What Does Social Security Mean By "Disability"?

It's important that you understand how Social Security defines "disability." That's because other programs have different definitions for disability. Some programs 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 cannot do work you did before and Social Security decides that you cannot adjust to other work because of your medical conditions. Your disability also must last or be expected to last for at least a year or result in death.

This is a strict definition of disability. 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.

Who Can Get Disability Benefits?

Certain members of your family may qualify for benefits on your record. They include:

Your spouse who is age 62 or older, or any age if he or she is caring for a child of yours who is under age 16 or disabled and also< receiving checks.
Your disabled widow or widower age 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.)
Your unmarried son or daughter, including an adopted child, or in some cases, a stepchild or grandchild. The child must be under age 18 or under age 19 if in high school full time.
Your unmarried son or daughter, age 18 or older, if he or she has a disability that started before age 22. These children are considered disabled if they meet the adult definition of disability. (If a disabled child under age 18 is receiving benefits as the dependent of a retired, deceased or disabled worker, someone should contact Social Security to have his or her checks continued at age 18 on the basis of disability.)

How Much Work Do I Need?

To qualify for Social Security disability benefits, you must have worked long enough and recently enough under Social Security. You can earn up to a maximum of four work 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 you need 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 became disabled. However, younger workers may 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 age 21 and the time you became 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 27).

Who Decides If I Am Disabled?

After helping you complete your application, the Social Security office will review it to see if you meet the basic requirements for disability benefits. They will look at whether you have worked long enough and recently enough, your age and, if you are applying for benefits as a family member, your relationship to the worker. The office then will send your application to the Disability Determination Services (DDS) office in your state. The DDS will decide whether you are disabled under the Social Security Law.

The DDS will consider all the facts in your case. They will use the medical evidence from your doctors and from hospitals, clinics or institutions where you have been treated and all the other information they have. 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
What treatment you have received

How Does Social Security Determine Disability?

You should be familiar with the process that Social Security uses to determine if you are disabled. It's a step-by-step process involving five questions. They are:

Are you working? If you are and your earnings average more than $810 a month, you generally cannot be considered disabled. If you are not working, Social Security goes to the next step.
Is your condition "severe"? Your condition must interfere with basic work-related activities for your claim to be considered. If it does not, Social Security will find that you are not disabled. If it does, Social Security will go to the next step.
Is your condition found in the list of disabling impairments? Social Security maintains 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, Social Security will have to decide if it is of equal severity to an impairment on the list. If it is, Social Security will find that you are disabled. If it is not, Social Security goes on to the next step.
Can you do the work you did previously? If your condition is severs, but not at the same or equal severity as an impairment on the list, then Social Security must determine if it interferes with your ability to do the work you did previously. If it does not, your claim will be denied. If it does, Social Security goes to the next step.
Can you do any other type of work? If you cannot do the work you did in the past, Social Security will see if you are able to adjust to other work. Social Security considers your medical conditions and your age, education, past work experience and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved. If you can, your claim will be denied.

What If My Claim Is Denied?

If your claim is denied or you disagree with any part of their decision, you may appeal the decision. You have 60 days from the time you receive the letter to file an appeal. Social Security assumes that you received the letter with their decision five days after the date on it, unless you can show that you received it later.

When Do My Benefits Start?

If your application is approved, your first Social Security benefits will be paid for the sixth full month after the date your disability began. For example, if Social Security finds that your disability began on January 15, your first disability benefit will be paid for the month of July. Because Social Security benefits are paid in the month following the month for which they are due, you would receive your July benefit in August.

How Much Will I Get From Social Security?

The amount of your monthly disability benefit is based on your lifetime average earnings covered by Social Security. If you would like an estimate of your disability benefit, you can request a Social Security Statement that displays your earnings record and provides an estimate of your disability benefit. It will also include estimates of retirement and survivors' benefits which you and your family may be eligible to receive now and in the future.

Are Benefits 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. Use the statement to complete your federal income tax return if any of your benefits are subject to tax. For more information about this tax, ask the Internal Revenue Service for a copy of Publication 915. Also, you may choose to have federal taxes withheld from your benefits.

Can I Get Medicare If I Am Disabled?

Social Security will automatically enroll you in Medicare after you get 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 free. The other part of Medicare, medical insurance, helps pay doctors' bills and other services. You will pay a monthly premium for this coverage if you want it. Most people have both parts of Medicare.

Is My Case Reviewed?

In general, your benefits will continue as long as you are disabled. However, Social Security will review your case 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 normally will be reviewed within 6 to 18 months.
If medical improvement is "possible," your case normally will be reviewed no sooner than three years.
If medical improvement is "not expected," your case normally will be reviewed no sooner than seven years.

What Can Cause Benefits To Stop?

There are two things that can cause SSA to decide that you are no longer disabled and to stop your benefits. Your benefits will stop if you work at a level Social Security considers "substantial." Usually, average earnings of $810 or more a month are considered substantial. Your disability benefits also will stop if Social Security decides that your medical condition has improved to the point that you are no longer disabled.