The definition of disability for Social Security claims is different from the definitions of disability used by insurance companies like New York Life or Unum. Social Security pays only for total disability. No benefits are payable for partial disability or short-term disability. For all individuals applying for disability benefits under Title II (Disability Insurance Benefits) and for adults applying under Title XVI (SSI), the definition of disability is the same.
The Definition of Disability
The law defines disability as the inability to engage in substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.
In easier-to-understand terms, Social Security pays monthly cash benefits to people who cannot work full-time for a year or more because of a disability. “Disability” is based on inability to work.
The SSA considers you disabled under its rules if:
- You cannot do work that you did before and you cannot adjust to other work because of your medical condition(s), and
- Your disability has lasted or is expected to last for at least one year or to result in death.
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The One-Year Rule
As you can see, there is a time requirement to receive disability benefits, often referred to as the “one year rule.” Thus, an individual who undergoes a major medical procedure such as surgery but returns to work after 11 months and two weeks is not likely to be eligible for benefits. This is a strict definition of disability, but the Social Security program rules assume that working families have access to other resources to provide support during periods of short-term disabilities, including workers’ compensation, insurance, savings, and investments.
Special Issues Concerning the One-Year Rule
At least one of a claimant’s disabling impairments must satisfy the one-year duration requirement to qualify for Social Security disability. Thus, if a claimant has two severe impairments that last less than one year each, such individual may not be eligible for benefits.
An example should clarify this a bit more:
Let’s say that Mr. Smith suffered a fractured spine in an automobile accident on January 1, 2020. He undergoes immediate surgery and applies for disability. He is denied and files for reconsideration, but is denied reconsideration and files for a hearing before an Administrative Law Judge.
Meanwhile, he goes through eight months of post-surgery physical rehabilitation therapy. Mr. Smith had a miraculous recovery and is preparing to return to work on September 1, 2020, when he is diagnosed with cancer. Mr. Smith does not return to work and undergoes nine months of chemotherapy. It is now July 1, 2021. Mr. Smith’s cancer treatment is a complete success, and his cancer is in complete remission. Mr. Smith returns to work on July 15, 2021.
The hearing on his Social Security Disability claim is scheduled for August 1, 2021. Mr. Smith attends the hearing and argues for a “closed period” of benefits from January 1, 2020, to July 1, 2021. He argues that he was out of work for one-and-a-half years due to a combination of impairments, thus satisfying the one-year durational requirement.
However, Mr. Smith will likely be denied benefits because neither impairment individually lasted at least 12 months. A harsh result given Mr. Smith’s terrible ordeal.
