How Does the Judge Decide if You are Approved for SSI or SSDI
I regularly get questions from readers of my blog and web site about SSI, SSDI and the differences between the two. The biggest difference: you will be eligible for SSDI if you have worked and paid Social Security taxes into the system. Generally to be fully insured, you need to have worked and paid taxes for 5 out of the last 10 years.
If you have worked consistently for 10 years then stopped working, therefore, you “insurability” will follow you for approximately 5 years.
One of the pieces of information I always look for is my client’s “date last insured” for SSDI. If you have not worked regularly or if there is a big gap between dates that you worked, your date last insured could be an issue. In order to recover SSDI, your onset date has to be earlier than your date last insured.
This, by the way, is why part time work and large gaps between work attempts can create issues. When you add a lot of zero dollar quarters into the calculation, the date last insured will get closer and closer to the present.
The amount you received from SSDI is a function of what you paid in. If your annual earnings were in the $75,000 range your monthly SSDI benefit will be in the $2,000 + range. If your annual earnings were in the $20,000 range you are more likely to be looking at $1,000 or $1,250 per month.
SSI, by contrast, is a welfare program that pays a statutory amount (around $670) to individuals who meet the definition of disability but who are not insured for SSDI. The problem with SSI – household income serves to reduce the benefit, sometimes dollar for dollar. So, if your spouse is working and earning $50,000 annually, your SSI benefit will be totally offset.
Here is a question I received from one of my readers:
my husband was recently given a fully favorable decision and is insured and eligible for ssdi. i would like to know what they use to decide whether you get ssdi or ssi considering ssi is so much less than ssdi.do you get ssdi automtically if you’re insured or are there other factors.
My answer: your eligibility for SSDI is solely based on your insured status. There are some instances where you can get both. If your SSDI benefit is low (say $500) and you are eligible for your full SSI benefit, you would get $500 from SSDI and $270 from SSI.
Also, SSDI claims are subject to a 5 month “waiting period” whereas SSI claims are not. In some cases, you can get SSI for the 5 months, then SSDI thereafter.
Filed under Earnings requirements, Eligibility Issues, SSI issues by 
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Comments on How Does the Judge Decide if You are Approved for SSI or SSDI
How long I have to wait until I receive my first SSd check after the judge decisions. I had a court date for SSD 3 weeks ago, what will happen now?
Dagmar, depending upon how busy your hearing office is, you may find yourself waiting between 4 to 12 weeks for the written decision from the judge. Once that is issued, your file is transferred to the payment office. If everything goes smoothly, it will take about 4 weeks for payments to be processed. However, I have seen situations where payment processing drags on for months. Once the payment center has received your file, your attorney should follow up if you don’t see payment within 30 days.
How is SSDI calculated for prior years. I received a decision in May 2009 for full SSDI and it was made retroactive to 2003. Does that mean I will get one large separate check for the prior years and then a monthly check or is the monies calculated into the monthly check? So if a person is receiving $1600.00 per month in 2009, but the amount was only 987 in 2003 how is the total amount calculated?
My daughters disability case status has changed from “ready to schedule” to “Pre-hearing review” how long does your claim usually stay in this status. Can they make a decision without having a hearing?
I had my hearing early this month and later got the letter of unfavorable decision by the judge. It was agreed that I was in fact disabled by my chronic disease, the vocational expert confirmed that. But denied because doctor did not diagnose me till 3 months after my date of last insured had expired. My county is so far behind and this has dragged on for so long. I can’t back in time to have paper work from doctors prior to 12/2005. The diagnosis came 3/06. Those three lousy 3 months are what is keeping me from being approved. There truly isn’t any record during time of insured to prove I was disabled prior to 3/06. Of course the disease didn’t just pop up on March. There is even plenty record that majority who suffer from my disease takes 7+ yrs to get the proper diagnosis. Do I appeal? DO I start the whole lengthy process all over again? Help! I have an attorney but can’t get past the office help to talk to him.
I think you should appeal – if you don’t then any new application would apply to the period of time after the unfavorable decision – I think you would “estopped” from seeking benefits for the period when you were insured. You need to insist that your lawyer pursue the appeal or refer you to another attorney (preferably an appellate specialist).
I applied 3 years ago for ssi. was denied. Got a laywer this year as well and had to go for a mental examination. I got a check. Does that mean I am set? Havent seen the big check yet for back pay, just one that of 500. Also got a letter from fia saying my insurance is changed
I broke my neck and filed for SSI over 10 years ago. I was denied and filed an appeal.. at that time the judge basically called me a liar and denied me ssi. I have had surgery to omit the constant pain I have been in since my accident. The surgery eliveated the pain for approximately a year. I have been on pain management since. I tried last year to see if there were any other surgeries I can get to deal with the ongoing problems I am having and was told they couldnt help me and I was to just continue pain management. I am on medicaid and have found the care I recieve is quite limited. I am considering reapplying for SSI benefits. I was wondering how far back will they go if I can get an approval this time?
I have applied for ssdi since Feb 2007 and for ssi at same time. I was turned down and I have an attorney and he is really mad for. I had a wreck in June 2006 and have letters from doctors stating condition I would have to live with seat belt came across right shoulder ( I was a passenger) and injured the nerve and chipped a bone on collar bone. Doctor says no operation will fix and I will have to live with pain and sometimes numbness and nerves tense and causes loss of strength and loss of movement on right side. I have had mri and ct scans along with neurological tests but results the same. Now I have breast cancer affecting the left side of body. Diagnois with DICS, had lumpetcomy and Mastecmy. In the last 5 months continously in and out of hospital Been through with appeal for ssdi and appeal hearing for ssi which approved for Medicaid. Medicaid judged ruled in my favor but SSDI says SSI the problem the SSI says SSDI is the hold up so who is correct and now due to mastecmy can not use left arm and with the extense of the right arm i lose all strength in both arms and now i have developed a tiredness, I sleep all the time, no energy, and have like a pain and shortness of breath across mid section of body, Heart doctor says shows 2 strokes which when first had wreck was not diagnosed correctly. And now all these other problems from wreck showed up, diabetes, high blood pressure, shortness of breath, angina, strokes and now Breast cancer, when does the SSDI and SSI recognise a person who is really a disabled person. Ive even tried missing some meals to see if that is what makes me so sleepy at times. I used to be energic until the wreck and now it has been all down hill for me ever since. My lawyer was very upset with the Medicaid judge and she kept asking person at Medicaid where was my papers sent in by my lawyer the person could not answer the judge so judge agreed with my lawyer that as long as I was in appeal to the SSDI that I would receive Medicaid. But I need my SSDI and my SSI. I am 62 years old now and my lawyer cannot get a response from the SSDI or the SSI offices. Can you help I would be glad to give you the information you need to help. My name is Judy Ann Peoples Love, 105 Kentucky ST, Monroe, La. 71203 Thank you Judy Love
When I first applied for SSDI they sent me a letter stating I qualified for $783 Disability but I never got a letter from SSI Would tell me how much would that qualify me for from SSI
I’m on remission for breast cancer, had an elevator accident which left me without being able to bare children, then I had a hip dilocation of right leg, can’t stand or sit too long, want to work but can’t because of my condition. Would like to get disability and get rehabilitaed to work again. Please help, Depression, neorophathy on both legs, can’t eat or sleep at times. I isolate myself from normal people look out the window watching people going to work and living a normal life. Please help.
judy love i agree with you completly and hope you case is taken care of. i feel the worst for you . good luck on your journey.
hi i have a question i have been diagnosed with asthma,pluracy,anxiety,ptsd,depression,constocondritis i have lots and lots of hospital visits and dr visits and am on phsyc meds right now and seeing a therapist i applied for ssi in 2008
denied twice they i just went to my hearing i feel it went well they determined i cant do my old work due to panic attacks but i have had a history of substance abuse in the past they asked about it at the hearing i told them i been clean for a year ive been waiting 3 years for my ssi my lawyer told me to keep all my answers short very short the truth is i been clean for 4 years when i initially applied for the ssi but ive had relapses so i told them a year clean because thats my last relapse and the reason i ever used was to medicate for the depression and anxiety in the first place do you think this will affect the judges decision???
Jonathan, I think that substance abuse is always a problem in a Social Security case, however, if you have been honest with the judge and your medical record is consistent with your statements about your sobriety, your judge will hopefully conclude that you are now clean and that as of your onset date, any substance abuse was not a “material contributing factor” to your disability.
I got approved this is the first time i’ve applied and i’m getting ssi because im ptsd severe bi polar and severe depression and i been locked up for 2 years in prison and in and out of group homes hospitals residental places my whole life was screwed up im supprise they did not denied me.
DEAR JONATHAN,
I have a big delimma and need help! I am a RN and unable to work since Nov 07, and have filed for ssdi and been turned down by judge in sept 09. I was told by my layer who I only got to speak to right before my trial to appeal and file a new claim. Well I have osteo arth, siatica of the left hip and leg with ridiculopathy and no cure. Daily severe back, neck , shoulder, hip , feet and allover pain. When I fell I messed up my siatic nerve and caused sacroilic syndrome which I was told by the back specialist would be almost impossible to fix, and surgery would more than likely make it worse. I get migraines weekly that make it impossible to get out of bed for 1-2 days. I suffer severe Depression, Severe Anxiety that keeps getting worse. I did not know why I was suffering severe pain all over which escalated to keeping me bed bound several days a week. I no longer can sit up or stand or walk but for very limited amounts of time due to pain and fatigue. I started suffering bad memory loss and ability to think clearly. I was dx with Fibromyalgia. I also have other dx that seem to all fit under this dx, eg. IBS, nerve pain, muscle pain, migraines, corpal tunnel, osteoartritis and bursitis. I am 42 with a college degree. I am in pain all the time with it giving me only short periods of relief ranging from very severe to less severe.
I did get approved on my new application for mental “depression and anxiety” and without this monthly amount coming in my family will lose everything. My attorney was only focusing on the Fibromyalgia DX , but I have been told the judge I had does not believe in Fibro. The Appeals council has sent the case back to the same judge. He is known as the worst one in this area even by the people in the social security building, very mean and hard headed. I was told he only gets worse when the appeals council corrects him. Well, what I am in fear of is him trying to undo the new approved decision when I have to go before him. The council did not limit him to just the old case, they did not affirm my new case, they left it binding but did not reopen it. I know that if I were to get the back pay around 20-30k it would help pay off the debt we incured while waiting, but if this judge can undo it we will lose everything. He didn’t listen to the physicians the first time, and took things I said and twisted them. One example is I told him I can’t grocery shop anymore, but every few months if I can I will go to the local Dollar store and may be able to walk 1 or 2 isles and leave. In his decision he stated I walked from my home to the store. He stated my physicians oppions werent medical opinions and invade the ultimate issue of disability, the appeals council cited him for that. I can not gamble my familys future away by placing it in the hands of this hateful man. I can’t talk with my attorney, he only does that right before the case, my layer even said right before that trial that we would win my case with any judge, but the one I have. I know I am not your client but I really need help, I also have a child with spina bifida and I have already let my family down with my illnessess and inability to be even a drop of the person I once was. I can’t gamble with our lives, and I don’t have anything left to offer. please help me with any recomendations you have about my situation. Thank You
I have had my hearing,waiting on decision.since my hearing I’ve been to the Dr. And I know have a new diagnois should I inform my lawyer about it.
while waiting for a hearing with a law judge i recieved a letter stating that i was found to be disabled by a state agency that i would be getting ssi no mention of ssdi denial or about the hearing with the law judge i have enough credits to get ssdi please explain what could have happened i just got the letter today. thank you very much for this site i moniter it regurlly
Joe, there are several possibilities – first, it is possible that Social Security made a mistake and is not processing an SSDI claim. They may believe that your claim is for Supplemental Security income only. Second, it is possible that the adjudicator has approved your case but has amended your onset date to a date after you were last insured for SSDI (Title II). Third, it is possible that you have been approved for both SSDI and SSI but all of the letters have not yet come through. It is very common that the SSI staff process their paperwork first because if you are eligible for SSDI, there is a good chance that it will offset your SSI. The SSI folks have go thru the exercise of approving your for SSI then notifying you that your benefits are offset. The SSI processing center is located in a different location than the SSDI processing center, which is why there can be a delay in one or the other. I would wait a week or so to see if additional letters come. I would also carefully read whatever letters have been sent to see if there is any discussion of your SSDI and/or if there was any change to your onset date. You can appeal a favorable decision if there is an error like this but I would not file any appeal paperwork on a favorable decision without first talking to a lawyer.
I have had a law judge set for the past 5 months, but still waiting on a court date for the administrative law hearing. How long does it usually take to get a hearing date set? This is for ssdi, and i do have a lawyer.
I recently had my odar hearing. The judge asked me if I had ever used drugs and I answered no. Not to deceive but b/c I was nervous. Later that day I wrote a quick letter to the judge letting him know I do not use any substance other than prescribed to me and I did have a problem years ago and got tx. I also included a copy of my drug tx services that precluded my diagnosis by 16 months. Did I screw myself by sending the judge a one paragraph explanation of that answer with the certificate?
Tasha, I don’t think your letter is a problem although it is always better to submit evidence and correspondence through your lawyer rather than directly to a judge.
@jginsberg: i have c.o.p.d and a high heail hernia and had a stroke in 2005 and just got a court date from an appeal on feb 7 2012 what are my chances of getting my ssi payments and how long after the court date will i start to receive my ssi bennafites this is my third time filing and they said they are only going back as far as 2009 when i first applyed was in 2005 why is this and will i be intideled to the back pay of waiting ty jd
ps the court letter says i have to appear in court do i have to go to court for this or can my lawyer just go without me being there ty jd
JD, your lawyer could appear without you but that would not be wise. Your hearing is your chance to present your case to the judge and you should take advantage of the opportunity for the face time.