Most of us expect to work until we retire and then live peacefully and contentedly on a pension and our savings. What we don’t expect is to become disabled.
However, according to the U.S. Social Security Administration, it’s not uncommon to incur a disability during your working years. In fact, a 20-year-old has a 30% chance of becoming disabled before retirement age. If you are not working because of an illness or injury, or have been told you may be facing a disabling diagnosis, it is essential that you know what your rights are when it comes to social programs and benefits.
The Social Security Disability Program
One of the most important programs that provides support for disabled workers is the Social Security Disability (SSD) program. The program is much like the standard Social Security pension program, except that recipients qualify to receive their benefits earlier and generally at a higher rate.
Disability benefits are available if you are temporarily (12 months or more) or permanently disabled. Applicants must go through a screening process that begins with a written application and may include a phone or in-person interview. This initial screening process is to your benefit, as it is designed to make sure your application is as complete as possible.
Children can also receive Social Security Disability benefits, but the application procedure and requirements are different from those of the adult Disability Program.
The Difference Between Social Security Disability and SSI
The Social Security Disability program is not the same as the Supplemental Income Progra (SSI), which is generally available to people who are blind, disabled, or 65 or older and have very limited income. Disability has income limitations too, but they are not as severe. Plus, Disability applicants must have worked long enough to have paid into Social Security (see Criteria for Eligibility), which is not a requirement for SSI applicants. For example, SSI may be granted to a young adult who doesn’t qualify for SSD benefits and whose disability interferes with his or her ability to work a full-time job.
Criteria for Eligibility
You can apply for Disability benefits whether you are working or not. The reviewer considers:
- Your Age. You must be an adult to qualify (at least 18 years old).
- Whether You Are Working. SSD is designed for people who are incapable of supporting themselves because of a disabling condition; if you are working in 2013 and earn more than $1,040 per month, you will normally not be considered disabled.
- How Severe Your Condition Is. If you aren’t working, or aren’t earning above the $1,040 per-month cutoff, the reviewer looks at whether your condition is considered severe enough to interfere with work-related activities. For example, are you still able to handle walking, bending, reaching, lifting, and other functions you would use while working? If so, then SSD would probably not consider you to be disabled.
- Whether Your Condition Is Considered a Qualifying Condition. SSD considers certain conditions severe enough to normally qualify for benefits. This listing helps the reviewer expedite cases that qualify. Examples of some of the more serious conditions include ALS (Lou Gehrig’s disease) and pancreatic cancer. But other diseases, such as ischemic heart disease, systemic lupus erythematosis, and diabetes are also on a list of potentially severe conditions. Each condition on the list has its own set of qualifiers that help the reviewer determine whether your personal circumstances are serious enough to be disabling.
- The Type of Work You Previously Performed. If your condition is not on the list of disabling conditions, then the reviewer will look at the kind of work you performed prior to becoming ill, comparing your current abilities to your previous work history. He or she generally examines 15 years of your work history and takes into consideration what is required to perform the work you’ve done. For example, if you had worked full-time as a legal secretary for 10 years prior to becoming ill, the reviewer may want to know whether you can still sit for long periods at a desk and handle tasks that require hand dexterity, such as typing, answering telephones, taking notes, and other major duties that are normally part of a secretarial job.
- If You Can Perform Other Work. If you can no longer perform the functions you used to, the reviewer considers what other jobs you can do. For example, if you were a postal carrier and are now unable to walk long distances or stand for long periods of time, you may still be able to handle desk duties. Your ability to perform related work could affect your eligibility for benefits.
- Your Recent Earnings History. You must have worked a certain number of years recently to be eligible for Disability. The required amount differs according to age, and is determined by how old you were when you were diagnosed with your debilitating condition. SSD divides the year into four quarters. For example, if you were younger than age 24, you would have to have worked one and a half years out of the three years prior to the quarter in which you became sick. However, if you were older than 31 when you got sick, you would be required to have worked 5 of the 10 years prior to when you were diagnosed.
- Your Overall Earnings History. The “duration of work test” determines whether you have paid into the Social Security system long enough to have earned SSD benefits and is based on the date you became disabled. For example, if you became disabled at age 42, you would need to have worked at least five years in your lifetime. If you were 60, you would need to have worked a minimum of nine and a half years. For a chart showing the exact number of years you must have worked in relation to the date of disability, see page six of the Social Security Disability pamphlet.
- Whether There Are Any Special Circumstances Under Which You Would Qualify. Individuals with low vision, widows or widowers of a qualifying worker, or former members of the military who were wounded during service may be eligible for benefits through SSD.
What You Need to Apply
Don’t be put off by the amount of documentation required to fill out the application. It may be daunting, but you can save time by gathering it well in advance. You need:
- Personal identity information (the name by which you file your taxes, your address, and other contact information)
- Social Security number
- Birth certificate or baptismal certificate
Medical information, including:
- Names, addresses, and phone numbers of all doctors, counselors, hospitals, clinics, and other medical professionals acquainted with your medical situation (Remember that the reviewer places a fair amount of weight on your medical status, so make sure they have up-to-date contact information for doctors, as well as access to test results.)
- A list of all medications you take, including who prescribed them, the dosage amounts, and the frequency you take them
- Medical records and lab results
- Information about any prior insurance or workers’ compensation claims
Work history information, including:
- Your most recent W2 forms or your most recent tax return
- Military discharge papers (DD214)
- Work history for the last 15 years before you became disabled
Other personal information, including:
- Dates of marriage and/or divorce, name of your spouse, and minor children
In addition, you are required to provide the name and number of the bank account where the monthly check is to be deposited. Social Security now pays all benefits electronically.
Applying for Social Security Disability Benefits
Applicants can apply online, by calling 800-772-1213, or by stopping by any Social Security office, where you can obtain help filling out the forms.
The above link takes you through a four-step process that includes the following:
- A checklist of those items you need to complete each of the following sections
- The Adult Disability Benefits Application, which asks you general questions about your reason for applying
- The Adult Disability Report, which covers specific questions relating to your condition
- The Authorization to Disclose Information form, which gives Social Security the ability to talk to your healthcare providers, insurance carriers, caregivers, and representatives familiar with your health condition
Social Security estimates that the process takes up to 30 minutes; however, it is best to plan for 40 to 45 minutes to allow for interruptions. You can start, save, and come back to the application at any time should you need to obtain additional information or take a break. But in order to do this, you’ll need to make note of the application number you are given when you start the online application process.
Additionally, your spouse may be asked to fill out a form if he or she provides any support for you. Let your reviewer know also if you are receiving support from other sources, such as caregivers.
If you are nervous about filling out the application yourself, take heart. Some medical offices, such as state or federally subsidized clinics have counselors or social workers who can help you with the process. Ask your doctor or clinic if they have such a service. Also, don’t forget to sign the application, either electronically or by printing, signing, and mailing it.
Time to Process
Be prepared for the application to take several months to process. While waiting, explore backup financial plans. For example, if you are unable to work, do you have family members who can help you cover expenses? Do you have emergency savings put away in case the application takes longer than you expect? Applying for Disability is often not a quick process.
If Your Application Is Denied
Don’t be discouraged if you are turned down the first time – this is common. The letter of decision you receive will state the reason you are denied. For example, it may be because information is missing in your application. In this case, you must submit the requested information as soon as possible.
If the letter states that the review has determined that you are not disabled, remember that you can still appeal the decision by using the online appeal form. The application process for the appeal asks you to provide any updated information, such as a doctor report or other medical information that may help in determining whether you have a basis for an appeal. The two sections of the online appeal take approximately an hour total to complete.
If you are denied for any other reason than one pertaining to your medical condition, contact the nearest Social Security office.
It is important to note that in most cases, Disability benefit recipients don’t have to pay federal taxes on their payments. However, if you file single and earn more than $25,000, or you file jointly with your spouse and earn more than $32,000 together, you may have to pay federal taxes. Many states don’t tax Disability payments, but check with your state to be sure. For additional information about tax rates on Disability benefits and other information, visit the Social Security FAQ page.
Have you applied for disability benefits? What was your experience?