The term Social Security brings to mind retirement benefits to people who leave the workforce. This makes sense, considering that more than three-quarters of the 62 million people receiving Social Security benefits receive retirement benefits. Still, social security covers others under age 62, including many disabled people.
Though Social Security was originally meant to assist the elderly, in the 1950’s, President Dwight Eisenhower sought to expand Social Security’s purview to include disabled workers. So, in 1956, federal legislation established the Social Security Disability Insurance Benefits program. This legislation allowed payment of benefits to injured workers between the ages of 50 and 64 who met certain requirements for disability benefits and for disabled adult children who had a disability that began before the age of 18 and were survivors or dependents of Social Security beneficiaries.
In the last sixty years, Social Security’s disability benefits programs have provided billions of dollars in assistance to injured workers. In this module, we’ll discuss the two Social Security programs that offer disability benefits, how an injured worker can qualify for disability payments, how the Social Security Administration evaluates disability claims and the calculation and payment of disability benefits.
Studies show that more than one in four 20-year old workers will become disabled before reaching retirement age. Once a worker becomes impaired due to a medical condition and needs disability benefits, she should file for them as soon as possible.
There are two programs that offer cash benefits for disabled individuals: the Social Security Disability Insurance program, known as “SSDI” or “SSD,” and the Supplemental Security Income program, or “SSI.” The difference between the two is that SSDI assistance eligibility is based on an applicant’s contribution history through employment. It’s available only to workers who accumulate enough work credits. On the other hand, SSI is a needs-based program providing disability benefits to low-income people who need not have earned enough work credits to qualify for other social security benefits. Note that people can (and often do) qualify for both SSI and SSDI.
SSI assistance is available to poor, disabled people of any age, though people over age 65 need not demonstrate complete disability to be eligible. People under age 65, on the other hand, must demonstrate that they are unable to work due to disability and have no adequate means of support. Eligibility requires that the applicant have no more than $2,000 in available assets (which includes almost anything of value other than one’s home and first car), or $3,000 for a married couple. 
Currently, the maximum monthly SSI payment for an eligible individual is $750 and $1,125 for an eligible individual with an eligible spouse. Additionally, a state may supplement the payment levels of all or selected categories of recipients. Currently, about 6.3 million Americans receive SSI because of disability and payments run more than $3.4 billion annually.
SSDI applies to a broader range of injured workers and isn’t need-based. Benefits can provide an economic safety net for a qualified, disabled person who has earned a sufficient number of work credits and has a medical condition that prevents her from continuing to work.
Each claim proceeds as follows. A Social Security disability claim is initially processed through a local Social Security Administration field office. A Social Security representative in the field office will obtain the application and will verify non-medical eligibility requirements, which may include age, employment, marital status and Social Security coverage information.
The field office then sends the case to a state agency responsible for developing medical evidence and making the initial determination on whether a claimant is disabled under the law. Then, the stage agency returns the case to the field office for appropriate action. If the state agency finds that the claimant is disabled, the Administration completes any outstanding non-disability development, computes the benefit amount and begins paying benefits. If the claimant is found not to be disabled, the file is kept in the field office in case the claimant decides to appeal the determination.
To qualify and claim SSDI benefits, the injured worker must prove each of the following:
- that he has met the work eligibility requirements, including having earned sufficient lifetime work credits and satisfying the “recent work” requirement discussed a bit later;
- that he’s unable to engage in any work because of a medically-determinable impairment that is expected to result in death, or that has lasted, or is expected, to last for a continuous period of at least 12 months;
- he does not have a disability caused by alcohol or drug addiction; and
- he is younger than full retirement age.
The final two elements are self-explanatory, but the first two are what the Social Security representative will scrutinize. First, an injured worker will need to satisfy an earnings requirement, which has two prongs:
- recent work; and
- duration of work.
The demands of each prong depend on the age of the applicant. For example, “a person over age 31 must have worked a total of 5 out of the 10 years prior to the onset of the disability to satisfy the “recent work” prong.” Whereas, “a fifty-year-old worker who develops a disability that makes it impossible for her to work generally needs a total of 7 years of past work history to meet the “duration of work” test.” These two requirements exclude workers with sparse work histories.
Proving the second element in the claims process is the most difficult and time-consuming, and the Social Security Administration employs a five-step sequential evaluation process when analyzing whether the applicant is unable to work. The first step involves determining whether the injured worker is engaged in “substantial gainful activity,” as applicants who are working and earning significant salaries are not eligible for SSDI. Work activity is “substantial” if it requires significant physical or mental exertion. A job doesn’t have to be performed on a full-time basis, however, to be substantial; the amount of time spent working is only one factor considered in determining whether a job is substantial and gainful.
Substantial gainful activity also has a dollar amount requirement, which caps the amount a disabled worker can earn from other sources and still be eligible for SSDI. In 2018, that amount is $1,180 for a non-blind injured worker, and $1,970 for a blind applicant. Though an injured worker that makes more than this amount per month may be physically impaired, he is not eligible for SSDI benefits because he can engage in competitive employment.
In one case, Ken Keyes contracted polio at a young age and was unable to use either of his legs and had very limited use of his hands. Thirty years after contracting polio, he applied for and was awarded Social Security disability payments. However, upon discovering that he had been working, the Social Security Administration terminated his benefits. He filed a complaint, asking the court to reverse the representative’s termination decision.
The court sided with the representative, however. It reviewed Keyes’s work history and found that though he was physically disabled, he had been engaged in substantial gainful activity during the years he received disability payments. Keyes had authored five books between 1975 and 1982 and he had worked over five hours daily for the Living Love Church, a church he had founded. He gave frequent lectures and seminars on self-help and sponsored Church retreats. The Church didn’t pay him a salary and he didn’t intend to profit from his activities, but his work was substantial because he supervised other Church employees and had other major responsibilities. Additionally, his work activities were gainful because it was the kind of work usually done for pay or profit.
The second step in the eligibility analysis is determining whether the injured worker’s impairment is sufficiently severe to limit his work activities. An impairment isn’t severe if it doesn’t limit the worker’s physical or mental ability to do basic work activities, such as walking, sitting, lifting, seeing or carrying out simple instructions. The party applying for disability benefits bears the burden of proving the inability to perform work and needs to provide enough medical evidence to demonstrate a severe impairment. The evidence must be complete and detailed enough for the representative to determine:
- the nature of the impairment;
- how long the applicant has experienced the impairment; and
- whether the applicant can still perform work-related physical and mental activities with the impairment.
The representative won’t just rely on information that the injured worker provides. With the applicant’s waiver, the representative may seek medical evidence from the applicant’s doctors who have evaluated, examined, or treated her. Additionally, the representative can request copies of medical evidence from hospitals, clinics, or other health facilities when appropriate. An injured worker who provides the representative with timely, accurate, and complete information and evidence can help accelerate the processing of the claim. Furthermore, the injured worker has an ongoing duty to inform the representative or submit all evidence known to her that relates to her disability, even if it may disqualify her from benefits.
Third, the representative determines whether the injured worker’s disability is included on its official list of impairments. On its website, the Social Security Administration lists 14 categories of physical and mental impairments, ranging from those impacting an injured worker’s musculoskeletal system to respiratory disorders to mental disorders such as bipolar disorder, anxiety and obsessive-compulsive disorder. The Administration considers these medical impairments severe enough to prevent the applicant from completing substantial gainful activity.
A diagnosis of one of these medical impairments is not enough; the applicant must establish that he “satisfies all of the criteria of that listing,” meaning he must continuously demonstrate the impairment’s symptoms. For example, if an applicant is diagnosed with arrhythmia and claims inability to work because of it, the Administration may require him to show evidence that he has been plagued with symptoms of arrhythmia, such as fainting and recurrent loss of consciousness.
The fourth and fifth steps in the determination apply when the applicant’s medical condition isn’t on the Administration’s official list of impairments or if the applicant’s symptoms aren’t as severe as the listed conditions. In the fourth step, the representative will analyze whether an injured worker’s medical impairment prevents her from performing any of her past relevant work and will look at what the she can still do despite the limitations due to the impairment. If she has enough residual functional capacity or can meet the necessary physical or mental demands of her old job, then the representative may deny benefits.
In Crane v. Shalala, the plaintiff worked as a laborer, carpenter, and firefighter prior to leaving his jobs and filing for disability benefits, claiming that his anxiety and depression prevented him from working. The representative rejected his request and this determination was upheld on appeal. The court reasoned that, though he was dealing with these mental impairments, neither his anxiety or depression prevented him from performing his prior work activities. Even though he could no longer be a firefighter, he could still work as a laborer or carpenter. So, he wasn’t disabled for purposes of receiving Social Security Disability benefits.
Even if an injured worker can’t do the work he did in the past, in the fifth step of the evaluation process, the representative will look to see if there’s other work the injured worker can do despite the impairment. Here, the burden shifts from the injured worker to the representative to prove that the applicant is not disabled or that he can do some other type of work. To show that the applicant isn’t disabled, for example, the representative may solicit the help of a vocational expert who can provide evidence that there are jobs the injured worker can perform despite his impairment and that these jobs are available in the national economy.
Payment of SSDI Benefits
Once the representative finds that an injured worker is disabled, the Social Security Administration will start providing benefit payments. SSDI benefits may start as early as the injured worker’s sixth month of disability and can continue so long as his medical condition doesn’t improve, and he remains unable to work.
A disabled worker may receive other forms of disability benefits, such as workers’ compensation, in addition to those provided by Social Security. Other benefits do not necessarily decrease or eliminate eligibility for SSDI. However, the total amount received from SSDI and other benefits cannot exceed 80% of the worker’s pre-disability earnings. If they do, then SSDI is reduced, dollar-for-dollar, by the amount received through other programs.
Let’s look at an example.
Josh is a 40-year old clerical assistant working at a state-operated psychiatric facility, earning $5,000 per month. He injures himself on the job and suffers a serious back injury, leaving him unable to work. He starts to receive $1,400 in monthly SSDI benefits, but also receives $3,000 in workers’ compensation, for a total of $4,400 of combined benefits monthly. Since that amount exceeds 80% the $5,000 Josh was taking home prior to his injury, it will reduce his SSDI benefits payment from $1,400 to $1,000 so that combined with the $3,000 in workers’ compensation, he will receive $4,000 per month, or 80 percent of $5,000.
Other Disability Benefits Recipients
The disabled worker isn’t the only person who can receive disability benefits, as the system also compensates the family members of disabled workers. A spouse may receive benefits if she is 62 or older or if she is caring for a child who’s disabled or under age 16. Each family member may be eligible for a monthly benefit of up to 50 percent of the disabled worker’s SSDI benefit rate, but generally, the total maximum amount a family can receive is about 150 to 180 percent of the disabled worker’s disability benefit.
Appealing a Decision
An applicant who applied for disability benefits or SSI assistance but was denied them can appeal the decision. The request must be in writing and received by the Social Security Administration within 60 days of the date of the denial. The appeal form is called a Form SSA-561 and the Social Security Administration recommends that an aggrieved party apply online to save time. The appeals process is exhaustive and an injured worker can request an appeal up to four times during the claims process.
Unfortunately, the availability of the appeals system has created a backlog. In a recent article, The Washington Post found that the SSDI program has one of the federal government’s biggest backlogs. In 2017, 1.1 million disability benefits applicants waited for one of 1,600 Social Security Administration administrative law judges to decide whether they deserve benefits. In the past few years, tens of thousands of people have died while waiting for a judge’s decision, exceeding 10,000 such deaths in 2017 alone.
The process of appealing a denial of benefits is the subject of our last module, where we’ll also examine how to appeal the denial of retirement benefits. In our next module, we will focus on benefits available to family members of social security beneficiaries.
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 20 C.F.R. § 404.1525(c)(3).
 Selver, supra note 17, at 963.
 Crane v. Shalala, 76 F.3d 251 (9th Cir. 1996).
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 579 days. And still waiting. Washington Post