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Social Security
Disability Benefits
Benefits
can help your family when you're unable to work.
Who Should Read This Information
You should, if you want
to know more about the various kinds of disability benefits available
from Social Security. This booklet will tell you who is eligible, how
to apply, and what you need to know once benefits start.
We pay disability
benefits under two programs: the Social Security disability insurance
program and the Supplemental Security Income (SSI) program. The
medical requirements for disability payments are the same under both
programs and a person's disability is determined by the same process.
While eligibility for Social Security disability is based on prior
work under Social Security, SSI disability payments are made on the
basis of financial need. And there are other differences in the
eligibility rules for the two programs. This booklet deals primarily
with the Social Security disability program. For information on SSI
disability payments, ask at any Social Security office for the
booklet, SSI (Publication No. 05-11000).
Please Note: This
booklet provides a general overview of the Social Security disability
program. The information it contains is not intended to cover all
provisions of the law. For specific information about your case,
contact Social Security.
Part 1--Introduction
To Disability And Social Security
What We Mean By
"Disability"
Who Can Get Social
Security Disability Benefits?
Disability Benefits For
People With HIV Infection
Disability Benefits For
Children
How Much Work You Need
Part 2--Signing Up
For Disability
How To Apply
How To Speed Up Your
Claim
Who Decides If You Are
Disabled?
How We Determine
Disability
Rules For Blind Persons
If Your Claim Is Denied
Part 3--When Your
Claim Is Approved
Your Benefits Start
How Much You Will Get
From Social Security
How Other Payments
Affect Benefits
Benefits May Be Taxed
You Can Get Medicare If
You're Disabled
Reviewing Your
Disability
What Can Cause Benefits
To Stop
Part 4--Going Back To
Work
Benefits While You Work
For More Information
Other Booklets Available
Part 1--Introduction
To Disability And Social Security
Disability is something
most people don't like to think about. But the chances of your
becoming disabled are probably greater than you realize. In fact,
studies show that one out of four young workers will become disabled
some time during his or her lifetime.
It's a fact that, while
most people spend time working to succeed in their jobs and careers,
few think about ensuring that they have a safety net to fall back on
should the unthinkable happen. This is where Social Security comes in.
We pay cash benefits to people who are unable to work for a year or
more because of a disability. Benefits continue until a person is able
to work again on a regular basis, and a number of work incentives are
available to ease the transition back to work.
What We Mean By
"Disability"
It's important that you
understand how Social Security defines "disability." That's
because different programs have different bases for determining
disability. Some programs may pay for partial disability or for
short-term disability. Social Security does not.
Disability under Social
Security is based on your inability to work. You will be considered
disabled if you are unable to do any kind of work for which you are
suited and your disability has lasted or is expected to last for at
least a year or to result in death.
Some consider this a
strict definition of disability and it is. The program assumes that
working families have access to other resources to provide support
during periods of short-term disabilities, including workers'
compensation, insurance, savings, and investments. It is designed to
provide a continuing income to you and your family when you are unable
to do so. Benefits continue as long as you remain disabled.
Who Can Get Social
Security Disability Benefits?
You can receive Social
Security disability benefits at any age. If you are receiving
disability benefits at age 65, they become retirement benefits,
although the amount remains the same. Certain members of your family
may also qualify for benefits on your record. They include:
•Your unmarried son or
daughter, including an adopted child, or, in some cases, a stepchild
or grandchild. The child must be under 18 or under 19 if in high
school full time.
•Your unmarried son or
daughter, 18 or older, if he or she has a disability that started
before 22. (If a disabled child under 18 is receiving benefits as a
dependent of a retired, deceased, or disabled worker, someone should
contact Social Security to have his or her checks continued at 18 on
the basis of disability.)
•Your spouse who is 62
or older, or any age if he or she is caring for a child of yours who
is under 16 or disabled and also receiving checks.
Certain family members
may qualify for disability benefits if you should die. They
include:
•Your disabled widow
or widower 50 or older. The disability must have started before your
death or within seven years after your death. (If your widow or
widower caring for your children receives Social Security checks, she
or he is eligible if she or he becomes disabled before those payments
end or within seven years after they end.)
Disability Benefits
For People With HIV Infection
People with HIV
infection or AIDS may also qualify for disability benefits when they
are no longer able to work. Some people with HIV infection that has
not progressed to AIDS may be just as severely disabled as a person
with AIDS and, therefore, just as likely to qualify for disability.
For more information, ask for the booklet A Guide to Social Security
And SSI Disability Benefits For People With HIV Infection (Publication
No. 05-10020).
Disability Benefits
For Children
While this booklet
focuses on disability benefits under the Social Security program,
disability benefits to children are made under the SSI program. The
information is included in this section because of the concern that
many parents are not aware of the disability payments available to
children.
SSI pays disability
benefits to needy people of any age, including children, A different
definition of disability applies for children since children generally
do not work. Under SSI, a child is considered disabled if his or her
physical or mental condition is so severe that it results in marked
and severe functional limitations. The condition must last or be
expected to last at least 12 months of be expected to result in the
child's death. And, of course, the child must not be working at a job
that we consider to be substantial work
Social Security
disability benefits are paid to children age 18 or older who were
disabled before age 22, if they have a parent who is receiving Social
Security retirement or disability benefits, or is deceased. Under both
Social Security and SSI, children age 18 or older are considered
disabled of they meet the adult definition of disability, i.e., their
condition must be severe enough to prevent them form doing any kind of
work for which they are suited.
For more information on
disability benefits for children, ask Social Security for the booklets
Benefits For Children With Disabilities (Publication No. 05-10026) or
SSI (Publication No. 05-11000)
How Much Work You
Need
To qualify for Social
Security disability benefits, you must have worked long enough and
recently enough under Social Security. You earn up to a maximum of
four credits per year. The amount of earnings required for a credit
increases each year as general wage levels rise. Family members who
qualify for benefits on your work record do not need work credits. The
number of work credits needed for disability benefits depends on your
age when you become disabled. Generally you need 20 credits earned in
the last 10 years ending with the year you become disabled. However,
younger workers may also qualify with fewer credits: The rules are as
follows:
•Before age 24--You
may qualify if you have six credits earned in the three-year period
ending when your disability starts.
•Age 24 to 31--You may
qualify if you have credit for having worked half the time between 21
and the time you become disabled. For example, if you become disabled
at age 27 you would need credit for three years of work (12 credits)
out of the past six years (between age 21 and age 27).
•Age 31 or older--In
general, you will need to have the number of work credits shown in the
chart shown below. Unless you are blind, at least 20 of the credits
must have been earned in the 10 years immediately before you became
disabled.
Born After 1929, Become
Disabled At Age
31 through 42 - 20
44 - 22
46 - 24
48 - 26
50 - 28
52 - 30
54 - 32
56 - 34
58 - 36
60 - 38
62 or older - 40
Part 2--Signing Up
For Disability
How To Apply
You should apply at any
Social Security office as soon as you become disabled. (You may file
by phone, mail, or by visiting the nearest office.) However, Social
Security disability benefits will not begin until the sixth full month
of disability. This "waiting period" begins with the first
full month after the date we decide your disability began.
How To Speed Up Your
Claim
The claims process for
disability benefits is generally longer than for other types of Social
Security benefits from 60 to 90 days. It takes longer to obtain
medical information and to assess the nature of the disability in
terms of your ability to work. However, you can help shorten the
process by bringing certain documents with you when you apply and
helping us to get any other medical evidence you need to show you are
disabled. These include:
•the Social Security
number and proof of age for each person applying for payments; (This
includes your spouse and children, if they are applying for
benefits.)
•names, addresses, and
phone numbers of doctors, hospitals, clinics, and institutions that
treated you and dates of treatment;
•names of all
medications you are taking;
•medical records from
your doctors, therapists, hospitals, clinics, and caseworkers;
•laboratory and test
results;
•a summary of where
you worked in the past 15 years and the kind of work you did;
•a copy of your W-2
Form (Wage and Tax Statement), or if you are self-employed, your
federal tax return for the past year; and
•dates of prior
marriages if your spouse is applying.
Do not delay filing for
benefits just because you do not have all of the information you need.
The Social Security office will be glad to help you.
Who Decides If You
Are Disabled?
After helping you
complete your application, the Social Security office will review it
to see if you are eligible to apply for disability benefits. These
include such factors as whether you have worked long enough and
recently enough to qualify for disability benefits, your age, and,if
you are applying for benefits as a family member, your relationship to
the worker. The office will then send your application to the
Disability Determination Services (DDS) office in your state. There, a
decision will be made as to whether you are disabled under the Social
Security law.
In the DDS office, a
team consisting of a physician (or psychologist) and a disability
evaluation specialist will consider all the facts in your case and
decide if you are disabled. They will use the medical evidence from
your doctors and from hospitals, clinics, or institutions where you
have been treated. Again, the quicker we get the evidence, the faster
your claim will be processed. This is why we suggest you bring any
copies of your medical reports you have with you. You should also be
sure to contact the doctors and treatment facilities to let them know
we will be requesting medical evidence in your case.
On the medical report
forms, your doctors or other sources are asked for a medical history
of your condition: what is wrong with you; when it began; how it
limits your activities; what the medical tests have shown; and what
treatment has been provided. They are also asked for information about
your ability to do work-related activities, such as walking, sitting,
lifting, and carrying. They are not asked to decide whether you are
disabled.
Additional medical
information may be needed before the DDS team can decide your case. If
it is not available from your current medical sources, you may be
asked to take a special examination called a consultative examination.
Your doctor or the medical facility where you have been treated is the
preferred source to perform this examination. Social Security will pay
for the examination or any other additional medical tests you may
need, and for certain travel expenses related to it.
Social Security's rules
for determining disability differ from those in other government and
private programs. However, a decision made by another agency and the
medical reports it obtains may be considered in determining whether
you are disabled under Social Security rules.
Once a decision on your
claim is reached, you will receive a written notice from the Social
Security Administration. If your claim is approved, the notice will
show the amount of your benefit and when payments start. If it is not
approved, the notice will explain why.
How We Determine
Disability
You should be familiar
with the process we use to determine if you are disabled. It's a
step-by-step process involving five questions. They are:
1. Are you working?
If you are and your
earnings average more than $500 a month, you generally cannot be
considered disabled.
2. Is your condition
"severe" ?
Your impairments must
interfere with basic work-related activities for your claim to be
considered.
3. Is your condition
found in the list of disabling impairments?
We maintain a list of
impairments for each of the major body systems that are so severe they
automatically mean you are disabled. If your condition is not on the
list, we have to decide if it is of equal severity to an impairment on
the list. If it is, your claim is approved. If it is not, we go to the
next step.
4. Can you do the work
you did previously?
If your condition is
severe, but not at the same or equal severity as an impairment on the
list, then we must determine if it interferes with your ability to do
the work you did in the last 15 years. If it does not, your claim will
be denied. 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 in the last 15 years, we then look to see if you can do
any other type of work. We consider your age, education, past work
experience, and transferable skills, and we review the job demands of
occupations as determined by the Department of Labor. If you cannot do
any other kind of work, your claim will be approved. If you can, your
claim will be denied.
Rules For Blind
Persons
You are considered blind
under Social Security rules if your vision cannot be corrected to
better than 20/200 in your better eye, or if your visual field is 20
degrees or less, even with a corrective lens.
There are a number of
special rules for persons who are blind. The rules recognize the
severe impact of blindness on a person's ability to work. For example,
the earnings limit for people who are blind is generally higher than
the $500 limit that applies to non-blind disabled workers. This figure
changes annually. For current figures and other information on special
rules for persons who are blind, ask for the leaflet, If You Are
Blind...How We Can Help (Publication No. 05-10052).
If Your Claim Is
Denied
If your claim is denied
or you disagree with any other decision we make, you may appeal the
decision. The Social Security office will help you complete the
paperwork.
There are four levels of
appeal. If you disagree with the decision at one level, you may appeal
to the next level. You have 60 days from the time you receive the
decision to file an appeal to the next level. We assume that you
receive the decision five days after the date on it, unless you can
show us that you received it later. For more information about
appeals, ask for the factsheet, The Appeals Process (Publication No.
05-10041).
Part 3--When Your
Claim Is Approved
Your Benefits Start
Once a decision is made
that you are disabled, you will receive your first Social Security
disability benefits starting with the sixth full month from the date
we decide your disability began (but no more than one year of back
benefits can be paid). You also will receive a booklet describing your
responsibilities as a Social Security beneficiary: What You Need To
Know When You Get Disability Benefits (Publication No. 05-10153). You
should read this booklet carefully and keep it in a safe place with
your other valuable papers in order to refer to it whenever questions
arise.
How Much You Will Get
From Social Security
The amount of your
monthly disability benefits is based on your lifetime average earnings
covered by Social Security. If you would like an estimate of your
disability benefit, all you have to do is call or visit Social
Security and ask for it. We'll send you a form you can use to get a
Personal Earnings and Benefit Estimate Statement.
How Other Payments
Affect Benefits
Eligibility for other
government benefits can affect the amount of your Social Security
disability benefits.
Other Disability
Benefits
Social Security benefits
may be affected if you are also eligible for workers' compensation
(including black lung) or for disability benefits from certain
federal, state, local government, Civil Service, or military
disability programs. Total combined payments to you and your family
from Social Security and any of these other programs generally cannot
exceed 80 percent of your average current earnings before becoming
disabled. (Note that for income tax purposes, your unreduced benefit
is counted.)
Government Pension
Offset
If you are a disabled
widow or widower or the spouse of a disabled worker, a
"government pension offset" may reduce your Social Security
payment. The offset applies if you become eligible for a federal,
state, or local government pension based on your own work not covered
by Social Security. The amount of your Social Security spouse's
benefit may be reduced by two-thirds of the amount of your government
pension.
There are some
exceptions when the offset would not apply. For more information, call
or visit Social Security to ask for a free copy of the factsheet,
Government Pension Offset (Publication No. 05-10007).
Pension From Work Not
Covered By Social Security
If you become disabled
and entitled to a Social Security disability benefit and you also
receive a monthly pension based on work not covered by Social
Security, your disability payment will be smaller than normal. That's
because we use a different formula to figure the Social Security
benefit of people who get other public pensions.
For more information,
call or visit Social Security to ask for a free copy of the factsheet,
A Pension From Work Not Covered By Social Security (Publication No.
05-10045).
Benefits May Be Taxed
Some people have to pay
federal income taxes on their Social Security benefits. This usually
happens only if your total income is high. At the end of the year, you
will receive a Social Security Benefit Statement (Form SSA-1099)
showing the amount of benefits you received. The statement is to be
used for completing your federal income tax return if any of your
benefits are subject to tax. You may use the Internal Revenue Service
Publication 915 for additional information on the tax.
You Can Get Medicare
If You're Disabled
You will be
automatically enrolled in Medicare after you have been getting
disability benefits for two years.
Medicare has two
parts--hospital insurance and medical insurance. Hospital insurance
helps pay hospital bills and some follow-up care. The taxes you paid
while you were working financed this coverage, so it's premium free if
you're eligible. The other part of Medicare, medical insurance, helps
pay doctors' bills and other services. You pay a monthly premium for
this coverage if you want it. Most people have both parts of Medicare.
Help For Low-Income
Medicare Beneficiaries
If you get Medicare and
have low income and few resources, your state may pay your Medicare
premiums and, in some cases, other out-of-pocket Medicare expenses
such as deductibles and coinsurance. Only your state can decide if you
qualify. To find out if you do, contact your state or local welfare
office or Medicaid agency. For more general information about the
program, contact Social Security and ask for the leaflet Medicare
Savings For Qualified Beneficiaries (HCFA Publication No. 02184).
Reviewing Your
Disability
Your benefits will
continue as long as you are disabled. However, your case will be
reviewed periodically to see if you are still disabled. The frequency
of the reviews depends on the expectation of recovery.
•If medical
improvement is "expected," your case will normally be
reviewed within six to 18 months.
•If medical
improvement is "possible," your case will normally be
reviewed no sooner than three years.
•If medical
improvement is "not expected," your case may be reviewed no
sooner than seven years.
What Can Cause
Benefits To Stop?
There are two things
that can cause us to decide that you are no longer disabled and to
stop your benefits.
Your benefits will stop
if you work at a level we consider "substantial." Usually,
average earnings of $500 or more a month are considered substantial.
Your disability benefits
would also stop if we decide that your medical condition has improved
to the point that you are no longer disabled.
You must promptly report
any improvement in your condition, your return to work, and certain
other events as long as you are receiving benefits. These
responsibilities are explained in the booklet you will receive when
benefits start.
Part 4--Going Back To
Work
Benefits While You
Work
If you're like most
people, you would rather work than try to live on disability benefits.
There are a number of special rules that provide cash benefits and
Medicare while you attempt to work. We call these rules work
incentives. You should be familiar with these disability work
incentives so you can use them to your advantage.
If you are receiving
Social Security disability benefits, the following work incentives
apply:
•Trial Work
Period--For nine months (not necessarily consecutive), you may earn as
much as you can without affecting your benefits. (The nine months of
work must fall within a five-year period before your trial work period
can end.) A trial work month is any month in which you earn more than
$200. After your trial work period ends, your work is evaluated to see
if it is "substantial." If your earnings do not average more
than $500 a month, benefits will generally continue. If earnings do
average more than $500 a month, benefits will continue for a
three-month grace period before they stop.
•Extended Period of
Eligibility--For 36 months after a successful trial work period, if
you are still disabled, you will be eligible to receive a monthly
benefit without a new application for any month your earnings drop
below $500.
•Deductions for
Impairment--Related Expenses--Work expenses related to your disability
will be discounted in figuring whether your earnings constitute
substantial work.
•Medicare
Continuation--Your Medicare coverage will continue for 39 months
beyond the trial work period. If your Medicare coverage stops because
of your work, you may purchase it for a monthly premium.
Different rules apply to
SSI recipients who work. For more information about Social Security
and SSI work incentives, ask for a copy of the booklet, Working While
Disabled ... How We Can Help (Publication No. 05-10095).
For More Information
You can get more
information 24 hours a day by calling Social Security's toll-free
number: 1-800-772-1213. You can speak to a service representative
between the hours of 7 a.m. and 7 p.m. on business days. Pre-recorded
information and services also are available during and after normal
business hours.
If you want to speak to
a representative, it's best to call later in the week and later in the
month. When you call, have your Social Security number handy.
Hearing-impaired callers
using "TTY" equipment can reach Social Security between 7
a.m. and 7 p.m. weekdays by calling1-800-325-0778.
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