SSDI attorneys handle a variety of cases pertaining to disability benefits and claim denials. In Illinois, a person who develops a disability caused by some type of illness or injury is entitled to file a claim for disability benefits through two federal programs, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both programs provide assistance to people with disabilities, but they have different qualification requirements for approval.
Understanding SSDI Eligibility in Illinois
Social Security disability insurance (SSDI) pays benefits to Illinois workers who sustain a disability and their family members as long as the worker has a credible work history, has accumulated a sufficient number of work credits through employment, and has worked long enough to pay Social Security taxes. In Illinois, Social Security disability benefits are funded to recipients through Social Security taxes that are paid by Illinois workers, employers, and self-employed individuals.
What Is the Criteria for Qualifying for SSDI Benefits in Illinois?
To qualify for SSDI benefits in Illinois, it is a requirement that a worker must earn sufficient work credits based on taxable work history. If SSDI benefits are approved, they can be payable to (1) disabled or blind workers under 65 years old, (2) adults disabled since childhood (3) the worker’s spouse or widower, and (4) the worker’s children. The amount of monthly disability benefits is based on the worker’s Social Security earnings record during employment. After a worker receives SSDI benefits for two years, the worker will automatically get Medicare coverage.
In some cases, workers who qualify for SSDI benefits can also collect SSI benefits simultaneously, if they meet the requirements for SSI. This may occur when a worker’s SSDI benefit payments are low or when the worker has not worked much in recent years. If a worker’s SSDI benefit payment is less than $934 per month, the worker can get an additional SSI payment to raise the total monthly benefit payment. For instance, if the monthly SSDI benefit payment is $450, and the worker has no other source of income, he or she can receive a monthly SSI benefit payment of $504 to raise it to the allowable monthly benefit payment of $954.
In Illinois, whether a worker applies for SSDI or SSI, the definition of a medical disability is the same for both programs. When an applicant files for disability benefits, it is not necessary to request SSDI and SSI concurrent benefits. If the applicant’s income, including the anticipated SSDI payment, is less than the federal benefit rate, the Social Security Administration (SSA) will automatically consider the application for SSI. If the application is approved, the applicant will receive two different checks, one for SSDI and one for SSI, scheduled on different payment dates.
Common Reasons for Denial of SSDI Claims
When filing for SSDI in Illinois, it’s important for an applicant to understand how to get approved for disability. Unfortunately, about 60% to 70% of initial disability applications received by the Social Security Administration each year are denied. The most common reasons for denied claims include:
- Errors or missing information on claim forms
- Lack of sufficient medical evidence to prove a disability
- Lack of response to messages from the SSA and DDS
- Not following through with a consultative exam
- Not adhering to a medical treatment plan
- Illness or injury that’s not considered severe enough
Types of Cases Handled by SSDI Attorneys in Illinois
Eligibility rules for Social Security’s disability program differ from the rules of private insurance plans and other government agencies. Unlike workers’ compensation benefits and veterans’ benefits, the Social Security Administration (SSA) does not provide temporary or partial disability benefits. To receive SSDI benefits, a person must meet the definition of disability under the Social Security Act, which states that a person is considered disabled if he or she can’t work due to a severe medical condition that has lasted, or is expected to last, at least one year or result in death.
Under SSA regulations, a person’s medical condition(s) must prevent that person from doing work that was done in a present or past job, and it must prevent them from adjusting to other types of work. In Chicago, Social Security disability attorneys commonly handle disability claims related to health conditions listed in the SSA Blue Book, a list of impairments that qualify for SSDI benefits:
Physical Disabilities
The Blue Book listings for physical disabilities are extensive, but usually fall under specific categories. These categories include a variety of blood disorders, cardiovascular disorders, congenital disorders, digestive disorders, immune system disorders, musculoskeletal disorders, respiratory disorders, skin disorders, senses and speech disorders, and cancer.
Mental Health Disabilities
The Blue Book listings for mental health disabilities are grouped into 11 categories. These categories include anxiety and obsessive-compulsive disorders, autism spectrum disorders, depressive and bipolar disorders, eating disorders, neurocognitive and developmental disorders, personality and impulse-control disorders, schizophrenia and psychotic disorders, and trauma and stress-related disorders.
Chronic Illnesses
The Blue Book defines a chronic illness as one that lasts for a long period of time and typically can’t be cured, although it can be managed and treated. Not every person with a chronic illness is recognized as disabled. In some cases, the impairments caused by the illness can reach the level of disability because the illness prevents the person from working and participating in daily activities. In Illinois, SSDI attorneys often handle disability claims related to chronic illnesses that prevent regular employment.
Neurological Disorders
The Blue Book listings for neurological disorders are evaluated on both medical and nonmedical evidence. These disorders often cause impairments in communication skills, motor functions, and physical and mental functions. Common neurological disorders that qualify for SSDI include: Benign brain tumors, Cerebral palsy, Multiple sclerosis, Muscular dystrophy, Parkinson’s disease, spinal cord disorders, and traumatic brain injury.
What Is the Role of SSDI Attorneys in the Application Process?
Due to strict federal regulations imposed by the Social Security Administration, filing an SSDI or SSI disability claim can be a complicated and lengthy process. An Illinois disability lawyer can provide valuable help when filing for SSDI benefits. SSDI attorneys can oversee the SSDI process from start to finish, ensuring the following:
- All requested information is included in the application
- Correct personal and work-related information is provided
- Documented medical evidence supports the disability claim
- The application is submitted to the SSA within the required timeline
- Followup with SSA officials
- An appeal is filed if the claim is denied
Initial Application Assistance
Many disability claims are denied due to incorrect or missing information on the initial application. A disability lawyer can ensure that the application contains correct personal information, work-related information, and detailed medical information about injuries, illnesses, and health conditions.
Appeal Representation
The SSA denies many applications for disability benefits, often because there is insufficient medical evidence to prove a disability claim. If the SSA denies a claim, an Illinois disability lawyer can be a helpful guide to the SSDI appeal process. When a claim is denied, it’s always better to file an appeal rather than to wait and reapply with a new claim. More than 50% of disability appeals are successful. There are three different appeal processes:
Request for Reconsideration
When the SSA denies a claim, they send the applicant a notice. The applicant then has 65 days from the date on the notice to make a written “Request for Reconsideration.” During this stage, the SSA will ask the applicant to submit to further medical examination. SSDI attorneys can ensure that the SSA receives all information regarding doctor’s visits, treatments and medications, and doctors and hospital records. They can also follow up with the SSA to ensure all required information is received.
Request for Administrative Legal Hearing
If a claim is denied after Reconsideration, SSA will send the applicant a second notice. The applicant then has 65 days from the date on the notice to make a written request for a hearing before an administration legal judge (ALJ). ALJs are administrative judges who are hired by the SSA to conduct legal hearings. During the hearing, the ALJ may arrange for vocational and/or medical experts to attend the hearing and testify on pertinent matters.
Request for Review by the Appeals Council
If an ALJ decision is unfavorable, an applicant or his or her SSDI attorney can then file one more appeal with the Appeals Council. The applicant then has 65 days from the date of the ALJ’s notice to make a written request for review by the Council. At this stage, a review is limited. Reasons for a review by the Appeals Council often include errors made by the ALJ, an ALJ decision not supported by substantial evidence, and an abuse or discretion in the ALJ hearing process.
