Guide to Social Security Disability Benefits

The Social Security Administration (SSA) offers disability benefits to people in need of financial assistance due to a life-altering injury or mental condition that prevents them from holding a full-time job and supporting themselves.

The two major programs, SSDI and SSI, provide a financial benefit on a monthly basis that covers basic living costs. In order to obtain benefits, you have to apply to the SSA for either program, provide the required information, and wait for the agency to make a decision. However, qualifying for SSDI or SSI can be difficult for various reasons, and help from a lawyer to get approved for benefits may be necessary.

WHAT IS SSDI?

Social Security Disability Insurance, or SSDI, is a federal government benefits program funded by payroll taxes. It provides financial aid to qualifying adults with disabilities if they have earned 20 work credits in the last 10 years. People who can prove they have a mental or physical condition that resulted from an injury and restricts or prevents them from working are usually eligible for SSDI.

WHAT IS SSI?

Supplemental Security Income, or SSI, is also a federal benefits program but is funded by general taxes instead of payroll taxes. It helps children and adults who meet one or more of the following criteria:

  • Disabled
  • Blind
  • Age 65 or older with no work history

The program is open to those with little to no income who are limited in their ability to hold down regular employment. It’s similar to Social Security benefits, but qualifying is based on disability as opposed to income.

WHO QUALIFIES FOR EACH?

Both programs provide benefits to people who are unable to work through disability, but SSDI is intended for adults who were able to work until they became disabled. SSI is for those who have been unable to hold a job for any length of time throughout their life.

SSDI is for people who have worked up until recently and have been employed in positions that are covered by Social Security. The disability must meet the SSA’s definition of a disability, and it has to prevent you from working for at least a year.

Work credits earned from wages or self-employment are also required, but the income needed for SSDI changes every year. You can earn up to four work credits each year, and you can get all four credits after you’ve earned more than the minimum income for the year.

For example, in 2021, a credit was awarded after a worker earned $1,470 in wages. After earning $5,880 in 2021, a worker received all four credits.

SSI is for those who are over the age of 65 or unable to work due to disability or blindness. You must have income from earnings or pensions and have little in the way of resources to help you survive. The program is not funded through payroll taxes, unlike SSDI, and you’re not required to have work credits when applying.

APPLICATION PROCESS

The application process for both SSDI and SSI requires information that proves you are unable to work in your field or unable to work at all due to disability. Getting approved for either type of disability is a difficult process due to strict criteria and the requirements to prove your eligibility. You’ll have to obtain medical records that date back to the moment you were injured or diagnosed with an illness that impaired your ability to work.

The qualifying criteria for SSDI include working in jobs that contributed to Social Security and having a medical condition that meets the SSA’s definition of a disability. You must also be unable to work for at least a year after receiving your disability.

How to apply?

The applications for SSDI and SSI are the same and are available on the Social Security Administration’s website. Follow the instructions and fill out the form to the best of your abilities. It’s better to complete as much of the form as you can than to leave areas blank.

What information is needed?

In order to apply for SSDI or SSI, you’ll need the following information:

The checklist provides further details about the type of information you need for the application.

Why are most applicants declined?

There are multiple reasons why an applicant may be denied benefits, but most denials come down to the severity and permanence of the disability.

The SSA uses five questions to determine if you’re disabled according to its criteria. The questions are:

  • Are you currently employed and earning more than $1,310 a month?
  • Is your condition severe enough to limit your ability to do basic work activities?
  • Is your condition on the list of disabling conditions?
  • Can you do the work you did before your disabling injury?
  • Can you do other kinds of work despite your disability?

Other conditions that can affect your ability to collect SSDI include:

  • Your disability won’t last for at least a year.
  • You have an outstanding warrant for your arrest.
  • You were convicted of a crime.
  • You committed fraud to obtain SSDI or SSI.

Qualifications under different disabilities

The SSA has a list of qualifying disabilities, known as the SSA Blue Book, that helps you qualify for SSDI and SSI benefits. If you are suffering from any one of the following physical or mental disorders and unable to work for at least a year, you can apply for benefits according to your employment status or needs.

Any disorder of the spine or upper or lower extremities that affects your ability to move freely. A musculoskeletal disorder can be congenital or acquired and can involve the bones, major joints, tendons, muscles, ligaments, and other soft tissues.

This covers disorders of the eyes, ears, and mouth that impact your ability to see, hear, and speak. The SSA defines blindness under the Social Security Act sections 216(i)(1) and 1614(a)(2). Your blindness has to meet specific criteria in order to be eligible for SSDI or SSI.

The respiratory disorder category covers all disorders that cause obstruction or restriction in the lungs, or interfere with the diffusion of oxygen in the lungs. Disorders include cystic fibrosis, pneumoconiosis, asthma, chronic obstructive pulmonary disease, and lung transplants. The Blue Book has a chart that lays out the criteria for eligibility.

Any disorder that prevents the heart or circulatory system from working properly falls under this category. The condition can be congenital or acquired, and be the result of heart failure, myocardial ischemia, syncope, central cyanosis, and disorders of the veins or arteries.

Disorders of the digestive system are considered disabilities due to the fact they can make it difficult or impossible to focus for any length of time. They include liver dysfunction, gastrointestinal hemorrhage, short bowel syndrome, inflammatory bowel disease, and malnutrition.

Genitourinary disorders are ones that result in chronic kidney disease (CKD). They include diabetic nephropathy, chronic glomerulonephritis, chronic obstructive uropathy, hypertensive nephropathy, and hereditary nephropathies. You will need to provide medical paperwork that shows you are dealing with CKD as the result of any one of these conditions.

All non-cancerous blood disorders are considered under this disorder. That includes hemolytic anemia, disorders of bone marrow failure, and disorders of thrombosis and hemostasis.

The skin disorder listing covers skin conditions that are the result of ichthyosis dermatitis, hidradenitis suppurativa, chronic infections of the skin or mucous membranes, and more. The SSA requires a large amount of documentation to prove the fact your skin disorder is affecting your ability to work.

This disorder is evaluated by the impairment that results in an endocrine disorder. Some of the disorders include the pituitary gland, thyroid gland, parathyroid gland, diabetes mellitus, and other pancreatic gland disorders, hyperglycemia, diabetic ketoacidosis, chronic hyperglycemia, and more.

Only non-mosaic Down syndrome is evaluated for disability and has to meet the criteria that are listed under 10.06A of the Blue Book. A laboratory finding with karyotype analysis and a physician’s signature certifying the presence of Down syndrome is a key part of getting approval.

Multiple neurological disorders are considered disabilities as long as they cause disorganization of motor function, communication impairment, neuromuscular and bulbar dysfunction, or a combination of limitations in physical and mental functions. Cerebral palsy characterized by a marked limitation, disorganization, or significant interference in speech, hearing, or visual deficits is a disability covered by SSDI/SSI.

There are 11 categories for mental disorders. They include:

  • Neurocognitive
  • Schizophrenia spectrum
  • Depressive and bipolar
  • Anxiety and obsessive-compulsive
  • Somatic symptom
  • Personality and impulse-control
  • Autism
  • Neurodevelopmental
  • Eating disorders
  • Trauma and stressor-related
  • Intellectual

All cancers except those associated with human immunodeficiency virus (HIV) can be evaluated for disability. An applicant needs to submit as much medical evidence that supports the diagnosis as possible, and supply the information required by the Blue Book.

Immune system disorders are evaluated based on the dysfunction they cause in one or more parts of the immune system. Some of the disorders include lupus, systemic vasculitis, scleroderma, inflammatory arthritis, and more.

How are SSDI payments calculated?

The amount you receive from SSDI is based on the average income you earned before you were disabled. The type or severity of your disability does not factor into the benefit. The SSA has a formula that pays a percentage of your income at increasing levels. For example, in 2022 the SSA will pay:

90%

of the first $1,024 of average monthly earnings

32%

of average monthly earnings over $1,024 through $6,172

15%

of average monthly earnings over $6,172

Can you work while on Social Security Disability?

Yes, you can work while you’re receiving SSDI or SSI. The program has special rules that are designed to help people transition from SSDI to full employment over time. You can enroll in a trial work period that lasts nine months, keep your earnings below the monthly limit ($1,310 in 2021), or enroll in the Ticket to Work program. If it so happens that an SSDI recipient can’t maintain employment for any reason and their benefits have stopped, they can start receiving benefits again and may not need to reapply.

What caretakers need to know

Caretakers, or caregivers, can apply on behalf of a family member or friend, but the person who is to receive the benefits has to sign the application and other related documents. The only way a caregiver can sign is if they have power of attorney or are a legal guardian. SSDI/SSI will not pay the wages of a caregiver, but the recipient can use the money for wages and other costs of caregiving if they so choose.

Blindness and benefits

You can apply for and receive SSDI or SSI if you’re blind or your vision problems alone or with other health problems prevent you from working. SSDI requires you to have paid into Social Security through payroll taxes, whereas SSI doesn’t. If you don’t have enough credits for SSDI from your wages, you may be able to use the credits of a parent or spouse. You’re also allowed to work while receiving SSDI and earn a much higher amount every month ($2,190 in 2021) in wages and self-employment than you would if you had normal sight.

SSDI benefits and retirement

The amount provided by SSDI benefits may or may not be enough to live off of. Recipients of SSDI/SSI can usually take advantage of other government programs such as Medicare and Medicaid to reduce medical costs, SNAP benefits for food, and subsidized housing.

How can a law firm help?

The law firm of Marasco & Nesselbush in Providence, Rhode Island, can help you pursue an SSDI or SSI claim and improve your chances of getting approved for benefits. Applying for Social Security Disability is an involved process that requires providing sufficient documentation by a deadline. Missing the deadline may result in you starting the application process all over again. You also run the risk of being barred from ever applying for SSDI again. Getting help from Marasco & Nesselbush helps you avoid the pitfalls of applying for SSDI.

Our team understands the application process and what the SSA is looking for in terms of information, and we can obtain the medical opinion that’s needed to support your claim. If you’re denied, we handle the appeals process and represent you in front of an administrative law judge. We advocate for you until you receive the benefits that you are legally entitled to.