If you become disabled before you can retire from work, you may be eligible for disability benefits under the Social Security Act. Under that Act, a worker who is found to be blind or disabled is entitled to Social Security disability insurance benefits ordinarily equal to the primary insurance amount, which is the amount that the worker would receive at full retirement.
Qualifications for Benefits
To qualify for disability benefits, you must:
- Be under normal retirement age
- Have insured status for disability, which means that you have earned enough money in the required number of three month periods (known as quarters of coverage) before the disability began
- Have a disability currently or in the 12 months before the month in which the application is filed
- File an application for benefits
- Establish a waiting period of five consecutive months, beginning with a month in which you were both insured for disability and disabled
Disability benefits may be limited by a worker's compensation offset. The combined benefits of an individual entitled both to disability and worker's compensation benefits cannot exceed 80 percent of the individual's pre-disability earnings.
Determination of Disability
Disability is defined as the inability to do one's previous job or any other substantial gainful activity due to a severe physical or mental impairment, as determined by a doctor. Such impairment must last or be expected to last for at least 12 months or to end in death.
The Social Security Administration (SSA) uses an evaluation system for determining whether a worker is disabled. The major questions to be answered, in order, are the following:
- Step One: Is the person currently working and engaged in substantial gainful activity? If the answer is yes, the person is not considered disabled, regardless of medical condition. If the answer is no, go to Step Two.
- Step Two: Does the person have a severe medical impairment or combination of impairments which can be expected to last for a continuing period of one year or result in death, and which significantly limits the ability to do basic work activity? If the answer is no, the person is not disabled. If the answer is yes, go to Step Three.
- Step Three: Is the impairment (or combination of impairments) the same as or equivalent to an impairment found in the Listing of Impairments in Appendix I of the regulations, 20 C.F.R. pt. 404, subpt. P, app. 1? If the answer is yes, the impairment is automatically severe and prohibitive of gainful activity, and the person is disabled. If the answer is no, go to Step Four.
- Step Four: What is the person's ''residual functional capacity''? Does the person retain sufficient mental and physical capacity to meet the demands of the person's former work? If the answer is yes, the person is not disabled. If the answer is no, go to Step Five.
- Step Five: Does the person have sufficient residual functional capacity, when considered with the person's age, education, and work experience, to be able to undertake other work activity?
The burden to prove disability is on the claimant from steps one through four, but the burden shifts to the government at step five.
Termination of Benefits
If you are granted disability insurance benefits, you must report to SSA any changes in your medical condition, your return to or increase in work, or an increase in your earnings, as these may affect you continuing eligibility. SSA may also conduct a review to determine your continuing eligibility.
Questions for Your Attorney
- Do I have to be a certain age in order to qualify for Social Security disability insurance benefits?
- How does the Social Security Administration define disability?
- What are the steps in the disability evaluation process?