s Disease, Cerebral Palsy, Spinal Cord Trauma, Multiple Sclerosis, Amyotrophic Lateral Sclerosis, Myasthenia Gravis, Peripheral Neuropathy, and Muscular Dystrophy
- Hormone Disorders such as Thyroid Disorders, Hyperparathyroidism, Adrenal Cortical Insufficiency, Diabetes Mellitus (Type 1 and Type 2), and Hypoglycemia
- Blood Diseases such as Hemolytic Anemias, Disorders of Thrombosis and Hemostasis, and Bone Marrow Failure or Transplant
- Skin Diseases such as Ichthyosis, Bullous Disease, Chronic Infections, and Dermatitis
- Immune System Disorders such as Systemic Lupus Erythematosus, Vasculitis, Immune Deficiency Disorder, Inflammatory Arthritis, and Sjogren’s Syndrome
- Cancer such as Skin Cancer, Malignant Tumors, Lymphoma, Leukemia, Multiple Myeloma, Thyroid Gland Cancer, Breast Cancer, Bone Cancer, Lung Cancer, Stomach Cancer, Cancer of the Intestine, Pancreatic Cancer, Melanoma, and Prostate Cancer
How Will I Find Out That Social Security Approved My Disability Claim?
The SSA will send you a letter telling you that your application is approved. The message will also state the date the SSA found you disabled (this may not be the date you allege you became disabled), the amount of your monthly benefit, and when you will begin to receive your monthly disability benefit.
Your monthly disability benefit is based on a formula the SSA uses to determine your average lifetime earnings.
If a disability lawyer represents you, your lawyer may receive electronic notice that you have been approved a few days before receiving the SSA letter.
For more information on this topic, read my article: What to Expect After a Fully Favorable Disability Decision.
What Do I Do if I Disagree with Social Security’s Decision on My Disability Claim?
If you disagree with a decision made on your Social Security claim, you can appeal it. There are four levels of appeal with Social Security claims.
The first appeal of a disability denial is called a request for reconsideration. The reconsideration request is a review of your case by a second DDS claim examiner and a team that was not involved in the initial determination. The majority of claims that were denied at the initial level are also denied at the reconsideration level.
If your case is denied on reconsideration, you can request a hearing before an administrative law judge. As a Social Security Disability attorney, this is where I have my greatest success. The disability hearing is your opportunity to present live evidence and tell your story, and for your SSD attorney to explain the theory of your case.
If the administrative law judge denies your case, you can ask the Appeals Council to review it. And you can submit a written brief that outlines the errors made by the administrative law judge. If the Appeals Council agrees with your position, it may remand your case, which means it will send your case back for a new hearing before the administrative law judge. Or it may reverse the judge’s decision completely and award you benefits.
If you are unhappy with the Appeals Council decision and want to further pursue your case, you can file a civil lawsuit in federal district court and appeal it to the U.S. Supreme Court.
No matter what stage of appeal you are at, pay attention to the date of the Notice of Denial letter you receive. Usually, you have to submit a written request within 60 days of that date. If you miss the deadline, you’ll have to file a new application and start again.
When Do Social Security Disability Benefits Start if I am Approved?
SSDI payments are not made until the sixth full month after the SSA’s date finds your disability began.
Many of you will be entitled to monthly disability benefits and a lump sum for retroactive (past-due) disability benefits. Payment of back pay usually happens if you are found disabled before your application or have to appeal past denials to get approved for SSDI or SSI benefits.
You will usually receive your back pay and the first month of SSDI benefits within one to two months of receiving the decision awarding your case.
Under the SSI program, monthly disability benefits may begin as soon as the first day of the month after you applied. There is no waiting period.
In my experience, it will take six to eight weeks from the date you are approved to receive your first SSI payment. This is because your local Social Security office processes these payments, which takes additional time.
If you are receiving disability benefits through both the SSDI and SSI programs, it may take three months to start because the SSA will have to make offset calculations.
Will I Receive Medical Coverage if Social Security Disability Approves Me?
Yes.
IIf you receive SSDI, you will qualify for Medicare twenty-four months after the date you start receiving monthly SSDI benefits.
If you receive SSI, you will qualify for Medicaid coverage automatically.
Can I Work and Still Receive Social Security Disability?
Yes. To a point.
There are work incentives and rules that allow you to receive cash benefits, medical coverage, assistance with work assistance, and vocational training at the same time. But the rules for the two disability programs are different.
Make sure you talk with a disability attorney about how often you can work and how much you can earn not to forfeit your right to SSDI or SSI benefits.
Is There a Time Limit on How Long I Can Receive Social Security Disability Benefits?
No.
You will continue to receive SSDI or SSI benefits as long as your medical condition prevents you from working.
However, the SSA will review your case from time to time to see if your medical condition has improved. That is one reason you should continue to receive treatment after being awarded a disability benefit.
Can My Family Get Disability Benefits?
Yes. Individual family members may qualify for Social Security Disability benefits based on your work and medical condition.
Members of your family who may qualify include:
- Your spouse (husband or wife), if he or she is age 62 or older;
- Your spouse, regardless of age, if he or she is taking care of one of your children who is under age 16 or disabled;
- Your unmarried children under age 18, including adopted children and in some cases your stepchild or grandchild; or
- Your unmarried child age 18 or older if he or she has a disability that started before age 22.
In some situations, your divorced spouse may qualify for disability benefits on your work record if he or she was married to you for at least ten years, is not married now, and is at least age 62.
Can I Reapply for Disability if My Case is Denied or if I Go Back to Work for a Year or More After Being Approved?
Yes.
There is no limit on the number of times you can apply for SSDI or SSI, though frequent denials may raise a red flag with the claim examiner or administrative law judge deciding your case.
Read my article for more information: Can I Reapply for Social Security Disability if My Claim is Denied?
How Do Other Payments Affect My Social Security Disability?
If you are receiving other government benefits, the amount of those benefits or your SSDI or SSI payments may be affected. For more information, read my articles:
Your Right to Legal Representation: How a Social Security Disability Lawyer Can Help You Win
You do not have to hire a disability attorney. But having one can make your life easier and increase the likelihood that you are approved for SSDI or SSI benefits.
As your disability lawyer, I will:
- Help you get medical records, employment documents, and other evidence.
- Contact your physician and medical providers to explain the Social Security Disability claim process and ask for opinion statements supporting your claim.
- Analyze your case under Social Security Regulations and 4th Circuit Case law to develop a theory and strategy that gives you the best chance of getting approved.
- Connect you with community organizations and other resources to get the help you need while your claim is pending.
- Accompany you to all interviews, conferences, and hearings with Social Security staff.
- Refer you to a vocational professional to develop evidence that you cannot to return to the labor market with your restrictions.
- Review your situation to determine if you have other legal claims arising out of your disability. For example, you may have a personal injury and tort claim based on someone else’s negligence, a workers comp claim if you were injured at work, or an employment law claim if your employer terminated you in violation of the ADA or FMLA.
- Help you and your witnesses prepare for trial.
- File all the appeals necessary in your case.
- Request that the SSA send you for a consultative examination if your doctors do not want to participate in the claim process.
- Request subpoenas to ensure the SSA has all the evidence needed to decide your claim.
- Obtain information and documents from your Social Security file.
- Present your case at trial, including an opening statement, closing statement, and the vocational expert’s cross-examination.
- Ensure that the SSA is paying you the correct amount of back pay and monthly benefits if your claim is approved.
- And more.
Call One of the Best Disability Lawyers in Virginia Today
As a Virginia disability attorney based in Richmond, I understand the impact a denied Social Security Disability claim could have on you and your family, especially when you have no other income. People often come to me when the SSA has already denied their application – despite supportive medical evidence and repeated work attempts – and they have nowhere else to turn.
The unfortunate truth is that most applications for Social Security Disability benefits are denied initially. And it is easy to become frustrated and overwhelmed at the thought of applying for and pursuing disability benefits. The SSA is an enormous bureaucracy, with laws, rules, regulations, guidelines, and policies that fill hundreds of thousands of pages of paper – and are always changing.
But you can take a deep breath. I’m ready to serve as your Virginia disability attorney and guide you through the process.
Getting disability benefits is not easy. But it is possible to apply for and receive SSDI and SSI benefits with the help of an experienced Social Security disability lawyer in Virginia – someone familiar with the rules, regulations, and local administrative law judges.
As your disability attorney, I will not let you take on the SSA alone. I am here to fight for you from start to finish. My firm will do everything it can to prove that you have a medical impairment – or combination of medical impairments – that prevents you from working. And we will represent you through all the steps of the disability appeals process if appropriate.
For a free consultation with one of the best disability attorneys in Virginia or to talk about whether you need a disability lawyer, call now: 804-251-1620. And remember: There is no fee unless I help you get SSDI or SSI benefits.
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