Social Security Disability is a federally mandated insurance program designed to provide assistance to people with disabilities. This program pays monetary and health benefits to individuals who are unable to work resulting from physical and/or mental health conditions.
There are two disability programs. The first program is called Social Security Disability Insurance or SSDI. This program pays benefits as long as you are “insured”. This means you have worked long enough, recently enough, and paid enough in Social Security taxes on your working income or wages. The second disability program is called Supplemental Security Income, or SSI. The SSI program pays benefits to people with limited income and resources, not requiring an ”insured” status.
While these two programs are different, the medical requirements are the same and are reviewed using the same five-step evaluation process.
However, the initial qualifications for the SSDI and SSI programs are different. To qualify for SSDI benefits, you must:
- Have a medical condition that meets Social Security’s definition of disability.
- The law defines disability as the inability to do any substantial gainful activity because 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.
- Social security only pays for total disability. No benefits are payable for partial disability or short-term disability.
- Have worked the past five out of ten years.
- Not only must you have worked the past five out of 10 years but you must have paid taxes into the social security system on those earnings.
The SSI program requires a review of your financial situation, rather than your work history and what you have paid in taxes. For an individual to qualify for SSI benefits your total income and assets must be less than $2,000. This $2,000 calculation excludes one house and one car. So if you own more than one car, SSA will consider only the 2nd car as part of your assets. Also, any additional homes will be considered an asset, the same as any bank accounts that are in your name. It should be noted that SSA will look back through your financial records to make sure you are not simply shifting around money and assets to family members to meet the financial qualifications of the program.
Whether you are applying for the SSDI or SSI program, an individual will qualify for SSD benefits if all of the following are true:
- You cannot do work and engage in a substantial gainful activity (SGA) because of your medical condition.
- You cannot do work you did previously or adjust to other work because of your medical condition.
- Your condition has lasted or is expected to last for at least one year or to result in death.
As mentioned above, disability claims, both SSDI and SSI, are evaluated using a five-step sequential evaluation process.
- The first step in the process is to ask “Are you working”? Do your monthly earnings exceed Substantial Gainful Activity? In 2022 SGA is $1,350. If your monthly gross earnings exceed SGA then you will not be considered disabled under the social security program. If you are not working, or your earnings are less than SGA, social security will continue to evaluate your claim.
- The second question SSA asks is whether your medical condition is severe? You must suffer a physical and/or mental condition that significantly limits your ability to do basic work-related activities for at least 12 months. If your condition(s) interfere with basic work-related activities social security will continue to evaluate your claim.
- The third question is whether your condition can be found in the list of disabling conditions? For each body system, there is a list of medical conditions that are considered severe enough to prevent a person from performing SGA. If your condition is found to meet a listing your claim for benefits will be approved. If it is not found to meet the listing social security will continue to evaluate your claim.
- The fourth step determines whether you can perform the work you have done in the past? Social security will determine if your medical condition(s) prevent you from performing any work you have done in the past fifteen years. If it does, social security will continue to evaluate your claim. If it does not your claim will be denied.
- The fifth and final step asks whether you can perform any other type of work? Social security will consider your medical conditions, age, and education to determine if other work in the national economy could be performed despite your limitations. If you can do other work your claim will be denied. If you are unable to do any other work in the national economy your claim for disability benefits will be approved.
For the social security administration to evaluate the type of claim you qualify for and whether your medical situation renders you disabled under their regulations, they first require an application or claim for benefits to be submitted. This application provides SSA with the necessary information to determine the applicable program and your medical situation. While it may seem cumbersome to provide all of the information requested, the social security administration must decide on your claim. The information needed falls into three general categories: information about you, information about your medical conditions, and information about your work history.
The information required about you includes:
- Your date and place of birth and Social Security number.
- The name, Social Security number, and date of birth or age of your current spouse and any former spouse. You should also know the dates and places of marriage and dates of divorce or death (if appropriate).
- Names and dates of birth of children not yet 18 years of age.
The information needed about your medical conditions includes:
- Third party contact information of someone close to you that knows about your medical conditions and may be able to help with your application.
- Detailed information about your medical illnesses, injuries, or conditions:
- Names, addresses, phone numbers, patient ID numbers, and dates of treatment for all doctors, hospitals, and clinics.
- Names of medicines you are taking and who prescribed them.
- Names and dates of medical tests you have had and who ordered them.
The information needed about your work history includes:
- The amount of money earned last year and this year.
- The name and address of your employer(s) for this year and last year.
- The beginning and ending dates of any active U.S. military service you had before 1968.
- A list of the jobs (up to 5) that you had in the 15 years before you became unable to work and the dates you worked at those jobs.
The above is a very brief overview of the social security disability system in terms of how to qualify and the information needed in the application. If you have found yourself in a position where you are unable to work due to a physical and/or mental condition, please reach out to the LaBovick Law Group for a free consultation. We will discuss your situation with you and determine if this is the right path for you to choose. Call us today at (561) 625-8400.