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Useful Information


Social Security Disability Benefits

  1. Definition and Purpose. Social security disability benefits are part of the overall system of social insurance that we know as "social security". Social security disability benefits are designed to assist those who have become disabled, whether as the result of a work injury or some other non-work-related injury or disease. The system is funded through payroll taxes and only those who are or have been employed and who meet or have met the duration of employment and earnings requirements are eligible for these benefits.
  2. Basic Requirement.
    • A claimant for benefits must establish that the claimant has worked long enough and has sufficient earnings from that work to be eligible for social security disability benefits. The usual rule is that the employee claiming social security disability benefits must have worked a minimum of 20 of the 40 calendar quarters (i.e., at least five of the preceding ten years) prior to the date of the onset of the alleged disability. If the employee succeeds in establishing disability but only at a point after the expiration of insured status, the employee is not eligible for social security disability benefits.
    • An employee must demonstrate the existence of a "severe" impairment that is likely to be fatal or, if non-fatal, that can or is expected to last 12 months. Social security disability is a long-term disability program and is not designed for short-term coverage. Indeed, social security disability benefits are not payable until after five months following the month in which the employee became disabled. For example, a claimant who became disabled on January 15, 1998 would first be entitled to receive a monthly benefit check for July 1998.
  3. Procedure.
    • The first step in the attempt to obtain social security disability benefits is to apply for them at or through a local social security office. Applications can be made over the telephone, although such applications are usually taken only after an initial contact during which the telephone application was arranged.
    • An application for benefits can be submitted at any time. However, ordinarily the social security representatives will not accept an application from an individual who is engaging in what is known as "substantial gainful activity", i.e., who is working. Although it is possible to recover social security disability benefits for periods in the past, the period of recovery is limited to one-year back from the application.
    • It usually takes the social security administration a number of months to act on an initial application for benefits. There is no hearing upon initial consideration, and the decision is based upon the written or oral information provided at the time of the application, together with the medical records that the claimant provides or the administration collects.
    • If the decision upon initial consideration is unfavorable to the employee, the employee can request a reconsideration. Reconsideration is a second level of administrative review during which the employee does not ordinarily appear for an in-person hearing. The reviews are conducted by the Disability Determination Service, a state agency. The reconsideration process can be very lengthy, lasting six to nine months or even more in certain cases.
    • A claimant who has been denied benefits upon reconsideration has the right to file a request a hearing before an administrative law judge of the Office of Hearings and Appeals of the Social Security Administration. Both the request for reconsideration and for a hearing must be filed within 60 days of the date of receipt of the prior decision. Although there has been recent improvement, the hearings office, like the Disability Determination Service, is backlogged and it can take many months for a claim to come up for a hearing before an administrative law judge.
    • An unfavorable decision from an administrative law judge can be appealed to the Appeals Council in Washington D.C. If that decision is unfavorable, the claimant has the right to review in the appropriate Federal District Court. However, court review is limited to determining whether the decision of the Social Security Administration was legally correct and supported by substantial evidence. The Federal District Court does not take new evidence or decide the case as though it were the social security judge.
  4. Disability Standard.
    • A "disability" for social security purposes means the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment. The medical impairment must be "severe", i.e., the impairment must be of a sufficient nature and intensity to interfere with the performance of basic work activities such as walking, standing, sitting, lifting, seeing, hearing, understanding and executing instructions, etc.
    • In addition to a showing of "severity", the claimant must demonstrate that the severe impairment renders the claimant unable to perform the claimant's "past relevant work" or other substantial gainful activity which exists in the national economy.
    • It is not sufficient for a claimant to allege disability on the basis that "no one will hire me". Social security disability benefits are for the disabled and are not unemployment insurance. A successful claimant for social security disability benefits will have to produce medical evidence of a disease or condition that is sufficient to interfere significantly with the claimant's ability to work. Although a claimant's age and past work experience are not ignored, a firm medical basis must be established before benefits can and will be awarded.
  5. Proving Disability.
    • There are several different ways of establishing disability to the satisfaction of the Social Security Administration. First, a claimant can demonstrate the existence of an impairment that meets or equals the "listings". The "listings" are simply that, a list of impairments that are presumed to be disabling by their very existence. The listings include specific and stringent medical criteria. It usually requires a detailed statement from a physician for a claimant to demonstrate that the claimant's impairment meets or equals a listed impairment.
    • 1.An employee will also be found to be disabled if he or she meets the requirements of the "grids". The grids take into account the claimant's impairment level as well as the claimant's age, education, and work experience. The various factors are plugged into the appropriate grid which then indicates whether the claimant is "disabled" or "not disabled" based upon the factors identified. It is much easier for a claimant to satisfy the requirements of the grids after age 50. Copies of the "grids" can be found at the end of these materials.
    • It is possible to establish disability through medical records and physicians' statements, even if the condition does not meet or equal a listed impairment. In these circumstances it is often necessary to take a statement from a physician to establish that the impairment is significant enough to make it extremely difficult or impossible for the claimant to perform any work.
  6. Relationship of Social Security Disability Benefits to Workers' Compensation Benefits.
    • Since the source of the disabling impairment is usually irrelevant for social security disability purposes, an individual may become eligible for these benefits as a result of a work injury that also entitles the claimant to workers' compensation benefits. Social security disability is not limited to non-work injuries or diseases as are most employer long-term disability plans.
    • Even though it is possible to be entitled to both benefits at the same time, the amount of disability benefits that the recipient of workers' compensation benefits will receive from the Social Security Administration is limited. Generally the maximum amount payable when both benefits are being received at the same time is 80% of the claimant's "average current earnings". This is a figure derived by the Social Security Administration from the employee's earnings record. Usually it represents one-twelfth of the employee's earnings in the best year of the five years prior to the onset of disability. If the total of social security disability and workers' compensation benefits in one month exceeds the 80% figure, the social security disability benefits are reduced.
  7. Supplemental Security Income (SSI) Benefits.
    • The supplemental security income (SSI) benefit program is a companion to social security disability. It provides benefits to disabled people who are indigent and who do not qualify for social security disability benefits for whatever reason. The disability standards are the same as for social security disability.
    • It must be remembered that SSI benefits are based on income and are payable only to those who have very limited income and resources. Thus, a wealthy individual might be eligible for social security disability benefits but would not be eligible for SSI benefits because the wealthy individual would undoubtedly have too much other income and/or resources.
    • SSI benefits are payable beginning with the first month following the month in which the application is submitted. There is no recovery of past-due benefits for any months of disability prior to the submission of the application.