Understanding Social Security Disability: Your Questions Answered

Social Security Disability Insurance, known as SSDI or DIB (Disability Insurance Benefits), provides monthly payments to workers who have become disabled and their dependents. The Social Security Administration manages this program, which operates similarly to the retirement benefits system. SSDI receives funding from social security taxes paid by employees, employers, and self-employed individuals. 

To qualify for SSDI, you must have contributed to the social security fund through payroll deductions, typically labeled as FICA on pay stubs. The amount you receive in monthly disability benefits depends on your past earnings. 

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SSDI can assist various groups, including disabled workers, disabled surviving spouses or former spouses of deceased workers, adults who became disabled before turning 22 and have a disabled, retired, or deceased parent, and the dependents of disabled workers. The program’s purpose is to offer financial assistance to those who can no longer engage in substantial work activities due to a medical condition. 

Unlike some other benefit programs, SSDI does not consider your current financial status or assets when determining eligibility. Instead, it focuses on your work history and the nature of your disability.

Supplemental Security Income, or SSI, functions as a separate program from Social Security Disability Insurance. While both aim to assist people with disabilities, they have distinct eligibility requirements and funding sources. 

SSI operates as a means-tested program, drawing its funding from general tax revenues rather than social security taxes. This program provides financial support to disabled individuals who have limited income and resources. Unlike SSDI, SSI does not require a work history or previous payments into the social security system. 

You may qualify for SSI even if you have never held a job or contributed to social security taxes. However, SSI imposes strict limits on income and resources. Another key distinction is that SSI does not offer benefits to dependents, whereas SSDI does. 

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SSI serves as a financial safety net for adults or children with disabilities who meet the Social Security Administration’s income and resource criteria. This program can help those who may not qualify for SSDI due to insufficient work credits but still need financial assistance because of their disability. The SSI program aims to provide a basic level of income to those who might otherwise struggle to meet their basic needs due to disability and financial limitations.

To receive benefits under Social Security Disability or SSI programs, you must have a physical or mental health problem, or a combination of problems, expected to last at least one year or result in death. 

This condition must prevent you from engaging in substantial gainful activity. The Social Security Administration does not base its decision on whether you can return to your previous job or if an employer would hire you for another position. Instead, they consider whether you can perform any job in the national economy.  When making this determination, the Social Security Administration evaluates your medical condition, age, education, and work experience. 

The Social Security Administration uses a five-step process to evaluate disability claims:

• Step 1: They check if you are working. If you earn more than $1,550 per month in 2024, you generally cannot be considered disabled.
• Step 2: They assess if your condition is severe enough to interfere with basic work-related activities.
• Step 3: They check if your condition is on their list of impairments presumed to be disabling.
• Step 4: If not, they evaluate whether you can do any of your past relevant work.
• Step 5: If you cannot, they determine if you can perform any other type of work available in the national economy. This assessment considers your age, education, past work experience, and transferable skills.

The Social Security Administration recognizes a wide range of medical conditions that can potentially qualify as disabling. These conditions vary in nature and severity, and the impact on your ability to work determines whether they meet the criteria for disability benefits. 

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The Social Security Administration maintains a comprehensive listing of impairments, known as the “Blue Book,” which details the specific criteria for each condition. Some examples of conditions that may be considered disabling include musculoskeletal problems such as severe spinal disorders, amputations, or fractures that do not heal properly. 

Cardiovascular conditions like chronic heart failure, coronary artery disease, or recurrent arrhythmias can also qualify. Respiratory illnesses, including chronic obstructive pulmonary disease (COPD), severe asthma, or cystic fibrosis, may meet the criteria. Neurological disorders such as epilepsy, Parkinson’s disease, multiple sclerosis, or cerebral palsy are also considered. Mental disorders that significantly impair functioning, including schizophrenia, autism, intellectual disability, depression, anxiety, and post-traumatic stress disorder (PTSD), can qualify. 

Immune system disorders like HIV/AIDS, lupus, rheumatoid arthritis, and kidney disease requiring dialysis may be deemed disabling. Other conditions that might qualify include digestive tract problems, endocrine disorders, various forms of cancer, and hematological disorders. The Social Security Administration evaluates each case individually, considering how the condition affects your ability to perform work-related activities.

The Social Security Administration uses a five-step evaluation process to determine if you are disabled. This process examines various aspects of your condition and work capability:

• Step 1: Are you working?
  • They assess whether you are employed.
  • If you are earning more than the current substantial gainful activity amount ($1,550 per month in 2024), you generally cannot be considered disabled.
• Step 2: Is your condition severe?
  • They evaluate the severity of your condition.
  • To be considered severe, your impairment must interfere with basic work-related activities.
• Step 3: Is your condition on the list of disabling impairments?
  • The Social Security Administration checks if your condition is found on their list of impairments presumed to be disabling.
  • If you meet the specific criteria for one of these conditions, you will automatically be found disabled.
  • If your impairment does not meet these criteria, the evaluation continues to the fourth step.
• Step 4: Can you perform any of your past relevant work?
  • They determine if you can do any work you’ve done in the past.
  • If you can, your claim will be denied.
  • If not, the process moves to the fifth and final step.
• Step 5: Can you do any other type of work available in the national economy?
  • The Social Security Administration considers whether you can do any other type of work.
  • They take into account your age, education, past work experience, and transferable skills.
  • If they conclude that you cannot perform such work, your claim will be approved.

This comprehensive evaluation process aims to ensure that disability benefits are provided to those who truly cannot engage in substantial gainful activity due to their medical condition.

Substantial gainful activity is a concept used by the Social Security Administration to describe a level of work activity and earnings. This term plays a significant role in determining eligibility for disability benefits. 

Work is considered “substantial” if it involves performing significant physical or mental activities, or a combination of both. The “gainful” aspect of the term refers to work that is either performed for pay or profit, of a nature generally performed for pay or profit, or work intended for profit, regardless of whether a profit is realized. 

The Social Security Administration uses substantial gainful activity as one of the factors to decide if you are eligible for disability benefits. If you earn more than a certain amount and are engaged in productive work, the Social Security Administration generally considers that you are engaging in substantial gainful activity. In 2024, earnings above $1,550 per month for non-blind individuals, or $2,590 for blind individuals, typically demonstrate substantial gainful activity. 

It’s important to note that the Social Security Administration applies different rules to determine substantial gainful activity for self-employed individuals. These rules take into account factors beyond just income, such as the nature of the work and its value to the business. Understanding the concept of substantial gainful activity is essential when applying for or receiving Social Security Disability benefits, as it can affect both initial eligibility and ongoing benefit status.

The Social Security Administration provides multiple ways to apply for disability benefits, allowing you to choose the method that works best for your situation. One option is to use the online disability application available on the Social Security Administration’s website. This online process allows you to complete the application at your own pace and from the comfort of your home. 

If you prefer to apply by phone, you can call the Social Security Administration’s toll-free number at 1-800-772-1213. For those who are deaf or hard of hearing, a TTY line is available at 1-800-325-0778. These phone lines are staffed Monday through Friday, from 8:00 a.m. to 7:00 p.m. 

Another option is to visit your local Social Security office in person to submit your application. If you’re unsure about the location of your nearest office, the Social Security Administration’s website offers a locator tool to help you find it. 

For individuals who do not live in the United States or its territories, you can contact the nearest U.S. Social Security office, U.S. Embassy, or consulate for assistance with your application. Regardless of the method you choose, you’ll need to provide information about your medical condition, work history, and other relevant details to support your claim. The application process can be complex, so it’s important to gather all necessary documentation before starting your application.

Given the complexity of the application process, many people find it beneficial to work with a Social Security Disability lawyer. An experienced attorney can:

• Help you gather and organize the necessary medical evidence
• Ensure your application is complete and accurately represents your condition
• Guide you through the appeals process if your initial claim is denied
• Represent you at hearings
• Help you understand the legal aspects of your case

In Goldsboro, Attorney Phil Baddour of Baddour, Parker, Hine & Hale, P.C. helps clients with Social Security Disability claims and would be honored to help you with the application process.

Compassionate Allowances are an initiative by the Social Security Administration designed to expedite the processing of disability claims for applicants whose medical conditions are so severe that they clearly meet Social Security’s disability standards. 

This program identifies diseases and other medical conditions that, by definition, qualify for Social Security disability benefits. The Social Security Administration uses advanced technology to flag claims involving these conditions for fast-track processing. This approach allows individuals with severe disabilities to receive a decision on their claim more quickly, reducing waiting times for those who are most in need. 

The list of conditions that qualify for Compassionate Allowances is extensive and includes various forms of cancer, rare genetic disorders, and severe neurological conditions. This list is periodically updated based on public feedback, counsel from medical and scientific experts, and research conducted by the Social Security Administration. 

The Compassionate Allowances program does not change the criteria for receiving disability benefits; rather, it accelerates the decision-making process for conditions that invariably qualify as disabling under Social Security’s rules.

If you receive workers’ compensation or other public disability benefit payments, the Social Security Administration may reduce your Social Security Disability benefits. 

This reduction applies not only to your benefits but also to those payable to your family members. Workers’ compensation benefits are payments you receive due to job-related injuries or illnesses. 

Public disability benefits, which can also affect your SSDI, include civil service disability benefits, temporary state disability benefits, and state or local government retirement benefits based on disabilities not related to employment. 

The Social Security Administration will reduce your monthly Social Security disability benefits if the combined total amount of your benefits, workers’ compensation, and public disability payments exceeds 80% of your average earnings before you became injured or ill. It’s important to note that disability payments from private sources, such as private pensions or insurance benefits, do not affect your Social Security disability benefits. This offset rule ensures that the total amount of disability-related benefits you receive does not exceed a certain threshold of your pre-disability earnings.

The Social Security Administration may pay disability benefits for up to 12 months before the date you apply, a period known as retroactive benefits. This is possible if they find that you met the disability requirements during that time and you satisfy all other eligibility criteria. 

However, it’s important to understand that there is typically a five-month waiting period for disability benefits. This means that the Social Security Administration will pay your first benefit for the sixth full month after the date they determine your disability began. 

The purpose of this waiting period is to allow for short-term disabilities to resolve. For example, if the Social Security Administration determines that your disability began on January 15, your first benefit would be paid for the month of July. The possibility of receiving retroactive benefits underscores the importance of applying for disability benefits as soon as you become disabled, even if you’re unsure about your eligibility. Delaying your application could result in the loss of potential retroactive benefits.