Need-to-Know Basics of Social Security Disability

What is Social Security Disability? I can tell you that it is not a welfare program and is certainly NOT handed out to just anyone. If this were true I would be driving a Rolls and not a Jeep Patriot.

My name is April Roberts and I am a professional disability advocate. I represent individuals that are applying for Social Security Disability, Veterans Benefits, and Medicare benefits. Through my work I learned that many Americans do not understand the Social Security Disability Programs and how they work.

In truth it is not easy to get approved for Social Security Disability and there are inconsistencies in how the rules are applied by the administration. In fact over 70% of all applications are denied upon initial review. This is not because SSA 'has' to deny claimants the first time. There are many reasons for this unfortunate percentage which I will address in future blogs.

There are great people who work at SSA and most are just like anyone else trying to do a job. Like any organization there are problems and mistakes are made. There are times when claimants do not need a representative or attorney to help them. Most of the time claimants can benefit from having someone advocate for them. Some representatives and attorneys are great. Some representatives and attorneys are not. This issue will be addressed in an upcoming article.

What is Social Security Disability?

Simply put, Social Security Disability (otherwise known as SSDI) is a disability insurance program. Most working Americans pay into this insurance program via income tax withholding. SSDI is NOT a welfare program like many people believe it to be. Once a person has achieved a required minimum of earnings and time worked, she will become eligible for disability income should she become disabled. Basic eligibility requirements are:

1. The claimant must be disabled per Social Security's rules and meet the minimum work and earnings requirements or;
   1. Be the dependent of a person who is receiving SSDI benefits or;
   2. Be the Substitution of Party (ie. surviving family member or appointed person) of a deceased person to whom SSA still owes benefits to

SSDI is not the same program as Supplemental Security Income or SSI.

What is SSI?

SSI is a needs based disability program through Social Security and the medical eligibility are the same as SSDI. Often SSI claimants have not earned enough work credits for SSDI and they must have very limited assets. A disabled child whose parents' income and assets fall below a certain threshold may also be eligible for SSI.

SSA keeps tabs on recipients of SSI to make sure that at no time does a claimant rise above the minimum income or assets to continue receiving SSI. If a person does rise above the threshold, SSA can stop the benefits and sometimes even demand return of any over-payments that may have been received by the claimant.

Who is eligible to receive Disability Benefits?

This blog addresses adult disability. A separate article will be published regarding child cases.

SSA has a five step process to determine if a claimant meets the medical requirements for eligibility. There are many thing that affects these steps but the basic breakdown is as follows:

1. Is the person performing work beyond the maximum threshold allowed by SSA?

For 2017 a person working and earning more than $1170/mo is performing what SSA considers to be 'Substantial gainful Activity' or 'SGA' and NOT disabled.If a person has worked since his disability started and the work is under the monthly SGA amount or he has not worked at all, then SSA proceeds to step 2. (Yikes I can work while getting disability? Yes! I am saving that for another blog)

2. Does the claimant suffer from a severe impairment?

The claimant must suffer from a mental and/or physical condition that is so severe that it will be expected to prevent her from working at SGA levels for twelve months; or result in death. Of course these conditions must be diagnosed by a medical doctor. If SSA finds there is a severe medical condition at this step the process moves to step 3.

3. Do the claimant's impairments meet or equal the one of SSA's "Listings" of medical conditions?

These lists of criteria are referred to as listings or body systems. In other words if your diagnoses, symptoms, and prognosis fit under certain specific disease listings then SSA may find you disabled. If SSA does not find that the claimant's conditions fit into one or more of these listings then process moves to step 4.

4. Can the claimant return to his past relevant work?

Past Relevant Work is work that a claimant has performed in the past for a period long enough to have learned each job. If SSA finds the person cannot perform any work he has done before then the process moves to step 5.

5. Can the claimant perform other work?

What SSA means by 'other' work is any other type of work that the claimant may be able to perform at SGA levels. SSA considers the claimant's age, level of education completed, residual functional capacity (the maximum the claimant can do now in a work setting), and transfer-ability of job skills from past work that could be used in other jobs.If the claimant cannot perform any of his past work and any other work he may be approved for SSDI and/or SSI.

There is a lot of things that can uniquely affect this process depending on the individual claimant. I will be addressing these various issues in upcoming blogs.

Please leave comments and questions or contact me directly.

April L. Roberts, EJD EDPNA - april@aaria.org

www.aaria.org

Next up, "Why do so many people who should not get disability get approved for it?"
©2017 April L. Roberts and Aaria Consulting, LLC. All Rights Reserved.