Disability Benefits Basics

Unexpected and severe injuries can happen to anyone. A car accident or a serious injury at work may cause temporary impairment or be life-changing. Medical bills, time off work, and rehabilitation can affect every aspect of your and your family's lives.

According to the Social Security Administration (SSA), one-quarter of workers will experience a disability before reaching retirement age. For those who suffer from injury or illness and can't work, disability insurance can provide an essential source of income.

Dealing with disability insurance can be challenging, given the technical, legal, and medical issues involved. The requirements of insurance policies and the possibility of denial also make it difficult.

In this section, you'll find resources to help you deal with issues related to disability insurance. You can learn about the difference between long-term and short-term disability insurance. You can also learn about Social Security disability benefits, different definitions of disability, how to apply for benefits, and what to do if your disability claim gets denied.

Types of Disability Benefits

There are several types of disability benefits to help with your financial needs while you're out of work due to injury or disability. Eligibility for coverage depends on the kind of benefit, your age, whether your injury happened at work, and the severity or longevity of your injury or illness.

Workers' compensation. Workers' compensation often covers a work-related injury. All states, except Texas, require employers to provide worker's comp benefits to salaried employees. These benefits usually include partial salary compensation and payment of medical bills and rehabilitation therapy. A private insurance company manages these benefits, and the requirements vary by state. Check with your state's workers' compensation board for more information.

Short-term disability insurance. Short-term disability coverage protects you when injured or temporarily disabled by a non-work-related event. This coverage is a benefit you elect and pay for through your job or a private company, though a few states offer this coverage for workers. Short-term disability generally begins paying out for a personal injury claim quickly, but as the name suggests, your benefits are for a limited time.

Long-term disability insurance: Long-term disability is also a benefit offered by an employer. You elect and pay for the coverage. Long-term disability won't begin paying for at least six months after your injury or illness. But, it can pay out much longer, with some policies covering you until retirement age.

Social Security disability insurance (SSD or SSDI): If your injury has kept you from work for one year, you could qualify for Social Security disability benefits. SSDI benefit eligibility has a disability and work history criteria. You can meet the work credit rule if you work for five to 10 years and have paid into Social Security. Meeting the disability is more complicated. There is a "blue book" list of injuries and illnesses that generally qualify automatically. You are also eligible if you show that your disability prevents you from working. The SSA will enroll you in Medicare after getting benefits for two years.

Supplemental Security Income (SSI): The SSI program provides monthly benefits to qualifying applicants. SSI is a need-based program available to blind or disabled people whose disability will affect their ability to work for more than a year or will result in death. To be eligible, you must meet specific criteria, such as age or disability. You must have limited income and meet asset limits. You can check your SSI eligibility on the Social Security Administration website.

Qualifying for Disability

If you don't have private disability insurance, you may be eligible for SSDI or SSI benefits. Specific legal requirements govern all aspects of SSD and SSI. These include filing claims and challenging a denial to qualify for benefits.

For SSDI and SSI, you must meet the Social Security Administration's definition of disability. Not all disabilities or injuries will make you eligible. You need medical proof of your condition, that you cannot work, and that you meet other requirements of each program. For example, you must meet work requirements to get SSDI benefits. For SSI, you can't exceed $1,913 per month, pre-tax, wages, self-employment income, or $2,827 monthly for a couple.

If you file a lawsuit over a personal injury that left you disabled, you should know that any personal injury settlement amount can affect your SSI payments or Medicaid eligibility.

Applying for Benefits

Processing a disability claim can take a long time. File your application early to get SSDI or SSI payments as soon as you're eligible. The SSA has compassionate allowances, which remove waiting times from certain conditions, giving you access to your benefits sooner. Examples include specific cancers or Lou Gehrig's disease (ALS).

If you are applying for SSI or SSDI, you must provide detailed information about your disability. Before you begin your application, ensure you have:

• Your medical care providers' names and phone numbers
• A list of your medications
• A list of medical tests given
• Your Social Security number
• Information about your last two years of employment
• Banking account details

You can apply for SSDI or SSI benefits online or at your local Social Security office.

Appealing a Denial

Certain conditions will generally meet approval for SSDI benefits. SSI should get approval if you honestly meet the criteria and have not tried to hide assets. If your disability claim gets initially denied, it can feel discouraging. But, Social Security disability insurance and SSI allow you to appeal a denial several times.

The SSA has four levels of appeal:

1. First, you should request reconsideration of the SSA's decision. You can fill out a request online or at your local SSA office.
2. If you disagree with the SSA's follow-up response, request a hearing with an administrative law judge.
3. If denied again, request that the Appeals Council review your case and a judge to review it.
4. Finally, you may file a federal district court action in the appropriate U.S. District Court.

Pay attention to why the SSA rejected your claim. Provide any supporting information required to improve your case. During your appeal, make sure to note important deadlines and other requirements. Consider seeking legal advice during the appeal process. Find a local legal clinic or law school to locate low- to no-cost legal representation.

How an Attorney Can Help

Disability benefits are an important lifeline for those who can't work due to illness or injury. An experienced disability attorney can work with you to assemble the strongest case before you file a claim. Your attorney can also determine if extra medical testing will benefit you. Seek legal advice if the SSA denies your claim or your benefits get lowered or terminated. A disability lawyer can help you avoid financial hardship and get the coverage you deserve.

If your disability is the result of another person's negligence, speak with a personal injury attorney right away. A personal injury lawyer can evaluate your situation. Your attorney can help you fight for a settlement if you have a personal injury case.