The Social Security Administration (SSA) pays disability benefits through two programs:  the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program.  This article provides an overview of the SSDI program. 

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What is the Social Security Administration?

The U.S. Social Security Administration (SSA) is an agency of the U.S. federal government that administers Social Security.  The Social Security Administration's website is: https://www.ssa.gov.

What is Social Security?

Social Security is a social insurance program through which the U.S. federal government pays retirement (“old age”), disability, and survivors’ benefits to qualified individuals.  The program is funded primarily through taxes collected by the Internal Revenue Service (IRS) under the Federal Insurance Contributions Act (FICA) and the Self Employed Contributions Act (SECA).  Benefits are paid to qualified individuals either on the basis of their past contributions as wage earners or on the basis of their demonstrated need.

What is Social Security Disability Insurance?

Social Security Disability Insurance (SSDI) is one of the Social Security programs that is administered by the SSA.  It is intended to provide supplemental income to individuals who are restricted in their ability to work due to a disability.

In 2018, more than 8.5 million Americans received SSDI.  In addition, 117,000 spouses and 1.5 million children received SSDI through a family member. 

SSDI benefits are often called “Social Security disability benefits.”

How does SSDI differ from SSI?

Whereas individuals qualify for Supplemental Security Income (SSI) on the basis of their limited income, individuals qualify for SSDI on the basis of their inability to work.

Why is SSDI important?

SSDI is important because an individual beginning their career today at age 20 has between a 1 in 4 and 1 in 3 chance of either dying or losing their ability to work before reaching Social Security’s full retirement age.  SSDI thus ensures that they, their spouse, and/or their children will have access to income even if they become unable to work in the future.

Who qualifies for SSDI?

In order to qualify for SSDI, an individual must:

1.      meet the SSA’s “earnings requirement”

2.      suffer from a severe, medically determinable physical or mental impairment that is expected to last at least 12 months or result in death; and

3.      be unable to perform “substantial gainful activity”

What is the “earnings requirement” for SSDI?

To qualify for SSDI, an individual must meet two different earnings tests:

1.      a recent work test, which is based on the age of the individual at the time their disability began; and

2.      a duration of work test, which is based on how long the individual worked

These two “tests” – both of which must be met – are calculated using what the SSA calls “calendar quarters”:

·       the First Quarter is January 1 through March 31

·       the Second Quarter is April 1 through June 30

·       the Third Quarter is July 1 through September 30

·       the Fourth Quarter is October 1 through December 31.

1.  The recent work test

The recent work test is based on the age of the individual during the quarter when their disability began:

·       If an individual’s disability begins either before or during the quarter when they turn age 24, then they generally will need to have worked for at least 1.5 years during the 3-year period ending with the quarter when their disability began.

·       If an individual’s disability begins during any quarter after they turn age 24 but before the quarter when they turn age 31, then they generally will need to have worked during at least half of the period beginning with the quarter after they turned age 21 and ending with the quarter when their disability began.   For example, if an individual’s disability begins during the quarter when they turn 27, then they will need to have worked at least 3 of the prior 6 years.

·       If an individual’s disability begins either during or after the quarter when they turn age 31, then they generally will need to have worked at least 5 of the prior 10 years.  Although individuals may lose their ability to work at any age, the majority of individuals who qualify for SSDI do so later in life, so this 5/10 rule is the most common.

2.  The duration of work test

The duration of work test is based on how long the individual worked before their disability began.

·       As a general rule, determining the number of quarters required involves taking the year when the individual’s disability begins and subtracting from that number the year when the individual turned age 22.  To make things easier, the SSA provides the following table (which does not cover all situations):

       Age at Disability Onset              Overall Years of Work Required

28 or younger                              1.5

29 – 33                                           2

34 – 37                                           3

38 – 41                                           4

42 – 43                                           5

44 – 45                                           5.5

46 – 47                                           6

48 – 49                                           6.5

50 – 51                                           7

52 – 53                                           7.5

54 – 55                                           8

56 – 57                                           8.5

58 – 59                                           9

60 – 61                                           9.5

62 or older                                      10

 

Who is considered to have a disability for SSDI purposes?

The definition of “disability” for SSDI purposes is different than it is for many other programs or under the Americans with Disabilities Act (ADA).  The SSA pays SSDI benefits only for what it considers to be a “total” disability.  It does not pay SSDI benefits for partial disability or for short-term disability.

For SSDI purposes, an individual is considered to have a disability if they are unable to engage in any substantial gainful activity (SGA) due to any “medically determinable physical or mental impairment” which is expected to result in death or which has lasted or is expected to last for a continuous period of at least one year.

What is a “medically determinable physical or mental impairment”?

A medically determinable physical or mental impairment is an impairment that results from “anatomical, physiological, or psychological abnormalities” and is evidenced by medically acceptable clinical and laboratory diagnostic techniques.  In other words, the impairment must be shown to exist by independent medical evidence.

What sort of evidence of disability does the SSA require?

The SSA requires “objective medical evidence” from an “acceptable medical source” to establish that an individual has a medically determinable impairment.

How is it determined that an individual has a qualifying disability?

The Disability Determination Services (DDS) office in each state completes the initial “disability determination” for the SSA.

The DDS uses a 5-step process to determine whether an individual is qualified for SSDI due to a disability by obtaining the answers to each of the following questions:

              1.  Is the individual working?

If the individual is working and their work-related earnings average a certain amount or more each month, then they generally will not be considered to be unable to work due to a disability.

The amount (which is referred to as the “substantial gainful activity” limit) changes each year.  In 2019, it was $1,220 per month.  (It was $2,040 per month for individuals who are blind.)

              2.  Is the individual’s medical condition “severe”?

For an individual to be considered to have a disability according to the SSA’s definition, their medical condition must significantly limit their ability to do basic work activities — such as lifting, standing, walking, sitting, and remembering — for at least 12 months.

              3.  Does the individuals’ medical condition either meet or medically equal any of the SSA’s impairment “listings”?

For an individual to have a qualifying disability, their medical condition must either meet or be medically equal to one of the SSA’s impairment “listings.”  The SSA’s listings describe in detail the medical conditions that the SSA considers to be severe enough to prevent an individual from being gainfully employed, regardless of their age, education, or work experience.

The listings include detailed descriptions of medical conditions related to:

·       the musculoskeletal system

·       special senses and speech

·       respiratory disorders

·       the cardiovascular system

·       the digestive system

·       genitourinary disorders

·       hematological disorders

·       skin disorders

·       endocrine disorders

·       congenital disorders that affect multiple body systems

·       neurological disorders

·       mental disorders

·       cancer (malignant neoplastic diseases)

·       immune system disorders

The listings are available here:  https://www.ssa.gov/disability/professionals/bluebook/listing-impairments.htm

              4.  Can the individual do the work they did before?

For an individual to have a qualifying disability, they must also be unable to do any of the work they did before their disability began.

              5.  Can the individual do any other type of work?

For an individual to have a qualifying disability, they must also be unable to do any other type of work, taking into consideration the individual’s age, education, skills, and prior work experience.

How may an individual apply for SSDI?

An individual may apply for SSDI online, by telephone, by mail, or in person.

What information does an individual need to apply for SSDI?

To apply for SSDI, the applicant (or whomever will be helping them apply) must provide to the SSA the following information:

·       the applicant’s Social Security number (or proof of their eligible nonimmigrant status)

·       proof of the applicant’s age

·       the applicant’s direct deposit information

·       the contact information of the doctors, therapists, caseworkers, hospitals, and clinics that take or took care of the applicant and the dates of the applicant’s visits

·       the names and dosages of all the medications that the applicant is taking

·       any medical records already in the applicant’s possession (the applicant will be asked to sign a release allowing the SSA to obtain additional records and information)

·       the applicant’s laboratory and other test results

·       a summary of where the applicant worked and the kind(s) of work the applicant did

·       the applicant’s most recent W-2 form or, if the applicant was self-employed, a copy of their federal tax return

A complete list of the information that the applicant may need to provide is available here:  https://www.ssa.gov/forms/ssa-16.html

Does the SSA review the disability status of current recipients of SSDI?

Yes.  An individual will continue to receive SSDI benefits so long as they are unable to work due to a disability – and so long as the individual continues to receive SSDI benefits, the SSA will continue to monitor their disability status.  The frequency with which the SSA will review the recipient’s case will depend on whether the individual’s medical condition is expected to improve.

If medical improvement is “expected,” then the SSA generally will review the individual’s case within 6 to 18 months after they begin receiving SSDI.  If medical improvement is “possible,” then the SSA generally will review the individual’s no sooner than 3 years after they begin receiving SSDI.  If medical improvement is “not expected,” then the SSA generally will review the individual’s case no sooner than 7 years after they begin receiving SSDI.

What may cause the SSA to cease paying benefits to a current recipient of SSDI?

The SSA will stop paying benefits to a current recipient of SSDI if the SSA determines that the individual is no longer unable to work due to a disability either because:

·       they work at a level that is considered to be “substantial” (in 2019, average monthly earnings of $1,220 or more); or

·       their medical condition has improved to the point that they are no longer considered to have a disability according to the SSA’s definition

Recipients of SSDI are responsible for informing the SSA if they return to work or if their hours or wages increase and/or if their medical condition improves.  An individual who is “overpaid” SSDI because they receive more benefits than they should may be required by the SSA to repay the overpayment.

What if an applicant for (or current recipient of) SSDI disagrees with the SSA’s determination?

If an applicant (or current recipient) is denied SSDI even though they believe they are qualified, they may appeal the SSA’s determination by requesting a reconsideration.  If the applicant (or current recipient) disagrees with the reconsideration determination, then they may request a hearing before an administrative law judge (ALJ).  If the applicant (or current recipient) disagrees with the ALJ’s determination, then they may request a review by the Appeals Council.  If the applicant (or current recipient) disagrees with the Appeals Council’s determination, then they have the option of seeking judicial review by filing a civil action in their local federal district court.

Information about the appeals process is available here:  https://www.ssa.gov/benefits/disability/appeal.html

For additional information related to SSDI, please click on the pages below.

 

 

Sources and further reading

Center on Budget and Policy Priorities – “Chart Book:  Social Security Disability Insurance”:  https://www.cbpp.org/research/social-security/chart-book-social-security-disability-insurance

Benefits.gov – “Social Security Disability Insurance Benefits”:  https://www.benefits.gov/benefit/4382

Social Security Administration – “Benefits for People with Disabilities”:  https://www.ssa.gov/disability

Social Security Administration – “Benefits Planner:  Disability”:  https://www.ssa.gov/planners/disability

Social Security Administration – “Disability Benefits”:  https://www.ssa.gov/pubs/EN-05-10029.pdf