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Disability Benefits
Eligibility
guidelines for SS disability benefits.
When a worker covered by
Social Security becomes disabled or blind, he may be entitled to
receive disability benefits. In addition, certain family members may
qualify for benefits based on the disabled worker's earnings record.
These relatives would include:
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Your unmarried
children (and in some cases, a grandchild) under age 18, or under
age 19 if attending high school full-time.
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Your unmarried child
18 years of age or older, when that child was disabled before
reaching age 22.
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Your spouse age 62
or older.
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Your spouse of any
age who is caring for a child of yours under age 16, or who is
disabled and also receiving disability checks.
In addition, certain
relatives may qualify for disability benefits if you should die. This
would include your disabled surviving spouse age 50 or older, when he
or she became disabled before you died, or within seven years of your
death. And a disabled ex-spouse who is 50 or older may also be
entitled to disability benefits based on your record, if your marriage
lasted at least 10 years.
The criteria for
determining eligibility for Social Security disability benefits are
extremely strict. While private disability insurance may pay for
short-term disability or partial disability, or provide benefits when
you can't work at your regular job, Social Security does not. Under
Social Security's eligibility rules, you must be completely unable to
do any kind of substantial gainful work for which you are suited, and
the disability must be expected to last for at least a year or result
in death. To qualify for disability payments on the basis of
blindness, your vision must not be correctable to better than 20/200
in your better eye, or your visual field must be 20 degrees or less
even when using a corrective lens.
In addition, you must
also have worked long enough and recently enough at a job covered by
Social Security in order to be eligible for benefits. The exact number
of work credits you need will depend on your age when you become
disabled. If you become disabled before you reach age 24, you will
need to have earned six work credits in the three years immediately
before becoming disabled. Between ages 24 and 31, you need to have
earned credits for at least half the time between age 21 and the time
you become disabled. For example, if you became disabled at age 29,
you would need 16 credits, which equal credit for four years out of
eight. And for workers older than age 31, you must generally have the
same number of credits as you would need for retirement, and have
earned at least 20 credits in the last ten years.
If you have earned
sufficient work credits to qualify for disability benefits, your
application is reviewed by a physician and a disability evaluation
specialist at the Disability Determination Services (DDS) office in
your state, which will decide if you are entitled to receive benefit
payments.
This evaluation team
will review reports submitted by your physician about your disability.
Your physician will be asked for information about the nature of your
condition and when it began, the medical tests that have been
conducted, and the treatment you have received. Your doctor will also
be asked about how your condition limits your everyday activities and
your ability to perform work related tasks such as walking, sitting,
lifting, and carrying.
In some cases, a
determination can't be made by the DDS team without further
information, and you may be required to take another medical
examination. In most cases, your own doctor will be asked to
administer this examination. The Social Security Administration pays
for the cost of this examination and any other medical tests it may
need, and may even pay for your travel expenses related to the
examination.
In determining whether
or not you are disabled under Social Security's rules, the Social
Security Administration considers five questions.
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Are you working? If
you are and your earnings average more than $500 per month, you
cannot generally be considered disabled.
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Is your condition so
severe that it interferes with basic work related activities?
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Is your condition
found on the Social Security Administration's list of
"disabling impairments?" If so, you are automatically
considered disabled. If not, Social Security compares your
disability to those on the list to determine if it is of equal
severity to a listed condition. If it is, then your claim is
approved; if not, the process goes on to the next question.
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Can you continue to
do the work you did during the last 15 years? If the answer is
yes, your claim is rejected. If the answer is no, the evaluation
process goes on to ask the final question.
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Can you do any other
type of work, when your age, education, past work experience and
transferable work skills are taken into account? If you can, no
benefits are awarded. But if you can't, you will be entitled to
receive disability payments.
If your disability claim
is approved, you will receive a written notice from the Social
Security Administration, showing the amount of the monthly benefit you
will receive and the date on which payments will start. In general,
you will receive your first Social Security disability check in the
sixth full month after you became disabled. Along with your check, you
will also get a copy of a booklet describing your responsibilities as
a disability payment beneficiary. Among these responsibilities are
providing notice to the Social Security Administration if your
condition improves enough to allow you to perform substantial gainful
work.
If your claim is denied,
or if you disagree with any decision made by the Social Security
Administration in handling your claim, you have the right to appeal
the decision, and the Social Security office will even help you
complete the paperwork for filing an appeal. Initially, your appeal
will lead to reconsideration of your file by persons within the Social
Security Administration other than those who made the decision you are
appealing. If you are still dissatisfied, you may then appeal for a
hearing before an administrative law judge. If the judge fails to
address your concerns, you may then appeal to the Appeals Council, and
if you still are dissatisfied, you may file an appeal in the U.S.
District Court.
You should apply for
Social Security disability benefits as soon as you become disabled,
either by visiting, writing to or telephoning your local Social
Security office. Since the Social Security Administration must obtain
medical information and to evaluate your ability to work, it usually
takes from 60 to 90 days to process a Social Security disability
claim. To help speed your application through the evaluation process,
be sure to provide the following documents to the Social Security
Administration:
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Your Social Security
number and the numbers of your spouse and children, if they are
applying for benefits, and proof of each applicant's age;
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The name, address,
and telephone number of any doctor, clinic, hospital, or other
health care institution that treated you for the disability and
the dates on which you received those treatments;
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A summary of your
employment history during the past 15 years, including where you
worked and the kind of work you did;
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A copy of your most
recent W-2 form from your employer, or a copy of your most recent
tax return if you are self-employed;
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If your spouse is
applying for benefits, the date of any prior marriage.
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