We've been disability advocates for decades. And we recently put our heads together to answer questions that almost everyone wants to know before they apply for disability benefits.
Of course, space here is limited, so we haven't given excessive details. So, if you need a specific question answered--or you need more detailed answers--we are always happy to get your free phone call. Here are the questions:
Who Qualifies for Social Security Disability?
- 1. You have worked at least 5 out of the most recent 10-year period and accumulated enough work credits to have insured status (applies to SSDI, not SSI).
- 2. You are not presently working, or at least not working at "substantial gainful activity" due to verifiable and severe medical condition, physical or mental. If you earn at least $1,260 in gross wages per month, you are working and can't get benefits.
- 3. Your severe medical condition has lasted, or is reasonably expected to last, 12 straight months or more. There is no short term disability benefit with Social Security.
- 4. This is sort of an unwritten rule but you must have objective medical evidence (from a doctor) to prove the severity and duration of your impairment(s).
How Much Will My Monthly Benefit Be?
The amount is based on your lifetime earnings. The average monthly benefit is around $1250 per month, but the maximum can be as much as $3,011 for an individual. You can call your local Social Security office to get your estimated amount. They call it the "PIA" or Primary Insurance Amount.
Does it Take a Long Time to Get Approved?
Yes, unfortunately, it often does. It takes about 5 months to get the initial decision on your application. This decision will be a denial in approximately 73 percent of cases. The required appeal process will take about 10 to 12 more months, but may give you a much better result and you may get back pay for waiting.
Are There Specific Medical Problems that Always Pay a Benefit?
Any disabling impairment (other than substance abuse) may pay a benefit if it is severe and makes the claimant truly unable to work at any full-time job. If a claimant has a end-of-life illness, it usually qualifies for prompt approval. If the symptoms are so severe that they meet or equal a "Listing," a payment may be possible faster. Social Security also has "compassionate allowances" for certain incurable diseases that post very severe restrictions on the claimant's ability to function. However, the average claimant will not meet these extreme requirements and must wade through the determination process, and often the appeals process, too.
The claimant's age and past work history plays a large part in how quickly he or she can be approved. Claimants age 50 and over, especially 55 and over, who have a history of difficult physical work, may meet one of the Medical-Vocational allowances for quicker approval. Even these claims often must be appealed, however.
Why Isn't Every American Insured by Social Security?
Basically because Social Security (SSDI) insures workers, not non-workers. To have "insured status," an individual must have worked and paid into Social Security through payroll deductions called FICA. The general rule: you must have worked at least 5 out of the past 10 years or less, and paid FICA tax on your earnings. Even self-employment can count if the FICA tax was paid and other work requirements re met. Individuals who have not worked in approximately 5 years do not have coverage under SSDI, even if they are severely disabled. (They might qualify under Supplemental Security Income, SSI, however).
What's the Difference Between SSDI and SSI?
They are entirely different programs which insure different people, although both are administered through the Social Security Administration. Key differences:
SSDI - Social Security Disability Insurance (Also Called Title II)
- Must be paid for by workers who have contributed work related FICA tax
- Has no financial or resource restrictions, however, you cannot be working.
- Monthly benefit is based on lifetime earnings/wages; $3,011 per month is maximum)
- Has a 5-month waiting period (Will not pay the first 5 months of disability)
- Covers disabled individuals who are under full retirement age
- Automatically comes with Medicare insurance after a 29-month waiting period
SSI - Supplemental Security Income (Also called Title XIV)- Designed to provide essential needs of the elderly or disabled
- Has strict income and financial resources limitations
- Requires no work history and nothing is paid into the program by the claimant
- Requires the same medical evidence as SSDI for disability (or, you meet age requirement)
- Claimants can also be eligible due to age (65 or over)
- Maximum monthly benefit is currently $783.
- Has no waiting period (can pay the month following your application)
- Automatically comes with Medicaid insurance.
