The Social Security Disability Benefits: SSI and SSDI
Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) are federal benefits available to people with severe health problems who are unable to work.
Both programs are administered by the Social Security Administration (SSA), and the process of applying for the two programs is very similar.
However, there are a few important differences in the eligibility requirements for SSI and SSDI.
The Difference Between SSI and SSDI
For both SSI and SSDI, medical eligibility is determined in the same way. A person with a chronic illness or other debilitating conditions would qualify for either program.
However, the two programs have different financial and legal requirements you must meet.
SSI is strictly need-based, so it’s available to people with disabilities who have no or low income and assets. Your work history doesn’t factor into whether you’re eligible to receive SSI. The program is funded by general taxes, and all recipients get the same amount each month.
On the other hand, SSDI is an insurance program funded through payroll taxes. In order to be eligible, you need to have worked for many years and have paid into the Social Security trust fund. The amount of benefits that you will receive depends on your wages before you developed a disability.
Who Is Eligible for SSI or SSDI?
To receive benefits under either program, you must be a U.S. citizen, national or qualified immigrant.
The eligibility rules for SSI and SSDI are identical with respect to current income and underlying medical conditions, but there are some different financial qualifications for the two programs.
In order to be eligible for SSI or SSDI, you cannot currently earn a substantial income.
For SSI, you also must not own assets above a certain amount.
To be eligible for SSDI, you must have paid into the system through Social Security payroll taxes for a certain amount of time.
Additionally, you cannot receive either SSI or SSDI while you are receiving disability benefits from your state. Most states provide disability benefits for a maximum of one year, after which you can qualify for SSI or SSDI.
To qualify for either SSI or SSDI, you must be unable to perform “substantial” work.
Substantial work is defined by how much you earn. This limit, which changes over time, is called “substantial gainful activity,” or SGA.
If you are self-employed, Social Security uses a different test to determine whether you are doing SGA.
If you are working and earning above the SGA level when you apply for SSI or SSDI, your application will be denied.
However, you can continue to work part-time when you apply, as long as you earn less than the SGA amount.
You should be warned that working part-time could lead the SSA to believe that you could manage full-time work—and deny your benefits.
If you’re applying for SSI, you—or you and your spouse—must own assets valued under a limit set by the SSA. Assets for Social Security purposes can include cash, bank accounts, cars (your first car is not counted), household goods and other property.
To qualify for SSDI, you must have worked for at least 40 qualifying quarters. A Quarter of Coverage (QOC) is earned when you earn enough money in a three month period to exceed the minimum amount calculated by SSA. The amount needed to earn a QOC changes each year with changes in the national average wage index.
If you were working consistently, always earning above this amount, and paying payroll taxes, you would qualify for SSDI after 10 years. The twists and turns of life can prevent you from accruing these qualifying quarters, so it could take much more than 10 years to become eligible for SSDI.
In addition, you must be younger than 65 to qualify for SSDI. These age and earnings requirements do not apply to SSI.
For either SSDI or SSI, you must have an impairment that keeps you from being able to work. Your impairment can be medical, psychological, psychiatric in nature, or a combination of impairments.
Social Security has a manual that lists a broad range of impairments. If you have one or more of the listed impairments, you may automatically qualify for SSDI or SSI—if you have proof that your condition meets or equals the criteria of the listing.
You may still be eligible for disability benefits even if you don’t meet or equal the criteria for a listed impairment, as long as your condition—whatever it is—limits your ability to function so much that you are unable to work.
The SSA will ask about your daily activities and work and use that information, along with your medical records, to decide whether there are jobs that would be possible for you to do.
The central issue here is whether you have a medically determinable impairment that prevents you from working.
Evidence of Your Disability
To convince the SSA that you qualify for disability benefits, you must present your medical records, showing evidence of your physical or mental impairment.
For the SSA to agree you have a qualifying disability, you need information that details exactly how your impairment impacts you and makes it impossible for you to work.
You must provide Social Security with up-to-date medical records. Be sure to include new medical records and lab tests within 60 to 90 days of receiving them.
Timeline of Your Disability
In addition to showing that your condition currently prevents you from working, you must convince the SSA that your impairment has prevented or will prevent you from doing substantial gainful activity for at least a year.
Unlike most state disability programs, temporary disabilities, lasting less than a year, will not qualify you for SSI or SSDI.
Overview of SSI and SSDI Benefits
If you’re approved for Social Security Disability benefits, you will receive benefits for the month when you submitted your application onwards, or for the time since Social Security agreed you officially began experiencing a disabling condition.
The SSA updates the benefits amount each year, based on the changing cost of living. States with higher costs of living can also opt to provide a supplemental amount.
With SSDI, your benefit amount will depend on your average earnings before your disability. Social Security applies a complicated formula to determine how much you’re owed each month.
If you qualify to receive SSDI benefits in an amount less than the current SSI rate, the difference will be paid by the SSI fund.
If you’re are approved for Social Security Disability benefits, you will receive benefits from the month when you submitted your application onwards. This means that if you waited for a year for the SSA to decide your case, you will receive back benefits covering the entire period, not just starting from the month that you are approved.
However, there is a five-month waiting period, so the SSA won’t pay benefits covering the first five months after it determines you officially had a disability.
- SSI benefits are paid back to the application date and not earlier (this is different from SSDI).
- SSDI benefits can be paid as early as a year before the application date.
Example A – An SSDI claimant files an application dated January 15, 2018, claiming a disability onset date of June 15, 2015. If an administrative law judge agreed to the onset date of June 15, 2015, the claimant would be eligible for benefits beginning on February 1, 2017 (one year prior to application date and first full month of eligibility). Medicare eligibility would start February 1, 2019 (24 months from date of eligibility).
Example B – An SSDI claimant files an application February 15, 2018, alleging disability on January 15, 2018. The claimant’s date of eligibility (DOE) and first month of benefits would be July 1, 2018. It would not go back to the application date, or one year prior. And, Medicare eligibility is 24 months from the DOE, so 24 months from July 1, 2018 is July 1, 2020.
If you’re eligible for SSI, you’ll also be eligible for Medicaid benefits, including prescription coverage under Part D. Most people whose incomes qualify for SSI are also eligible to receive SNAP benefits (formerly known as food stamps).
If you’re approved for SSDI, you will automatically be enrolled in Medicare after two years.
Overview of the Claims and Litigation Process
The process of obtaining SSI or SSDI benefits can be long and difficult, especially considering that you’re also facing a debilitating medical condition.
The first step is to submit a claim for benefits to your local Social Security Administration office.
You can file the claims form with the assistance of a claim representative, either in person at the office, or over the phone, if that is more convenient for you. You can also submit a claim online, by visiting www.ssa.gov.
A claims representative at the Social Security Administration will screen your application to see whether you’re eligible on the basis of your non-medical situation. If you’re still working, and earning over a certain amount (the SGA amount), you will be disqualified.
You can also be disqualified for having too much in assets for SSI, or for not having enough work quarters to qualify for SSDI (remember that the work quarters requirement does not apply to SSI).
If you meet the financial criteria for either SSDI or SSI, your claim will be sent to a state office of Disability Determination Services (DDS), where disability claims examiners evaluate your medical condition, with assistance from a medical consultant.
Waiting for a determination from Social Security can take several months, and most applicants are denied on the first try. You should prepare yourself for a denial. And you should be ready to appeal this decision.
If you receive notification that your Social Security Disability claim has been denied, you will have a chance to request an appeal.
As part of the appeal process, you will need to appear before an administrative law judge at a disability hearing. Due to the large backlog of cases pending before the SSA judges, it can often take a year or more to schedule a hearing for your case. A knowledgeable and experienced disability lawyer can help you prepare for your Social Security Disability hearing, and will greatly improve your chances of approval.
If the judge still denies your claim, it is possible to appeal your case all the way to federal court.
If you have questions about the relationship between your workers’ comp claim and Social Security Disability, contact Mitchell & Associates today.