Two Social Security programs help people whose ability to earn income has been impaired by a disability. Social Security disability benefits differ from Social Security retirement benefits. Social Security retirement benefits are available to any person with a qualifying work history who reaches the eligibility age. Social security disability benefits are available to applicants of any age, but only if they meet a qualifying standard. That standard depends upon the program.
Social Security Disability Insurance (SSDI) benefits are available to individuals who are:
- disabled (as that term is defined below), and
- “insured” by virtue of their work history.
Most individuals are “insured” when they earn 40 work credits, but only if 20 credits were earned within the last 10 years before the disability began. Workers who become disabled before the age of 31 need fewer credits to be insured by SSDI.
Workers earn a maximum of 4 credits during each tax year. Workers earn a work credit by earning a defined amount of income. That amount changes every year. In 2022, workers need to earn $1,510 to earn a work credit. After earning $6,040 during the tax year, a worker will have earned all 4 credits that are available in that year.
SSDI is not a means-tested program. The benefits are available to individuals who are insured and disabled regardless of the assets they may own. That makes SSDI a better choice than SSI for people with a qualifying work history.
Supplemental Security Income (SSI) benefits are available to disabled individuals who have a low income and limited assets. They are also available to people (regardless of disability) who are 65 and older who do not qualify for Social Security benefits. People who are blind are generally not subject to the asset limitations that apply to other disabled individuals.
People who earn significant incomes usually do not meet the definition of “disabled” discussed below. When a small income does not disqualify an individual from receiving SSI benefits, that income may reduce SSI benefits.
Individuals who have certain assets valued at more than $2,000, and couples with certain assets worth more than $3,000, will usually not qualify for SSI benefits. Those assets include cash, bank account balances, investments, land, jewelry, and most personal property. A few assets are not counted, including the individual’s home, household goods, personal effects (such as clothing and a wedding ring), and one vehicle.
Definition of Disability
The SSDI and SSI programs share the same definition of “disability.” Other benefits programs and insurance policies may use different definitions. To receive Social Security disability benefits, however, applicants must satisfy the Social Security Administration’s definition of “disability.”
An individual is “disabled” for the purpose of SSDI or SSI benefits if the individual is:
- incapable of engaging in substantial gainful activity because of a severely disabling medical condition; and
- the condition has lasted or is expected to last more than a year or to result in death in less than a year.
The severity of a disabling medical condition is primarily measured by whether it significantly impairs the ability to earn income and has done so, or will continue to do so, for at least 12 months.
A few medical conditions are presumed to be severely disabling. If the applicant has any other medical condition, the Social Security Administration asks:
- Is the applicant earning more than a defined threshold income? An applicant who is earning that amount of income or more is not eligible for disability benefits.
- Is the applicant capable of engaging in substantial gainful employment? If so, the applicant is not eligible for disability benefits.
With few exceptions, substantial gainful employment is any employment that pays more than the defined threshold income. In 2022, that threshold is $1,350 a month. Any person who earns more than amount will not qualify for benefits. The sticky question is usually whether an individual is capable of earning more than the threshold income.
Applying for and Receiving Benefits
The process of qualifying for Social Security disability benefits proceeds in stages. The applicant first submits a claim for benefits to the Social Security Administration, furnishing:
- current and past employment and earnings, and
- medical records that support the existence of a disability.
If the claim is denied, the applicant can ask for reconsideration. It may help to submit additional information if the application was denied for lack of evidence.
If reconsideration is denied, the applicant can ask for a hearing before an administrative law judge who works for the Social Security Administration. Many applicants whose claims have been denied prior to the hearing receive a favorable determination from the judge.
Administrative reviews and an appeal to a court are the final steps for individuals who do not succeed before the administrative judge. It is always best to focus on winning the case at the hearing, as it is difficult to prevail on appeal.
Legal Representation in Social Security Disability Cases
All applicants for Social Security disability benefits are allowed to be represented by a lawyer at a hearing before an administrative law judge. Legal fees are usually a percentage of back benefits awarded by the judge. Fees are limited by federal law.
Experienced lawyers understand the importance of presenting the correct evidence at an administrative hearing. Lawyers call the judge’s attention to important information in medical records that establishes the existence of a disabling condition.
The key issue at an administrative hearing is usually whether the claimant is capable of substantial gainful employment. Administrative law judges often rely on the testimony of a vocational expert who is under contract with the Social Security Administration. The vocational expert determines whether there are a significant number of jobs in the national economy that a person with the claimant’s disability would be able to perform.
Claimants who do not have a lawyer cannot usually cross-examine the vocational expert in a way that undermines the expert’s conclusions. Experienced lawyers understand that vocational experts may not be familiar with the entire medical record or with all limitations that may prevent a claimant from working. By exposing gaps in the expert’s knowledge, lawyers can often persuade an administrative judge that the expert’s opinion does not support a denial of benefits.