SSDI is one of two programs where disability benefits are paid by SSA. Supplemental Security Income (SSI) , the second program, is a needs based program for individuals with little or no income and few resources. SSDI is an insurance program for workers who have paid into the system. SSDI can also provide monthly disability benefits and health coverage for a deceased, disabled or retired worker’s dependents.
For workers who have paid into the system (FICA withholding) there is an earnings requirement
to become insured. A worker must meet two different earnings
to obtain insured status.
1. The "Recent Work Test"
2. The "Duration of Work Test"
Also, the onset of disability must be prior to the date last insured and at least 5 months
prior to full retirement age.
Children with no work history and disabled before age 22 may be eligible for benefits. The child’s parent must be deceased or receiving Social Security Disability or retirement.
Widows or widowers with no work history and disabled at age 50-60 may be eligible for benefits. The applicant’s disability onset must occur within 7yrs of the date of death plus additional qualifying criteria.
|Rules for work needed for the "recent work test"|
|If you become disabled...||Then you generally need:|
|In or before the quarter you turn age 24||1.5 years of work during the three-year period ending with the quarter your disability began|
|In the quarter after you turn age 24 but before the quarter you turn age 31
||Work during half the time for the period beginning with the quarter after you turned 21 and ending with the quarter you became disabled.
Example: If you become disabled in the quarter you turned age 27, then you would need three years of work out of the six-year period ending with the quarter you became disabled.
|In the quarter you turned age 31 or later
||Work during five years out of the 10-year period ending with the quarter your disability began
The following table shows examples of how much work you need to meet the "duration of work test" if you have become disabled at various selected ages. For the "duration of work" test, your work does not have to fall within a certain period of time.
Note: This table does not cover all situations.
|Examples of work needed for the "duration of work test"|
|If you become disabled...||Then you generally need:|
|Before age 28||1.5 years of work|
|Age 30||2 years|
|Age 34||3 years|
|Age 38||4 years|
|Age 42||5 years|
|Age 44||5.5 years|
|Age 46||6 years|
|Age 48||6.5 years|
|Age 50||7 years|
|Age 52||7.5 years|
|Age 54||8 years|
|Age 56||8.5 years|
|Age 58||9 years|
|Age 60||9.5 years|
Basic definition of disability – adult
The law defines disability as the inability to do any substantial gainful activity by
reason of a medically determinable physical or mental impairment which can be expected to
result in death or which has lasted or can be expected to last for a continuous period of
not less than 12 months.
SSA uses a five step process to determine if an adult applicant is disabled. This process is
called the “sequential evaluation”. The sequential evaluation looks at employment (past and
present), medical impairments and the capacity to work.
The amount of benefits paid to a disabled worker or their dependent is based (primarily) on the
workers lifetime earnings. SSA converts past earnings to estimated values near the time of a
- Average monthly benefit for a Disabled worker in August 2009 was $1,064.
- Average monthly benefit for a Disabled worker, young spouse and one or more child in August 2009 was $1,799
- Average monthly benefit for a Disabled widow in August 2009 was $684.
- Average monthly benefit for a Disabled adult child in 2008 was $682.
The maximum family benefit is the maximum monthly amount that can be paid on a worker's earnings record. There is a special formula for computing the maximum benefits payable to the family of a disabled worker.
Other payments may affect SSDI benefits
If a worker or beneficiary is receiving other government benefits, the amount of a Social Security disability benefit may be affected.
Other government benefits include- Workers compensation (state and federal), government pensions based on disability and civil service disability benefits.
When SSDI benefits are awarded Medicare coverage follows. Coverage begins after two years of receiving SSDI benefits. In some cases the Medicare coverage begins prior to the date of an SSDI award letter. This can occur when denials and appeals have delayed the process.
What about dependent benefits?
Certain members of a family may qualify for benefits based on a deceased, disabled
or retired workers earnings. They include:
In some situations, a divorced spouse may qualify for benefits based on the workers earnings if he or she was married to the worker for at least 10 years, is not currently married and is at least age 62. The money paid to a divorced spouse does not reduce a workers benefit or any benefits due to the workers current spouse or children.
- Your spouse, if he or she is 62 or older;
- Your spouse, at any age if he or she is caring for a child of yours who is younger than age 16 or disabled;
- Your unmarried child, including an adopted child, or, in some cases, a stepchild or grandchild. The child must be under age 18 or under age 19 if in elementary or secondary school full time; and
- Your unmarried disabled adult child(DAC), age 18 or older, if he or she has a disability that started before age 22. The child’s disability also must meet the definition of disability for adults.
Who decides if you are disabled?
SSA contracts with a Disability Determination Service (DDS) in every state. This agency makes the initial medical decision on your application. If your claim is denied they also review your first appeal which is called a reconsideration. There are five additional appeal steps which involve administrative hearings and the Federal Court system. The medical and legal decisions during the additional five appeal steps on your claim may involve contract medical consultants, judges and appeals council members.
When DDS reaches a decision on your case, SSA will send you a letter. If your application is approved, the letter will show the amount of your benefit and the payments start. If your application is not approved, the letter will explain why and tell you how to appeal the decision.
When you appeal a denial you have the right to be represented. An attorney or other qualified representative can provide valuable assistance.
Receiving SSDI and working or training
After you start receiving disability benefits, you may want to try working again. There are special rules that help you keep your cash benefits and Medicare while you test your ability to work. SSA calls these rules “work incentives” or “employment support” programs. To learn more about these rules go to http://www.socialsecurity.gov/pubs/10095.pdf
or ask for Working While Disabled---How We Can Help (Publication No.10095).
Another program called “Your Ticket to Work” provides SSDI beneficiaries with help for training and other services they need to go to work at no cost. Most beneficiaries will receive a “ticket” that they can take to a provider of their choice who can offer the kind of services they need. To learn more about this program go to http://www.socialsecurity.gov/pubs/10061.pdf
or ask for Your Ticket To Work
(Publication No. 05-10061).