Social Security Disability

The federal government provides disability benefits under two programs, collectively referred to as "social security disability benefits."

• The Social Security Disability Insurance Benefits program (SSDI) authorized under Title II of the Social Security Act, provides benefits to disabled workers, dependents, and surviving spouses.
• The Supplemental Security Income program (SSI), authorized under Title XVI of the Social Security Act, provides benefits to disabled individuals whose income and assets fall below a specified level.

Requirements for Determining Disability

While the eligibility criteria differ under the two programs, many of the standards and procedures required in determining disability are virtually identical in both programs.

The individual applying for SSDI or SSI benefits is required to meet one standard of disability. Under both programs, a person is disabled if they are unable 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
• has lasted or can be expected to last for a continuous period of not less than 12 months"

To meet this definition, an SSDI or SSI applicant must have "physical or mental impairment[s] of such severity that they are not only unable to do their previous work but cannot, considering their age, education, and work experience, engage in any other type of substantial gainful work existing in the national economy."

Disability is determined using a five-step sequential evaluation process conducted by the SSA. If, at any point, an applicant is found not to be disabled, the evaluation process terminates and the claim for disability insurance benefits is denied. Following are the five requirments in determining disability:

• Substantial gainful activity. If the applicant is currently engaged in substantial gainful activity, there is no disability, regardless of medical condition, age, or work experience.
• Severe impairment. If the applicant is not engaged in substantial gainful activity, the SSA determines whether the applicant has a severe impairment. An impairment is considered "severe" if it significantly limits a person's physical or mental ability to do basic work activities. If there is a finding of severity, the evaluation proceeds to the third step.
• Listing of impairments. If the applicant's condition meets the requirements, or is the equivalent of a disability on the SSA's Listing of Impairments, then the applicant is ruled disabled. If the applicant does not meet the requirements, the sequential evaluation process continues to the fourth step.
• Past relevant work. A medical assessment is performed to determine whether the impairment prevents the applicant from performing his past relevant work. If the applicant is found to be able to perform past relevant work, the claim will be denied. If not, the evaluation process continues to the final step.
• Other work. The SSA evaluates whether the applicant can perform other available work existing in significant numbers in the national economy. The evaluation considers the applicant's residual functional capacity (what the applicant is able to do in a work setting despite the impairment), age, education, and past work experience. If an applicant cannot perform other work, they will be found disabled.

Disability Benefits

Once the disability evaluation requirements have been met and the disability has been proven, disability payments will begin after a five-month waiting period. Benefits are payable starting with the sixth month after the onset of the disability and continue through the second month after it ends. Benefits continue until the disability improves or the recipient returns to substantial work.

Termination/Reduction of Benefits

Disability benefits terminate when the disability recipient dies or reaches full retirement age. Benefits may be reduced to offset payments received from other government programs designed to replace lost earning capacity. Derivative benefits may be available to disabled spouses, widows or widowers, or children. In addition, the social security laws contain work incentive provisions allowing disability recipients to return to work for a trial work period, during which time they can test their ability to work without losing benefits.

Ongoing Evaluation

The SSA will conduct a continuing disability review on a periodic basis to determine whether the applicant is still eligible for disability benefits. The applicant is notified in writing of the impending review and its requirements. The applicant may be required to undergo a medical examination and may submit other relevant evidence for SSA consideration.

Appeals

Appealing unfavorable decisions by the SSA involves a three-step appeal procedure, after which a dissatisfied applicant or benefits recipient may sue in federal court. Each step concludes with written notification of the outcome and includes a 60-day period during which a claimant may file for further review. Following are the three steps of the appeal process:

1. Reconsideration. A reconsideration entails a complete review by the SSA of its initial decision. A social security representative who was not involved in the original application or decision conducts the review. The representative may also review any new evidence submitted by the claimant.
2. Hearing. An administrative law judge conducts a hearing. The claimant may appear in person at the hearing but is not required to do so.
3. Appeals Council Review. The Appeals Council of the SSA does not review all hearing decisions. For decisions it does review, the Council will either render a decision or return it to the administrative law judge for further review.

A claimant who is dissatisfied with the final appeal decision may bring suit in federal court within 60 days of the decision.

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