Social Security Disability: The Basics
A plain-language overview for individuals having difficulty remaining in the workforce and considering their options.
Over the course of their lives, a significant minority of Americans are left with no choice but to pursue disability benefits. The Social Security Administration estimates that a 20-year-old worker has a 30% chance of becoming disabled before reaching retirement age.
Disability benefits are not a cure for all of the problems caused by physical or mental afflictions, and they will never fully replace a person’s prior earnings. They can, however, soften the transition from work and reduce stressors that aggravate an individual’s symptoms.
“Going on disability” refers to several different programs sponsored by the government or private insurers. This article focuses on two Social Security-based programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both compensate individuals who, due to a disabling condition, are no longer capable of participating in the workforce. Notably, SSI does not have a work-history requirement, but does have a maximum-asset requirement.
Date of disability — when you can no longer work due to your condition. Date of application — when you apply. Date of approval — when your claim is approved (if at all).
1 · Qualifying for benefits
To qualify for SSDI, you generally must have a significant work history. This is reviewed in “quarters,” or three-month periods. When you earn roughly $1,200 in a quarter (about $400 a month for three months), that is a qualifying quarter.
As a rule of thumb, you typically must have worked five of the ten years immediately preceding your date of disability, and have accrued a certain number of quarters over your lifetime. Although this varies with age, a person who has worked regularly during their adult life will generally qualify — including, for example, a parent who took a few years out of the workforce to raise children, or someone who took time off for education to change careers.
You must also show that the condition (or conditions) keeping you out of the workforce has lasted, or is expected to last, at least one year.
The two-step test for “disability”
First, you must show you cannot perform the least-demanding job you have held in the last 15 years. Second — for both SSDI and SSI — you must show you cannot do a generic job at a certain level of difficulty. Although the Administration uses an in-depth table of job duties, the following rules of thumb often apply:
- Under 50: must be unable to do “sedentary work” — picture a sit-down receptionist job (answering the phone, taking messages, sorting mail).
- 50 to 60: must be unable to do “light duty” work — e.g. assembly-line work with significant standing and twisting but no heavy lifting.
- Over 60: need only show inability to do “medium duty” work — lifting 50 pounds and standing or walking six hours per day.
This graduated test favors older individuals, who have presumably paid more into the system. Please note that the above condenses thousands of pages of regulations into a few paragraphs — these are guidelines, not concrete rules, and even a person who believes they meet the requirements may be denied. Different judges may interpret the same testimony and records differently.
2 · Benefits
An approved applicant is eligible for several benefits, including regular payments, Medicare or Medicaid eligibility, and eligibility for dependents. There are waiting periods based on the date of disability: five full calendar months for payments, and two years for Medicare eligibility.
Monthly payment amounts vary as much as work histories do. To estimate yours, refer to the statement the Administration mails roughly three months before your birthday, which reports your earnings for every year of your life and lists your eligible benefits — or contact the Administration directly. Note that benefits may be reduced if you also receive a government pension, workers’ compensation, or other benefits.
3 · The application process & timeline
Timelines vary by region. The estimates below reflect eastern Pennsylvania, whose response times are considered average to above-average. Typically, a person who applies can expect a final resolution within about two years — sometimes sooner, depending on the stage at which the claim is approved.
Roughly one-third of approved claimants are approved at the initial Administrative Review, where a reviewer receives your medical records and background information and — without ever seeing you — approves or denies the claim. This usually takes three to six months.
If you are denied at the Administrative Review stage, there is a strictly enforced period to appeal and request a hearing. Failing to file before the deadline may forfeit your right to appeal. Review your decision closely, and talk to an attorney or the Administration to be sure any appeal is timely.
Generally, six to nine months pass between filing an appeal and the hearing. If you did not have an attorney at the initial filing, it is strongly suggested you obtain one for the hearing: your testimony is taken at this stage, and the record is effectively closed at its end. The hearing is your best opportunity for approval. Should you be denied there, additional appeals are available — all the way to the Supreme Court — though later stages require finding a serious error in the prior decision.
4 · Conclusion
The above is a legal snapshot of the disability process, intended to give you the basics of whether disability is appropriate for your situation. It is meant to supplement — not replace — the advice of trained professionals, including representatives at your local Social Security office or an attorney. Mr. Hall can be reached for questions at (610) 570-5253 or jhall@jrhlegal.com.
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