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Social Security Disability Insurance

There are two main Federal programs that provide income to individuals with disabilities, or who are disabled because of lymphedema. On is Social Security Disability Insurance, the other is Supplemental Security Income. Social Security Disability funding comes from Social Security itself, while the Supplemental Security Income program comes from general taxes and is only administered by Social Security.

Social Security Disability Insurance (SSDI) is wage replacement income for those who pay FICA taxes when they have a disability meeting Social Security disability rules. SSDI provides a variety of benefits to family members when a primary wage earner in the family becomes disabled or dies. SSDI is financed with Social Security taxes paid by workers, employers, and self-employed persons. SSDI benefits are payable to disabled workers, widows, widowers, and children or adults disabled since childhood who are otherwise eligible.

In 1935, the federal government established a retirement benefits program for older workers in commerce and industry. Most employees are required by the Federal Insurance Contributions Act (FICA) to pay into the federal retirement fund through payroll deductions. FICA taxes are withheld from an individual’s salary to fund Social Security and Medicare programs. Self-employed individuals contribute to FICA through their federal tax returns.

In 1956, protection was established to cover “involuntary retirement” due to disability. Depending upon how long a person paid FICA taxes, an individual could access disability insurance.

Pat O'Connor

June 20, 2008

What is Social Security Disability Insurance (SSDI)?

Social Security Disability Insurance (SSDI) is a monthly benefit for people who have worked in the past and paid Social Security taxes. SSDI benefits are paid to people who are unable to work for a year or more because of their disability.

What is the difference between Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)?

The medical requirements for disability payments are the same under both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs, and the same process is used for both programs to determine your client's disability.

Supplemental Security Income is a program run by Social Security that pays monthly benefits to the elderly, the blind and people who have disabilities and very low income. If your client is receiving SSI, he/she will also most likely qualify for food stamps and Medicaid, too. While non-medical eligibility for Social Security Disability Insurance (SSDI) is based on prior work under Social Security, SSI disability payments are based on income and resource specifications.

What health coverage comes with SSDI?

Medicare (Part A and Part B) comes with SSDI after you have been eligible for Social Security Disability Insurance cash benefits for 24 months.

If your disability is the result of kidney disease requiring regular dialysis or transplant, or of Amyotrophic Lateral Sclerosis (ALS), known as Lou Gehrig's Disease, you may qualify for Medicare coverage when eligible for Social Security Disability Insurance.

Who decides if I am disabled?

From the SS handbook

We will review your application to make sure you meet some basic requirements for disability benefits. We will check whether you worked enough years to qualify. Also, we will evaluate any current work activities. If you meet these requirements, we will send your application to the Disability Determination Services office in your state.

This state agency completes the disability decision for us. Doctors and disability specialists in the state agency ask your doctors for information about your condition. They will consider all the facts in your case. They will use the medical evidence from your doctors and hospitals, clinics or institutions where you have been treated and all other information. They will ask your doctors:

  • What your medical condition is;
  • When your medical condition began;
  • How your medical condition limits your activities;
  • What the medical tests have shown; and
  • What treatment you have received.

They also will ask the doctors for information about your ability to do work-related activities, such as walking, sitting, lifting, carrying and remembering instructions. Your doctors are not asked to decide if you are disabled.

The state agency staff may need more medical information before they can decide if you are disabled. If more information is not available from your current medical sources, the state agency may ask you to go for a special examination. We prefer to ask your own doctor, but sometimes the exam may have to be done by someone else. Social Security will pay for the exam and for some of the related travel costs.

How is the decision made that you qualify?

From the SS handbook

“How we make the decision”

We use a five-step process to decide if you are disabled.

Are you working? If you are working and your earnings average more than a certain amount each month, we generally will not consider you disabled. The amount changes each year. For the current figure, see the annual Update (Publication No. 05-10003).

If you are not working, or your monthly earnings average the current amount or less, the state agency then looks at your medical condition.

Is your medical condition “severe”? For the state agency to decide that you are disabled, your medical condition must significantly limit your ability to do basic work activities—such as walking, sitting and remembering—for at least one year. If your medical condition is not that severe, the state agency will not consider you disabled. If your condition is that severe, the state agency goes on to step three.

Is your medical condition on the List of Impairments? The state agency has a List of Impairments that describes medical conditions that are considered so severe that they automatically mean that you are disabled as defined by law. If your condition (or combination of medical conditions) is not on this list, the state agency looks to see if your condition is as severe as a condition that is on the list. If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide that you are disabled. If it does not, the state agency goes on to step four.

Can you do the work you did before? At this step, the state agency decides if your medical condition prevents you from being able to do the work you did before. If it does not, the state agency will decide that you are not disabled. If it does, the state agency goes on to step five.

Can you do any other type of work? If you cannot do the work you did in the past, the state agency looks to see if you would be able to do other work. It evaluates your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work. If you cannot do other work, the state agency will decide that you are disabled. If you can do other work, the state agency will decide that you are not disabled.

Do you Qualify for Social Security Insurance Income?

Review Of Criteria And Qualifications For Social Security Disability Insurance Income / SSDI

Definition Of Disability

Specific criteria must be met to qualify for Social Security Disability Insurance Income (SSDI). The Congress of the United States has defined disability, for purposes of entitlement to disabled worker's benefits as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

A person must not only be unable to do his or her previous work but cannot engage in any other kind of substantial gainful work which exists in the national economy, considering the persons:

  • age
  • education
  • work experience

It is immaterial whether such work exists in the immediate area, or whether a specific job vacancy exists, or whether the worker would be hired if he or she applied for work.

“The worker's impairment or impairment's must be the primary reason for his or her inability to engage in substantial gainful activity, although age, education, and work experience are also taken into consideration in determining the worker's ability to do work other than previous work”.

5 Step Process To Determine Disability

1–Are you working? If you are and your earnings average more than $860 a month, you generally cannot be considered disabled. Note: This amount increases annually. See: What Is Substantial Gainful Activity (SGA)?

2–Is your condition severe? Your impairments must interfere with basic work-related activities for your claim to be considered.

3–Is your condition found in the list of disabling impairments? Social Security maintains a list of impairments for each major body system which are so severe they automatically mean you are disabled. If your condition is not on the list, Social Security must decide if it is of equal severity to an impairment on the list, and if so, the claim is approved.

4–Can you do the work you did previously? If your condition is severe but not of same or equal severity with an impairment on the list, Social Security determines if it interferes with your ability to do the work you did in the last 15 years. If it does not, your claim is denied. If it does, further consideration is given.

5–Can you do any other type of work? If you cannot do the type of work you did in the last 15 years, Social Security determines if you can do any other type of work with consideration given to age, education, past work experience, and transferable skills. If you cannot do any other type of work, your claim is approved. If you can, your claim is denied.

What Is Residual Functional Capacity?

Residual Functional Capacity (RFC) is the total of what one is left capable of doing after impairments have taken their toll. Social Security identifies the level of work capability in categories of:

  • sedentary work
  • light work
  • medium work
  • heavy work

Sedentary work

Sedentary work is defined as “involving lifting no more than 10 pounds at a time and occasionally lifting and carrying articles like, docket files, ledgers, and small tools”. Although sitting is primarily involved in a sedentary job, walking and standing should be required only occasionally. Standing and walking should total no more than 2 hours per 8 hour workday, while sitting would total about 6 hours per 8 hour workday. Most unskilled sedentary jobs demand good manual dexterity for repetitive hand and finger motions.

Light Work

Light work is defined as “lifting no more than 20 pounds at one time with frequent lifting or carrying of objects weighing up to 10 pounds”. A good amount of standing and walking, approximately 6 hours of an 8 hour workday, is usually required of jobs in this category. Good use of hands and arms for grasping and holding is important also. A seated position which involved extensive pushing and pulling of hand or foot controls would be included in the light work category too.

Maximum RFC

In the age group 18-44, the maximum residual functional capacity allowed is “less than sedentary”. For literate people of all education levels between age 45-49, the maximum RFC allowed is also “less than sedentary”.

Above age 50, with consideration given to education, and previous work experience, the maximum RFC increases to sedentary, light, or medium.

Review Of Criteria And Qualifications For Social Security Disability Insurance Income / SSDI

The Standard of “Pain”

In 1984, Congress passed the Social Security Disability Benefits Reform Act, which defined the standard of judgment on pain. It stated that:

“an individual's statement as to pain or other symptoms shall not alone be conclusive evidence of disability as defined in this section; there must be medical signs and findings established by medically acceptable clinical or laboratory diagnostic techniques which show the existence of a medical impairment that results from anatomical, physiological or psychological abnormalities which could reasonably be expected to produce the pain or other symptoms alleged”.

Though this act had an expiration date of 1986, it became the standard of judgment. In 1988, Social Security ruled there need not be objective evidence of the degree of pain.

Factors Used In The Judgement Of Pain

Several factors are used in the standard judgement of pain including:

  • the nature of the pain
  • locations
  • onset
  • duration
  • frequency
  • radiation
  • pain intensity

Other Factors

Other factors which must be considered in determining proof of pain include:

what causes the pain and makes it worse name, dosage, effectiveness, and side effects of pain medications treatment for pain relief other than medications functional restrictions daily activities

Other Symptoms And Health Problems

Many other health problems can directly interfere with an individuals ability to work. These effects are also given consideration in the disability determination process. Factors considered can include health problems such as:

  • anxiety
  • depression
  • bowel problems
  • inability to concentrate
  • lightheadedness
  • dizziness
  • chronic sleep disturbances
  • drowsiness
  • chronic fatigue

Listing Of Impairments

The specific list of severe impairments used by the Social Security Administration to decide disability cases from Social Security Disability Determination (The Blue Book).

What is Substantial Gainful Activity (SGA)?

Substantial Gainful Activity (SGA) means any significant activity, physical or mental, which is performed for remuneration or profit over a reasonable period of time. To qualify, an individual’s monthly-earned income must be less than $940, the SGA amount for 2008. SGA dollar amounts are adjusted every January, a process called indexing.

Social Security has separate rules for those who are eligible for benefits because they are blind. SGA is $1,570 in 2008 for blind beneficiaries.

Is filing for disability difficult?

From: Disability

Yes and no. Filing an application for either social security disability or ssi disability benefits is an easy process to get started. A person simply needs to contact their local social security office and have an interview date scheduled. Application interviews can be conducted at the social security office itself, or over the phone at a later date.

However, when most individuals use the phrase 'filing for social security disability', they're not referring to just the application. They're referring to the entire disability process. And, in that respect, the process is not easy at all. By contrast, it can be gut wrenching.

True, some individuals will sail through the system and get approved on their very first ssd or ssi application. They'll never have to worry about enduring the appeals process and all the things that so often come with it (medical records get lost, case files get lost, important paperwork gets lost, etc) and they'll never face the prospect of bills falling behind or suffering the indignity of eviction or repossession.

But the percentage of claimants who escape such scenarios (i.e. get approved on their first application) tends to be fairly small.

And for this reason, I would have to say that two of the worst aspects regarding the social security disability - ssi disability system are:

The incredibly long wait involved for an application or appeal.

The fact that social security does not really tell claimants how long the process will likely take. Now, regarding item two, a number of social security employees might respond by saying, “We do inform claimants of how long the disability process will take. We inform them that it will probably take 120 days”.

And, yes, an initial claim may take 120 days on average. But averages tend to be very misleading. The simple truth is that an initial claim application can take as little as a month…but can also take as long as a year. For, unlike medicaid applications, there are no deadlines when it comes to social security disability and ssi applications.

However, for the majority of claimants, the initial claim is only where the process starts. And the vast majority of applicants for social security disability and ssi disability will have their claims denied at that level. When that happens, a claimant can either give up, file a brand new application (neither of those options is good), or follow the appeal process (usually this means filing a request for reconsideration, though in some states the recon step has been eliminated and in those states the very next step will be to file a request for a hearing before an administrative law judge).

All in all, the entire social security disability process can easily stretch out to two and a half years or longer. And for this reason, the social security administration does a great disservice to U.S. citizens by not explaining the the likely amount of time a disability claim will take to finish.

Who Pays for SSDI?

Each of 144.2 million workers and their employers pays 6.2 percent of the worker's wages, up to the taxable maximum ($87,000 in 2003) into OASDI. Another 14.6 million self-employed workers pay 12.4 percent (6.2 percent as employer and 6.2 percent as employee).1 Of the 12.4 percent:

1.88 percent is directed to SSDI; 10.52 percent is directed to OASI.

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social_security_disability_insurance.txt · Last modified: 2012/10/16 14:40 (external edit)