Are you unable to work because of a serious medical condition? If so, there’s a good chance you qualify for monthly payments and free health insurance from the U.S. government. We’ll help you figure out whether you qualify and what to do next.
Hundreds of thousands of disabled Americans get benefits from Supplemental Security Income. For patients and their families, this help can be life-saving. But not everyone with a serious condition is eligible, and government rules can make qualifying a nightmare. At Atticus, we help cut through the red tape and get you the benefits you need. We’ll explain how this program works, then tell you how to qualify.
Supplemental Security Income (“SSI”) is a government program that supports Americans that can’t work due to a medical condition. When someone says they’re “on disability,” they usually mean they are getting SSI. The program is huge: Almost 8 million Americans receive SSI today.
If you qualify for Social Security Income you will get two big benefits:
There isn’t one. If you are eligible, you should apply. Applying is free. You can keep your health insurance, or get Medicaid for free. It is true that other benefits may decrease the amount you’ll get in SSI: For example, if you are getting $200 in food stamps, you will be awarded less money each month from SSI than if you weren’t getting food stamps. But you won’t end up with less money overall each month.
In order to qualify for SSI, six things usually have to be true:
* If you have a strong work history (regardless of your current assets or non-work income) you may also qualify for a related program called Social Security Disability Insurance (“SSDI”), but the rest of this article will still largely apply to you.
Qualifying is never easy: The government treats claims with suspicion, and rejects most applicants. But if you meet the criteria above, you can likely get benefits with the right help.
If you have a medical condition that makes it impossible to work, and you are getting treatment from a doctor, you may qualify as disabled. If you are able to work or aren’t getting a lot of treatment, then you probably won’t qualify.
Some quick background: Under government rules, some medical conditions — like needing a kidney transplant or losing both your legs — always qualify a patient for disability benefits. Others — like pregnancy — are never enough. The vast majority of conditions are somewhere in between. You can qualify due to many, but just having one often isn’t enough. Instead, it depends on how long you’ll be sick, the symptoms you are experiencing, and how the condition impacts you.
The formal guidelines are complicated, but it boils down to this: If your condition has a big impact on your life even though you’re getting treatment, and as a result you just can’t hold a job, you’ll probably qualify as disabled with proper help.
Learn more about what conditions qualify for disability benefits.
You should apply as soon as it is clear that your condition is going to last a full year and you have the evidence to prove it. Sometimes that takes a while to figure out: your doctor may need to run tests and try a variety of treatment before they know how long your condition will last. Other times it is clear right away that a disability is long lasting. Once your doctor is pretty sure that your condition is going to keep you out of work for a full year, there is no reason to wait.
Atticus exists to help to people navigating this process — so the easiest thing to do is get free advice tailored to your situation via our online tools or caring staff. (People love us, and we don’t charge anything for our help.)
Applying for disability takes preparation. You can win, but this system doesn’t make it easy. So it’s worth taking some time to understand how things work.
The first step is to make a choice: Do you want to (a) Apply on your own, or (b) Get a professional to handle the process for you? Most successful applicants hire a professional. But not everyone needs to, and not everyone who wants to can. We’ll explain both paths and help you decide.
The government fears that people will exaggerate their medical problems in order to get free money. So it puts every applicant under a microscope. To win, you have to prove — beyond a doubt — that your medical condition is severe and disabling. There are two major stages in the process, and most people will need to go through both:
Unfortunately, the process takes time: 3 to 6 months to get an initial decision, and 1 to 2 years (or more) to get a hearing. Even a small mistake or omission (like a doctor failing to send in records, or bad answer on a form) can doom an application. The good news is that once you win – even if it takes a long time and several appeals – you get “back pay” (retroactive benefits) for the time you should have been getting benefits.
Because the process is so complicated, most successful applicants get a lawyer (or trained non-lawyer representative) to help. Lawyers will pull together your medical records, write your application, advise you on getting proper medical treatment, submit all the paperwork, and (if needed) argue your case before a judge.
There are two big upsides to hiring a lawyer: (1) They do almost all the work for you and hold your hand through the process. (2) They increase your chance of winning. (Government studies show that at the appeal stage, people with a lawyer are three times as likely to qualify.)
The only downside is cost. Lawyers aren’t allowed to charge any up-front fee so it doesn’t matter if you can afford one right now. If they win your case, they get 25% of any back pay (retroactive benefits) that they win for you. This is worth it for almost everyone — you only pay if you win (if you lose, you pay nothing), you only pay once, and the cost pales in comparison to the amount you get.
Most applicants should hire a lawyer or other professional. (There are exceptions — see, for example, our articles on Huntington’s disease or pancreatic cancer.)
Why? The government treats all but the most serious conditions with a lot of skepticism. Having assistance from an expert can make all the difference. There are only a handful of situations where we tell people to consider applying on their own:
Absolutely. It’s true that most lawyers won’t represent SSI applicants until they’ve been denied, but there are fantastic lawyers and representatives that will. These professionals are hard to find and vet, but they exist and their help can mean the difference between setting yourself up for success and making mistakes early in the process that will follow you through your appeals.
Atticus is a new kind of law firm that helps you navigate the early stages of a disability claim. We help you choose the right approach, hire the right lawyer, and get on with your life. We won’t charge you a dime for our services, so there’s no cost to you.
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