If you or a loved one suffer from a severe injury or illness (physical or mental) that has resulted in an inability to work , you may qualify for Social Security disability or SSI to help with financial support and medical care.
Definition of Disability
In order to be found “disabled” under Social Security Administration (SSA) rules, a person must be unable to perform substantial gainful activity (SGA) due to a severe impairment that is expected to last at least 12 months or result in death.
If a person is able to consistently perform work at a level considered to be SGA, he will be considered not disabled. SGA is a specific monthly amount determined by SSA. For 2020, the amount is $1,260. There are special rules for legally blind applicants.
Social Security Disability, a/k/a: SSD, SSDI, DIB, Title II, regular disability Social Security Disability (SSD):
- Disabled Adult Child (DAC) claims fall in this category
- Based on prior earnings
- Must be “insured” with sufficient quarters of coverage
- No asset or unearned income limitations
- Five-month waiting period before monetary benefits are payable
- Medicare entitlement after two years of monetary entitlement
- Converts to retirement at age 65
- No reduction in benefits due to pre-retirement payment
- Payments to children and spouse caring for younger children
Supplemental Security Income, a/k/a: SSI, Title XVI:
- All children’s claims are SSI only
- Monetary benefits payable the month following application
- Maximum SSI benefits for 20120 are $783 per month
- Financial need-based program
- Asset and household income limitations
- No payments to beneficiaries
- Medicaid entitlement
- Payable during five-month Disability Insurance Benefits (DIB) waiting period if application filed early
Five-Step Determination Process
The SSA has a disability determination process they use to determine if an applicant is (eligible) or denied (ineligible) to receive Disability Insurance (DI) and / or Supplemental Security Income (SSI)
- 1. Are you working? A person can work and still be entitled to disability. The question turns on whether the work is under SGA level and the inability to perform at SGA levels or above is caused by the person’s medical impairments.
- Is your condition severe? Does the condition impact the person’s ability to function to the point it interferes with the ability to perform work and/or activities of daily living?
- Does your condition meet a medical listing? SSA has compiled a Listing of Impairments. If a claimant’s impairments are listed therein, it must meet the criteria outlined in the Listings. If the impairment is found to meet a Listing, the claimant will be found to be disabled at Step 3 and SSA will pay the claim without further analysis. It can be argued that a claimant’s impairments “equal” the severity of a listing. For example, there is no listing for migraines; however, migraines frequently equal the severity of epileptic seizures, for which there is a listing.
- Can you do your past work? SSA looks at a claimant’s last 15 years of work, providing the claimant held the job long enough to learn it. Most ALJ’s consider a job that was held six months or longer. Generally, a claimant will need to show they cannot do his/her easiest job.
- Can you do any other work within your restrictions? SSA will identify Past Restricted Work (PRW) and break it down into exertional levels and skill levels. SSA will assign an exertional level and identify specific restrictions (both physical and mental) to determine the claimant’s residual functional capacity (RFC). If a claimant’s past work is beyond his/her current RFC, SSA will then determine if the claimant has skills that will transfer to a job within the claimant’s RFC and restrictions.
This article is to educate about benefits available for individuals who have become physically or mentally disabled and available benefits. When it comes to information, this is just the tip of the iceberg and we don’t want to overwhelm you with technicalities.
Daniels Law is familiar with the Social Security Administration (SSA) and the disability claims process. Hiring the right attorney can increase your odds of a successful hearing and outcomes. There are no up-front costs at Daniels Law, P.A. for assistance with your disability claims case. Feel free to contact us with questions or assistance (239) 214-6010.