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Social Security Disability

There are 2 disability programs that are administered by Social Security: Social Security Disability (SSD) and Supplemental Security Income (SSI). While both programs require a finding of "total disability", SSD provides benefits to individuals who have an employment history while SSI provides benefits to those who do not have a qualifying work record. To meet the employment qualifications of SSD, a worker is required to have worked sufficient quarters (the 3 month IRS reporting periods) to equal 5 years out of the 10 year period prior to having become disabled. Those who do not have sufficient quarters to qualify, but are totally disabled, will qualify for SSI as long as they do not possess assets in excess of $2500.00. There is no limitation on assets under SSD.

Under either benefit program, the major issue is whether the applicant is "totally disabled". The disability may be a physical or mental condition or a combination of physical and mental conditions that "because of their severity, as demonstrated by substantial medical proof, prevent the person from performing his/her past work or other work generally available in the national economy." The disability determination is effected by the applicant's age. Applicants under 50 years of age (a younger person) must be disabled from all employment while those 50-54 years of age (Closely Approaching Advanced Age) are disabled if they are only able to perform sedentary labor. Those of Advanced Age (55-60 years) are disabled if capable of only sedentary or light labor and those 60-64 years (Closely Approaching Retirement Age) are disabled if they cannot perform their prior labor (unless they possess "highly marketable skills"). Note the age definitions are those of the Social Security Administration, not this author.

Under either disability program, a claimant is entitled to benefits if totally disabled and anticipated to be totally disabled for at least 1 year. Both programs also have a 6 month elimination period which means there are no benefits paid for the first 6 months of disability and the process is started by filing an application with the Social Security Administration. The application may be processed in person at a Social Security office, by phone, or on line. The application should be filed even prior to the expiration of the 6 month elimination period since it may take 4 - 6 months for the department to process the application. If approved, the applicant commences receiving monthly benefits established by Social Security and is qualified for Medicaid for medical treatment. After being disabled for a period of 2 years, the applicant is entitled to Medicare, the same as retirees.

If denied, there is a multi-tiered appeal process. The first step is called reconsideration and must be requested within 60 days of the denial. During this step, additional medical records and evidence may be submitted to case adjudicator to prove the disability issue. This process may also take 4 - 6 months to complete. A denial at the end of the reconsideration requires the filing of a request for a hearing before an administrative law judge to make a factual determination of whether the claimant is disabled.

At whatever step in the process benefits are awarded, the monthly payment benefits are awarded retroactively to the date the claimant is determined to have become disabled, in a lump sum, minus the 6 month elimination period.

For more information, feel free to contact us.


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