How is "disability" determined?
Social Security disability examiners are required to apply a step-by-step process involving five questions in their determination of disability:
- Are you working? If you are working in 2018 and your gross earnings (i.e. earnings before any taxes or deductions are taken out) average more than $1,180 a month, you generally cannot be considered disabled. If no, go to Step 2.
- Is your condition severe? Your condition must interfere with basic work-related activities for your claim to be considered. If yes, go to Step 3.
- Is your condition found in the List of Disabling Impairments? (For each of the major body systems, the Social Security Administration maintains a list of medical conditions that are so severe that having one or more of them automatically qualifies you as disabled.) If your condition is not on the list, the Social Security Administration must decide if your condition is of equal severity to a medical condition on the list. If it is, you will be found disabled. If it is not, go to Step 4.
- Can you do the work you did previously? If your condition is severe but not at the same or equal level of severity as a medical condition on the list, then the Social Security Administration must determine if your injury or illness interferes with your ability to do the work you did previously. If it does not, your claim will be denied. If it does, proceed to Step 5.
Can you do any other type of work? If you cannot do the work you did in the past, the Social Security Administration determines if you are able to adjust to other work. They consider your medical conditions, your age, education, past work experience, and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied.
IMPORTANT: The examiner does not have to consider that you may not be hired for a job, or that the job is not readily available. The salary that the job would pay is also not a consideration. The examiner's only consideration is whether you are physically, emotionally, and mentally capable of performing a job appropriate to your education and work background on a full-time basis. If you are under age 45 (what Social Security considers a younger individual) you must be unable to pursue any job on a full-time basis.
I've been turned down already, is there any point in appealing my disability eligibility?
Absolutely. Most of the people who come to see me have already been turned down, sometimes twice. The Social Security's system is set up to deny claimants on these initial decisions. Many claimants (especially those who aren't represented) don't appeal these initial disability denials. Not appealing a negative decision is a big mistake. Once you have been denied twice, you can request a hearing. At this stage of the disability adjudication and review process you will have the right to appear before an Administrative Law Judge who will see you and actually listen to what you have to say. Many denials are reversed at this hearing. Persistence and experienced representation pay off.
What are "Work Credits"?
Social Security work credits are based on your total yearly wages or self-employment income on which you paid Social Security taxes. You can earn up to four credits each year. The amount needed for a credit changes from year to year. In 2018, for example, you earn one credit for each $1,320 of wages (or self-employment income). When you have earned $5,280, you've earned your four credits for the year. These contribute to the computation of disability back pay.
Does Social Security distinguish between mental and physical limitations?
No. Though many disability insurance policies limit benefits to 24 months (or less) if a disability is due to mental health problems, the Social Security disability administration does not distinguish between the two. Many claims involve a combination of mental and physical impairments.
Can I receive disability benefits if am able to work in the future?
Yes, as long as your disability keeps you from working for a substantial level for at least 12 months.
Can I return to work after I am awarded Social Security Benefits?
Yes, the regulations encourage attempts to work. Under some circumstances, attempts to work are permitted while you continue to receive benefits. Social Security provides for a trial work period up to 9 months that allows you to attempt to work and receive disability benefits as well. If you are not successful in your attempt to work, your Social Security benefits may not be interrupted.
Once awarded Social Security benefits, am I subject to annual reviews by the Social Security Administration for the continuance of my disability income?
Not necessarily. The law requires the SSA to review your case periodically to see if you are still disabled. The frequency of those reviews depends on whether your condition is expected to improve and your age. For example, if medical improvement is expected, your case may be reviewed within six to 18 months after benefits start. If improvement is not expected, your case will normally be reviewed no sooner than seven years. Older individuals approaching retirement age are less likely to be reviewed.
How does Supplemental Security Income (SSI) differ from Social Security Disability Insurance (SSDI)?
The key difference is that SSI is based on financial need. To qualify for SSI, you must be disabled under the same rules as for SSDI, be blind, or be over 65. However, instead of looking at how many work credits you have earned, the Administration looks at all other income and property in your household (not just your own) and the value of any support you may get from others (e.g., room and board) to determine whether you are financially eligible for SSI. In 2019, SSI pays a maximum benefit of $771, while Social Security Disability Benefits may be in excess of $2,500 a month, while the average benefit in 2018 is $1,197.
Are members of my family entitled to Social Security disability benefits, as well?
Generally, dependent children under 18 are entitled to a benefit. Typically your dependents will split a total benefit of 50% of the amount of your check.
Can I receive both Workers' Compensation and Social Security disability benefits?
Yes, with a reduction in your disability benefit. Total compensation between the two is usually limited to 80% of your average current earnings.
I'm 61 years old and I can receive early retirement benefits in less than a year. I don't believe I can work anymore; but I can get early retirement, so why should I bother applying for disability benefits?
There are several reasons. When you elect to draw early retirement (at age 62), you will receive approximately 80% of your full retirement (the amount you would get if you waited till age 66, or full retirement age, to retire) and you will receive this reduced amount (subject to annual cost-of-living raises) for the rest of your life. However, if you are approved for disability benefits (before age 66), you will receive a disability benefit very close to 100% of your full retirement benefit. Then, when you turn 66, you will be switched over to receive Social Security Retirement benefits. This can amount to a substantial amount of money over your lifetime.