SOCIAL SECURITY DISABILITY INSURANCE (SSDI) AND SUPPLEMENTAL SECURITY INCOME (SSI) FREQUENTLY ASKED QUESTIONS
What is Social Security Administration's definition of disability?
For adults, the Social Security Administration (SSA) defines disability as the "inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months."
A child is considered to be disabled under Social Security law if the child has any medically determinable physical or mental impairment or combination of impairments that causes marked or severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.
What types of Social Security Disability Benefits are there?
The Social Security Administration (SSA) administers two main programs that provide monthly benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. Medical requirements are the same for both programs.
The primary recipients of SSDI benefits are disabled individuals (and their dependents) who become disabled before age 65, and who have enough earnings credit to be "insured" under the Social Security Act ("the Act"). Generally, an individual must have worked 5 out of the last 10 years before becoming disabled to be insured, though the rule may be different for a younger worker. A widow or widower who is between the ages of 50 and 60 and who becomes disabled within a certain period of time after the death of his or her spouse may be able to collect disability benefits based on the earnings record of the deceased spouse. These are called Disabled Widow's or Widower's Benefits. Also, a disabled adult who can prove disability before age 22 may be able to collect disability benefits based on the record of a deceased, disabled or retired parent. These are called Disabled Adult Child Benefits.
Supplemental Security Income (SSI) benefits are generally paid to people of very limited income and assets. Typically, SSI recipients either have a limited or no work history. Children under the age of 18 can be paid SSI benefits if they meet Social Security's definition of childhood disability, and if their income and assets and their parents' income and assets do not exceed the amount allowed by Social Security. SSI recipients generally qualify for Medicaid, a State-run health assistance program.
I am receiving workers' compensation benefits and/or sick leave benefits for the condition that is causing my disability. Can I still file for Social Security Disability benefits?
Yes, you can and should apply for Social Security Disability and/or SSI benefits as soon as you know that you are likely to be disabled for 12 months or more. If your Social Security claim is granted, your benefits may be reduced because of your workers' compensation payments. However, if your earnings before your disability were very high, there may be little or no reduction. The long-term disability benefits would not be a factor in a claim based on an earnings record.
If I have money saved, do I have to spend it down before I apply for Social Security Disability benefits?
No. If your claim is based on your earnings record or the earnings record of another, Social Security does not even consider your savings or other assets. On the other hand, assets are considered in the SSI program, as it is a need-based program.
How do I apply for Social Security Disability benefits?
There are several ways to apply for benefits. One way is to go to the local office and wait (sometimes for many hours) to talk to someone who can assist you in filing your claim. Some local offices will not take an application unless you have an appointment. The easiest way to apply is to call Social Security at 1-800-772-1213 to schedule an appointment to file your claim. Oftentimes, your appointment will be by telephone. You also may be able to file online at www.socialsecurity.gov/applyfordisability/.
How long do I have to wait after I become disabled to apply for Social Security Disability benefits?
You do not have to wait to apply. As soon as you know or suspect you have a condition that is expected to disable you for 12 months or more, or result in death, you should apply. In SSI claims, you only receive benefits starting with the month after you apply. For SSDI claims, back benefits are only paid up to one year before the filing date of the application. Delay can be costly under both scenarios.
Do I need to provide Social Security with my medical records?
No, but you will need to provide Social Security with the names, addresses and telephone numbers of all relevant treatment providers (doctors, hospitals, therapists, etc.), as well as the approximate dates of your treatment with each provider. You will need to have this information to complete your application, but Social Security will request the records.
How does Social Security determine disability eligibility for adults?
The Social Security Administration uses a 5-step sequential evaluation process to determine who will receive disability benefits.
Step 1: Is the claimant working?
Step 1 determines if a person is "working", according to the Social Security Administration definition. In 2009, earning more than $980.00 a month as an employee is enough to disqualify a person from receiving Social Security Disability benefits. Gross earnings at this level constitute substantial gainful activity or SGA. It is the view of the Social Security Administration that an individual who is able to earn at least this amount per month is able to engage in competitive employment in the national economy. (If you are self-employed, the determination as to what constitutes SGA is more complicated, and will not be discussed here.)
Step 2: Is the claimant's condition severe?
Step 2 evaluates whether the claimant's medical condition is severe enough to significantly limit his or her ability to perform basic work activities. In addition, the impairment must last, or be expected to last, for a continuous period of not less than 12 months, or result in death.
Step 3: Is the claimant's condition a Listed Impairment?
Step 3 asks if the impairment meets or equals a medical "listing." The Social Security Administration uses more than 150 categories of medical conditions, called "listings." These listed conditions are considered severe enough to preclude a person from working or to permit a finding of entitlement to SSI Childhood Disability benefits. If a claimant meets or "equals" a listing, benefits will be granted, unless the claimant is engaging in substantial gainful work activity. However, the absence of a listing-level impairment does not mean the individual is not disabled. Rather, it merely requires the person making the disability determination to move on to Step 4 of the process and apply other rules in order to resolve the issue of disability.
Step 4: Can the claimant perform work he or she did previously?
Step 4 explores the claimant's ability to do any of the jobs he or she has performed in the past 15 years, despite his or her physical or mental impairments. If the Social Security Administration finds that the claimant can still perform this past relevant work, benefits are denied. Social Security is not concerned with issues such as the availability of those jobs or whether a particular claimant would be hired. The only concern at this step is whether the claimant has the residual functional physical and/or mental capacity to perform past relevant work activity. If the claimant cannot perform his or her past relevant work, then the process proceeds to the fifth and final step.
Step 5: Can the claimant do any other type of work?
Step 5 determines what other work, if any, the person can perform. Social Security gives consideration to the claimant's age, education, and work experience, in addition to the claimant's physical and/or mental conditions in making this determination. If Social Security finds that the claimant cannot make the transition to other work, then benefits will be granted.
Who actually makes the disability determination?
After your application is complete (and assuming you are an Ohio resident), your case is sent to a claims adjudicator at the Bureau of Disability Determination in Columbus, a State agency charged with making the disability determination for Social Security. That person, usually working with a doctor, makes the initial decision in your case. The formal decision is issued by Social Security, and you will have a right to appeal that decision. For detailed information about the appeals process, see THE SOCIAL SECURITY APPEALS PROCESS section on this site.
Can I receive disability benefits if I am working?
Sometimes, but if your earnings are too high, your work will automatically disqualify you. If you are able to work full time, you will not qualify. However, if you are only able to work part time, you should apply. Social Security will review your work and earnings to determine whether you may still qualify.
If I hire an attorney, how do I pay him or her?
In most cases, the attorney will be paid from the past-due benefits. Typically, the fee will be 25% of those benefits, up to a current maximum of $5,300.00, or any higher maximum set by the Commissioner of Social Security. The maximum fee will be increasing to $6,000.00 on June 22, 2009. The fee may be more than the maximum set by the Commissioner if the case proceeds to Federal Court, or if Social Security raises the minimum fee, but the fee will never exceed 25% of the past-due benefits. In a disability claim, there would be no fee unless you win your benefits.