Listed below are a number of frequently asked questions that Senator Pryor's office receives regarding Social Security. If you can not find the answer to your question below, please contact Mark by email or call his staff in Little Rock at (501) 324-6336.

• What are the disability requirements for an adult?
• Why is there a five-month waiting period for disability benefits?
• How do I appeal a Social Security decision?
• How long does it take to receive a hearing decision, and how may I check the status of my case?

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Q: What are the disability requirements for an adult?

A: The Social Security definition of disability is a strict one. To be eligible for disability benefits, a person must be unable to do any kind of substantial gainful work because of a physical or mental impairment (or a combination of impairments);

• which has lasted or is expected to last for a continuous period of at least 12 months, or
• that is expected to result in death.

You should be familiar with the process we use to determine if you are disabled. It's a step-by-step process involving five steps. They are:

1. Are you working? If you are and the work you are doing is substantial gainful activity, the Social Security Administration (SSA) will find that you are not disabled regardless of your medical condition or your age, education, and work experience. In 2004 SSA will generally find that you are doing substantial gainful activity if your earnings average more than $810 a month. If you are not, SSA will go to the next step.
2. Is your condition severe? Your impairment or combination of impairments must interfere with basic work-related activities for your condition to be considered severe. If you do not have an impairment or combination of impairments that is severe, SSA will find that you are not disabled. If you do have a severe condition, SSA will go to the next step.
3. Does your impairment meet the severity of an impairment in the Listing of Impairments? The Listing of Impairments contains examples of impairments for each of the major body systems that SSA considers so severe as to prevent you from working. If your impairment’s severity meets the severity of an impairment on the list and you meet the duration requirement, SSA will find you disabled. If your condition is not on the list, the administration has to decide if your impairment or combination of impairments is of equal severity to an impairment on the list. If it is and you meet the duration requirement, SSA will find you disabled. If it is not, the department will go to the next step.
4. Can you do work you did in the past? If your condition is severe, but not at the same or equal level of severity as an impairment on the list, then SSA must determine if it prevents you from doing work you did in the last 15 years. If it does not, SSA will find that you are not disabled and your claim will be denied. If it does, your claim will be considered further.
5. Can you do any other work? If you cannot do work you did in the last 15 years, SSA then looks to see if you can adjust to any other work. SSA considers your age, education, and past work experience, and reviews the job demands of occupations as determined by the Department of Labor in making this determination.

If you cannot adjust to any other kind of work, and your impairment meets the duration requirement, SSA will find you are disabled and your claim will be approved. If you can do other work, even if that work involves different skills or pays less than your past work, SSA will find that you are not disabled and your claim will be denied.

You may obtain a copy of Disability Evaluation Under Social Security ("The Blue Book") (1/03; SSA Publication No. 64-039) which contains the medical criteria that SSA uses to determine disability. It is intended primarily for physicians and other health professionals.

The Disability Starter Kit will help you get ready for your disability interview or online application.

If you believe that you meet the qualifications for Social Security disability benefits, see instructions for applying for disability benefits at http://www.socialsecurity.gov/applyforbenefits/

Q: Why is there a five-month waiting period for disability benefits?

A: The philosophy behind the waiting period requirement is that this period is long enough to permit most temporary disabilities to be corrected or for the person to show signs of probable recovery within less than 12 months after the onset of disability. The intent is to help assure that Social Security disability benefits are provided only to persons with long-term disabilities and to avoid duplicating disability payments by private disability plans and employer sick-pay plans during the early months of disability. Originally, the disability waiting period requirement was six months, but the 1972 Social Security Amendments reduced the waiting period to five-months to help diminish financial hardships by individuals who might have little or no savings or other resources to fall back on during the early months of a long-term disability.

To see the regulation on the five-month waiting period, see http://www.socialsecurity.gov/OP_Home/cfr20/404/404-0315.htm

Q: How do I appeal a Social Security decision?

A: The Social Security Administration wants to be sure that every decision made regarding a Social Security or Supplemental Security Income claim is correct. SSA considers all the information in a claim before a decision is rendered regarding eligibility or benefit amount.

If the Social Security Administration decides a person is not eligible or is no longer eligible for benefits, or that the amount of payment should be changed, it sends a notice explaining the decision. If an individual disagrees with the decision, they can request a review. This is called an "appeal." The request for an appeal must be made in writing within 60 days (plus 5 days mailing time) from the date of the notice they receive. Under certain conditions, an extension of this time frame can be granted.

There are four levels in the appeals process. They are:

RECONSIDERATION: A reconsideration is a complete review of the claim by someone other than the individual who made the original decision. All evidence, plus any additional evidence submitted, will be reevaluated and a new decision will be rendered. If an individual disagrees with the reconsidered decision, they can choose to go to the next level of the appeals process.

HEARING: A hearing will be conducted by an Administrative Law Judge (ALJ). The individual and/or their representative may come to the hearing and present their case in person. The ALJ will evaluate all the evidence on record, plus any additional evidence brought to the hearing, and will render a decision. A "Notice of Decision" will be issued to the individual and their representative. If they disagree with the hearing decision, they can choose to go to the next level of appeal.

APPEALS COUNCIL: The Appeals Council may decide to issue its own decision, remand the case to the ALJ to issue another decision, or allow the ALJ's decision to stand. The appellant will receive a copy of the Appeals Council's action.

FEDERAL COURT REVIEW: If the claimant disagrees with the Appeals Council's action, he or she has the right to file a civil suit in Federal District Court.

Many people handle their own appeals, but they can choose an attorney or non-attorney to help them. Your representative cannot charge or collect a fee from you without first getting written approval from Social Security. For a necessary form for Appointment of Representative, see http://www.socialsecurity.gov/online/ssa-1696.html

For more information, you may call the SSA toll-free number, 1-800-772-1213, and ask for our fact sheet called "The Appeals Process," publication number 05-10041, and "Social Security And Your Right to Representation," publication number 05-10075. You can also access publications on the Internet at: http://www.socialsecurity.gov/pubs/englist.html

All requests for appeals should be sent to your local office; you can find the address of your local office at http://www.socialsecurity.gov/locator/

Q: How long does it take to receive a hearing decision, and how may I check the status of my case?

A: The social security Administration will contact you if any additional information is necessary to process the Administrative Law Judge's decision. The toll-free number personnel can assist you in determining the status of your appeal at (800) 772-1213. It generally takes approximately 60 days to process the judge's decision.

 

Information compiled from the Social Security Administration website >