Social Security Disability
If you or a family member suffer from an injury or disease that prevents you from working or is expected to prevent you from working for one year or longer, you may be entitled to Social Security Disability benefits. The Social Security Administration, which administers retirement and disability benefits, defines a disability as the inability to engage in substantial gainful activity due to an impairment or combination of impairments. The Social Security system provides benefits for the disabled under two separate but related programs: Social Security Disability Insurance and Supplemental Security Income. While both programs are concerned with a person’s disability, DIB is an insurance benefits program while SSI is a need-based program.
Test for Disability Benefits
In order to receive disability benefits under DIB and/or SSI, the
individual must be totally disabled. To be considered disabled,
the individual must be unable to engage in ANY substantial,
gainful work activity by reason of a physical or mental
impairment which can be expected to result in death or has
lasted (or is expected to last) for one year or more. In
addition, an individual may qualify for disability benefits if
he or she is blind (minimum of 20/200 vision with corrective
wear). The individual must prove that he or she is disabled by
presenting reports from doctors, hospitals, or clinics providing
treatment. The worker might be asked to undergo additional
examinations or tests at the government’s expense in order to
determine the severity of the disability.
“Substantial” work activity involves the performance of significant physical
or mental duties or a combination of both which are productive
in nature. “Gainful” work activity is activity for profit (or
intended for profit) to the individual performing it or to
persons, if any, for whom it is performed. Work activity need
not be performed on a full-time basis to be considered
“substantial.” (As far as what does not constitute substantial
gainful work activity, according to current Social Security
guidelines, as of January 1, 2002 you can earn up to $780.00 per
month and still be considered disabled. That amount is expected
to increase in subsequent years. Therefore, you should contact
the local Social Security Administration district office to
determine how much you can earn and still be considered
disabled.) Lastly, “physical or mental impairment” results from
anatomical, physiological or psychological abnormalities which
are demonstrable by medically acceptable tests.
A person must not only be unable to do his or her previous work or
work similar to the previous work, but must also be unable to
engage in any other kind of substantial, gainful work which
exists in the national economy. It is immaterial whether such
work exists in the immediate area, or whether a specific job
vacancy exists, or whether the worker would be hired if he or
she applied for work.
These standards for determining disability are very stringent. A
doctor’s opinion that a worker is “disabled” is not binding on
the Social Security Administration. The Social Security
Administration will examine the doctor’s medical findings to
determine whether the disability is so severe that the person
cannot engage in any substantial, gainful work activity. The
Social Security Administration will also consider the person’s
age, education, work experience, and physical and mental
abilities.
Disability Insurance Benefits (DIB)
The DIB program provides disability protection in the
form of monthly cash benefits to disabled workers and their families
for the duration of the disability, depending upon their eligibility
to receive such benefits. In order to qualify for DIB, the worker must
prove the existence of a disability as defined above and must also be
insured. A worker becomes insured by working long enough and recently
enough under Social Security to earn sufficient credits for disability
benefits. These “credits” are earned when the individual pays taxes
that are normally deducted for Social Security from the worker’s paycheck
by the employer. The amount of credit that a worker needs to become
insured depends on the age of the worker at the time the disability
begins. In addition, to qualify for DIB, the worker must not have reached
retirement age, and must complete an application for benefits. There
is a mandatory waiting period such that the worker may not receive DIB
until 5 months after the disability is determined to have begun.
To briefly sum up the eligibility requirements under DIB, the worker
must:
- be “disabled” as defined in the Act;
- have the appropriate amount of disability insurance, or work credit;
- not have reached age 65; and,
- have filed an application for DIB benefits.
Dependent Benefits Under DIB
Supplemental Security Income (SSI)
The Supplemental Security Income (SSI) program is designed to
guarantee a minimum level of income to disabled persons 64 years
old or younger, or to persons who are blind or disabled and who
do not have sufficient resources to maintain a minimum standard
of living. Persons 65 years old do not have to be disabled. The
definition of “disability” and the standards for evaluating
medical impairments are the same for SSI and DIB. However, SSI
limits eligibility to persons who are also financially needy as
defined by federal regulations. The Social Security
Administration examines benefit guidelines which dictate how
much the person can receive based on his or her income level.
Because SSI is a need-based program, persons who earn more
income will receive less in SSI benefits. Unlike DIB, SSI does
not have a mandatory waiting period. As such, benefits may begin
either on the date of application or the date the person first
meets the eligibility requirements.
If you have been denied benefits by the Social Security
Administration, or are simply considering whether you should
apply, please contact the one of the attorneys in the Elderkin
Law Firm’s Social Security group today.
Social Security Department Members:
