Social Security Disability: The Basics

Jamie Hall is an attorney admitted to practice in Pennsylvania, New York, and New Jersey. He is a regular speaker on Social Security Disability issues for the National Multiple Sclerosis Society, having given disability seminars in eastern Pennsylvania and upstate New York.  Mr. Hall can be reached for questions at (610) 570-5253 or [email protected].

The following is intended to provide basic information about disability benefits for individuals who are having difficulties remaining in the workforce, and are considering their options. Although general information will be provided, this information is intended to supplement, not replace, the personalized assistance of an attorney or your local disability office.

Over the course of their lives, a significant minority of Americans are left with no choice but to pursue disability benefits. The Social Security Administration estimates that a 20-year-old worker has a 30% chance of becoming disabled before reaching retirement age. When a person can no longer perform his or her work, it may be time to consider a claim for disability benefits.

Disability benefits are not a cure for all of the problems caused by physical or mental afflictions. These benefits will never fully replace a person’s prior earnings. They can, however, soften the transition from work and reduce stressors aggravating an individual’s symptoms.

“Going on Disability” refers to several different programs sponsored by the government or private insurers. For the purposes of this article, we will focus on two Social Security-based programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both programs compensate individuals who, due to a disabling condition or conditions, are no longer capable of participating in the workforce. Notably, SSI does not have a work history requirement, but does have a maximum asset requirement.

To understand these disability programs, a few basic concepts must be understood. First, there is a distinction between “date of disability,” “date of application” and “date of approval.” A person’s date of disability is when the person can no longer work due to his or her disability. A person’s date of application is when they apply for disability. A person’s date of approval is when their claim for disability is approved (if at all).

(1) Qualifying for Benefits

To qualify for SSDI, an individual must have a significant work history. This history is reviewed in “quarters,” or three month periods. When a person earns approximately $1200 in a quarter (or approximately $400 a month for three months), this is a qualifying quarter.

To be eligible for benefits, a person typically must have worked five of the ten years immediately preceding their date of disability. Additionally, the individual must have accrued a certain number of quarters over their lifetime. Although this requirement varies with age, a general rule of thumb is that a person who has worked regularly during their adult life will still qualify. For example, a mother of two who took a few years out of the workforce to raise each of her children, or an individual who has taken time out of work for education to change careers, will still qualify.

An individual must also be able to show that the condition or conditions preventing them from remaining in the workforce have lasted or are expected to last at least one year.

A person with a qualifying work history must be able to show that they are unable to work, which is a two-step process. First, a person must show that they cannot engage in the least demanding job that they have worked in the last 15 years.

Additionally, for both SSDI and SSI, the person must prove that they cannot do a generic job at a certain level of difficulty. Although there is an in-depth table of job duties the Administration considers, the following rules of thumb can often be applied. A person under 50 must not be able to do what is called “sedentary work.” This is best envisioned as a sit-down receptionist job, with duties including answering the phone, taking messages and sorting mail. For a person between 50 and 60, inability to engage in “light duty” work must be shown. Assembly line work, involving a significant amount of standing and twisting, but no heavy lifting, is an example of light duty work. Finally, a person over 60 must only show that they cannot do “medium duty” work. This is a job in which a person must lift 50 pounds, and stand or walk six hours per day. Clearly, this graduated test favors older individuals, who have presumably paid more into the system and will spend less time on disability before converting to retirement benefits.

Please note that the above has condensed numerous intricate regulations and rulings – literally thousands of pages – into a few paragraphs. These are best considered rules of thumb or general guidelines, and not concrete rules. Additionally, even a person who believes that they fit the requirements may be denied benefits. Different judges may interpret the same claimant’s testimony and medical records differently.

(2) Benefits

A person whose disability application is approved is eligible for several benefits. These include regular payments, Medicare or Medicaid eligibility, and eligibility for their dependents. Please note that there are waiting periods for these benefits based upon the date of disability. This waiting period is five full calendar months after the date of disability for payments and two years after the date of disability for Medicare benefit eligibility.

The amount of monthly payments varies as much as work histories. To determine the amount of your benefit eligibility, refer to the green form mailed to you by the Administration approximately three months before your birthday, which reports your earnings for every year of your life. On this form, your eligible benefits are listed. You can also contact the administration and request your benefit eligibility. Please note, however, that these benefits may be reduced if you receive a government pension, workers’ compensation or other benefits.

(3) The Application Process and Timeline

The timeline for disability claims varies by the region of the country a person lives in. Below are estimates for eastern Pennsylvania, whose response times are considered average to above- average.

Typically, a person who applies for disability can expect to have a final resolution of their claim within two years. The actual time period may be shorter depending on what stage in the review process a person’s claim is approved.

Approximately one-third of individuals who are approved for disability benefits are approved at the initial Administrative Review. Here, a reviewer receives an applicant’s medical records and any background information that has been submitted (including work history). Without ever seeing the claimant, the reviewer approves or denies the claim. Typically, this process will take three to six months.

If a person is denied at the Administrative Review stage, he or she may appeal and request a hearing. Notably, there is a strictly enforced appeal period. It is suggested that you closely review your decision and/or talk to an attorney or the Administration to ensure that any appeal is filed within the necessary deadline. Failure to file before the deadline may forfeit your right to appeal.

Generally, six to nine months pass between when an appeal is filed and when a hearing is scheduled. It is strongly suggested that, if you did not have an attorney represent you at the initial filing, you obtain an attorney for the hearing. The claimant’s testimony is taken at this stage, and the record is effectively closed at the end of the hearing. The hearing is the claimant’s best opportunity for approval of benefits.

Should you be denied at the hearing level, there are additional appeals available, all the way to the Supreme Court. At these later stages, the courts must find a serious error in the prior decision to overturn the earlier denial. Again, appeals must be filed in a timely fashion.

(4) Conclusion

The above information is a legal snapshot of the disability process in mid-2010, intended to provide a person with the basics of whether disability is appropriate. It is meant to supplement, not replace, the advice of trained professionals, including representatives at your local Social Security office or an attorney.

Copyright 2010