Q&A: 24 things to know about SSDI

We hosted a webinar in partnership with Allsup on what you need to know about Social Security Disability Insurance (SSDI) and colon cancer. Here are 24 of your questions from the presentation answered by our experts. For more information, call our free Helpline at (877) 422-2030.

I have neuropathy in both my hands and feet and I am still being denied.

If you have been denied, you have the right to appeal. For more information on the appeal process visit http://www.allsup.com/about-ssdi/ssdi-process. You can also call Allsup’s Disability Evaluation Center at (888) 841-2126 if you would like help with your appeal.

I have been a teacher in Texas for the past eight years and we do not pay SS tax, but I have paid SS in past 10 years. Am I eligible?

If you have paid FICA taxes for at least five out of the last ten years, you may be eligible for SSDI. For more information on work history requirements, visit http://www.allsup.com/about-us/news-room/current-news/documenting-work-history-important-when-applying . If you meet the basic eligibility criteria, and are trying to determine whether or not you should file for SSDI benefits, please call Allsup’s Disability Evaluation Center at (888) 841-2126. Basic SSDI eligibility criteria includes:

• You must have worked and paid into the program (payroll taxes) for five of the last 10 years preceding your disability.
• You must also have been disabled before reaching full-retirement age (65-67).
• You must meet Social Security's definition of disability (condition that lasts/is expected to last 12 months or more or is terminal). However, if you have not worked and paid FICA in the last 8 years, your date last insured for disability benefits will be in the past. You would have to be found disabled prior to that date and continuing. You have stated you have been teaching for the last 8 years. Therefore, it is not likely you were disabled prior to your date last insured for disability benefits as you have been engaging in substantial gainful activity after that date.

You mentioned that metastatic colon cancer is automatically approved.  Is that true even if the person remains gainfully employed, or do they also still need to meet those 5 adjudication levels?

In the case of metastatic colon cancer, the Social Security Administration’s 5-step sequential evaluation process would stop at step 3 – a medical listing would be met (13.18C) and the case would be awarded. There is no need for steps 4 and 5 of the sequential evaluation process. 

Social Security called me to inform me of the award and I believe the gentleman said they would review my case in 1 year, but all the literature that came in the mail indicated my case would be reviewed in 5-7 years. Do they review cases after 1 year ?

If you have a condition that is likely to improve, Social Security may require that your case be reviewed after a year. A medical review determines if an individual is meeting the medical requirements to collect disability. If the person does not meet the medical requirements, SSA may stop the disability benefits. SSA must determine there has been “medical improvement related to the ability to work.” Medical improvement alone does not constitute a basis for the cessation of benefits.

How often SSA reviews an individual’s case depends on whether their condition is expected to improve. If medical improvement is:

• “Expected,” case will normally be reviewed within six to 18 months after benefits start.
• “Possible,” case will normally be reviewed no sooner than three years.
• “Not expected,” cases will normally be reviewed no sooner than five to seven years.

Individuals who participate in the Ticket to Work program are exempt from CDRs.

My wife's payment is very small, is she eligible to receive 50% of my payment ?

She may be eligible to receive 50% of your payment if you are collecting Social Security benefits (disability or retirement), you have been married for at least a year and she is at least 62 years old.

I am inquiring about the pros and cons of filing for SSDI and a big factor is financial concerns with medical bills.

If your husband is not able to work, or anticipates not being able to work for at least 12 months or more, I encourage you to file for SSDI benefits as soon as possible. For detailed information on the full range of SSDI benefits, including access to Medicare, please visit https://www.allsup.com/about-ssdi/why-you-want-ssdi

Many people lose their employer-provided health insurance when they stop working. Allsup provides healthcare insurance assistance to all of our SSDI claimants.

To obtain an SSDI eligibility screening, visit Expert.Allsup.com or call (888) 841-2126.

I’ve had a colostomy since 1984.  I had very advanced colon cancer.  Treatments caused long term damages that complicate the application of my pouch. I never know how many I will use in one day. Medicare limits the quantity I am allowed. I should have applied for disability in 1984. The judge told me this after I finally applied. Paying for my supplies and treatments is difficult. Please address these problems.

Even with Medicare coverage, many individuals find paying for prescriptions and medical supplies difficult. There are programs that may be able to assist you. 

Can you get disability for server reaction to Oxaliplatin chemotherapy drug?

If the reaction to treatment, alone, or in combination with other factors, precludes you from engaging in substantial gainful activity (earning more than $1,090 a month) for at least 12 months then you may be eligible for SSDI if you are currently and fully insured. Please visit Expert.Allsup.com or call  Allsup’s Disability Evaluation Center at (888) 841-2126 to help you determine your eligibility.

How quickly can SSDI be processed? How long must you be out of work? My husband's employer has kept him on, even though he last billed any hours in November and is now on hospice. Yesterday they dropped him to a portion of his salary but he still has insurance. He didn't make much before so we're not sure how to determine what to do. We don't want to lose his insurance and as he is on hospice we certainly don't want to lose his life insurance through his employer. Are there provisions with SSDI for this?

Initial SSDI applications, on average, are decided in about 109 days. There are ways to qualify for expedited review, such as in the case of a terminal condition. To qualify for SSDI, you must not be able to work for 12 months or more or have a terminal condition. Even if your husband was collecting a paycheck, if he was not actually performing work due to his condition, SSA would not count that as working. I encourage you to call Allsup’s Disability Evaluation Center at (888) 841-2126 to help you determine your SSDI and health insurance options. Allsup’s Certified Application Counselors help many claimants find no-cost or affordable health insurance on the Marketplace Exchange.

What happens to my SS check after my doctor releases me to go back to work?

If and when you return to work, you should notify Social Security. If you anticipate returning to work, I encourage you take advantage of the Ticket to Work program, which offers support and resources to help you find and maintain employment while keeping your SSDI benefits, and also exempts you from a Continuing Disability Review (CDR). If you return to work, are making more than $1,090 a month, and are not in the Ticket to Work program, your SSDI benefits may be terminated.

Is stage IV colon cancer an automatic for meeting criteria? Is it retroactive payments?

At stage IV, it is likely that an eligible applicant will be approved for SSDI, in that it is probable that the individual will not be able to work for 12 months or more, or be terminal. However, each case is unique. SSA will follow their five-step sequential evaluation for each case. SSA will pay retroactive benefits based on the “date of onset”. That is the date you could no longer work due to disability, minus the five full calendar month waiting period. 

I have not worked in 10 years due to our children having special needs, yet I was fully vested before then. Can I collect SSDI?

Unfortunately, the answer is no. You must be both currently and fully insured. Usually this means you have worked and paid FICA taxes for five out of the last 10 years.

Does a genetic condition such as Lynch Syndrome preclude you from SSDI or have any special considerations, for colon cancer survivors with this condition?

No genetic conditions will preclude you from being eligible for SSI or SSDI.

Since it takes so long, are you able to collect for the lost time? I was diagnosed last January and continue to have major issues after my surgeries for colon cancer. Do I have a chance here?

SSA will pay retroactive benefits based on the “date of onset”. That is the date you were no longer able to work due to disability, minus the five full calendar month wait period. If you are currently not working, or expect not to be working for 12 months or more, please call Allsup’s Disability Evaluation Center at (888) 841-2126 to help you determine whether or not you should apply for SSDI benefits.

I am a colon cancer stage 3 survivor. I tried all this and was so sick and just dropped out of the rat race for help...I managed with the love of my family to survive financially but I did work enough to keep my medical insurance and my job. I had a colon resection and ostomy chemo radiation then colostomy reversal and returned to work when my bowels were minimally controllable. I am working but am off many days because of the after effects of chemo radiation. I have a hard time working. I am sick many days and just have to stay in bed. I don't know what to do but I am feeling like I can't work as I used to. I applied for help and was rejected...what can I do now? I live in Maryland.

Unfortunately, many individuals who are deserving and need SSDI benefits abandon the application process due to the same frustrations that you faced. Please call  Allsup’s Disability Evaluation Center at (888) 841-2126 to help you determine your next steps. Depending on when your claim was denied, you may be able to appeal or you may want to refile your claim. Keep in mind that if you are still working, even part-time, SSA may deem that you are able to engage in substantial gainful activity (earn more than $1,090 per month), and thus not eligible for SSDI benefits.

What if you are self-employed and haven't paid for SSDI for over ten years? Are you “out of luck”?

Unfortunately, if you have not paid FICA taxes for the past 10 years, you are not currently insured for SSDI benefits.

I have stage III colon cancer and have started the process on my own. My illness started in June of 2014 but not diagnosed until December 2014.

Best wishes to you. If you are denied and have to appeal, please call Allsup’s Disability Evaluation Center at (888) 841-2126 to help you determine your next steps. If you would like help at this time, Allsup is able to provide that assistance. You do not have to wait until you receive a denial of benefits. It has been our experience, and confirmed by SSA reports, that having representation early in the process is beneficial to a claimant.

I was diagnosed with colorectal cancer last December 2013 and had the surgery in May 2014. What can I get if I have no income?

If you have not been able to work/will not be able to work for at least 12 months or more, and you meet the basic SSDI eligibility criteria, you may be eligible for cash benefits starting five full calendar months from the date you were no longer able to work. Call Allsup’s Disability Evaluation Center at (888) 841-2126 to help you determine your eligibility.

Can spouses receive financial support if full-time caregivers?

Social Security does not provide financial support for caregivers. If the parent, spouse, or other person you're caring for is eligible for Medicaid, its Cash and Counseling program, available in some states, can provide direct payments that could go to you. Visit http://www.bc.edu/schools/gssw/nrcpds/cash_and_counseling.html/   for more information. A few other states have similar programs for low-income seniors, even if the person receiving care doesn't quite qualify for Medicaid. Also, if the person you're caring for has long-term care insurance that includes in-home care coverage, in some cases those benefits can be used to pay you.

I was in that 1,000 that got denied. Fortunately, I was approved during the hearing level with representation. Also, the representative at the hearing level cost me 33.33%.

Per SSA guidelines, the fee for SSDI representation is 25% of a one-time retroactive payment, not to exceed $6,000. However, some representatives will charge for out of pocket expenses. 

According to the Code of Federal Regulations, colon cancer is almost an automatic approval for SSDI. Why are people having so many problems and getting denied? Are benefits paid for 36 months after the patient is deemed in remission?

Colon cancer is only an “automatic” approval when it meets the criteria established in Medical Listing 13.18. Many individuals with colon cancer do not meet the established criteria. If an individual does not meet the established criteria (Medical Listing 13.18) for colon cancer, then the individual’s claim is evaluated based on his/her residual functional capacity. This takes into consideration the effects of treatment which could be disabling. There is no set timeframe for benefits, e.g. for 36 months after remission. Once awarded, SSDI benefits continue to be paid unless there is medical improvement or work activity that causes the individual to no longer be eligible for benefits.

My condition has improved and I am trying to open up a small business and will not earn an income for a while. When do I need to report to SS that I have returned to work? Am I allowed to make a salary?

You should notify Social Security of any return to work attempts and take advantage of the Ticket to Work program. You are allowed to take a salary. Many vocational rehabilitation (VR) agencies and employment networks (ENs) promote entrepreneurship. Once you and your VR or EN agree to your self-employment goal and plan, they can, for example, help you with business development and writing a business plan, help you find funding to start your business, provide guidance and support for you in your business, and help you develop supports and accommodations. An important aspect of the Ticket to Work program is Social Security will do no continuing disability review (CDR) on your case while you are exercising the Ticket to Work.  

As a divorced spouse, could I have my SSDI payment reconsidered and re-evaluated on my ex-husband's income?

Yes. If you have reached age 50, but not age 60 and were married at least 10 years, you may be eligible for SSDI benefits on your ex-spouse’s work record.

For individuals who are denied the first time, it can mean loss of homes in addition to loss of income as people try to pay medical bills, insurance premiums, and general costs of living. What do you recommend people do? This is where we see people losing housing due to medical debt because they have no income to pay bills.

Unfortunately, you are correct. Many individuals endure significant financial, physical, emotional and psychological hardship due to disability and loss of income. 

You make it sound like a loss. My doctor says it’s not this bad. I'm 55 stage 4a in California. How will retirement funds effect my claim?

Income does not affect SSDI claims, so any retirement income would not affect the adjudication of your claim. Filing for SSDI may protect your Social Security retirement benefits. When you reach retirement age, SSDI ends and you transition to Social Security retirement benefits. Social Security disability entitlement "freezes" Social Security earnings records during your period of disability. Because the years in which you collect SSDI benefits are not counted when computing future benefits, your Social Security retirement benefits may be higher than if your earnings were averaged over a greater number of years.

If you are in need of support, please contact our free Helpline at (877) 422-2030. We’re here to help.