Social Security FAQs

Q: How does Social Security decide if I am disabled?

A: Disability under Social Security for an adult is based on your inability to work because of a medical condition. To be considered disabled:

  • You must be unable to do work you did before and we decide that you cannot adjust to other work because of a medical condition.
  • Your disability must last or be expected to last for at least one year or to result in death.

Social Security pays only for TOTAL disability. No benefits are payable for partial disability or short-term disability.

For adults, the Social Security Administration (part of the federal government) uses a five-step evaluation process to decide whether you are disabled under Social Security. Here is a summary of that process:

They first review your application to make sure you meet some basic requirements for disability benefits. For example, they check whether you worked enough years to qualify. Also, they look at any current work activities. If you meet the basic guidelines, your application will be sent to the Disability Determination Services office in Madison.

This Wisconsin state agency conducts the disability evaluation at the beginning of your claim. Doctors and disability specialists in the state agency ask your doctors for information about your condition. They will use the medical evidence from your doctors and hospitals, clinics or institutions where you have been treated and all other information. They will ask your doctors:

  • What your medical condition is;
  • When your medical condition began;
  • How your medical condition limits your activities;
  • What the medical tests have shown; and
  • What treatment you have received.

They also will ask the doctors for information about your ability to do work-related activities, such as walking, sitting, lifting, carrying and remembering instructions. Your doctors are not asked to decide if you are disabled.

The state agency staff may need more medical information before they can decide if you are disabled. If more information is not available from your current medical sources, the state agency may ask you to go for a special examination. If the Social Security Administration asks for such an evaluation, they will pay for the exam and for some of the related travel costs.

Q: How do they evaluate my disability claim?

A: A five-step process is followed to decide if you are disabled. These are the five \
steps:

  1. Are you working?
    If you are working and your earnings average more than a certain amount each month, we generally will not consider you disabled. The amount changes each year. For the current figure, see the annual Update (Publication No. 05-10003). If you are not working, or your monthly earnings average the current amount or less, the state agency then looks at your medical condition.
  2. Is your medical condition "severe"?
    For the state agency to decide that you are disabled, your medical condition must significantly limit your ability to do basic work activities-such as walking, sitting and remembering-for at least one year. If your medical condition is not that severe, the state agency will not consider you disabled. If your condition is that severe, the state agency goes on to step three.
  3. Is your medical condition on the List of Impairments?
    The state agency has a List of Impairments that describes medical conditions that are considered so severe that they automatically mean that you are disabled as defined by law. If your condition (or combination of medical conditions) is not on this list, the state agency looks to see if your condition is as severe as a condition that is on the list. If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide that you are disabled. If it does not, the state agency goes on to step four.
  4. Can you return to the work you've done earlier (within the last 15 years)?
    At this step, the state agency decides if your medical condition prevents you from being able to do the work you did before. If it does not, the state agency will decide that you are not disabled. If it does, the state agency goes on to step five.
  5. Can you do any other type of work?
    If you cannot do the work you did in the past, the state agency looks to see if you would be able to do other work. It evaluates your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work. If you cannot do other work, the state agency will decide that you are disabled. If you can do other work, the state agency will decide that you are not disabled.

Q: How do I apply for disability benefits?

A: There are two ways that you can apply for disability benefits. You can:

  1. Apply at www.socialsecurity.gov; or
  2. Call their toll-free number, 888-305-2099 , to make an appointment to file a disability claim at your local Social Security office or to set up an appointment for someone to take your claim over the telephone. The disability claims interview lasts about one hour. If you are deaf or hard of hearing, you may call a toll-free TTY number, 888-305-2099 , between 7 a.m. and 7 p.m. on business days. If you schedule an appointment, a Disability Starter Kit will be mailed to you. The Disability Starter Kit will help you get ready for your disability claims interview. If you apply online, the Disability Starter Kit is available at www.socialsecurity.gov/disability.

Q: What if my claim is denied?

A: If your application for disability benefits is denied a first time, and you believe you ARE disabled, you should continue the claim by asking for what is called "Reconsideration" (some call this an appeal).

To do this, within 60 days of the decision denying you benefits, you must file a simple one-page form called "Request for Reconsideration" with your local Social Security office. Sometimes a blank Reconsideration form is included with the decision. If not, you can print it from online, or obtain this "Request for Reconsideration" form from the Social Security office.

By filing this "Request for Reconsideration" form within 60 days, you keep your claim active and moving forward.

After you ask for reconsideration, you will wait a number of weeks while another analyst with the state agency reviews your claim file. Your claim will either be granted or denied at this "reconsideration" stage.

Then, if your claim is denied a SECOND time, you should contact an attorney. If you wish to continue to seek disability benefits, you will have to file a Request for Hearing before an Administrative Law Judge. Now you will have to prepare for such a hearing before an Administrative Law Judge employed by the Social Security Administration.

Having an attorney assist at this stage is strongly recommended.

Q: What is the difference between Social Security disability and SSI disability?

A: The Social Security Administration is responsible for two major programs that provide benefits based on disability: Social Security Disability Insurance (SSDI), which is based on prior work under Social Security, and Supplemental Security Income (SSI). Under SSI, payments are made on the basis of financial need.

In other words, SSDI is an insurance benefit provided by the federal government, based on a workers earnings and contributions into the system. By contrast, SSI is essentially a disability welfare program, for which only people with very limited assets will qualify for.

Social Security Disability Insurance (SSDI) is financed with Social Security taxes paid by workers, employers, and self-employed persons. To be eligible for a Social Security benefit, the worker must earn sufficient credits based on taxable work to be "insured" for Social Security purposes. Disability benefits are payable to blind or disabled workers, widow(er)s, or adults disabled since childhood, who are otherwise eligible. The amount of the monthly disability benefit is based on the Social Security earnings record of the insured worker.

Supplemental Security Income (SSI) is a program financed through general revenues. SSI disability benefits are payable to adults or children who are disabled or blind, have limited income and resources, meet the living arrangement requirements, and are otherwise eligible. The monthly payment varies up to the maximum federal benefit rate, which may be supplemented by the State or decreased by countable income and resources.