- Social Security Disability Insurance
- Supplemental Security Income
- Illinois SSI Supplemental Payment
- Appealing an SSA Decision
If you are unable to work or you take unpaid medical leave as a result of your cancer diagnosis, you may be forced to find alternative sources of income. One option may be to use disability insurance. Disability insurance is insurance that provides employees with some income (typically 50% to 70% of your salary) while they are unable to work as a result of a medical condition.
A. Illinoisans may have access to individual, employer-sponsored, and federal disability insurance plans. An employer-sponsored plan is one that your employer provides as part of your employee benefits package. An individual plan is one that you purchase directly from an insurance company. Both individual and employer-sponsored plans can be short-term (typically six months to one year) or long-term (typically longer than one year).
Keep in mind that each type of disability insurance has a different definition of disability. Even if you have completed treatment, you may be experiencing side effects from the treatment or have other medical conditions that are keeping you from being able to work. If you have one of these plans, you may be entitled to some retroactive benefits if you are already back at work. Even if you have completed treatment, you may be able to get reimbursed for things that you paid for while in treatment. Contact your employer’s human resources representative or the insurance company for more information about your specific plan. Some of the questions you may want to consider asking include:
- May I get a copy of the policy itself?
- What is the policy’s definition of disability?
- Are there specific procedures I need to follow to submit a claim for a disability?
- Are there any pre-existing condition exclusions that I need to be aware of?
- How long am I entitled to receive benefits?
- How much monthly should I expect to receive from this policy?
- My disability is likely going to be long-term (e.g., last a year or longer). Does this policy require that I also apply to the federal Social Security Disability Insurance (SSDI) program? If so, when do I need to do that by?
There are also two federal long-term disability programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Although these programs are slightly different, both are administered by the Social Security Administration (SSA) and are based on your inability to work as a result of a long-term (at least one year) disability.
Social Security Disability Insurance
SSDI pays benefits to you and certain members of your family if you are insured, meaning that you worked long enough and paid into the Social Security retirement system through Social Security taxes.
To be insured and, therefore, eligible for this program, you must have enough credits. Generally, individuals older than thirty-one years old will need forty credits, twenty of which were earned in the ten years immediately before your disability begins. In 2015, you earn one credit for each $1,220 of wages or self-employment income. When you have earned $4,880, you have earned your four credits for the year.
However, if you become disabled before you are twenty-four years old, you may qualify for SSDI if you have earned six credits in the three-year period ending when your disability starts. If you become disabled between the ages of twenty-four and thirty-one, you may be eligible for SSDI benefits if you have credit for working half the time between age twenty-one and the time you become disabled. For example, if you become disabled at age twenty-seven, you would need credit for three years of work (twelve credits) in the past six years (between twenty-one and twenty-seven years old).1
In addition to working enough in the past, you also must meet the Social Security Act’s definition of a disability2, which means the following:
- You cannot do the work that you did previously because of your disability.
- You cannot adjust to other work because of your disability.
- Your disability is expected to last for at least one year or result in death.
The SSA uses a five-step process to determine if you have a disability. It will first look to see if you have substantial gainful employment. In 2015, that means you are working and earning more than $1,090 a month. If you are not earning more than $1,090 a month, the SSA will then look to see if your condition is severe enough that it interferes with basic work-related activities. If your condition interferes with basic work-related activities, the SSA will then look to see if your condition is on the compassionate allowances list—a list of impairments that are deemed so severe that you will automatically be considered disabled. The list of impairments can be found at www.ssa.gov/disability/professionals/bluebook/listing-impairments.htm. Next, the SSA will determine if your condition is so severe that you cannot do the work you did previously. If you can do that work, you will not be eligible for SSA benefits. If you cannot do the work you did previously, the SSA will look to see if there is any other type of work that you can do considering your medical conditions, age, education, past work experience, and any transferable skills you may have. If you cannot adjust to other work, your SSDI claim will be approved.
If your claim is approved, then you will begin to receive payments, starting with the sixth full month after the date your disability was determined to have begun. For example, you have a disability that began on January 1, 2014, and you are approved for SSDI benefits on September 1, 2014. Your first check would arrive in February 2015 and would include first month’s payment, plus the retroactive benefits payments for the eight months of January 2014 to August 2014. Note that you are not eligible for benefits during the five-month waiting period, which is why you do not receive benefits from September 2014 to January 2015.
The amount that you will receive each month is based on your lifetime average earnings covered by Social Security. You can get an estimate of this amount by checking your annual Social Security statement or by using SSA’s benefit calculators at www.ssa.gov/planners/benefitcalculators.htm.
You may apply for SSDI benefits online at www.ssa.gov/applyfordisability or by calling 800-772-1213 to make an appointment to file a disability claim at your local Social Security office or set up an appointment for someone to take your claim by telephone. The disability claims interview typically lasts about one hour.
Supplemental Security Income
Unlike SSDI, SSI provides individuals with disability benefits based on financial need, not previous work history. Eligibility is determined based on an income and asset test and if you fit into one of three categories: sixty-five years old or older, blind, or disabled.
The SSA will look at the total amount of income that you have, including wages, Social Security benefits, pensions, and interest accrued on accounts. The amount of income you can receive each month and still get SSI depends partly on where you live. In 2015, the highest federal SSI payment was $733 a month for a person and $1,100 a month for a couple.
The SSA will not consider the following items when looking at your income:
- The first $20 per month of most income you receive
- The first $65 per month you earn from working and half the amount greater than $65
- Supplemental Nutrition Assistance Program (SNAP) benefits
- Shelter assistance you receive from nonprofit organizations
- Most home energy assistance
An individual must have less than $2,000 worth of assets or resources and a couple may have no more than $3,000 worth of assets or resources to be eligible for SSI. Assets might include stocks, bonds, and bank accounts. However, the SSA does exempt some assets. For example, the SSA does not include the following when calculating your asset level:
- Your home and the land it is on
- Life insurance policies worth less than $1,500
- Your car (usually)
- Burial plots for you and/or your immediate family
- Up to $1,500 in burial funds for you and up to $1,500 in burial funds for your spouse
To apply for SSI, complete the majority of your application online at www.ssa.gov/pgm/ssi.htm. You also can call the SSA at (800) 772-1213 to request an appointment to speak with an SSA representative. You will need to compile the following items to complete your application:
- Your Social Security card
- Your birth certificate or other proof of your age
- Proof of U.S. citizenship or eligible noncitizen status
- Information about the home where you live, such as your mortgage or your lease
- Payroll slips, bank books, insurance policies, burial fund records, and other information about your income and the things you own
- Your checkbook or other papers that show your bank, credit union, or savings and loan account number(s)
- Names and contact information for the doctors, hospitals, and clinics that you use if you are applying for SSI because you are disabled or blind
Illinois SSI Supplemental Payment
Illinois residents who are collecting SSI benefits also may be eligible for an additional payment from the state, called the state supplemental payment (SSP)3. To determine if you are eligible for SSP, subtract your monthly maintenance costs from the amount you receive from your SSI payment plus any other income. If your monthly maintenance costs are more than what you bring in with SSI and other income, then you will receive an additional amount. The Illinois Department of Human Services (DHS) administers the SSP.
Appealing an SSA Decision
Many people are discouraged because they are denied Social Security benefits the first time they apply. It is estimated that 70 percent of all applications are denied on the first attempt. You can appeal the SSA’s decision; however, you must you complete a “Request for Reconsideration” form within 60 days of receiving the denial letter (The SSA assumes that you have received the letter five days after the date on the letter, unless you can show you received it later). There are four levels of appeals:
- Request for reconsideration
- Hearing by an administrative law judge (Applicants who appeal to this level have a much better chance of getting their claim approved, and you may want to consider hiring an attorney for this stage.)
- Review by the Appeals Council
- Federal court review
Each level of appeal will delve into great detail about your medical condition and the severity of your disability. You may want to consider enlisting your health-care team’s assistance in applying for and appealing a denial of SSA benefits.
If you need to appeal an SSDI or an SSI determination, you may want to consider hiring an attorney. Almost all Social Security attorneys will work on a contingency fee. This means that you can hire an attorney to help with appealing your decision, even if you do not have the money upfront to pay for the attorney’s services. If the attorney is able to win your appeal, he or she will take a percentage of your benefits. The law limits the amount that attorneys can charge you on contingency to 25 percent of the past-due benefits you are awarded, up to a maximum of $6,000. If you would like to hire an attorney, one place to start is through the appropriate lawyer referral service in your county or contact the National Cancer Legal Services Network (www.nclsn.org).
The SSA has several online tools that you may find useful. If you are trying to determine if you are eligible for benefits, the disability planner at www.ssa.gov/dibplan may be helpful. If you are already collecting benefits or would like to keep track of your quarters of credit, you may want to create a “my Social Security Account” at www.ssa.gov/myaccount.
2 42 U.S.C. 423 Sec 223(d)(1)
3 305 ILCS, section 5/3-1 et seq.