Navigating the benefits for which you, as a disabled person, may qualify under one or more U.S. Social Security programs, and the processes for applying, can be a challenge. This article provides a brief overview of Social Security Disability programs, eligibility, benefits and procedures.
Social Security Disability Programs
The two main federal Social Security Disability-related programs are Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). SSDI is available to disabled people who have been in the workforce for at least five years. SSI is a cooperative program between the federal Social Security Administration (SSA) and each state government. SSI is available to disabled individuals and the elderly who have qualifying incomes and total assets (low incomes and asset holdings).
One key difference between SSI and SSDI is that with SSI, a person can work and still receive the benefits (so long as the total income derived from the work remains below specified thresholds).
Eligibility for SSDI depends not only on an applicant’s disabled status, but also on the applicant’s work history. An SSDI applicant must have worked for at least five of the 10 years before they became disabled, and must also be under the age of 65. Furthermore, to meet the disability criteria under SSDI, the person must have a physical or mental condition that prevents them from engaging in any "substantial gainful activity." That condition must also be reasonably expected to last at least 12 months or result in death.
The SSA requires medical evidence demonstrating an inability to work on the part of the applicant. Documentation of the existence of an impairment must come from medical professionals such as licensed physicians, licensed psychologists or from another qualified, licensed medical professional.
For federal purposes, an SSI applicant must meet the following criteria:
- The applicant must be either a citizen or permanent resident of the United States, or have political asylum or refugee status.
- The applicant must be blind, disabled or age 65 or older.
- The amount equal to 50% of the applicant's monthly income generally cannot be higher than $700 to $1,400 per month (with the exact range varying by state).
- There is a limit to the total "countable resources" that an applicant may own as an individual or, if married, as a couple. As of 2017, this is $2,000 for an individual and $3,000 for a couple. Countable resources include cash, bank savings, investments, personal property, land and vehicles (beyond a claimant's first vehicle). Excluded forms of "resources" include a person's home, household goods and personal effects, and one vehicle if it is used for transportation for the applicant or a household member.
There are additional eligibility criteria that apply depending on your state of residence.
Meeting the Definition of a Disabled Person Under SSDI and SSI
Both SSDI and SSI pay benefits only in instances of total disability. Benefits are not available in instances of partial disability or short-term disability. "Disability" under Social Security rules is based on a person's inability to work. A person is considered disabled under Social Security rules if:
- The person cannot do work that they did before.
- The SSA decides that the applicant cannot adjust to other work because of the person's medical condition(s).
- The person's disability has lasted or is expected to last for at least one year, or result in death.
The SSA will deny an applicant's claim if it finds in the affirmative as to any of the following:
- The applicant is currently performing a substantial gainful activity.
- The applicant's impairment is not severe.
- The applicant is able to perform the same work most recently performed by the applicant.
- The applicant is able to perform any work in the economy.
An applicant may be required to visit a third-party physician for medical documentation to supplement evidence not supplied by the applicant's physician.
Disability Benefits Basics
If an applicant's SSDI application is approved, the benefits will consist of cash payments calculated in accordance with the applicant's personal earnings record. After collecting disability benefits for 24 months, SSDI claimants become eligible for Medicare.
If an SSI applicant's application is approved, federal SSI benefits will include cash payments of $735 per month for an individual or $1,103 per month for a couple (as of 2017), minus part of the applicant's income. These federal benefits may be supplemented by a state payment called a State Supplementary Payment. SSI benefit payments start five months after an applicant has been disabled, and they continue until the applicant's condition has improved sufficiently to allow them to start working again.
If an applicant's adult child becomes disabled before the age of 22, they can qualify for benefits based on the applicant's earnings record. Applicants that continue to receive disability insurance at the time of retirement age have their payments converted to retirement benefits. The amount of the payments will remain the same.
Disability Payment Procedures
Initial claims for both Supplemental Security Income and Social Security Disability Income are filed directly with the SSA. Both applications can be filed online using the SSA website.
The processing time for a typical application can be quite lengthy—up to eight months or more. If an application is denied, the denial can be appealed to the SSA. The appeals process is similarly lengthy, ranging from 90 days to a year. Appeals must be filed within 60 days of receipt of any denial of an initial application.
Military service members are eligible to receive a highly expedited application processing.
Applicants may hire a third-party representative such as a lawyer to help them apply or appeal. The maximum fee that a representative may charge for SSDI representation is prescribed by law. Be aware that some representatives charge fees for costs related to the filing of the claim or appeal, such as photocopy costs or the cost to collect your medical records associated with the claim.
Editor's note: The above information is neither legal advice nor a guide for applying for Social Security benefits, nor a substitute for reference to applicable federal or state law; it instead provides general information.