Disability Insurance Benefits (DIB) aka Regular Disability Benefits
- You need to have worked and paid enough Social Security taxes in order to qualify.
- The amount of your benefit will generally depend on what you have paid into the Social Security system/taxes.
- Generally, the higher your earnings were, the higher your disability benefit will be.
- For the most part, this benefit is not affected by household income and assets.
- The only incomes that can affect this benefit are Workers’ Compensation and Federal Retirement benefits.
- Veterans can receive both their full service connected pensions, retirement and or disability benefits as well as their full Social Security Disability Insurance benefit.
- Recipients of this benefit that have children who are under 19 years old that have not yet graduated from high school, may also be entitled to benefits under their disabled parent’s account.
- There is a separate benefit for disabled adult children over age 18 known as DAC, please read our separate information regarding that disability benefit below.
- Benefits start 5 full months after you become disabled or one year prior to your application date, depending on when you are found disabled and when you applied for benefits. This is because Social Security penalizes people for waiting too long to apply for benefits.
- If you are approved for disability benefits, in addition to a monetary benefit, you will also be entitled to medical insurance, under the Medicare system. Medicare benefits begin 2 years after you are first entitled to Social Security Disability benefits.
Supplemental Security Income (SSI)
- SSI benefits provide income to a disabled person who meets Social Security’s financial requirements in addition to meeting their medical requirements.
- There are very restrictive limitations on the disabled individual’s income, household income and assets.
- For an adult, this benefit is designed for people who have no other income or support.
- For a child, the income and assets their parents or guardians have will be evaluated.
- For a child, the benefit is intended to meet the disabled child’s needs and additional expenses their parents couldn’t otherwise afford due to their child’s disability.
- When either an adult or child becomes entitled to SSI they also become entitled to medical coverage under the Medicaid program.
- Once an individual is approved, benefits are usually paid starting with the month following the application date.
Widow/Widowers Disability Benefits (WDB)
Widows Disability Benefits allows a widow or widower to claim disability benefits off of their deceased spouse’s Social Security account. Below is a list of the requirements that must be met to qualify for this benefit.
- The deceased spouse has to have paid enough into Social Security taxes while working in order for their spouse to be eligible for this benefit.
- There are retirement benefits a widow/er can get off of their deceased spouse’s account. This benefit is different because it is actually a disability benefit the widow/er can receive before retirement age.
- The widow/er must prove that they are disabled under Social Security’s rules and regulations.
- The widow/er must be between the ages of 50 and 59.
- The widow/er must have been married to their now deceased spouse for at least 9 months.
- The widow/er must show that they became disabled within a certain period of time, normally within 7 years of their spouse’s death. However, this time frame can be extended when dependent children received Survivor’s Benefits.
- Several factors can affect the eligibility of a widow/er including their current marital status. For the most part, the widow/er needs to have not remarried in order to qualify for this disability benefit. Unless they remarry after they turn 60.
- Some divorced spouses can qualify for benefits off of their deceased former spouse’s account if they were married for 10 years or more and they have not remarried. The ten year rule can be waived if the surviving ex-spouse is still caring for the deceased person’s child who is either under 16 years old or is disabled.
- If you become entitled to Widows Disability benefits, you will also become entitled to Medicare 2 years after you are first entitled to Widows Disability benefits.
- You cannot elect to claim benefits off of their deceased spouse’s account versus your own. Rather, an individual will always be paid off of their own account first. However, the individual can’t get the difference from Widows Disability benefits if their Widow’s benefit would be higher.
- If the Widow/er has their own benefit which is higher than what their Widow’s benefit would be, then they receive nothing off of their deceased spouse’s account.
Disabled Adult Child (DAC) aka Childhood Disability Benefit (CDB)
- This benefit is for the disabled adult child of a parent who has worked and paid enough into the Social Security system to qualify for their own benefit.
- The parent of the disabled adult child must be deceased, disabled or retired.
- With this benefit, the adult child is entitled to a percentage of their parent’s Social Security benefit. It does NOT affect their parents’ benefit amount.
- You must prove the disabled adult child was disabled in between the ages of 18 and 22 and that they are currently disabled if they are 22 or older.
- The adult child does NOT have to be between the ages of 18 and 22 when they apply for these benefits. For example, a 42-year-old can apply for this benefit once their mother or father retires.
- Because a disabled adult child can qualify for benefits well after they are 22 years old, we encourage their parent to save their disabled child’s medical records as if they are gold, to later prove that they were disabled in between the ages of 18 and 22.
- The disabled adult child has to have never been married. Unless they are married to a person that also receives disabled adult child benefits.
- A recipient of Disabled Adult Child benefits also becomes entitled to Medicare 2 years after they first became entitled to Disabled Adult Child benefits.
There are a number of benefits available under the Social Security Disability Program. You should apply for all of the benefits that are applicable to your case.
The guidelines below apply to Adult Disability Claims only. Social Security determines if an adult can potentially qualify for Disability Benefits by applying a review procedure known as “The Sequential Evaluation Process”. In essence, this process is a series of requirements Social Security uses to determine whether a person meets the minimum criteria to qualify for any benefit/s.
There are 5 main steps and they are:
- Are you working?
- Is your condition severe?
- Is your condition found in Social Security’s list of disabling conditions?
- Can you do the work you did before?
- Can you do any other type of work?
Step 1 – Are you working?
You must be making less than $1170 a month gross in order for Social Security to even take your application. Any earned income over this amount is an automatic disqualifier. Earned income means money you are being paid as a result of working, and not total household income.
*The only exception to this rule is made for those that are legally blind. A blind person can earn $1950 a month net. Please scroll down and read below for additional information regarding the blindness exemption.*
Though Social Security is usually lenient when reviewing the disability claim of a blind person, this is not the case for others seeking disability benefits. Though Social Security says that a person can work and still be approved for disability benefits, the truth is, that it’s very difficult for a non-blind person to be approved for disability benefits while working.
Step 2 – Is your condition severe?
An individual must have a medically determinable physical or mental impairment (or a combination of impairments) that is severe and meets the “duration requirement”.
The duration requirement is that the person has been out of work or expects to be out of work for 12 months or more, or their disability will result in death in less than 12 months.
To be severe, impairment(s) must interfere with basic work-related activities.
Basic Work-Related Activities refers to the following:
For physical conditions- lifting, carrying, standing, walking, sitting, pushing, pulling, plus the “non-exertional” activities rated in the “Selected Characteristics” of the jobs defined in the revised Dictionary of Occupational Titles.
For mental conditions-The ability to understand, carry out, and remember simple instructions, make simple, work-related judgments and decisions, respond appropriately to supervision, coworkers and work situations, deal with changes in a routine work setting.
Step 3 – Is your condition found in Social Security’s list of disabling conditions?
Social Security has a list of medical conditions that are so severe that an individual is found to be disabled if their physical or mental impairment(s) matches them. An individual’s impairment(s) can also be found to meet the listing if it is of equal severity.
Step 4 – Can you do the work you did before?
If an individual’s physical or mental impairment(s) are so severe that they cannot do any of their previous work and based on their age, education, and work experience, they cannot do any other type of work which exists in the national economy, then that person should be found disabled.
Work available in the national economy refers to available jobs regardless of whether that work exists in the immediate area where the person lives, or whether a specific job opening exists for the person, or whether the person would be hired if they applied for a job.
If the person retains the physical and mental capacity to perform any past work, they will not be found disabled depending on their age. This is where step 5 comes into play.
At this step the individual’s work over the past 15 years will be thoroughly evaluated.
Step 5 – Can you do any other type of work?
At step 5, Social Security has to show that work, other than work the individual performed in the past, exists in significant numbers in the national economy. Social Security also has to evaluate the disabled person’s age, education, and work experience. Considering these factors, if an individual can make an adjustment to do other work, they will not be found disabled. If an individual cannot make an adjustment to do other work, then they should be found disabled.
Age is an incredibly important factor at step 5, because if the person is 55 or older, technically speaking, whether they can be retrained to do some other type of work should be irrelevant. Rather, if they can prove that they are no longer able to do any of the work they have done in the past 15 years, due to their disabilities, then they should be found disabled.
Though Step 1 of Social Security’s Sequential Evaluation Process disqualifies an individual earning $1170 per month or more, individuals that are legally blind are exempt from this rule. A blind person can earn $1950 a month net. Once again, earned income means money an individual is being paid as a result of working, and not total household income.
Furthermore, for a blind individual, their gross earnings are not considered. Rather, their net income is evaluated.
Net earnings for a blind individual refer to the amount of earnings remaining after all of their blind related expenses are deducted from their gross earnings such as:
- A seeing eye dog.
- Special electronic equipment
- Any and all blindness related expenses
Social Security is usually lenient when reviewing the disability claim of a blind person and will allow them to work and receive their entire disability benefit.
An additional exemption is made for blind individuals by not requiring them to have the same amount of earnings quarters a non-blind individual is required to have. This means that legally blind individuals are allowed to have less earnings quarters in order to qualify for Social Security Disability benefits.
Unlike non-blind individuals, blind individuals only need to have one quarter of coverage for each year after age 21.
For Example: A 38 year old would only need 17 quarters of coverage. Because 38-21=17.
That means that if the person earned 4 quarters of coverage in one year, then that blind individual gets 4 years’ worth of coverage/insured status in the Social Security System.
The requirement to be deemed legally blind according to Social Security is:
Vision in best corrected eye is 20/200 or worse OR
Peripheral vision is less than 20 degrees.
Best corrected vision means their vision with glasses or contacts or if they can’t wear glasses or contacts because they are irrelevant, as in the case of a person that has no eye.
Yes it depends on the individual’s age how their claim will be evaluated and which rules are going to be applied. The older the claimant the more favorable the rules are. Essentially, the older the person is the lower the standard on types of work Social Security will consider when determining if the person is disabled.
For example: A claim for a 40 year old is not evaluated the same way a claim is evaluated for a 50 or 60 year old.
The following are Social Security’s age categories:
The younger a person is, the harder it will be for them to be found disabled.
Myth #1: All Disability benefits are income based.
FALSE-Though SSI benefits are income based; it is the only disability benefit that is.
Regular disability benefits and all of its related programs including Widow’s disability benefits and Disabled Adult Child benefits are not income based.
The technical qualification for any of these benefits will be determined by the wage earners’ work history and whether they paid enough into Social Security tax.
However, the actual benefit entitlement will not depend on the person’s income and assets.
We often tell people that “you can be a millionaire and still qualify for regular disability benefits”.
Myth #2: Your benefit will be a direct percentage of your regular earnings.
FALSE-Unlike Workers’ Compensation where you receive 80% of your previous average weekly wage and similar formulas and percentages are used to calculate Short Term and Long Term Disability benefits. Social Security does not take a direct percentage of your past weekly or monthly wage when calculating your benefit in order to determine what your monthly benefit amount will be. Rather, a calculation based on the wage earners’ entire work history and earnings is applied. Though a direct percentage is not applied, what is true, is that the higher the total earnings and Social Security taxes the wage earner paid, the higher their disability benefit will be.
Myth #3: You can get SSI while you wait for your regular benefit.
TRUE AND FALSE – Social Security does have a “presumptive disability benefit” which can be awarded when the claimant has a disability that is so severe that the Social Security Representative is almost certain, beyond a shadow of a doubt, that the person will be awarded benefits at the initial level and or that the claimant’s disability is expected to result in imminent death. The intention of this benefit is, in essence, to hold the person over until their claim is processed and approved.
However, this benefit is rarely awarded and only done so in a very small percentage of cases. In addition, the benefit awarded is SSI and not regular disability benefits. Which means that the monetary benefit is usually low and income based.
Myth #4: The benefit amount you get depends on your different or individual disabilities.
FALSE- To further illustrate this myth here is an example:
A person is receiving disability benefits due to a severe back injury. They are now diagnosed with a large brain tumor.
The person’s disability benefit will not be increased due to their new diagnosis or disability.
In addition, a claimant does not receive a higher benefit due to a more severe condition.
For example: A person with no legs and no arms will not receive a higher benefit than a person with a back injury.
Myth #5: You can get temporary benefits for less than 12 months
FALSE-Sometimes life happens and unexpected hardships occur that leave a person unable to work temporarily such as a car accident. When these temporary hardships occur people will often call us and tell us that they are just looking for “a temporary benefit to hold them over”. Unfortunately, a temporary benefit does not exist in the Social Security Disability program. The rule is that an individual must be disabled or expect to be disabled for a minimum of 12 months or more.
Myth #6: You can choose to just get medical benefits without a monetary benefit.
FALSE-Disabled individuals often have to endure the hardship of being uninsured or have a very high COBRA payment once they are unemployed. Often time people can manage “getting by” financially when their spouse works or they have a little money put away, but they cannot afford a monthly health insurance premium or COBRA payment so they will inquire about proving their disability claim just to get medical benefits. The thinking behind this is that it will take less processing/wait time if you opt to just get medical benefits without a monetary benefit. Unfortunately, this is not an option. It will take just as long for your disability claim to be processed whether you want just a medical or just a monetary benefit. What is more, no option to select one without the other exists when filing a disability claim.
Myth #7: Social Security has deadlines they must issue a decision by.
FALSE-After filing an initial application most individuals receive a pamphlet from Social Security which states that they will make a decision within 90 days. Subsequently similar letters are sent with estimated time frames. Unfortunately, unlike the claimant, Social Security is not required to make and issue a decision under any designated time frame. Though a claimant does have deadlines by which they must return completed forms, signed documents and submit appeals. Social Security however, only issues those “estimated” time frames for informational purposes but are not held to the same and in actuality, they often exceed their estimated time frames.
Secret #1: Don’t work.
It is very difficult to be found disabled under the Social Security program. However, working while applying for benefits makes a claim much harder to prove, delays it and often times automatically disqualifies a person. The only exception made for a working disabled individual is if the person is legally blind. They have their own set of complicated rules and regulations. However, for all others, if you are making approximately $1,170 a month or more, you are automatically disqualified from receiving benefits. Your claim won’t even be reviewed medically because technically, you cannot qualify. In addition, if you make less than $1,170 a month, though your application will be taken, your chances of being approved significantly decreases and your processing time increases. If you stop working after you have applied or if you attempt to work after you have applied, means more work for the Social Security representative which causes added delays in the processing of your claim.
Secret #2: Don’t choose a disability date before you stopped working.
Selecting your “onset date of disability” is a key factor in proving your disability claim. Multiple factors need to be considered when selecting a date and one that can be proven. This is not a cut and dry decision. However, what is true in most cases is that if you select a disability date prior to the date you stopped working full time, your claim will be delayed and most likely denied
Secret #3: Make sure you have ongoing medical treatment.
We know that having ongoing medical treatment may be easier said than done when you are out of work and uninsured. However, the only way you can prove your disability claim is by having the medical evidence necessary to show that you have disabling medical conditions severe enough that require ongoing medical treatment and that your disabilities cause ongoing limitations that prevent you from working. In most cases Social Security will not accept your financial hardship as a reasonable explanation for lack of treatment. Rather, the general thinking is that if you really need treatment, you will find a way to get it, whether through a county clinic or program, by borrowing money, or setting up a payment plan to get the treatment you need. The bottom line is that ongoing medical treatment will be critical to proving your disability claim.
Secret #4: Comply with your medical treatment.
In correlation with secret #3, it is as important to comply with your physician’s prescribed medical treatment, than it is to have it. In order to win your disability claim, you have to prove that despite complying with your medical treatment, you are still unable to work. Examples of medical treatment compliance include but are not limited to:
|Taking prescribed medications and dosages.||Adhering to recommendations such as not consuming alcohol while taking certain medications.||Keeping follow up appointments.||Quitting smoking.||Following dietary guidelines.|
The point is: are you doing all you can to comply with your doctor’s prescribed course of treatment?
And despite your compliance; are you still unable to work?
If you disagree with your physician’s recommended treatment plan, then you should discuss this with your physician so that this is documented and to explore potential treatment alternatives.
Secret #5: Explain any earnings after your disability date.
Your date of disability, known as your “onset date”, is the date you are claiming you have been disabled since. When you have earnings after this date it can cause a significant delay in the processing of your claim and in many cases, to be denied. Earnings do not always result from working. They can also result from other sources such as:
- Paid Sick Time
- Paid Vacation Time
- Short Term Disability
- Long Term Disability
- Owed Commissions
The important thing to remember is that if you have earnings after the date you are claiming you became disabled or stopped working, you should proactively clarify the source of the earnings and submit proof of the same.
Mistake #1 – Working after applying for benefits
Sometimes people think that they can apply for benefits, wait to see what happens and then if they’re approved or if their condition worsens, they’ll stop working then. This is a mistake since most claims are denied almost immediately when the person is working and making over $1,170 a month.
Mistake #2 – Re-applying versus appealing your denial
Many times when claimants apply and are denied they will let their appeal time lapse and will file a new application instead. This is a serious mistake. Many times people think that they were denied because they forget to include some important information when they applied, so they will decide to re-apply instead of appealing their existing denial. The truth is that most people are denied the first and second time when processing a disability claim. There are also long waiting periods at each and every level. Therefore, it is much more beneficial to appeal Social Security’s decision and include the additional information in the appeal. This way, you won’t lose the time you already spent waiting on Social Security’s first decision and you will keep your case moving forward.
Mistake #3 – Not pursuing a claim through to the hearing level
Most claims are denied at the Initial and Reconsideration levels. This happens to even severely disabled individuals. The hope is that the disabled person will be discouraged by the denial and not pursue their claim. This is a huge mistake, especially since the majority of approved claims are approved at the hearing level. It is estimated that roughly 85% of claimants are denied at the Initial level and 95% are denied at the Reconsideration level. However, over 50% of claimants are approved at the hearing level.
Mistake #4 – Not listing all of your disabilities
Often a disabled individual will want to claim disability benefits for “a disability”. They will even become angry when Social Security asks about other conditions that they feel are unrelated to their claim. For example, They will ask “Why is Social Security asking me about my depression when I’m claiming disability due to my heart condition?’.
When evaluating a disability claim, all medical conditions are considered to determine if a person is disabled. Usually, the more medical conditions a person has, the more limitations they have. This helps their case since the majority of claims are won based on a combination of impairments.
Mistake #5 – Not getting a receipt for information you submit to Social Security
It is a mistake to trust that Social Security received the information that you submitted. Unfortunately, Social Security often loses information that is sent to them and or that they receive. We recommend that all correspondence mailed to Social Security be sent via certified mail with a signed return receipt requested. If you submit information online, get an electronic receipt and if you fax information, keep your fax confirmation.
Mistake #6 – Not submitting the information Social Security requests
Most claimants hate the tedious forms Social Security and the Office of Disability sends them to complete. Often times, the same forms are sent at the second level of a claim as the first. Claimants won’t complete these forms because they feel they have already answered the questions. This is a mistake since by not submitting the information Social Security is requesting, they will delay the processing of their claim and it could have additional negative consequences on their claim.
Mistake #7 – Not following up on your claim status
First, you should follow up to make sure that Social Security received all of the information you submitted. Second, you should confirm that the information they received included all of the information they wanted and that they are not waiting for any additional information you need to supply.
Once this is done, you should then check on the status of your claim every 30-60 days to ensure that your claim is still pending with their office. Decisions that they issue often get lost. Therefore, you should always follow up with Social Security until you receive a written decision.