Social Security Disability Insurance benefits (“SSDI”) are also known as “Title II” benefits because they derive from Title II of the Social Security Act, 42 U.S.C. § 401 et seq. The applicable Federal Regulations are found in 20 C.F.R. Part 404, or “Regulations No. 4.” There are several subcategories of disability insurance benefits as described below. An individual may qualify for SSDIB in one of three ways:
- as a Disabled Individual Worker;
- as a Disabled Adult Child; or
- as a Disabled Widow/Widower, or Disabled Surviving Divorced Spouse.
Medical Requirements for Social Security Disability
Meeting the Definition of Disability
One way to satisfy Social Security’s definition of disability is for the claimant’s disability or impairment to meet or “equal” the level of severity described in Social Security book of listings called the Listing of Impairments. This is the comprehensive manual that identifies dozens of conditions – from physical conditions like spinal disorders to mental conditions such as severe depression and anxiety – and the level of severity of each condition that is required to “meet a listing”. If your condition satisfies all of the requirements of a particular listing, you are said to “meet the listing” and your disability claim will be approved.
However, it is important to note that it is very difficult to win a disability application based on meeting the disability criteria in the listing book. Most individuals who apply for Social Security disability will qualify in another way: that is when the claimant’s disabling condition is severe enough that he or she is unable to work and earn at least a minimum amount of money each month. The SSA will first determine whether you’re capable of doing your last job, or jobs you’ve had in the past 15 years. If you are not capable of doing your recent history of jobs, Social Security will determine whether you can do other types of work. The Social Security Administration will make this determination while taking into account the claimant’s age, highest level of education achieved, and the type of skills they learned in the past 15 years.
For example, an individual with a 9th grade education (who did not obtain a GED) who cannot do their past work in manual labor (for instance, because it requires a lot of standing and walking) will not be expected to perform other work that goes beyond his or her educational limits. In the same vein, individuals with severe mental or affective impairments (such as having a low IQ or severe depression or anxiety) will not be expected to perform other work that requires detailed attention and concentration.
You Must Have a Severe Medical Disease or Condition
Then you must have a medical condition that meets Social Security’s definition of disability. SSDI benefits are only available to those with a severe, long-term, total disability. Severe means that your disease or medical condition must interfere with your ability to perform basic work-related activities. In general, Social Security pays monthly cash benefits to individuals who are unable to work for a year or more due to a disability. Thus, long-term means that your condition has lasted is expected to last at least one year.
Total disability means that you are not able to perform “substantial gainful activity” (SGA) for at least one year. If you are currently working and make over a certain amount ($1,070 per month in 2014 for disabled applicants, $1,800 for blind applicants), Social Security will find that you’re performing SGA and that you are not disabled enough to qualify for SSDI benefits.
The following links break down the requirements more closely:
Non-Medical Requirements for Social Security Benefits
In order to qualify for “regular” Social Security Disability Insurance (SSDI) disability benefits, an individual must have paid Social Security payroll taxes over a certain length of time and earned enough “work credits”. An individual who has earned enough credits this will be considered “insured” for SSDI purposes. If an individual stops working and paying Social Security taxes, he or she must be able to show that his or her disability began before his or her “date last insured”, which is when the insured status ran out.
In order to qualify for “regular disability” (also called, disability insurance benefits, DIB, RSDI, and “Title II” or “Title 2” benefits) you must have worked long enough, paid in long enough–and recently enough–under Social Security to qualify for disability benefits (in addition to meeting Social Security’s definition of disability). That’s why some people know it as “workers’ disability.”[Note: If you have not worked long enough and earned enough credits when you become disabled, you may still apply for Supplemental Security Income (SSI) instead, if you have low income and assets. In order to qualify for Supplemental Security Income (SSI) disability benefits, an individual must have income and assets under the SSI program’s strict limits.]
The number of work credits you need to qualify for SSDI benefits depends upon how old you were when you became disabled. Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. However, younger workers may qualify with fewer credits.
The rules are as follows:
- Before age 24–You may qualify if you have 6 credits earned in the 3-year period ending when your disability starts.
- Age 24 to 31–You may qualify if you have credit for working half the time between age 21 and the time you become disabled. For example, if you become disabled at age 27, you would need credit for 3 years of work (12 credits) out of the past 6 years (between ages 21 and 27).
- Age 31 or older–In general, you need to have the number of work credits shown in the chart below. Unless you are blind, you must have earned at least 20 of the credits in the 10 years immediately before you became disabled.
For example, if you are 50 years old when you become disabled, you need 28 work credits according to the chart above – or to have worked for seven years (and at least five of those years must have been within the last 10 years).
The amount needed for a credit changes from year to year. In 2013, for example, you earn one credit for each $1,410 of wages or self-employment income. When you’ve earned $5,640, you’ve earned your four credits for the year.
IMPORTANT: Remember that whatever your age is, you must have earned the required number of work credits within a certain period ending with the time you become disabled. Your Social Security Statement shows whether you meet the work requirement at the time it was prepared. If you stop working under Social Security after the date of the Statement, you may not continue to meet the disability work requirement in the future.
Approval for Disability Benefits
If your claim for disability benefits is approved, you will not receive SSDI benefits until you have been disabled for five months. This “waiting period” means that even if you are approved right away (for instance, because you just had a liver transplant), you would still have to wait five months for your checks to start.
However, it is more likely that your initial application will not be approved for months (or even years), typically after at least one level of appeal. In such a case, you would be paid disability backpay starting with the sixth month after your disability began (your disability onset date).
After you are paid your back due benefits that are due and owing, you should get a disability benefit check each month. If your household income is over a certain amount, you may even have to pay taxes on your disability benefits.
Your family members may also be eligible for a partial monthly benefit. For more information, see our section on How to Get Disability Benefits for Your Dependents.
You can keep receiving SSDI as long as your medical condition prevents you from working. The SSA may still perform a continuing disability review (CDR) on your file every one to three years to determine if your condition has improved (and therefore your benefits should be cutoff).
Denial of Disability Benefits
If your SSD application is denied (and over 65% of most initial applications are denied), you can appeal the decision. You must, however, request a review of the denial within 60 days of when you receive the denial letter. The first step of the appeal process in most states – including Florida – is the Request for Reconsideration. In a Request for Recon, your claim is evaluated by someone who did review the initial claim. Another claims examiner is assigned to the claim. If you are denied again at the Reconsideration level, you can appeal to the next stage by requesting a hearing with an Administrative Law Judge who works for the SSA.
Appealing Disability Denials
It is common for an application for Social Security or SSI disability benefits to be denied in at the initial application stage (sometimes called the first round). In fact, well over 50% of all disability applications are denied. In these cases, appeals are required for disability benefits to be approved.
To be frank, all too many claims are denied because the patient’s claim record lacks enough medical documentation to fully document and establish the severity of the disability.
If you’ve applied for SSDI or SSI and been denied, you should not start over with a new application. This is a common mistake made by (unrepresented) applicants for disability benefits. You should not start over with a new application because new disability claims will simply be denied again. Instead, you should file an appeal called a Request for Reconsideration, and make sure the medical evidence is complete in your file. An experienced disability lawyer can advise you about what medical evidence will help you win an approval.
Hiring a Disability Lawyer or Representative
No matter what stage you are on in the disability process – whether it be the Initial Application, Reconsideration, or Hearing stage of appeal – you should consider retaining the services of a qualified disability lawyer to help guide your case through the disability appeals process. It is well established that claimants with legal help have a better chance of winning than those who are not represented by counsel.
The Ortiz Law Firm has years of experience in handling Social Security disability insurance claims. If you think you may qualify for disability and have questions about the process, contact Mr. Ortiz at (888) 321-8131 for a free case evaluation.