Nolo's Guide To Social Security Disability
Getting and Keeping Your Benefits
David A. Morton III, MD
The Social Security Administration (SSA) decides who is eligible for disability payments under rules established in the Social Security Act by the U.S. Congress. In this chapter we describe the two main SSA programs that administer disability payments. We briefly explain the requirements that any claimant must meet to receive benefits. We also provide a number of tips on how to deal with the SSA bureaucracy, including answers to some of the most frequently asked questions about Social Security Disability.
Two Different Programs
Once you qualify as disabled under the Social Security Act, the SSA makes disability payments under one of two programs:
* Social Security Disability Insurance (SSDI), for workers who have paid into the Social Security trust fund (and their dependents), and
* Supplemental Security Income (SSI), for disabled individuals with limited incomes and assets (and their dependents).
SSDI claims are also referred to as Title 2 claims because they are authorized under Title 2 of the Social Security Act. SSI claims may be referred to as Title 16 claims because they are authorized under Title 16 of the Social Security Act. A person claiming a disability is called a claimant. Some claimants apply under both Title 2 and Title 16; these are known as concurrent claims.
When the SSA receives your application, it will determine whether you are eligible for disability benefits under SSDI or SSI, even if you have not specifically requested both. This means that if you apply only for SSDI benefits, the SSA will automatically process your claim for any SSI disability benefits to which you might be entitled. If your SSDI claim is turned down, you don't have to file another claim for possible SSI benefits.
1. Social Security Disability Insurance
SSDI provides payments to workers who have made contributions to the Social Security trust fund through the Social Security tax on their earnings. SSDI is also available to certain dependents of workers. If you are found eligible for SSDI, you might be entitled to retroactive (past) benefits if you can show that you were disabled before the date of your application. (See Chapter 10 for more details on when benefits begin.)
a. Who Qualifies?
To qualify for SSDI, you must fall into one of the following categories:
i. You are a disabled insured worker under age 65
You must have worked both long enough and recently enough to qualify. It may not be sufficient that you worked for many years and paid Social Security taxes. When you worked is also important. The law requires that you earn a certain number of work credits in a specified time before you are eligible for benefits. You can earn up to four credits per year, each credit representing three months. The amount of earnings required for a credit increases each year as general wage levels rise.
The number of work credits needed for disability benefits depends on your age when you become disabled. Most people need at least 20 credits earned over ten years, ending with the year you become disabled. Younger workers may qualify with fewer credits.
In effect, you count backwards from the year that you became disabled to see whether you have the appropriate number of credits. That means that credits from many years before you became disabled are automatically wiped out, or expire. This can lead to a dangerous situation for people who haven't worked for many years before becoming disabled. Their credits may dip below the required amount, and they can lose eligibility for SSDI. The date on which they lose their eligibility is called the "date last insured," or DLI -- often a subject of dispute in Social Security cases. If you think your DLI is too far in the past to qualify you for SSDI, talk to your local SSA Field Office to make sure -- in certain rare circumstances, you may still qualify.
The rules are as follows:
* Before age 24. You'll need at least six credits earned in the three-year period ending when your disability started.
* Age 24 to 31. Credit for having worked 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 three years of work (12 credits) during the six years between ages 21 and 27.
* Age 31 or older. In general, you will need the number of work credits shown in the chart below. Unless you are blind (see Chapter 17 for definitions of legal blindness), at least 20 of the credits must have been earned in the ten years immediately before you became disabled.
Born after 1929 and
became disabled at age: Credits needed
31 through 42 20
62 or older 40
You can find out how many credits you have by contacting your local SSA office or, if you have access to the Internet, by filling out a form at www.ssa.gov/mystatement.
ii. You are the family member of an eligible worker
The SSA pays auxiliary benefits to people who qualify based on certain family members' entitlement to retirement or disability benefits. Benefits are paid based on the earnings records of the insured worker who paid enough Social Security taxes. If you qualify for auxiliary benefits, you do not necessarily have to be disabled; nor do you need the work credits described above.
Spouse's and divorced spouse's benefits. To qualify for auxiliary benefits as a spouse or divorced spouse, one of the following must apply (42 U.S.C. 402(b) (c) (e) (f); 20 CFR 404.330-349):
* You are the divorced spouse of a retired or disabled worker who is entitled to benefits, you are 62 years old or older, and you were married to the worker for at least ten years.
* You are the divorced spouse of a worker insured under SSDI who has not filed a claim for benefits, you are age 62 or older, your former spouse is aged 62 or older, you were married for at least ten years, and you have been divorced for at least two years.
* You are a disabled widow or widower, at least 50 years of age but less than 60 years old, and you are the surviving spouse of a worker who received Social Security disability or retirement benefits.
* You are the surviving spouse (including a surviving divorced spouse) of a deceased insured worker, and you are age 60 or older.
* You are the surviving spouse (including a surviving divorced spouse) of a deceased insured worker, and you care for a child of the deceased entitled to benefits who either is under age 16 or has been disabled since before age 22. (These benefits are known as "mother's or father's benefits.")
About the author:
David A. Morton has degrees in psychology (B.A.) and medicine (M.D.). For 14 years, he was a disability determination consultant for the Social Security Administration, serving as Chief Medical Consultant for eight years. In his capacity as Chief Medical Consultant, Dr. Morton hired, trained, supervised and evaluated the work of medical doctors and clinical psychologists, and made thousands of disability determinations for both adults and children. Since 1983, Dr. Morton has authored several books on Social Security disability for attorneys and judges, including Nolo's Guide to Social Security Disability.