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Social Security Disability Benefits

Social Security Disability Benefits

June 21, 2023

What is it?

Most people don't expect to become disabled and are unprepared when they are unable to work due to illness or injury. The fact is, however, that you are much more likely to become disabled than die during your earning years. Because eligibility standards are strict, Social Security disability benefits may not offer the comprehensive protection that you need. However, they can help protect you and your family from financial devastation when you can't work for a year or more.

Two programs administered by the Social Security Administration (SSA) pay disability benefits. The Social Security disability insurance program pays benefits to qualified individuals who are under full retirement age, regardless of income. The other program, Supplemental Security Income (SSI), pays benefits to qualified individuals who are either over age 65 or who are blind or disabled and have limited income. The following discussion pertains only to the Social Security disability insurance program.

Who is eligible for disability benefits?

Under the Social Security disability program, you may be eligible for benefits if you meet the following criteria:

  • You must be under full retirement age
  • You must have attained disability insured status by meeting one of the following requirements for Social Security credits (also known as quarters of coverage):

If you are disabled at age 31 or older, you are considered to be fully insured for disability benefits if you earn at least one credit for each year after age 21 and before the year you become disabled or reach age 62, whichever comes However, unless you are blind, you must also have earned at least 20 of the credits in the 10-year (40-quarter) period ending with the quarter in which disability begins. The following table, published by the SSA, shows the number of credits you will need: 

Example(s): Rob was disabled when he tripped over a footstool in his home. He was 46. Because 24 years had elapsed from the year he turned 22 until the year before he became disabled, he needed 24 credits to be eligible for disability benefits.

  • If you are disabled at any age between 24 and 30, you may qualify if you have attained special insured status. To qualify for benefits, you must have earned credits in one-half of the years that have elapsed after age 21 and up to the age you became
  • If you are disabled before age 24, you may qualify if you have earned six credits in the 12 quarters ending with the quarter in which your disability begins.
  • You have fulfilled the five-month waiting period for This waiting period begins with the first full month after the date the SSA decides your disability began.

Example(s): Keith was hurt on January 10. He applied for disability benefits on March 4. His claim was approved in May. The SSA determined that the onset of his disability was January 10, so the five-month waiting period began in February and ended in June. He became entitled to benefits on July 1.

  • You are a disabled individual, as defined by the SSA. Social Security does not allow coverage for partial disability; you're either disabled or you're not. In general, you're considered disabled if you're unable to engage in substantial gainful activity (productive work for which you could earn money) because you're impaired mentally or physically. This impairment must be medically The period of disability has to last or be expected to last 12 months or more or result in your death (for a detailed discussion about how your disabled status is determined, see below).

Tip: If you are blind, special considerations may govern your situation. The Social Security definition of blindness is that your vision field is 20 degrees or less, even with a corrective lens, or that your vision cannot be corrected to better than 20/200. If you are 55 or over, a special definition of disability exists that may affect your eligibility for disability benefits: the inability, because of blindness, to engage in substantial gainful activity requiring skills or abilities comparable to those of any gainful activity in which you have previously engaged with some regularity and over a substantial period of time.

In addition, if you are eligible for disability benefits, certain members of your family may also qualify for benefits if:

  1. Your spouse is age 62 or over or caring either for a dependent child of yours who is under age 16 or a child who is disabled
  2. Your dependent unmarried child is under 18, or under 19 if enrolled in secondary school full time
  3. Your dependent unmarried disabled child is over 18 (if disability began before age 22)

If you die, your disabled widow or widower, age 50 or older whose disability began before your death or within seven years after your death, and your disabled ex-spouse who is 50 or older (if the marriage lasted 10 years or longer) may also qualify for Social Security benefits based on your earnings record.

How much will you receive from disability insurance?

Your disability benefit amount will generally be 100 percent of your primary insurance amount (PIA). It is based on your average lifetime earnings. You can estimate your disability benefits by using one of the benefit calculators available at the Social Security website ( ssa.gov. ) You can also sign up at the website for a my Social Security account so that you can access your Social Security Statement where you can view your actual earnings record and get an estimate of how much you would receive if you were disabled right now.

Keep in mind that your disability benefit amount (or that of your family members) may be affected by income you receive from these other programs:

  • Workers' compensation benefits
  • Disability benefits from some federal, state, civil service, and local government programs
  • Government pensions from work not covered by Social Security Your disability benefit may end when:
  • Your condition improves and you are no longer considered disabled
  • You become eligible for retirement benefits
  • You refuse to follow a prescribed rehabilitation program that may restore your ability to engage in substantial gainful activity
  • You do not supply the SSA with the evidence necessary to substantiate your claim
  • You die

Benefits for family members are expressed as a percentage of your PIA. Generally, each family member can expect to receive 50 percent of your PIA, but the total benefit payable to all family members on your record can't exceed a certain limit. This limit varies, but is around 150 to 180 percent of your disability benefit. If the sum of benefits payable to your family members exceeds this limit, their benefits will be reduced proportionately. Your benefit will not be affected.

How does the SSA decide if you are disabled?

The claims process for disability benefits usually takes three to five months because the SSA has to obtain medical information and assess your disability. The eligibility determination generally proceeds as follows:

  • You apply for benefits as soon as you become disabled. If you choose to apply by phone, call (800) 772-1213 to start the application The SSA representative will arrange to take your claim over the telephone or in your local SSA office, send you a claim form, and tell you what documents or information you will need to support your claim. You can also complete an application online at the Social Security website.
  • You supply any supporting documents available to you, including a copy of your most recent W-2 Form (or tax return if you are self-employed) and the names, addresses, and phone numbers of doctors, hospitals, and clinics that treated you. You will also need your Social Security number, proof of age, a summary of where you worked in the past 15 years, and your medical records.
  • The SSA reviews your application to make sure that you meet the nondisability requirements of the law, such as age and insured status.
  • Your application is then forwarded to your state's Disability Determination Services (DDS) The DDS employs a team consisting of a physician and a disability evaluation specialist who will determine whether you are disabled (unable to perform substantial gainful activity). To do this, they try to answer the following five questions:
  1. Are you currently working? If your earnings in 2019 are more than the substantial gainful activity (SGA) level of $1,220 per month for individuals who are not blind or $2,040 per month for blind individuals, you generally cannot be considered disabled. Your claim may be denied.
  2. Is your condition severe? Your work activities must be limited by your condition. If not, your claim may be
  3. Is your condition found in the list of disabling impairments? The DDS maintains a list of impairments that automatically mean you are If your condition is not on the list, they decide whether it is of equal severity to one that is on the list. At this point, your claim may be approved based on this evidence.
  4. Can you do the work you did previously? If your disability was found to be limiting but not as severe as a disability on the list of impairments, then the DDS determines whether it interferes with your ability to do the work you did during the past 15 years. If it does, your claim will be considered further.
  5. Can you do any other type of work? If you cannot do the work you did previously, the DDS will decide whether you can do any other type of work by considering your age, education, experience, and If you cannot do any other kind of work, your claim will be approved. Otherwise, it will be denied.
  • If necessary, the DDS will gather medical evidence from your doctors and places where you have been treated. They may ask you for help in obtaining a medical report if Your doctors will be asked about your medical condition, when it began, how your activities are limited, and how you have been treated.
  • If medical evidence regarding your disability is scanty or inconclusive, you may be asked to take a "consultative " Social Security may ask you to take (and will pay for) a physical exam (often performed by your doctor) to gather more information.
  • Finally, you will receive a benefit If your claim is approved, the notice will tell you how much benefit you will receive and when it will begin. If the claim is denied, you will find out why.

If your disability claim is approved, what happens next?

If your claim is approved, your first benefit check will be dated the sixth full month after the date your disability is determined to have begun. If necessary, benefits can be paid up to 12 months retroactively. Your benefits will continue as long as you are considered disabled. Your case will be reviewed occasionally to see if you still meet the SSA's definition of disability.

While you are receiving disability benefits, you are encouraged to try to work again. The Social Security Administration has established various work incentives to help you succeed. Most beneficiaries become eligible for the SSA's Ticket to Work Program when they start receiving Social Security disability benefits or Supplemental Security Income benefits based on disability. This program is free and voluntary, and provides support services that will help you return to work. Other work incentives are also available.

If your disability benefit claim is denied, what can you do?

If your claim is denied, you may appeal the decision within 60 days. There are four levels of appeal. If you disagree with the decision at one level, you may move to the next:

  • A special group in the Office of Disability Operations of the SSA will review the claim
  • An administrative law judge will conduct a hearing
  • An Appeals Council will consider the case if it feels the judge overlooked an issue
  • If the Appeals Council will not hear the case or you disagree with the decision, you may appeal to federal civil court

Content in this material is for general information only and not intended to provide specific advice or recommendations for any individual. All performance referenced is historical and is no guarantee of future results. All indices are unmanaged and may not be invested into directly.

The information provided is not intended to be a substitute for specific individualized tax planning or legal advice. We suggest that you consult with a qualified tax or legal professional.

LPL Financial Representatives offer access to Trust Services through The Private Trust Company N.A., an affiliate of LPL Financial.

This article was prepared by Broadridge.

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