Social Security Disability
Many people become disabled due to a health condition, a traumatic event, or even an occupational disease. When such an event prevents a person from working, Social Security Disability may be an option that should be seriously considered. The Federal Insurance Contributions Act (FICA) is familiar to many as a tax deduction from income. What many do not realize is that this is a contribution made by an employee and an employer to fund Social Security and Medicare. These federal programs are familiar to most as there to provide benefits for retirees, the disabled, and survivors of deceased workers. For instance, many recognize that Medicare provides hospital and medical insurance benefits. These federal programs also provide benefits to permanently disabled workers. Social Security benefits include old-age, survivors, and disability insurance (OASDI). A portion of an employee’s FICA contribution is paid into the Social Security Disability Trust Fund which funds payments to those individuals who become disabled.
Social Security Disability Insurance (SSDI) is managed by the Social Security Administration. This program is designed to provide income to individuals who can longer work because of a disability. SSDI is granted after a determination process which examines each application to determine if an individual qualifies because of a disability.
SSDI is not the same thing as Supplemental Security Income ("SSI"). SSI is a needs-based program which is also administered by the Social Security Administration. Unlike SSDI, SSI provides benefits for individuals with limited income and resources. There are times when an individual may apply for both SSDI and SSI at the same time. Sometimes, SSI is referred to as a Title XVI case.
Informal names for SSDI include Disability Insurance Benefits (DIB) and Title II benefits, named for the chapter title of the section of the Social Security Act.The Required Factors To Qualify For SSDI
An individual may qualify for SSDI if he or she satisfies all of the following factors:
- Unable to Perform Substantial Gainful Activity
Substantial gainful activity” means the performance of significant physical and/or mental activities in work for pay or profit, or in work of a type generally performed for pay or profit, regardless of the legality of the work. “Significant activities” are useful in the accomplishment of a job or the operation of a business, and have economic value. Work may be substantial even if it is performed on a part-time basis, or even if the individual does less, is paid less, or has less responsibility than in previous work.
- Must Have an Impairment Which Is Expected to Last At Least 12 Months or Result in Death
An “impairment” must result from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques.
The existence of a medically determinable physical or mental impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings, the regulations but not by symptoms alone. Symptoms, such as pain, fatigue, shortness of breath, weakness or nervousness, are an individual's own perception or description of the impact of his or her physical or mental impairment(s).
- Must Be Under Full Retirement Age
To become entitled to a Disability Insurance Benefit (DIB) or to establish a period of disability, the claimant, also known as the number holder (NH), must meet all requirements in a month in which he/she has not yet attained full retirement age (FRA). The below chart calculates the Full Retirement Age or FRA based on the date of birth:
BIRTH DATE FRA BIRTH DATE FRA 1/2/38 thru 1/1/39 65 years and 2 months 1/2/55 thru 1/1/56 66 years and 2 months 1/2/39 thru 1/1/40 65 years and 4 months 1/2/56 thru 1/1/57 66 years and 4 months 1/2/40 thru 1/1/41 65 years and 6 months 1/2/57 thru 1/1/58 66 years and 6 months 1/2/41 thru 1/1/42 65 years and 8 months 1/2/58 thru 1/1/59 66 years and 8 months 1/2/42 thru 1/1/43 65 years and 10 months 1/2/59 thru 1/1/60 66 years and 10 months 1/2/43 thru 1/1/55 66 years 1/2/60 and later 67 years
Once you attain the full retirement age, your Social Security disability benefits automatically convert to retirement benefits, but the amount remains the same.
- Must Have a Work History Long Enough (and Recent Enough) under Social Security
The claimant also called the number holder or NH must meet an earnings test. The earnings test is based on income earned and Quarters of Coverage (QC). Most claimants must meet the 20/40 Test. The NH must have at least 20 QC's during a 40-quarter period ending with the quarter in which the waiting period begins and must be fully insured in that quarter.
Under the Social Security Act, the onset of disability is generally the first day a claimant meets the applicable definition of disability. For all title II claimants (DISABILITY INCOME) and for title XVI adults (SSI CLAIMS), the disability is 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 has lasted or can be expected to last for a continuous period of not less than 12 months. The work requirement is waived for applicants who can prove that they became disabled at or before the age of 22, as these individuals may be allowed to collect on their parent's or parents' work credits. The parent(s) experience no loss of benefits. The rules are different for children who are under the age of 18 and file for benefits under SSI. There are three categories of Onset Dates that could apply.
- Alleged Onset Date (AOD)
The AOD is the date the claimant alleges he or she became unable to work because of a medical condition, regardless of whether or not that date appears to be appropriate.
- Potential Onset Date (POD)
The POD is the earliest possible date the onset of disability can be established based on nonmedical factors. It may be the same as, earlier than, or later than the AOD.
- Established Onset Date (EOD)
The EOD is the date the disability adjudicator determines the claimant’s disability began based on the medical and other evidence in the case record.
Special Senses and Speech
Impairments That Affect Multiple Body Systems
Malignant Neoplastic Diseases
Immune System Disorders
The Administrative Review Process
- The Reconsideration
If you choose to appeal an unfavorable or partially favorable initial determination, the first appeal request is called a "Request for Reconsideration." You must file the appeal with all required documents to the SSA before the appeal period ends, which is normally 60 days.
- The Hearing Before an Administrative Law Judge
If you disagree with the reconsidered determination, you may request a hearing before an Administrative Law Judge (ALJ) of the Office of Disability Adjudication and Review. You must make a request for a hearing in writing within 60 days after you receive the notice of the determination.
- Appeals after the Administrative Law Judge
If you disagree with the ALJ's decision or dismissal, you may request a review by the Appeals Council of the Office of Disability Adjudication and Review. If you are dissatisfied with the Appeals Council's action, you may file a civil action in a Federal district court.
The information contained in this website provides only a general overview of the complex regulations found in Title II and Title XVI of the Social Security Act. Our firm has the necessary resources to obtain and assemble medical records, prepare and file all required petitions to establish a claim or appeal a denial of a claim for an impairment and social security disability benefits.