The Social Security Administration (SSA) has two programs which provide financial assistance to people with a disability. SSDI (Social Security Disability Insurance Benefits Program) is financed with work related Social Security taxes and pays benefits to disabled workers and their families. SSI (Supplemental Security Income Program) is financed by general taxes and pays benefits to adults with disabilities who have limited income and resources.
Determination of a DisabilityWhile eligibility requirements vary under each program, the determination of what constitutes an eligible disability is the same under both SSI and SSDI. Applicants for SSI or SSDI benefits programs will be considered “disabled” if they cannot perform reasonably paid work to support themselves due to a mental or physical impairment which: (i) may result in death, or (ii) which is expected to last continuously for longer than twelve months. The applicant must have either a mental or physical condition which is so severe that they are rendered unable to carry out the work that they previously performed and cannot find other work due to their education, age or work experience. The SSA will carry out a five step evaluation process to determine disability. If the applicant is found not to be disabled during any part of the process, the process will terminate and the application will be denied disability benefits.
SSA Five Step Disability Determination Process
1. Substantial Gainful ActivityAn applicant will not be considered disabled if they currently earn more than a certain amount of money per month. This limit, called “substantial gainful activity”, is $1,010 for non-blind disabled people and $1,690 for those who are blind.
2. Severe ImpairmentThe SSA determines whether the applicant’s ability to perform fundamental work duties is significantly limited by the mental or physical impairment. A slightly abnormal condition is not considered severe.
3. Impairments ListIf the impairment that the applicant is suffering from is on the SSA Listing of Impairments Listing of Impairments - Adult Listings (Part A) , the applicant will be immediately considered disabled. If the disability is not on the SSA Listing of Impairments, the applicant must move to the next step.
4. Relevant Prior WorkThe applicant’s medical records are reviewed by the SSA to determine whether the impairment is restricting his or her ability to carry out work the applicant previously performed. If the medical records are insufficient to make a reasonable determination (such as not seeing a doctor for a long time), the SSA may require the application to be examined by a doctor. If the applicant is found able to carry out these basic work duties the application will be denied. The applicant moves to the fifth step if found to be unable to carry out his or her basic work duties.
5. Other Work or EmploymentThe SSA will determine whether there are other jobs available which the applicant can perform. Factors taken into consideration include whether the applicant could properly perform this work given the applicant’s impairment, age, work experience and education. If the applicant is found to be unable to carry out such alternative work, the applicant will be considered to be disabled.
Disability Benefits Waiting PeriodThere is a five month waiting period between being found disabled and the first payment of disability benefits. Benefits are only payable on the sixth month after the disability benefits eligibility period has begun. Once the disability is gone, payments will stop on the second month after it comes to an end. Benefit payments will be made until the disability has gone or improved or until the person returns to work or substantial gainful activity.
Disability Benefits: Termination or ReductionDisability payments may be terminated if a person receiving the benefits reaches the age of retirement or dies. If other government programs are also being paid in order to replace loss of income, those payments will be reduced accordingly. Disabled spouses, widowers or widows, or children may be eligible for derivative benefits. Trial periods are available where a disabled person can test whether they can successfully return to work. They will not lose their benefits during this trial period.
Continuous Evaluation of the DisabilityRegardless of whether an applicant continues to be eligible for disability benefits, their eligibility will be reviewed periodically by the SSA. An applicant may receive written notice that they are to be reviewed and will be informed of requirements. A medical examination may be necessary and other information may also be required by the SSA.
Appeals to Denials of Disability BenefitsThere is a three step appeal procedure decisions to deny disability benefits. If the applicant is denied once again, he or she can sue the SSA in federal court. After each step, the applicant will receive written notification regarding a decision and has sixty days to file a request for a further review if denied again.
Reconsideration of SSA DecisionThe initial decision of the SSA is reviewed by a Social Security representative who had no part in the original review. The applicant may also submit new evidence for review.
Administrative HearingA hearing will be held by an administrative law judge. The applicant is not required to be present at the hearing but may attend.
Review by the SSA Appeals CouncilWhen filing for a review request by the SSA Appeals Council, the applicant may submit additional evidence and comments. The SSA Appeals Council may choose to hear a case and may deny a request if it believes that the decision made by the administrative law judge was correct. An SSA Appeals Council decision results in either a final decision by the Council or the case being sent back to the administrative law judge for further review.
A dissatisfied applicant may sue the SSA in federal court within sixty days of an unfavorable decision rendered by the Social Security Administration Appeals Council. It may be advisable to consider the use of an expert Social Security attorney to appeal an unfavorable decision. Many will consider contingency cases where the attorney only gets paid should you win a decision to receive benefits.
- Health, Medical & Social:
- Social Security Eligibility
Eligibility, Benefits How to Qualify a Disability for SSDI & SSI Benefits
By Michael M. Wechsler |
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