Mahatma Ghandi once said “a nation’s greatness is measured by how it treats its weakest members.” The U.S. government, through the Social Security Administration (“SSA”), oversees two programs dedicated to the ‘weakest members’ of society who are found to be disabled. These programs - Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”) – both provide cash payments to people who meet the federal definition of disabled, but they differ significantly.
SSDI pays benefits only if a person is insured and found to be disabled. The SSA will look at a claimant’s work history and the amount of Social Security Taxes that have been paid by the claimant in order to determine whether or not the claimant is insured. The claimant must then still prove that he/she is disabled in order to receive any benefits.
SSI pays benefits based on financial need if a person is found to be disabled but does not have sufficient work history to qualify for insurance under SSDI. The elderly, children, and people who are blind or disabled usually qualify under SSI rather than SSDI. Just as with SSDI claimants, an SSI claimant must prove that he/she meets the federal definition of disabled prior to receiving any benefits. An SSI claimant must also pass a resource test in order to qualify for benefits. The SSI resource test allows single claimants to have $3,000 in income and assets and still qualify for SSI.
SSA’s Definition of Disabled – “the inability to engage in any substantial gainful work activity because of a severe and medically provable physical or mental impairment or impairments which has either lasted or can be expected to last for twelve continuous months or to result in death”.
The SSA uses a 5-step process to evaluate whether or not a claimant meets the federal definition of disabled. If the claim fails at any step in the process, the claimant is found to be not disabled.
SSA’s 5-Step Evaluation Process
1. Are you working? (Substantial Gainful Activity)
If a person is earning more than $1,220 a month, he/she cannot be considered disabled.
2. Is your condition severe?
Individual must have a medically determinable physical or mental impairment (or combination) that is severe and meets duration requirements (12 months+).
3. Is your condition found in the list of disabling conditions?
If the condition is not on the list, is it as severe as a medical condition on the list.
4. Can you do the work you did previously? (Residual Functional Capacity)
It is an accounting of an individual’s capacity for full time work - maximum ability to do sustained work related physical and mental activities on a regular continuing basis (8 hours a day, for 5 days a week) despite the limitations and restrictions resulting from his or her medically determinable impairment.
If a person can, he/she does not have a qualifying disability.
5. Can you do any other type of work?
SSA will look at other work you could do despite your impairment(s).
Residual Functional Capacity, age, education and work experience are considered to see if claimant can make adjustment to other work.
For more information regarding SSDI and/or SSI, please visit https://www.ssa.gov/.
Legal Eagle Extras by Managing Attorney Molly I. Sanders, Esquire
70-80% of all initial Social Security claims are denied.
The process is extremely long and can take years to reach a final determination.
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